World Association for the Advancement of Veterinary Parasitology (W.A.A.V.P.): Third edition of the guideline for evaluating efficacy of anthelmintics in ruminants (bovine, ovine, caprine).

This guideline is aimed at those who are involved in the assessment of anthelmintic efficacy in ruminant livestock species (bovine, ovine and caprine). The intent is to provide a framework that can be adopted worldwide for the testing of anthelmintics in ruminants, such that studies carried out in different countries can be compared and thereby unnecessary duplication can be reduced. Recommendations are made for the selection, housing and feeding of study animals, the type of studies required, the method used to conduct those studies, the assessment of results and the standards for defining anthelmintic efficacy.

University and stakeholder partnerships to innovate in sport - the development of the South African Cricketers' Association (SACA) career transition screening tool.

In sports, the value and mutual benefit of university-stakeholder partnerships have been well-recognised. It has been argued that cricket has a unique set of challenges compared to other team sports. In 2016, the South African Cricketers' Association (SACA) and the University of Cape Town established a partnership to (i) conduct novel research on professional cricketers and (ii) ensure SACA programmes and initiatives are informed by said research and/or the currently available literature. As the demand on professional cricketers has increased, so has the interest in their career transitioning. That is, how do professional cricketers manage stressors created by changes (or non-changes) throughout their playing careers? To help identify gaps for intervention as a cricketer transitions through their professional career, the purpose of this short report is to describe how a university-stakeholder partnership developed a career transitioning screening tool for professional cricketers in South Africa.

Inside edge - prevalence and factors associated with symptoms of anxiety/depression in professional cricketers.

The purpose of this study was to i) determine the prevalence of anxiety/depression symptoms in professional cricketers and ii) identify factors associated with symptoms of anxiety/depression. One-hundred and seventy-seven (n = 177, response rate of 76%) professional cricketers completed the General Health Questionnaire 12 (GHQ-12). Odd ratios (OR) for anxiety/depression symptoms were related to players' career, family and education. Prevalence of symptoms of anxiety/depression was 59% (n = 104/177). Anxiety/depression symptoms increased when players were contracted for more than 2 years (OR: 5.0; 95% CI: 1.2-21.3; p = 0.028) and if they played their last offseason overseas (OR: 3.5; 95% CI: 1.3-9.6; p = 0.013). Anxiety/depression symptoms decreased by 70% when players made "productive use" of their time in the offseason (OR: 0.3; 95% CI: 0.1-0.9; p = 0.036) and contracted for 2 years (OR: 0.3; 95% CI: 0.1-1.0; p = 0.049). These findings can be incorporated into cricket mental health literacy programmes to improve awareness and understanding, and to encourage early help-seeking.

Student perceptions of an online surgical teaching programme during the COVID-19 pandemic at the University of KwaZulu-Natal: A short report

Background. The COVID-19 pandemic has led to an unprecedented global health crisis, with impacts on many facets of the health system, including lack of access to regular training wards and the need for social distancing, which posed particular challenges to undergraduate teaching. Objectives. To explore the perceptions of students of the online surgical programme at the University of KwaZulu-Natal (UKZN). Methods. An online survey was administered to 258 final-year students. Data were collected on student demographics, the impact of COVID-19 restrictions on the teaching programme, engagement and learning from live Zoom sessions, overall perceptions about the module and general feedback on students' experience of the programme. Results. Most students (84%, 77/91) supported the need to change to the virtual programme. The module was perceived as well-structured (89%, 81/91). Most students (87%, 79/91) regarded the online resource materials as beneficial. Analysis of open-ended responses showed that asynchronous delivery allowed students to review and revisit resources in their own time. Student challenges included poor internet connectivity, difficulty in concentrating where live sessions exceeded an hour, and lack of clinical exposure. Conclusion. Online teaching in medical education is a feasible option for remote learning. However, it cannot replace the benefits gained during clinical exposure. Findings from this study will help to set a benchmark for online surgical training at UKZN and develop best practices for blended teaching models. As we adapt to a new normal in the era of COVID-19, the disruptions and results of innovative teaching methods have the potential to change the future of medical education

Breed effects and heterosis for weight traits and tick count in a cross between an indigenous fat-tailed and a commercial sheep breed.

