SUNScholar - Browsing by Author "Harvey, Justin"

Browsing by Author "Harvey, Justin"

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The effect of skills training on attitudes, knowledge and clinical uptake of post-placental IUD use
(PAGEpress, 2015-11-25) Els, Christene; Van der Merwe, Johannes L.; Harvey, Justin; Steyn, Petrus
ENGLISH ABSTRACT: The objective of the present study is to investigate the effect of skills training on knowledge and attitudes of post-placental intra-uterine device (PPIUD) use, including the uptake thereof, and suggest training proposals. In-service skills training, alongside departmental protocol implementation, on PPIUD insertions were offered to healthcare professionals at Tygerberg Hospital, South Africa. Training was based on The postpartum intrauterine device. A training course for service providers, participant handbook from EngenderHealth (New York, NY, USA). Participants completed a questionnaire at enrolment and after 6 months to assess their knowledge and attitude towards PPIUD use. Most participants reported having the necessary skills to fulfil their family planning responsibilities (P<0.01), defined by their own perceived ability, and also reported that they could apply what they learnt (P<0.01). Most health care providers recommended IUDs to post-partum women (P=0.03), especially those who desire no more children (P=0.05), resulting in more participants providing IUDs (P=0.03) that could be attributed to the increased availability of reference material, i.e. training materials (P=0.02) and protocols (P=0.02). In conclusion, in-service PPIUD skills training guided by local protocol implementation resulted in an improvement of self-reported competency, counselling and PPIUD insertion. Repeated training with adequate supervision is imperative.
An examination of differences in psychological resilience between social anxiety disorder and posttraumaic stress disorder in the context of early childhood trauma
(Frontiers, 2017-12) Marx, Melanie; Young, Susanne Y.; Harvey, Justin; Rosenstein, David; Seedat, Soraya
ENGLISH SUMMARY : Background: Much of the research on anxiety disorders has focused on associated risk factors with less attention paid to factors such as resilience that may mitigate risk or offer protection in the face of psychopathology. Objective: This study sought to compare resilience in individuals with posttraumatic stress disorder (PTSD) and social anxiety disorder (SAD) relative to age-, gender- and education- matched individuals with no psychiatric disorder. We further assessed the correlation of resilience scores with childhood trauma severity and type. Method: The sample comprised of 93 participants, 40 with SAD with childhood trauma), 22 with PTSD with childhood trauma, and 31 with no psychiatric disorder (i.e., healthy matched controls). Participants were administered the Mini-International Neuropsychiatric Interview (MINI), Liebowitz Social Anxiety Scale (LSAS), Clinician-Administered PTSD Scale (CAPS), Childhood Trauma Questionnaire—Short Form (CTQ-SF), and the Connor-Davidson Resilience Scale (CD-RISC). The mean age of participants was 34 years (SD = 11). 52 Participants were female (55.9%) and 54 Caucasian (58.1%). Analysis of variance was used to assess for significant group differences in resilience scores. Non-parametric correlation analyses were conducted for resilience and different types of childhood trauma. Results: There were significant differences in resilience between the SAD and PTSD groups with childhood trauma, and controls. Both disorder groups had significantly lower levels of resilience than healthy controls. No significant correlation was found between total resilience scores and childhood trauma scores in the childhood trauma (SAD and PTSD) groups. However, in the combined dataset (SAD, PTSD, healthy controls), significant negative correlations were found between resilience scores and emotional abuse, emotional neglect, and total childhood trauma scores. Conclusions: Patients who have PTSD and SAD with childhood trauma appear to be significantly less resilient than those with no disorder. Assessing and addressing resilience in these disorders, particularly when childhood trauma is present,may facilitate long-term recovery and warrants further investigation.
