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Item
An Evaluation of High‑Risk HPV in Squamous Cell Carcinomas of the Lip in a South African Cohort
(Springer Nature, 2024-05-06) Harbor, Sharon N.; Schneider, Johann W.; Solomons, Nadine; Sanderson, Micheline; Afrogheh, Amir H.
Background
To determine the prevalence of HR-HPV in a series of lip SCC from South African patients, using currently accepted HPV-testing methodologies and to define the clinical and histomorphologic features of HPV-associated lip SCC.
Methods
Fifty SCC of lip and 50 control cases were tested for HR-HPV using p16 and HR-HPV DNA PCR. p16-equivocal/positive and HPV DNA PCR-positive SCC were further evaluated for the expression of HPV-16 and HPV-18 mRNA transcripts using reverse transcription quantitative real-time polymerase chain reaction (RT-qPCR) to confirm transcriptionally active HPV.
Results
p16 was positive in 22% (n = 11) and equivocal in 4% (n = 2) of the SCC. One p16-positive case showed positivity for both HPV-16 DNA and HPV-16 E6/E7 mRNA transcripts (HPV prevalence rate of 2%). The HPV-positive case was non-keratinizing and occurred in an 80-year-old female. The two p16-equivocal cases were HR-HPV DNA positive and mRNA PCR negative. p16 was found to have a positive predictive value of 9%.
Conclusion
Findings from our cohort of lip SCC suggest that HR-HPV may have an insignificant role in the pathogenesis of SCC at this site. Due to its low ppv, p16 is insufficient to establish HR-HPV infection in SCC of the lip. The combination of p16 and DNA PCR appears to correlate with the presence of transcriptionally active virus. HPV E6/E7 mRNA detection is the gold standard for identifying HR-HPV. mRNA testing is not widely available in sub-Saharan Africa due to technical and financial constraints; however, the test appears to be of great value in p16-equivocal lip SCC.
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Rehabilitation and primary care treatment guidelines, South Africa
(World Health Organization, 2022-08-22) Conradie, Thandi; Charumbira, Maria; Bezuidenhout, Maryke; Leong, Trudy; Louw, Quinette
The World Health Organization recognizes rehabilitation as an essential component of universal health coverage (UHC). In many countries, UHC builds on a standard benefits package of services that is informed by the country’s essential medicines list, standard treatment guidelines and primary health care essential laboratory list. In South Africa, primary health care is largely provided and managed by primary health-care nurses and medical officers in accordance with primary health care standard treatment guidelines. However, rehabilitation is mostly excluded from these guidelines. This paper describes the 10-year process that led to rehabilitation referral recommendations being considered for inclusion in South Africa’s primary health care standard treatment guidelines. There were five key events: (i) a breakthrough moment; (ii) producing a scientific evidence synthesis and formulating recommendations; (iii) presenting recommendations to the national essential medicines list committee; (iv) mapping rehabilitation recommendations onto relevant treatment guideline sections; and (v) submitting revised recommendations to the committee for final consideration. The main lesson learnt is that, by working together, rehabilitation professionals can be of sufficient number to make a difference, improve service delivery and increase referrals to rehabilitation from primary health care. A remaining challenge is the lack of a rehabilitation representative on the national essential medicines list committee, which could hamper understanding of rehabilitation and of the complexities of the supporting evidence.
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Factors influencing Western Cape community service doctors’ choice of whether to seek employment in public, rural practice
(Stellenbosch : Stellenbosch University, 2024-12) Baytopp, Tamryn; Motsohi, Ts'epo; Lomas, Vanessa; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Family and Emergency Medicine. Family Medicine and Primary Care.
ENGLISH SUMMARY: Background: Shortage of staff in rural areas has contributed to long-standing inequitable healthcare access between urban and rural populations. One of South Africa’s strategies to address this is the compulsory community service program.(1) To capitalize on this, doctors need to be encouraged to remain in their facilities beyond their community service periods. Identifying factors that positively or negatively influence their decisions to stay could help to develop more focused strategies to promote the retention of doctors in rural areas.(2)
Aim: To describe the important factors influencing Western Cape community service doctors’ choice of whether they will seek employment in public rural practice.
Design and setting: This was an observational cross-sectional study with correlational analysis of community service doctors working in the Western Cape in 2022.
Method: Western Cape community service doctors were invited to complete an internet-based questionnaire.
Results: A total of 86 community service doctors completed the questionnaire, of whom 8% intended to work in public rural practice in 2023 and 21% considered rural practice sometime in the future. Demographic factors associated with the intention to work in rural practice were a rural upbringing (6.5 times more likely to consider rural practice) and rural placement for internship (7.7 times more likely to consider rural practice) and community
service (3.5 times more likely to consider rural practice). The most important factors influencing their decision for or against rural practice were issues of personal safety and security (mean likert score of 4.7) followed by job
satisfaction (mean likert score of 4.6) and mental health (mean likert score of 4.6). Rural upbringing (mean likert score of 1.8) and exposure in internship (mean likert score of 2.4) were ranked low in importance.
Conclusion: This study found the proportion of community service doctors considering working in public rural practice has not significantly increased (20%) compared to previous findings in the literature. Suggestions based on the
results include revision of strategy on the part of policy makers, preferential enrolment of medical students with a rural upbringing, and prioritisation of placing community service doctors in rural areas. More focus should be placed upon promoting safe, satisfying work environments which are protective of staff mental and psychological wellbeing.
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Phenomenological engagement as pedagogical impetus in career counselling education
(Services Cristal, 2024-06-30) Conradie, Karlien
This article aims to present the author’s understanding of how a phenomenologically concerned pedagogy can offer an antidote to the influence that a post-industrial consumerist culture has on career counselling education. In the age of mediatisation, surges of endless commercialisation and consumption has evolved in a crisis of relationality, characterised by ecological fragmentation and disconnectedness. The present article explains how an overly utilitarian mindset reinforces an instrumentalist approach to career counselling, inhibiting student educational psychologists’ capacity for being conscious of the embodied lifeworld situation of a person engaging in career counselling. The embodied lifeworld situation refers to an ecologically integrated person reality, intricately anchored in time, space, and historicity. A pedagogical approach is needed that forefronts phenomenological engagement – relational being and knowing - as a way of conserving students’ ability for embodied consciousness.
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The vertex centroid of a Van Aubel result involving similar quadrilaterals and its further generalisation
(Taylor & Francis Group, 2024 ) De Villiers, Michael; Humenberger, Hans
This paper explores the position of the vertex centroid for a generalisation of Van Aubel’s theorem: specifically we look at what happens to the vertex centroid when directly similar quadrilaterals are placed on the sides of an arbitrary quadrilateral. After giving a simple proof that the position of the vertex centroid remains unchanged, the result is further generalised to directly similar triangles (or other directly similar shapes) on the sides of polygons using vectors. Not only are the results mathematically interesting, but can also provide an appropriate classroom opportunity for dynamic geometry exploration, and to build 2D models with clay and drinking straws (or thin wire) to illustrate and check the theoretical solutions. [ABSTRACT FROM AUTHOR]