Ticks can compromise productivity and welfare in free-ranging sheep. Chemical tick control may not be sustainable in the long term. Alternative control measures must be sought for an integrated control programme. Birth and weaning weights as well as log transformed overall tick count of indigenous fat-tailed Namaqua Afrikaner (NA), commercial Dorper and NA x Dorper cross lambs were studied under extensive conditions. Relative to NA lambs, Dorper lambs were 22.2% heavier at weaning (P < 0.05). Geometric means for total tick count on Dorper lambs exceeded those of their Namaqua Afrikaner contemporaries by more than twofold (P < 0.05). Relative to the pure-breed midparent value, the mean performance of NA x Dorper lambs was 7.9% more for birth weight, 11.2% more for weaning weight and 26.2% less for the back transformed means for total tick count (P < 0.05). Heterosis for total tick count was slightly greater at -29.3% when data were adjusted for the larger size of NA x Dorper lambs. Crossing commercial Dorper sheep with a hardy, indigenous breed therefore resulted in lower levels of tick infestation without compromising live weight in progeny so derived. Hardy, indigenous genetic resources like the NA should be conserved and used in further studies of ovine genetics of resistance to ticks in South Africa.

Effectiveness and safety of dolutegravir two-drug regimens in virologically suppressed people living with HIV: a systematic literature review and meta-analysis of real-world evidence.

OBJECTIVES: Dolutegravir (DTG) is widely recommended within three-drug regimens. However, similar efficacy and tolerability have also been achieved with DTG within two-drug regimens in clinical trials. This study evaluated the real-world effectiveness and discontinuations in people living with HIV-1 (PLHIV) switching to DTG with lamivudine (3TC) or rilpivirine (RPV). METHODS: This was a one-arm meta-analysis utilizing data from a systematic literature review. Data from real-world evidence studies of DTG + RPV and DTG + 3TC were extracted, pooled and analysed. The primary outcome was the proportion of patients with viral failure (VF; ≥ 50 copies/mL in two consecutive measurements and/or ≥ 1000 copies/mL in a single measurement) at week 48 (W48) and week 96 (W96). Other outcomes included virological suppression (VS; < 50 copies/mL) and discontinuations (W48 and W96). Estimates were calculated for VF, VS as per snapshot (VSS) and on treatment analysis (VSOT), and discontinuations. RESULTS: Pooled mean estimates of VF for DTG + 3TC and DTG + RPV were 0.8% [95% confidence interval (CI): 0.4-1.3] and 0.6% (95% CI: 0.0-1.6), respectively, at W48. VSS rate at W48 was 85.0% (95% CI: 82.3-87.5) for DTG + 3TC regimen and 92.4% (95% CI: 85.0-97.7) in the DTG + RPV regimen. The DTG + 3TC and DTG + RPV regimens led to discontinuations in 13.6% (95% CI: 11.1-16.2) and 7.2% (95% CI: 2.1-14.4) of patients, respectively, at W48. Similar results were observed at W96. CONCLUSIONS: Treatment with DTG + 3TC or DTG + RPV in clinical practice provides a low rate of VF and a high rate of VS when initiated in virologically suppressed PLHIV with diverse backgrounds.

Predictors of 1-year survival in South African transcatheter aortic valve implant candidates.