Factors influencing the development of early- or late-onset Parkinson's disease in a cohort of South African patients
(Health & Medical Publishing Group, 2012-10-01) Van der Merwe, Celia; Haylett, William; Harvey, Justin; Lombard, Debbie; Bardien, Soraya; Carr, Jonathan
Background. Neurodegenerative disorders such as Parkinson’s disease (PD) contribute significantly to global disease burden. PD can be categorised into early-onset PD (EOPD) with an age at onset (AAO) of ≤50 years and late-onset PD (LOPD) with an AAO of 50 years. Aims. To identify factors influencing EOPD and LOPD development in a group of patients in South Africa (SA). Methods. A total of 397 unrelated PD patients were recruited from the Movement Disorders Clinic at Tygerberg Hospital and via the Parkinson’s Association of SA. Patient demographic and environmental data were recorded and associations with PD onset (EOPD v. LOPD) were analysed with a Pearson’s Chi-squared test. The English- and Afrikaans-speaking (Afrikaner) white patients were analysed separately. Results. Logistic regression analysis showed that ethnicity (p<0.001) and family history (p=0.004) were independently associated with AAO of PD. Average AAO was younger in black, coloured and Afrikaner patients than English-speaking white patients. A positive family history of PD, seen in 31.1% of LOPD patients, was associated with a younger AAO in the study population. Conclusions. These associations may be attributed to specific genetic and/or environmental risk factors that increase PD susceptibility and influence the clinical course of the disorder. More studies on PD in the unique SA populations are required to provide novel insights into mechanisms underlying this debilitating condition.
Intradialytic hypertension during chronic haemodialysis and subclinical fluid overload assessed by bioimpedance spectroscopy
(Oxford University Press European Renal Association, 2016-06-19) Sebastian, Sajith; Filmalter, Christelle; Harvey, Justin; Chothia, Mogamat-Yazied
Background: Intradialytic hypertension (IDH) increases morbidity and mortality. The prevalence in South Africa is unknown. The pathogenesis is unclear, but it has been suggested that IDH may be due to subclinical fluid overload. The objective of this study was to determine the prevalence of IDH and to evaluate its association with fluid overload using bioimpedance spectroscopy (BIS). Methods: A cross-sectional study involving 190 chronic haemodialysis patients in the Western Cape province of South Africa was conducted between January 2013 and May 2014. IDH was defined as a >10 mmHg increase in systolic blood pressure in at least four of six prior consecutive haemodialysis sessions. Results: The prevalence of IDH was 28.4% (n = 54). Therewas a trend towards pre-dialysis overhydration in the IDH group when compared with controls {2.6 L [95% confidence interval (CI) 1.7–3.4] versus 1.8 L [95% CI 1.4–2.1], respectively; P = 0.06} as measured by BIS, but no difference in mean ultrafiltration (UF) volume (2.4 versus 2.6 L; P = 0.30). A trend towards greater use of antihypertensive drugs was noted in the IDH group [2.5 drugs (95% CI 2.15–2.87) versus 2.1 (95% CI 1.82–2.30); P = 0.05]. More participants in the IDH group received calcium channel blockers (54 versus 36; P = 0.03). Conclusions: The prevalence of IDH in our treatment centres is much higher than previously reported. Subclinical fluid overload may be a major contributing factor to the mechanism of this condition. The use of BIS identifies patients who may benefit from additional UF.
Lipoatrophy/lipohypertrophy outcomes after antiretroviral therapy switch in children in the UK/Ireland
(Public Library of Science, 2017) Innes, Steve; Harvey, Justin; Collins, Intira Jeannie; Cotton, Mark F.; Judd, Ali
Background: Following widespread use of stavudine, a thymidine analogue, in antiretroviral therapy (ART) over the past three decades, up to a third of children developed lipoatrophy (LA) and/or lipohypertrophy (LH). Following phasing-out of stavudine, incidence of newly-diagnosed LA and LH declined dramatically. However, the natural history of existing cases should be explored, particularly with prolonged protease inhibitor exposure. Methods: The Collaborative HIV Paediatric Study (CHIPS) is a multicentre cohort study of most HIV-infected children in the United Kingdom and Ireland. Those on ART with a LA/LH assessment recorded in 2003–2011 were included. Assessments were completed annually by consultant physicians. Using the 0–3 grading system, LA or LH was defined as grade 2 or 3. Resolution was defined as return to grade 1 or 0 in all body regions. Results: Of 1345 children followed for median (IQR) 5.5 (2.9, 8.2) years after ART initiation, 30 developed LA and 27 developed LH, all at least 2 years after ART initiation. Median age at LA diagnosis was 11 (10, 13) years and at LH diagnosis was 13 (11, 15) years. Children with LA were more likely white (p<0.0001); lower height-for-age z-score at ART initiation (p = 0.02); initiated ART earlier (p = 0.04), with longer ART exposure (p = 0.04). Children with LH were similar to those without. Analysis of individual drugs revealed that LA was associated with greater duration of exposure to stavudine and didanosine; while LH was associated with greater duration of exposure to stavudine and ritonavir (given alone or in combination with another protease inhibitor). Median time in follow-up following ART switch was 2.8 (1.9, 4.9) and 2.5 (1.6, 4.7) years respectively. Resolution occurred in 10 (30%) of LA cases (median time to resolution 2.3 [1.8, 3.6] years) and 3 (11%) of LH cases (median time to resolution 2.0 [1.7, 2.1] years). Conclusions: Prevalence of LA and LH were low, with some resolution noted, especially for LA. More long-term data are needed.
