Esme Jordaan - Academia.edu (original) (raw)

Papers by Esme Jordaan

The International Journal of Tuberculosis and Lung Disease

Better integration of treatment support for people living with tuberculosis (TB) and human immuno... more Better integration of treatment support for people living with tuberculosis (TB) and human immuno-deficiency virus/acquired immune-deficiency syndrome (HIV/AIDS) is a challenge in many settings, and has been identified as a service priority. To determine the impact, compared to directly observed therapy, of a TB treatment intervention modelled on the community antiretroviral treatment (ART) support programme in South Africa. An interrupted time-series design was used, including five intervention clinics and five comparison clinics. Data were collected from January 2005 to March 2008 and analysed using Poisson regression. Between April 2007 and March 2008, a total of 71% of all new TB patients starting treatment at the intervention clinics were placed on the intervention. There were no significant differences in cure or treatment success rates for new TB patients between intervention and comparison clinics. There was a small improvement in smear conversion rates in intervention clini...

Driver anger is strongly related with aggressive road behaviours and adverse injury outcomes. Thi... more Driver anger is strongly related with aggressive road behaviours and adverse injury outcomes. This paper seeks to explore the nature and extent of driver anger in the South African east-coast city of Durban. Findings revealed that over a one-year period, most motorists (96%) reported experiencing anger at consistently high intensity levels when being a victim to the different dimensions of aggressive road behaviours. With general self-reported anger-provoking events, behaviours relating to impeding one's progress were reported most often, by more than one-third of participants. Additionally, multiple linear regression modelling was used to identify several significant relationships with anger, including associations with the different types of anger coping strategies used by motorists. This study has yielded valuable preliminary findings on anger and its expressions in this setting, and are important considerations towards comprehensive road safety intervention strategies.

British journal of sports medicine, 2014

Non-communicable disease (NCD) is increasing, but management remains mostly curative, disease-cen... more Non-communicable disease (NCD) is increasing, but management remains mostly curative, disease-centred and focused on single interventions. We describe the development and implementation of a patient-centred, comprehensive, multidisciplinary lifestyle intervention programme (LIP) for patients with NCD in the sport and exercise medicine (SEM) setting (part 1) and present preliminary observational data (part 2). Part 1 is a description of the programme development and implementation. In part 2, 210 participants with NCD underwent a 12-week LIP (U-Turn Medical). Physiological, functional and metabolic outcomes were assessed at baseline and at completion. 84% of patients had two or more comorbidities, requiring additional considerations for exercise rehabilitation. On completion, there were decreases in % body fat (29.8±6.7% vs 28.5±6.6%), waist (100.2±16.2 vs 97.3±14.8 cm) and hip circumference (105.4±13 vs 104±12 cm), resting heart rate (74.2±13.4 vs 71.4±11.9 bpm), resting systolic bl...

The Journal of the Dental Association of South Africa = Die Tydskrif van die Tandheelkundige Vereniging van Suid-Afrika, 1987

South African Journal of Psychiatry, 2014

ABSTRACT Background. Clozapine use is known to be associated with significant side-effects, inclu... more ABSTRACT Background. Clozapine use is known to be associated with significant side-effects, including prolongation of the QT-interval, agranulocytosis and metabolic syndrome. However, few data exist on the prevalence of clozapine side-effects in patients of Xhosa descent. Objective. To gather data from Xhosa patients with schizophrenia to establish the prevalence of clozapine side-effects in this population. Methods. Twenty-nine Xhosa patients with schizophrenia (as per the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR)) who had been receiving clozapine treatment for > 1 year on an outpatient basis were selected for inclusion. All patients were participating in a genetics study in the Cape Metropolitan area. The participants were evaluated for the presence of side-effects (tests including an electrocardiogram, white blood cell count (WCC) and fasting blood glucose). Results. The prevalence of metabolic syndrome was 44.8% (95% confidence interval (CI) 26.7 - 62.9) and of undiagnosed diabetes mellitus 13.8% (95% CI 1.24 - 26.34). There was a significant association between metabolic syndrome and body mass index (BMI) (p < 0.01). The mean (SD) WCC was 7.8 x 10(9)/L (2.8), with 3.4% of the subjects having a WCC < 3.5 x 10(9)/L. Sedation (82.8%; 95% CI 69.0 - 96.5), hypersalivation (79.3%; 95% CI 64.6 - 94.1) and constipation (44.8%; 95% CI 26.7 - 62.9) were common. The mean QT-interval was 373.8 (35.9) ms and 10% had a corrected QT-interval > 440 ms. There was an association between the duration of clozapine treatment and QT-interval (with Bazett's correction). Conclusion. The high prevalence of metabolic syndrome and undiagnosed diabetes mellitus in this sample points to a need to monitor glucose levels and BMI on a regular basis. A larger study should be done to accurately quantify the differences in prevalence of side-effects between population groups.