BACKGROUND: Transcatheter aortic valve implantation (TAVI) has undergone rapid expansion internationally over the past 15 years. In view of resource constraints in developing countries, a major challenge in applying this technology lies in identifying patients most likely to benefit. The development of a risk prediction model for TAVI has proved elusive, with a reported area under the curve (AUC) of 0.6 - 0.65. The available models were developed in a First-World setting and may not be applicable to South Africa (SA). OBJECTIVES: To evaluate novel indicators and to develop a TAVI risk prediction model unique to the SA context. The current work represents the important initial steps of derivation cohort risk model development and internal validation. METHODS: Seven-year experience with 244 successive TAVI implants in three centres in Western Cape Province, SA, was used to derive risk parameters. All outcomes are reported in accordance with the Valve Academic Research Consortium definitions. Multiple preprocedural variables were assessed for their impact on 1-year survival using univariate and multivariate models. RESULTS: Factors found not to correlate with 1-year survival included age, renal function and aortic valve gradients. The commonly used surgical risk prediction models (Society of Thoracic Surgeons score and EuroSCORE) showed no correlation with outcomes. Factors found to correlate best with 1-year survival on multivariate analysis were preprocedural body mass index (BMI) (favouring higher BMI), preprocedural left ventricular end-diastolic dimension (LVED) and ejection fraction (EF) (favouring smaller LVED and higher EF), absence of atrial fibrillation, and three novel parameters: independent living, ability to drive a car, and independent food acquisition/cooking. Discriminant analysis of these factors yielded an AUC of 0.8 (95% confidence interval 0.7 - 0.9) to predict 1-year survival, with resubstitution sensitivities and specificities of 72% and 71%, respectively. CONCLUSIONS: Apart from existing predictors, we identified three novel risk predictors (independent living, ability to drive a car, and independent food acquisition/cooking) for 1-year survival in TAVI candidates. These novel parameters performed well in this early evaluation, with an AUC for predicting 1-year survival higher than the AUCs for many of the internationally derived parameters. The parameters are inexpensive and easy to obtain at the initial patient visit. If validated prospectively in external cohorts, they may be applicable to other resource-constrained environments.

Polypharmacy and potential drug-drug interactions for people with HIV in the UK from the Climate-HIV database.

OBJECTIVES: People with HIV (PWHIV) are likely to need therapies for comorbidities as they age. We assessed risk of drug-drug interactions (DDIs) in PWHIV. METHODS: The Climate-HIV electronic recording system was used to cross-sectionally analyse records from PWHIV aged ≥ 18 years attending four UK HIV units with a current antiretroviral (ARV) prescription in February 2018. Antiretroviral and non-ARV medications were categorized by clinical significance of DDIs (University of Liverpool DDI tool). Potential DDIs were predicted using treatment guidelines for commonly recorded comorbidities. RESULTS: Among 4630 PWHIV (44% female), 41% were ≥ 50 years old. The average number of non-ARV comedications increased from < 1 for patients aged ≤ 24 years to > 5 for patients aged ≥ 75 years; 65% were taking one or more non-ARV comedications. The median (interquartile range) number of non-ARVs was 1 (0-2) and 2 (1-5) for those aged < 50 and ≥ 50 years, respectively. Common comorbidities/concurrent health conditions occurred more frequently in patients aged ≥ 50 years vs. < 50 (53% vs. 34%). Boosted protease inhibitors were associated with the highest proportion of contraindicated comedications; dolutegravir and raltegravir had the fewest. For non-ARVs, sildenafil and quetiapine were most likely to result in DDIs. Guideline-recommended treatments for hepatitis C, hepatitis B, and tuberculosis had the highest proportions of contraindications when combined with ARV regimens, while treatments for hepatitis C, malignancy, and mental health conditions had the highest proportion of combinations potentially causing DDIs requiring dose monitoring or adjustment. CONCLUSIONS: Non-ARV use by PWHIV is high and increases with age. Treatment decisions for ageing PWHIV should consider guideline recommendations for comorbidities.

The pH of lye and no-lye hair relaxers, including those advertised for children, is at levels that are corrosive to the skin.