Outcome of children admitted to a general highcare unit in a regional hospital in the Western Cape, South Africa
(Health & Medical Publishing Group, 2016-10-03) Kruger, Irma; Gie, Robert Peter; Harvey, Justin; Kruger, Mariana
Background. Critically ill children are often managed in non-tertiary general intensive care units admitting both adults and children, but few data are currently available regarding paediatric outcomes in these general units. Objective. To determine the outcome of critically ill neonates and children admitted to a general high-care unit in a large regional hospital in the Western Cape, South Africa. Methods. This was a retrospective descriptive analysis of outcome of all neonatal and paediatric (<13 years of age) patients admitted with non-surgical disease, during a 1-year period, to a general high-care unit at a large regional hospital in Worcester, South Africa. Data included demography, admission time, length of stay, diagnoses, HIV status, therapeutic interventions and outcome. The primary outcome was defined as successful discharge, transfer to a central hospital or death. Results. There were 185 admissions, with the majority (83%) <12 months of age (median age 3.7 months; range 0 - 151 months) and a male:female ratio of 1.3:1. The majority (70%) were successfully discharged, while 24% were transferred to a tertiary paediatric intensive care unit (PICU) and only 6% died. Causes of death included acute lower respiratory tract infections (33%), acute gastroenteritis (33%), birth asphyxia (16%) and complications of prematurity (16%). Nasal continuous positive airway pressure (p<0.001), ventilation (p<0.001) and HIV infection (p=0.010) were associated with transfer to a PICU in a central hospital or death. Conclusion. The majority of children (70%) requiring admission to a general high-care unit in a regional hospital were successfully treated and discharged. These good outcomes were only achievable with a good transfer system and supportive tertiary healthcare system.
Outcomes of adult heroin users v. abstinent users four years after presenting for heroin detoxification treatment
(AOSIS Publishing, 2014-08) Khan, Zureida; Cloete, Karen Jacqueline; Harvey, Justin; Weich, Lize
Background. There are no studies in South Africa (SA) on the outcomes following detoxification and psychosocial rehabilitation of heroindependent patients. Objective. To compare the demographic, clinical, forensic and treatment data of active heroin users v. users who were abstinent at the time of interview 4 years after attending the Opioid Detoxification Unit at Stikland Hospital in the Western Cape Province, SA. Method. Participants included patients above the age of 16 years who had been admitted to the Opioid Detoxification Unit at Stikland Hospital for heroin detoxification between July 2006 and June 2007. Participants were individually interviewed (either in person or telephonically) using a structured self-report questionnaire to collect demographic, clinical, forensic and treatment data 4 years following heroin detoxification treatment at this unit. Results. Of the participants, 60% were abstinent and a large portion (34%) attributed this to social support. Furthermore, there was a significant (p=0.04) difference in the longest period of abstinence between the past user group and active users, with more participants in the past user group being abstinent for 18 months or longer (n=24, 57%) than in the active users group (n=8, 29%). Active users (n=18, 64%) had significantly (p=0.03) more legal problems than abstinent users (n=14, 33%). Most participants (n=38, 54%) relapsed within 3 months after index detoxification and rehabilitation. Conclusion. Active users had more legal problems than abstinent users, with social support structures playing a pivotal role in abstinence. Future research should assess the impact of interventions such as post-discharge social support programmes on criminality and heroin use in those that relapse following treatment.