PM&R, 2014

Prevention of illness is important for a team physician. However, there are few studies that repo... more Prevention of illness is important for a team physician. However, there are few studies that reported clinical aspects of illness of athletes with impairment. To describe the clinical characteristics of the 385 illnesses reported on the a novel Web-based electronic injury and illness capturing system (WEB-IISS) during the London 2012 Paralympic Games. Part of a large prospective cohort study. London 2012 Paralympic Games. Team physicians of 78 delegations (3329 athletes over 14 days) used WEB-IISS. Each day, information was recorded, which included daily team size and illness details, system affected, final diagnosis, type and onset of symptoms, training and/or competition days lost, and suspected cause. Incidence of illness (illness per 1000 athlete days). The incidence of illness in the cohort was 8.3 per 1000 (95% confidence interval, 7.5-9.1) athlete days, and the percentage of athletes with an illness in this study was 9.2%. Respiratory system illnesses were the most common (39.4%), followed by the digestive system (15.8%), skin and subcutaneous system (11.8%), genitourinary system (8.8%), and nervous system (7.3%). Urinary tract illness was more common in athletes with spinal cord injury (22%) compared with the athletes with other impairments (0%-5%). Skin and subcutaneous illness varied from 0%-18% between impairment categories and was highest for athletes with spinal cord injury. Infections accounted for 40.8% of all illness and 19.5% of illness that resulted in a time loss of ≥1 day. In 34% of illnesses, symptoms were present for ≥1 day before being reported to the team physician. The majority of illnesses affected the respiratory, gastrointestinal, skin and subcutaneous, and genitourinary systems, and were mostly infective in nature. The highest number of all illnesses, including skin and subcutaneous illnesses, and urinary tract illnesses, were of athletes with spinal cord injury. Although most illnesses were not time-loss illnesses, 19.5% of illnesses resulted in ≥1 day lost. Team physicians should be aware that, in many cases of infection reported, the symptoms were already present the day before. A delay in reporting of symptoms >24 hours could have important clinical implications for athletes' medical care.

Journal of Asthma, 2001

This study investigated whether household environmental tobacco smoke (ETS) exposure is associate... more This study investigated whether household environmental tobacco smoke (ETS) exposure is associated with increased bronchial hyperresponsiveness (BHR) in children with asthma. Two hundred forty-nine children, ages 7-11 years, sampled from a larger group with reported asthma or multiple asthma symptoms identified in a community survey in Cape Town, underwent histamine challenge testing and had urinary cotinine measured. Parents were interviewed for information on smoking habits and a variety of covariates. Children with asthma whose mothers smoked had a lower frequency of BHR than asthmatic children of nonsmoking mothers, particularly if the mother smoked > or = 15 cigarettes daily. BHR was also less common among children sharing a house with four or more smokers vs. fewer or none. BHR was unrelated to paternal smoking. In contrast, FEV1 was lower among children whose mothers currently smoked. The findings do not support a mechanism whereby ETS exposure aggravates existing childhood asthma by increasing BHR. This association may be masked, however, by the degree to which mothers of asthmatic children adjust their smoking. The results are consistent with an adverse effect of maternal smoking on lung function in asthmatic children.

