Cardiac Structure and Function in Morbidly Obese Parturients: An Echocardiographic Study.

BACKGROUND: The increasing prevalence of obesity worldwide is a major threat to global health. Cardiac structural and functional changes are well documented for obesity as well as for pregnancy, but there is limited literature on morbidly obese parturients. We hypothesized that there are both cardiac structural and functional differences between morbidly obese pregnant women and pregnant women of normal body mass index (BMI). METHODS: This prospective cross-sectional study was performed in 2 referral maternity units in Cape Town, South Africa, over a 3-month period. Forty morbidly obese pregnant women of BMI ≥40 kg·m (group O) were compared to 45 pregnant women of BMI ≤30 kg·m (group N). Cardiac structure and function were assessed by transthoracic echocardiography, according to the recommendations of the British Society of Echocardiography. The 2-sample t-test with unequal variances was used for the comparison of the mean values between the groups. RESULTS: Acceptable echocardiographic images were obtained in all obese women. Statistical significance was defined as P < .0225 after applying the Benjamini-Hochberg correction for multiple testing. Mean (standard deviation) mean arterial pressure was higher in group O (91 [8.42] vs 84 [9.49] mm Hg, P < .001). There were no between-group differences in heart rate, stroke volume, or cardiac index (84 [12] vs 79 [13] beats·minute, P = .103; 64.4 [9.7] vs 59.5 [13.5] mL, P = .069; 2551 [474] vs 2729 [623] mL·minute·m, P = .156, for groups O and N, respectively). Stroke volume index was lower, and left ventricular mass was higher in group O (30.14 [4.51] vs 34.25 [7.00] mL·m, P = .003; 152 [24] vs 115 [29] g, P < .001). S' septal was lower in group O (8.43 [1.20] vs 9.25 [1.64] cm·second, P = .012). Considering diastolic function, isovolumetric relaxation time was significantly prolonged in group O (73 [15] vs 61 [15] milliseconds, P < .001). The septal tissue Doppler index E' septal was lower in group O (9.08 [1.69] vs 11.28 [3.18], P < .001). There were no between-group differences in E' average (10.7 [2.3] vs 12.0 [2.7], P = .018, O versus N) or E/E' average (7.85 [1.77] vs 7.27 [1.68], P = .137, O versus N). Right ventricular E'/A' was lower in group O (1.07 [0.47] vs 1.29 [0.32], P = .016). CONCLUSIONS: Cardiac index did not differ between obese pregnant women and those with normal BMI. Their increased left ventricular mass and lower stroke volume index could indicate a limited adaptive reserve. Obese women had minor decreases in septal left ventricular tissue Doppler velocity, but the E/E' average values did not suggest clinically significant diastolic dysfunction.

Transition for Adolescents with Autism Spectrum Disorder: South African Parent and Professional Perspectives.

Adolescents with autism and their families experience a significant increase in the number of challenges encountered when leaving the structure of the formal education system. The purpose of this study was to gain an understanding of the factors parents and professionals regard as important in preparing for transition of adolescents with autism spectrum disorder (ASD) to adulthood, vocational, and residential arrangements. Semistructured interviews were conducted with 14 participants (i.e., 7 parents and 7 professionals) who were involved with adolescents with ASD in Johannesburg, South Africa. The findings revealed that there was a need for advocacy on behalf of learners with ASD transitioning into adult working and living environments. The responses of the participants highlighted needs for curriculum transformation from basic literacy skills to development and teaching of functional self-help and daily living skills. The results also indicated lack of planning and the absence of service facilities for adolescents with autism post-school. There was a general feeling of fear and uncertainty when the participants thought about transition of adolescents with autism and their future. However, there was also a sense of hope and optimism. Transition of adolescents with autism into adulthood is a challenging and stressful time for parents and professionals involved in trying to prepare them. With appropriate attention and support structures, individuals with autism can attain a reasonable quality of life, including residential, employment, and social opportunities.

South African foundation phase teachers' perceptions of ADHD at private and public schools.

This study investigated foundation phase teachers' perceptions of Attention Deficit Hyperactivity Disorder (ADHD). The teachers' views on the aetiology, appropriate interventions and incidence rates of ADHD were examined. A total of 130 foundation phase teachers from mainstream private and public schools completed a self-developed questionnaire that had been piloted by the researchers. Both descriptive and inferential statistics were used to analyse the data, specifically to determine whether there were differences in responses between public and private school teachers. Thematic content analysis was used to identify the themes that emerged from the open-ended questions. It was found that the teachers had a limited understanding of ADHD, in terms of what it is as well as the aetiology. In addition, it emerged that medication was the preferred method of intervention despite the participants' awareness of alternative intervention methods. A comparison of the private and public school teachers' results indicated no significant difference in their perceptions regarding the aetiology, interventions or incidence rates of ADHD.

The role of parental style in the conduct disorders: a comparison between adolescent boys with and without conduct disorder.

OBJECTIVE: An important contributing factor, but one that has not been investigated thoroughly in South Africa, is the role of parental styles which has been consistently found to be a precursor of conduct disorder. METHOD: To establish whether specific parental factors that contribute to this disorder in a South African sample, the Parental Bonding Instrument and the Family Environment Scale were administered to 2 groups of adolescent boys: a group diagnosed with conduct disorder (n = 40) and a group without a diagnosis of conduct disorder (n = 40). To test for significant differences between the two groups, t-tests were performed. RESULTS: A typical parenting style characterised by low care by the mother and overprotection by the father, which forms an affectionless, controlling parenting style, was found in the children in the conduct disorder group. This type of parenting style results in high control, low expressiveness of emotions, minimal involvement with children, and inadequate supervision and monitoring of children. CONCLUSION: The study provided sufficient evidence to conclude that a specific style of parenting can contribute to the aetiology of conduct disorder.