BACKGROUND: Hair relaxers are used by up to 70% of females of black African ancestry. Occupational safety regulations list a pH ≥10.5 as irritant and a pH ≥11.50 as corrosive to the skin. OBJECTIVES: To determine the pH of all relaxers sold on the South African market and whether it is lower in no-lye relaxers and those marketed for children. METHODS: Relaxers were purchased from retailers in Cape Town, but more than half (54%) of the 39 brands tested were international. The pH was determined using a benchtop pH meter with an electrode for emulsions. Three pH readings were done over 3 consecutive days for each sample, and the average was used for data analysis. Differences between relaxers were analysed using Kruskal-Wallis, Wilcoxon rank-sum (Mann-Whitney) and two-sample t-tests (p<0.05). RESULTS: The median pH of all relaxers (calcium hydroxide, lithium hydroxide and sodium hydroxide) was 12.36 (interquartile range 12.10 - 12.62). The active ingredient was sodium hydroxide (lye or caustic soda) in 63% of the total of 121 relaxers (6/76 (7.9%) of these marketed for children). Lithium hydroxide and calcium hydroxide (no-lye) relaxers comprised 17% and 20%, respectively. No difference in pH was found between relaxers marketed for adults and those for children (sodium hydroxide p=0.2703, lithium hydroxide p=0.6787 and calcium hydroxide p=0.1048) or between lye (sodium hydroxide) and no-lye (calcium hydroxide) relaxers (p=0.2740). Furthermore, 64/70 (91%) of sodium hydroxide relaxers for adults and 4/6 (67%) of those for children were sold packaged without a neutralising shampoo. CONCLUSIONS: The pH of all the relaxers tested was at levels deemed corrosive to the skin and may contribute to the high prevalence of alopecia in females with afro-textured hair. A review of permissible safe pH levels for cosmetic use is warranted.

Isolation of cellulase enzyme from brown garden snail (Cornu aspersum) for the saccharification of waste paper materials.

Garden snails (Cornu aspersum) have been sacrificed by drowning the snails overnight in water. The visceral organs (inside the shell organs) have been separated from the foot as well as the shell and homogenized using tris-HCl buffer, pH 5. The homogenate of visceral organs was dialysed in distilled water at 4 °C for 18 h where after the dialysed material was used to bio-convert the cellulose component of various waste paper materials into fermentable sugars such as glucose. Saccharification of the waste cellulose materials was performed with the extracted snail cellulase during ten consecutive incubation periods of 2 h each. The amount of sugars produced during cellulase action on waste cellulose was determined by the dinitrosalicylic acid (DNS) method. All incubations were performed in triplicate and the percent saccharification of each paper material was determined as a fraction of the paper material exposed to cellulase action. •Cellulase extracted from brown garden snail•Saccharification of waste paper using garden snail cellulase.

A laboratory based exposure of Microcystis and Oscillatoria cyanobacterial isolates to heterotrophic bacteria.

Biological control of cyanobacteria is a viable means of controlling nuisance bloom occurrences; however the majority of studies done are against Microcystis sp., with a commonly lytic effect caused. Filamentous cyanobacteria such as Oscillatoria are not as extensively studied in this area of biological control and are often part of Microcystis dominated blooms. This study employed heterotrophic bacterial isolates selected from bloom waters that indicated potential predatory behaviour against both filamentous and colonial cyanobacterial isolates. In comparison to a known Bacillus isolate, which is often reported among bacterial control agents, three other bacteria isolates were tested as control agents against non-axenic Oscillatoria and Microcystis cyanobacterial cultures. Assessments of cyanobacterial cell responses to the bacteria were conducted through water chemistry, chlorophyll a, alkaline phosphatase activity, microscopy and cyanotoxin measurements. The changes in these parameters were compared to untreated cyanobacterial cultures where no bacteria were added. The study found that at ratios of bacteria half that of Microcystis, minimal changes in chlorophyll a were observed, whilst Oscillatoria showed a decreased chlorophyll a more in the presence of isolates 1 and 3w. The assessment of alkaline phosphatase activity showed decreased activity in both cyanobacterial isolates exposed to the bacteria, relative to the untreated control sample. Microscopy analysis through fluorescence indicated that the attachment of the bacteria to the surface of the cyanobacteria hampered with the fluorescence and scanning electron microscopy indicated that the cells were damaged by the addition of the bacterial isolates. Cyanotoxin detection through the ELISA kit testing indicated that there was toxin reduction in samples treated with the bacterial isolates, with the highest reduction being close to 60% in the case of Microcystis sp. treated with isolate 3w. Similar reductions were noted in the filamentous cyanobacterium Oscillatoria, in the presence of isolate 1.