Evaluation & the Health Professions, 2013

Interviewers administered the Rosenberg Self-Esteem scale (RSES) to five groups of Black (formal ... more Interviewers administered the Rosenberg Self-Esteem scale (RSES) to five groups of Black (formal township and informal settlement), White, Indian, and mixed race adult residents of Greater Pretoria. The results demonstrated that the RSES was psychometrically sound for the five groups. The minimal effects of sociodemographic characteristics on global self-esteem showed that the RSES and its two dimensions, self-competence (SC) and self-liking (SL), were suitable in this setting. All five groups scored above the theoretical midpoint of the RSES, indicating that generally positive self-evaluations appear to be universal. The relationships between positively and negatively worded items, SC, and SL attested to the following: internal structure reliability, congruence between positive and negative items, no negative biases in response, and concordance between SC and SL dimensions. The significant differences between informal settlement residents and the other four groups on global self-esteem, positively and negatively worded items, and SC and SL were possibly due to physiological needs taking precedence over higher order needs.

European Neuropsychopharmacology, 2010

Environmental Research, 2000

The purpose of this study was to remeasure in vivo tibia lead levels in a lead+acid battery manuf... more The purpose of this study was to remeasure in vivo tibia lead levels in a lead+acid battery manufacturing workforce measured in a previous survey and believed to be unrealistically high. Tibia lead levels were measured by K-shell X-ray Buorescence (XRF) spectroscopy in a stratiAed random sample (n‫؍‬ 40) of the original study group (n‫؍‬ 381). The repeat survey showed much lower tibia lead levels (median"54.3 g lead/g bone mineral, compared to 217.9 g lead/g bone mineral, n‫؍‬ 40). Tibia lead levels were signiAcantly correlated with duration of occupational exposure, zinc protoporphyrin levels, and cumulative blood lead index, but not with current blood lead levels. Thirty-eight of the 40 subjects underwent two consecutive tibia lead measurements to assess the test+retest repeatability of the XRF tibia lead measurement technique. The intraclass correlation coefAcient between repeated measurements was 0.926 (P(0.0001). Three measurement pairs differed by more than 20 g/g. There was no Axed or proportional bias between the two sets of measurements. We conclude that the technique offers a highly repeatable measurement of tibia bone lead. However, care needs to be taken to avoid contamination when performing measurements on active lead workers.

Early Child Development and Care, 2011

... Olivier c , Johanna de Waal c & Caroline Poole c pages 463-474. ... Underreporting is mos... more ... Olivier c , Johanna de Waal c & Caroline Poole c pages 463-474. ... Underreporting is mostly due to the mistrust within the clinic settings between nurses and clients (Jewkes, Abrahams, & Mvo, 199813. Jewkes, R., Abrahams, N. and Mvo, Z. 1998. Why do nurses abuse patients? ...

Curationis, 2004

The management of aggressive behaviour has always been a critical issue in psychiatry. Finding me... more The management of aggressive behaviour has always been a critical issue in psychiatry. Finding measures that can be used to accurately predict the likelihood of assaultative behaviour and thus ensure timeous appropriate pharmacological management remains a dilemma. The study objective was to investigate the naturalistic, pharmacological management of inpatient aggressive behaviour in a group of 50 schizophrenic subjects with a view to determine: (1) whether a presenting history of recent violence lead to altered pharmacological management and (2) whether the NOSIE could be regarded as a useful assessment tool with regards to inpatient behaviour management. No significant difference could be demonstrated between the 2 subsets of subjects (history of violence vs none) with respect to total doses of medication administered. No statistical correlation could be found between the total NOSIE score and the dose of psychotropic medication used. The relationship between a subset of NOSIE-items and the total dose of medication was more complex and a clear linear relationship could be demonstrated for a total score of 0 to 5. In this particular ward setting a presenting history of recent violent behaviour did not influence the administration of medication and neither could the clinical judgement employed by the nursing staff to manage inpatient behaviour be captured by the NOSIE. However, a five-item subset of the NOSIE with questions relating to aggression and irritability warrants further scrutiny in this regard.