Polymerase chain reaction to search for Herpes viruses in uveitic and healthy eyes : a South African perspective
(Makerere University, Faculty of Medicine, 2015) Laaks, Debbie; Smit, Derrick Peter; Harvey, Justin
Objective: To analyse aqueous polymerase chain reaction (PCR) results in patients diagnosed with undifferentiated uveitis and determine prevalence of herpesviridae in non-uveitic patients undergoing routine cataract extraction. Design: Retrospective comparative case series and prospective cross-sectional study. Subjects: 72 patients with idiopathic uveitis and 57 surgical patients. Methods: Diagnostic aqueous paracentesis with PCR testing for 6 herpes viridae in uveitic patients. Anterior chamber paracentesis immediately pre-operative in the prospective arm, with PCR testing. Results: In the retrospective review we had a 47.2% positive PCR yield. Data analysis revealed a statistically significant correlation between a positive yield and being HIV+ (p=0.018); between an EBV+ yield and being HIV+ (p= 0.026) and a CMV+ result and being HIV+ (p=0.032). Posterior uveitis (p=0.014) and symptoms <30 days (p= 0.0014) had a statistically significant yield. In the prospective arm of the study: all 57 patients were HIV- and all aqueous samples were negative for the 6 herpesviridae. Conclusion: We recommend PCR testing for Herpesviridae as a safe second line test for patients with undifferentiated uveitis. We were unable to establish prevalence and suggest that the idea of a commensal herpes virus is unlikely if the blood-ocular barrier is intact
Pregnancy outcomes in super-obese women – an even bigger problem? A prospective cohort study
(Health & Medical Publishing Group, 2014-08) Nieuwoudt, Marina; Van der Merwe, Johannes Lodewicus; Harvey, Justin; Hall, David R.
Objective. To investigate whether differences exist in adverse pregnancy outcomes between morbidly obese (body mass index (BMI, kg/m2) 40 - 49.9) and super-obese women (BMI ≥50). Methods. A prospective cohort study was undertaken at Tygerberg Hospital, a referral centre in the Western Cape Province of South Africa, of morbidly obese and super-obese pregnant women recruited from the antenatal clinic. Data were collected from the files 6 weeks after delivery. Primary outcomes included hypertension, diabetes mellitus and fetal macrosomia. Secondary outcomes included baseline characteristics, previous complications, antenatal and peripartum complications, and short-term neonatal outcomes. Results. Sixty-six morbidly obese and 46 super-obese women were enrolled. Super-obese women experienced significantly higher incidences of pre-eclampsia (24% v. 9%; p=0.03) and interuterine growth restriction (13% v. 2%; p=0.02) than morbidly obese women, and both groups had a high incidence of gestational diabetes (24% v. 24%; non-significant (NS)). Both super-obese and morbidly obese women experienced high rates of caesarean section (54% v. 41%; NS). In super-obese women these procedures lasted longer (50 v. 41 minutes; p<0.01) and there were more surgical complications (36% v. 7%; p=0.01). Prolonged admission (>3 days) after delivery was also more common in super-obese women (65% v. 42%; p=0.03). Conclusion. Super-obese women encounter more major pregnancy complications (especially hypertensive, pre-eclamptic and surgical) than morbidly obese women, emphasising the fact that these women should be managed at institutions with sufficient expertise.
Retinoblastoma outcome at a single institution in South Africa
(Health & Medical Publishing Group, 2014-12) Kruger, Mariana; Reynders, David; Omar, Fareed; Schoeman, Judy; Wedi, Oloko; Harvey, Justin
Introduction. Retinoblastoma (RB) is the most common eye cancer in children. Early detection is necessary for cure. Objective. To compare stage and outcome of children with RB treated at Kalafong Hospital, Pretoria, South Africa (SA), during two time periods (1993 - 2000 and 2001 - 2008, after outreach interventions in 2000 and introduction of compulsory community service for doctors in 1998). Methods. Data collected included demography (age, gender, date of birth), stage and treatment received. The main outcome measure was disease-free survival and the study end-point was 60 months after diagnosis. Results. There were 51 patients during the time period 1993 - 2000 (group 1) and 73 during 2001 - 2008 (group 2), with median ages of 32 and 26 months, respectively (marginally significantly younger in group 2; p=0.046). In group 1, the majority (57%) presented with advanced disease (stages III and IV), a decline in this proportion in group 2 (40%) indicating a downward but not significant trend (p=0.075). Bilateral disease was diagnosed in 22% of patients in group 1 and 33% in group 2. Overall survival was 33% and 43% for groups 1 and 2, respectively. Excluding absconding patients, event-free survival was 50% in group 1, improving to 68% in group 2 (not statistically significant; p=0.18). Fewer patients needed radiotherapy during the second period (statistically significant; p=0.04), probably because of less advanced disease. Conclusion. Poor outcome is probably a result of late diagnosis. It is important to implement a strategy that will ensure early diagnosis and optimal management of RB in SA.
The routine paediatric human immunodeficiency virus visit as an intervention opportunity for failed maternal care, and use of point-of-care CD4 testing as an adjunct in determining antiretroviral therapy eligibility
(Medpharm Publications, 2014) Picken, Sandra Claire; Williams, Sadeeka; Harvey, Justin; Esser, Monika M.