Multidisciplinary perspectives to prevent occupational health-related conditions among dental practitioners.

INTRODUCTION: The prevalence of occupational health conditions is high among dental practitioners and this study investigated the role which occupational health plays in dental training. PURPOSE/OBJECTIVES: This study was conducted to explore occupational health and to determine the topics to include from an occupational health perspective into the dental curriculum. METHODS: A descriptive qualitative study was conducted to explore the perceptions of dental practitioners, dental academics, physiotherapists, occupational therapists, occupational health specialists, ergonomists, optometrists and audiologists about dental training from an occupational health perspective in KwaZulu- Natal, South Africa. The interdisciplinary and multidisciplinary approach was used in this study. RESULTS: Three main themes became evident that hinged on varying understanding of occupational health-related conditions to dental practice, how practitioners experience practising in the resource-poor settings and its impact on the dental practice. There was also a lack of awareness of the occupational health policies and practices, which could inform safe dental practice. CONCLUSION: Dental academics should gain input from a multidisciplinary team. An occupational health course with a student-centred approach would enrich the dental curriculum and make dental practitioners more aware of occupational health issues.

Experiences of foreign medical graduates (FMGs), international medical graduates (IMGs) and overseas trained graduates (OTGs) on entering developing or middle-income countries like South Africa: a scoping review.

BACKGROUND: Foreign medical graduates (FMGs) have continued to render effective health care services to underserved communities in many high- and middle-income countries. In rural and disadvantaged areas of South Africa, FMGs have alleviated the critical shortage of doctors. FMGs experience challenges to adjust to new working environments as they have studied and obtained their medical qualifications in a country that differs from the one where they eventually choose to practise. OBJECTIVES: This scoping review synthesises literature about the experiences of FMGs upon entering a host country and the factors that facilitate their adjustment to the new context. METHODS: The systematic review was performed to analyse articles from an initial scoping of published literature on the experiences and adjustment of FMGs between 2000 and 2016. Searches were conducted through MEDLINE and PUBMED on keywords that included "foreign medical graduates", "experiences" "adjustment", "adaptation" and "assimilation". The database searches yielded 268 articles and a further 3 were identified through other sources. The number of articles was reduced to 20 after the removal of duplicates and the application of the exclusion criteria. A qualitative thematic analysis was performed. RESULTS: The searches revealed an overall lack of studies on the experiences and adjustment of FMGs from the African continent. FMGs faced professional barriers, lacked country-specific knowledge and experienced stress when practising in a new location. They attributed their successful adjustment to innate personal characteristics including a persistent attitude and the use of various coping strategies. Other facilitating factors included early orientation and professional and personal support. CONCLUSION: The review highlighted the need for research from developing and middle-income countries and for an increased awareness of the challenges and enablers to help FMGs adjust to new clinical settings.

Bacteria as biological control agents of freshwater cyanobacteria: is it feasible beyond the laboratory?

Biological control of cyanobacteria is a well-researched area with a central focus on laboratory-scale studies. Numerous reports have been made on algicidal isolates, with bacteria as a major component of the antagonists. The research in this review draws a brief summary of what is currently known in the area of freshwater cyanobacteria being inhibited by bacterial isolates. Proteobacteria, Bacteroidetes and Firmicutes are among the most commonly reported phyla of bacteria associated with or employed in this research area. However, there are limited reports of upscaling these control measures beyond the laboratory scale. Lytic control agents are the most commonly reported in the literature with subsequent cyanotoxin release. From a water quality perspective, this is not feasible. Based on the available literature, temperature, pH and nutrient changes have been explored in this short review as possible contributors to less optimal bacterial performance. Moreover, the investigation into optimising some of these parameters may lead to increased bacterial performance and, therefore, viability for upscaling this biological control. Through the compilation of current research, this review offers insight to live predator-prey cell interactions between cyanobacteria and algicidal bacteria.