British Journal of Sports Medicine, 2012

Illness accounts for a significant proportion of consultations with a team physician travelling w... more Illness accounts for a significant proportion of consultations with a team physician travelling with elite athletes. To determine if international travel increases the incidence of illness in rugby union players participating in a 16-week tournament. 2010 Super 14 Rugby Union tournament. 259 elite rugby players from eight teams were followed daily over the 16-week competition period (22 676 player-days). Team physicians completed a logbook detailing the daily squad size and illness in any player (system affected, final diagnosis, type and onset of symptoms, training/match days lost and suspected cause) with 100% compliance. Time periods during the tournament were divided as follows: located and playing in the home country before travelling (baseline), located and playing abroad in countries >5 h time zone difference (travel) and located back in the home country following international travel (return). Incidence of illness (illness per 1000 player-days) during baseline, travel and return. The overall incidence of illness in the cohort was 20.7 (95% CI 18.5 to 23.1). For all teams, the incidence of illness according to location and travelling was significantly higher in the time period following international travel (32.6; 95% CI 19.6 to 53.5) compared with the baseline (15.4; 95% CI 8.7 to 27.0) or after returning to their home country (10.6; 95% CI 6.1 to 18.2). There is a higher incidence of illness in athletes following international travel to a foreign country that is >5 h time difference and this returns to baseline on return to the home country.

BJOG: An International Journal of Obstetrics & Gynaecology, 2007

Objective To determine the effects of magnesium supplementation in pregnancy on the incidence of ... more Objective To determine the effects of magnesium supplementation in pregnancy on the incidence of hypoxic-ischaemic encephalopathy (HIE).

American Journal of Respiratory and Critical Care Medicine, 1996

To identify modifiable risk factors for wheezing illness in childhood, the associations between c... more To identify modifiable risk factors for wheezing illness in childhood, the associations between current asthma or wheezing and factors such as household smoking, damp and dietary salt preference were measured in a questionnaire-based prevalence study of schoolchildren 7 to 9 yr of age in Cape Town. In a random sample of 15 schools, questionnaires were completed by parents of 1,955 children, from which 368 cases and 294 controls were selected on the basis of reported asthma diagnosis or symptoms. Urinary cotinine concentrations were measured, and the parents were interviewed. An exposureresponse relationship between the urinary cotinine creatinine ratio and asthma/wheeze was observed.

African Journal of Psychiatry, 2012

The use of endophenotypes, such as neurological soft signs (NSS), is advocated as one possible me... more The use of endophenotypes, such as neurological soft signs (NSS), is advocated as one possible method to elucidate the heterogeneity of schizophrenia. Exploring the associations between NSS and specific illness symptoms has revealed some trends, although results have been conflicting. To date, such studies have been conducted largely on Caucasian populations and our pilot study represents the first attempt to gather such data in a homogenous African population. Fifty-one patients, all of Xhosa ethnicity and participating in a larger schizophrenia genetic study were recruited. NSS were evaluated using a modified Neurological Evaluation Scale. Data were analysed using SPSS with the strength of the overall relationships between NES groups and SANS and SAPS components analyzed by means of canonical correlation analysis. The canonical correlation of SANS domains (excluding asociality) with the NES conceptual groups was 0.53 (SE=0.11, p=0.024) and of the SAPS domains 0.38 (SE=0.13, p=0.943). Our results suggest a correlation between negative symptoms of schizophrenia and the presence of NSS, supporting the recruitment of a larger sample to more comprehensively evaluate a possible role for NSS as an endophenotype in the Xhosa schizophrenia population. Taking into account that NSS evaluations allow for inexpensive, relatively easy-to-do objective evaluations, this method presents us with a valuable research tool that can be used effectively within our under-resourced environment to help inform on the neurobiological substrate of schizophrenia.