South African women and children remain at the centre of the human immunodeficiency virus (HIV) pandemic, and maternal well-being plays a critical role in child health. In this study, we evaluated the impact of the paediatric visit on the determination of antiretroviral therapy (ART) eligibility in mothers using Alere Pima™ Analyser (Pima™) testing as an adjunct to routine care. Fifty-two mothers who had failed to obtain routine CD4 screening were enrolled during the paediatric visit at Tygerberg Children’s Hospital between November 2011 and May 2012. Clinical staging assessments and parallel standard CD4 cell count testing were performed. Finger-prick samples for the Pima™, and simultaneous venous samples for reference flow cytometry, were obtained. The Pima™ identified 37% of mothers as meeting ART eligibility versus 35% using the reference flow cytometry method. An additional 4% of mothers were identified using World Health Organization clinical staging only. The sensitivity of the Pima™ was 89%, specificity 91%, and positive and negative predictive values 84% and 94%, respectively. These results indicate that the paediatric HIV care visit can provide a valuable additional intervention opportunity to identify mothers in need of ART, with point-of-care CD4 technologies being used as a meaningful adjunct in screening for ART eligibility.
School-based human papillomavirus vaccination : an opportunity to increase knowledge about cervical cancer and improve uptake of screening
(Health and Medical Publishing Group, 2015-11) Dreyer, Greta; Van der Merwe, Frederick H.; Botha, Matthys H.; Snyman, Leon C.; Constant, Deborah; Visser, Cathy; Harvey, Justin
Background. Poor knowledge about cervical cancer plays a role in limiting screening uptake. HPV vaccination provides an untested platform to distribute information that could possibly improve knowledge and screening coverage. Objective. To measure changes in knowledge and screening uptake when information and screening opportunities were provided to mothers of adolescent HPV vaccine recipients. Methods. During an HPV vaccine implementation project in the Western Cape (WC) and Gauteng Province (GP), South Africa, information about cervical cancer was provided to parents during a lecture, written information was distributed, and mothers were then invited to either screen at their clinic (WC) or use a self-screening kit (GP). A structured questionnaire was used to test cervical cancer knowledge and screening practices, comparing these before and after the project and between the two screening groups. Results. Complete data for both questionnaires were available for 777 of 906 recruited women. Initial knowledge was poor, but on retesting 6 months later, knowledge about symptoms (p<0.005), screening (p<0.005) and vaccination (p<0.05) improved significantly after the information session and school-based HPV vaccination. In the second questionnaire, women reported significantly more screening and the last reported screening test was more recent. This improvement was more favourable in GP than in the WC (41% v. 26% reporting screening in the past 12 months). Conclusion. These results demonstrate how adolescent HPV vaccine programmes can help to control cervical cancer among mothers by offering information and screening. It is important not to lose this opportunity to educate mothers and their daughters and offer effective methods to prevent cervical cancer in both generations.
Time between skin incision and delivery during cesarean
(Elsevier, 2013-12) Rossouw, Jana N.; Hall, David R.; Harvey, Justin
Objective: To investigate factors influencing skin incision-to-delivery time (including sub-divisions thereof) and the effect of these surgical intervals on immediate neonatal outcome. Methods A prospective cohort analysis was conducted of all women undergoing cesarean delivery at Tygerberg Hospital, Cape Town, South Africa, from May 24 to November 2, 2010. Three surgical intervals were evaluated: skin incision to myometrium, myometrium to delivery, and skin incision to delivery. Neonatal outcome was assessed by the 5-minute Apgar score. Results Of 1120 cesarean deliveries recorded during the study period, 77.2% were emergency procedures, which were performed more quickly at all surgical planes (P < 0.01). Adhesions in the surgical field were present in 7.4% of all primary procedures versus 67.7% of all third procedures (P < 0.001). The skin incision-to-delivery time was significantly extended among repeat procedures (P < 0.001) and increased progressively with degree of obesity (P < 0.001). Although the 3 surgical intervals were calculated individually, none of the median values correlated with a 5-minute Apgar score below 7 for emergency deliveries. Conclusion Repeat procedures, adhesions, and obesity prolonged the time taken for cesarean delivery. Nevertheless, the effect of these factors on the 5-minute Apgar score was minimal.

Browsing by Author "Harvey, Justin"

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