Sex, size and isotopes: cryptic trophic ecology of an apex predator, the white shark Carcharodon carcharias.

Demographic differences in resource use are key components of population and species ecology across the animal kingdom. White sharks (Carcharodon carcharias) are migratory, apex predators, which have undergone significant population declines across their range. Understanding their ecology is key to ensuring that management strategies are effective. Here, we carry out the first stable isotope analyses of free-swimming white sharks in South Africa. Biopsies were collected in Gansbaai (34.5805°S, 19.3518°E) between February and July 2015. We used Stable Isotope Bayesian Ellipsis in R and traditional statistical analyses to quantify and compare isotopic niches of male and female sharks of two size classes, and analyse relationships between isotopic values and shark length. Our results reveal cryptic trophic differences between the sexes and life stages. Males, but not females, were inferred to feed in more offshore or westerly habitats as they grow larger, and only males exhibited evidence of an ontogenetic niche shift. Lack of relationship between δ13C, δ15N and female shark length may be caused by females exhibiting multiple migration and foraging strategies, and a greater propensity to travel further north. Sharks < 3 m had much wider, and more diverse niches than sharks > 3 m, drivers of which may include individual dietary specialisation and temporal factors. The differences in migratory and foraging behaviour between sexes, life stages, and individuals will affect their exposure to anthropogenic threats, and should be considered in management strategies.

Evidence for sperm storage in common smoothhound shark Mustelus mustelus and paternity assessment in a single litter from South Africa.

The present histological study of adult female common smoothhound shark Mustelus mustelus demonstrates that the species can store sperm in their oviducal glands. In addition, single paternity of a litter of 22 pups is reported, contributing to further knowledge regarding the genetic and behavioural mating strategy of M. mustelus.

Determinants of hair cortisol concentration in children: A systematic review.

BACKGROUND: Several factors are known contribute to hair cortisol concentration (HCC) in adults. However, there is less research on determinants of HCC in children and adolescents. HCC is a valuable tool for medical research pertaining to the hypothalamic-pituitary-adrenal (HPA) axis. This review aims to assess the extent to which established determinants of HCC in adults have been consistently reported in children (birth - 18 years) and to identify determinants of HCC specific to this age group. METHODS: Eligible studies were identified, selected and appraised as per PRISMA-P guidelines and as detailed in our systematic review protocol, registered on PROSPERO (registration number CRD42017056220). In view of contrasting methods and measures, a meta-analysis could not be done but a qualitative synthesis was performed. RESULTS: Thirty-six studies were included in the analysis. Higher HCC is associated with male sex and anthropometry, particularly increased body mass index and waist circumference. There is preliminary evidence to suggest that socio-economic status is inversely related to child HCC, particularly with reference to caregiver education and income. Of note, most of the studies analysing socio-economic variables were performed in relatively equal societies. Hair wash frequency and use of hair products and treatments do not affect HCC when proximal segments of hair are used. There is conflicting evidence regarding the relationship between HCC and age in children and adolescents. Further investigation is required to better delineate if and how the following are associated with HCC in children: hair colour, hair type, exposure to trauma and stressors, psychiatric illness, atopic illness, steroid use (including topical and inhaled steroids) and perinatal variables. CONCLUSIONS: Sex and anthropometry are potential confounders and should be considered for adjustment in hair cortisol research. Hair wash frequency and use of hair products and treatments are not important confounders when proximal hair segments are used. A better understanding of HCC in children in relation to exposure to trauma and stressors is required before it can be used as a biomarker, particularly in terms of vulnerable developmental stages, definition and measurement of stress, and temporal relationship to stressors. Age, SES and other correlates also warrant further investigation.

Comparative Early Life Stage Toxicity of the African Clawed Frog, Xenopus laevis Following Exposure to Selected Herbicide Formulations Applied to Eradicate Alien Plants in South Africa.