African Journal of Psychiatry, 2012

There are several methods of evaluating medical students' performance, such as written ex... more There are several methods of evaluating medical students' performance, such as written examination, oral examination and objective structured clinical examination (OSCE). Many studies have focused on the reliability and validity of these methods but few studies have explored comparison between these methods. Psychiatry is the only subject at the University of Stellenbosch where the final assessment consists of solely an oral component. The aim of the study was to compare students' final overall and discipline specific examination marks (i.e. in the other subjects) with the examination marks in psychiatry, and to determine if content or structure (e,g. oral, written or OSCE format) of examination impacts more on the student performance in the examination. 343 final year medical students were included. All undertook their psychiatry rotation at the University of Stellenbosch, South Africa during 2008 and 2009. Data of marks obtained in all the disciplines during 2008 and 2009 were collected and class marks were compared with their final examination marks across all disciplines. Bland-Altman plots were used to assess the level of agreement between the class and examination marks. Cases below the lower threshold were compared to all other cases across all disciplines. The odds ratio for group status was calculated for gender distribution of examiners. The psychiatry class mark and final oral examination mark provided similar measures within a width of 31.5. Cases below the threshold had poorer performance in two other disciplines. The gender distribution of the examiners (female-female) significantly increased the odds ratio for poorer performance in the oral examination. The results suggest that a group of students underperform in their final examination independent of method of evaluation and that the gender of examiners impacts on examination marks. Therefore future research should focus on identifying and modifying factors (including choice of examiner combinations) that contribute to the poor performance of medical students in their final examination, in order to help students perform better. Gender distribution of examiners should also be considered when examinations are structured and designed.

We examined the cardiovascular physiology of guilt and pride to elucidate physiological substrate... more We examined the cardiovascular physiology of guilt and pride to elucidate physiological substrates underpinning the behavioral motivations of these moral emotions. Although both emotions motivate prosocial behavior, guilt typically inhibits ongoing behavior, whereas pride reinforces current behavior. To succeed in eliciting real emotions, we used a novel social interaction task. We found dissociable sympathetic activation during guilt and pride; specifically, Guilt participants experienced prolonged cardiac sympathetic arousal as measured by preejection period (PEP), whereas Pride participants experienced transient non-cardiac somatic arousal and a shift to low frequency (LF) power in the cardiac spectrogram. This dissociation supports their distinctive motivational functions. Higher self-reported Behavioral Inhibition System (BIS) sensitivity was furthermore uniquely associated with guilt, supporting its function as a punishment cue.

South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde

Manual Therapy, 2015

There is evidence that consistent sitting for prolonged periods is associated with upper quadrant... more There is evidence that consistent sitting for prolonged periods is associated with upper quadrant musculoskeletal pain (UQMP). It is unclear whether postural alignment is a significant risk factor. The aim of the prospective study (2010-2011) was to ascertain if three-dimensional sitting postural angles, measured in a real-life school computer classroom setting, predict seated-related UQMP. Asymptomatic Grade 10 high-school students, aged 15-17 years, undertaking Computer Application Technology, were eligible to participate. Using the 3D Posture Analysis Tool, sitting posture was measured while students used desk-top computers. Posture was reported as five upper quadrant angles (Head flexion, Neck flexion; Craniocervical angle, Trunk flexion and Head lateral bending). The Computer Usage Questionnaire measured seated-related UQMP and hours of computer use. The Beck Depression Inventory and the Multidimensional Anxiety Scale for Children assessed psychosocial factors. Sitting posture, computer use and psychosocial factors were measured at baseline. UQMP was measured at six months and one-year follow-up. 211, 190 and 153 students participated at baseline, six months and one-year follow-up respectively. 34.2% students complained of seated-related UQMP during the follow-up period. Increased head flexion (HF) predicted seated-related UQMP developing over time for a small group of students with pain scores greater than the 90th pain percentile, adjusted for age, gender, BMI, computer use and psychosocial factors (p = 0.003). The pain score increased 0.22 points per 1° increase in HF. Classroom ergonomics and postural hygiene should therefore focus on reducing large HF angles among computing adolescents.

