Further offences by discharged psychiatric patients--can somebody be held liable?

The decision to release a state patient who is unfit to stand trial and/or not criminally responsible, who had been committed to a mental institution in terms of the Criminal Procedure Act or who was held in terms of section 28 of the Mental Health Act, may have harmful or even fatal consequences. The multi-professional team at Oranje Hospital will only institute discharge procedures regulated in terms of section 29 of the Mental Health Act when it is of the opinion that a state patient's mental illness is stable and well-controlled and his clinical picture is such that he qualifies to be discharged. In this discussion focus will be placed on: a. the two discharge procedures applied in South Africa. b. four case studies which will be presented dealing with the observation period, admission, offence, diagnosis, treatment, hospitalisation, leave periods, discharge on certain conditions, re-admission and further offences. c. the question of whether the State may be held liable for the negligent or wrongful discharge or release of a state patient who subsequently commits a serious crime.

Nutritional status of preschool children in informal settlement areas near Bloemfontein, South Africa.

OBJECTIVE: To determine the nutritional status and household resources of preschool children. DESIGN: A cross-sectional survey. SETTING: : Two informal settlement areas, Joe Slovo (JS) and JB Mafora (JBM) in Mangaung, near Bloemfontein, South Africa. SUBJECTS: Preschool children (<72 months) of a randomly selected sample of households in JS (experimental) (n = 162) and JBM (control) (n = 186) were included. Standard methods were used to obtain household and care-giver particulars, weight and height measurements, blood and stool samples, and 24-hour dietary recalls. RESULTS: Breast-feeding and dietary intake in the two areas were nearly similar; breast-feeding was continued for 12 months and longer. Although the children's total protein intake was sufficient, their energy intake was low. A low median intake of micronutrients prevailed, including iron, zinc, calcium, niacin, riboflavin, thiamine and vitamins C, B6, A and D. The prevalence of being underweight (JS = 19.8%; JBM = 18.8%), stunted (JS = 29%; JBM = 21. 5%) and wasted (JS = 6.5%; JBM = 3.7%) were fairly similar in both areas, as well as the prevalence of marginal vitamin A deficiency, anaemia, iron deficiency and parasite infestations. No significant associations could be found between household and nutritional status indicators, probably due to the small number of well-nourished children and the generally poor household situation of the participants. CONCLUSIONS: The generally poor nutritional status and environmental conditions emphasize the urgency of intervention for these children.

Effects of a low-insulin-response, energy-restricted diet on weight loss and plasma insulin concentrations in hyperinsulinemic obese females.

The effects of two low-energy diets on serum insulin concentrations and weight loss in obese hyperinsulinemic females were compared during a 12-wk period. The first diet (n = 15) was designed to evoke a low insulin response (ID), and the second (n = 15) was a conventionally balanced diet (ND). After a 12-wk washout period, seven and nine subjects who had been on the ID and ND, respectively, changed to the alternative diet for 12 wk. Variables studied were basal and 30- and 120-min concentrations of blood glucose, insulin, and C-peptide after an oral glucose load; body weight; and energy intake. Mean (+/- SD) weight was significantly reduced after ID and ND (9.35 +/- 2.49 and 7.41 +/- 4.23, respectively). The mean weight loss was more after ID. Fasting insulin concentrations decreased more after ID compared with ND (91.3 +/- 61.8 vs 21.0 +/- 71.5 pmol/L; P < 0.05). We conclude that ID significantly reduces serum insulin concentrations and weight in obese hyperinsulinemic females.