The rise in pesticides application has increased the need for better understanding of their ecological impacts. The global amphibian declines, for example, have been positively correlated with pesticides use. The differential susceptibility in the developmental stages of amphibians to chemical substances are still largely unknown. We examined the 96-h differential toxicity responses of embryos, premetamorphic and transitional larval stage of Xenopus laevis, to six formulated aquatic herbicide products containing the active ingredients of diquat dibromide (Midstream), glufosinate ammonium (Basta), imazapyr (Arsenal), and three glyphosate formulations (Roundup, Kilo Max, and Environ Glyphosate). The results showed the premetamorphic stage as the most sensitive to the herbicides toxicity. This study confirmed that the developmental stage at which amphibian are exposed to contaminants is critical to their survival and that the chemical contamination hypothesis of the global decline of amphibians should continue to be considered. This establishment of the premetamorphic larval as sensitive toxicity representative for all developmental stages of X. laevis means that this stage could be used more extensively in pesticides toxicity assessments.

Impact of the learning environment on career intentions of paediatric interns.

BACKGROUND: High childhood disease burdens in South Africa (SA) prioritise the need for careers in paediatrics. Experiences of junior doctors during internship may influence career trajectories in a direction that is discordant with national health priorities. OBJECTIVE: To explore the influence of the learning environment and demography on career intentions of SA paediatric interns. METHODS: This cross-sectional study involved sampling intern groups at the start and completion of internship in paediatrics to determine their career intentions. A validated version of the Postgraduate Hospital Educational Environmental Measure was used to measure perceptions of the learning environment (LE) in the post-paediatric internship cohort. Measures of the LE in combination with demographic factors were compared with career intentions. Associations were determined by t-tests or analysis of variance and χ2 tests. RESULTS: A total sample size of 422 was obtained from two separate cohorts, which were demographically similar except for age. Most interns (88.4%) intended to remain in SA, with 72.6% indicating an intention to practise in the public healthcare sector. There was a high intention to specialise (85.9%), and 60.2% were keen on a career that involved children. Previous educational exposure and demographic factors other than gender did not significantly influence career intentions. Perceptions of the LE significantly influenced decisions to stay in SA's public sector and to care for children. The decision to specialise, however, was not influenced by demographic variables or perceptions of the LE. CONCLUSIONS: Paediatric interns from diverse sociocultural and educational backgrounds had similar career intentions. Most interns were keen to work with children in SA's public sector. However, learning experiences during internship significantly influence these intentions and have the potential to drive young doctors away from SA, its public health service and paediatric care. Ensuring that training and support of interns are optimised is essential if SA is to align its healthcare needs with the aspirations of its future healthcare workers.

Does gender impact on female doctors'experiences in the training and practice of surgery? A single centre study.

BACKGROUND: Surgery has been identified as a male-dominated specialty in South Africa and abroad. This study explored how female registrars perceived the impact of gender on their training and practice of surgery. METHOD: A self-administered questionnaire was used to explore whether females perceived any benefits to training in a male-dominated specialty, their choice of mentors and the challenges that they encountered during surgical training. RESULTS: Thirty-two female registrars participated in the study. The respondents were mainly South African (91%) and enrolled in seven surgical specialties. Twenty-seven (84%) respondents were satisfied with their training and skills development. Twenty-four (75%) respondents had a mentor from the department. Seventeen (53%) respondents perceived having received differential treatment due to their gender and 25 (78.2%) thought that the gender of their mentor did not impact on the quality of the guidance received in surgery. Challenges included physical threats to female respondents from patients and disrespect, emotional threats and defaming statements from male registrars. Additional challenges included time-constraints for family and academic work, poor work-life balance and being treated differently due to their gender. Seventeen (53%) respondents would consider teaching in the Department of Surgery. CONCLUSION: Generally, females had positive perceptions of their training in Surgery. They expressed concern about finding and maintaining a work-life balance. The gender of their mentor did not impact on the quality of the training but 'bullying' from male peers and selected supervisors occurred. Respondents will continue to recommend the specialty as a satisfying career to young female students.