The International Journal of Tuberculosis and Lung Disease

Better integration of treatment support for people living with tuberculosis (TB) and human immuno... more Better integration of treatment support for people living with tuberculosis (TB) and human immuno-deficiency virus/acquired immune-deficiency syndrome (HIV/AIDS) is a challenge in many settings, and has been identified as a service priority. To determine the impact, compared to directly observed therapy, of a TB treatment intervention modelled on the community antiretroviral treatment (ART) support programme in South Africa. An interrupted time-series design was used, including five intervention clinics and five comparison clinics. Data were collected from January 2005 to March 2008 and analysed using Poisson regression. Between April 2007 and March 2008, a total of 71% of all new TB patients starting treatment at the intervention clinics were placed on the intervention. There were no significant differences in cure or treatment success rates for new TB patients between intervention and comparison clinics. There was a small improvement in smear conversion rates in intervention clini...

Driver anger is strongly related with aggressive road behaviours and adverse injury outcomes. Thi... more Driver anger is strongly related with aggressive road behaviours and adverse injury outcomes. This paper seeks to explore the nature and extent of driver anger in the South African east-coast city of Durban. Findings revealed that over a one-year period, most motorists (96%) reported experiencing anger at consistently high intensity levels when being a victim to the different dimensions of aggressive road behaviours. With general self-reported anger-provoking events, behaviours relating to impeding one's progress were reported most often, by more than one-third of participants. Additionally, multiple linear regression modelling was used to identify several significant relationships with anger, including associations with the different types of anger coping strategies used by motorists. This study has yielded valuable preliminary findings on anger and its expressions in this setting, and are important considerations towards comprehensive road safety intervention strategies.

British journal of sports medicine, 2014

Non-communicable disease (NCD) is increasing, but management remains mostly curative, disease-cen... more Non-communicable disease (NCD) is increasing, but management remains mostly curative, disease-centred and focused on single interventions. We describe the development and implementation of a patient-centred, comprehensive, multidisciplinary lifestyle intervention programme (LIP) for patients with NCD in the sport and exercise medicine (SEM) setting (part 1) and present preliminary observational data (part 2). Part 1 is a description of the programme development and implementation. In part 2, 210 participants with NCD underwent a 12-week LIP (U-Turn Medical). Physiological, functional and metabolic outcomes were assessed at baseline and at completion. 84% of patients had two or more comorbidities, requiring additional considerations for exercise rehabilitation. On completion, there were decreases in % body fat (29.8±6.7% vs 28.5±6.6%), waist (100.2±16.2 vs 97.3±14.8 cm) and hip circumference (105.4±13 vs 104±12 cm), resting heart rate (74.2±13.4 vs 71.4±11.9 bpm), resting systolic bl...

The Journal of the Dental Association of South Africa = Die Tydskrif van die Tandheelkundige Vereniging van Suid-Afrika, 1987

South African Journal of Psychiatry, 2014

ABSTRACT Background. Clozapine use is known to be associated with significant side-effects, inclu... more ABSTRACT Background. Clozapine use is known to be associated with significant side-effects, including prolongation of the QT-interval, agranulocytosis and metabolic syndrome. However, few data exist on the prevalence of clozapine side-effects in patients of Xhosa descent. Objective. To gather data from Xhosa patients with schizophrenia to establish the prevalence of clozapine side-effects in this population. Methods. Twenty-nine Xhosa patients with schizophrenia (as per the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR)) who had been receiving clozapine treatment for > 1 year on an outpatient basis were selected for inclusion. All patients were participating in a genetics study in the Cape Metropolitan area. The participants were evaluated for the presence of side-effects (tests including an electrocardiogram, white blood cell count (WCC) and fasting blood glucose). Results. The prevalence of metabolic syndrome was 44.8% (95% confidence interval (CI) 26.7 - 62.9) and of undiagnosed diabetes mellitus 13.8% (95% CI 1.24 - 26.34). There was a significant association between metabolic syndrome and body mass index (BMI) (p < 0.01). The mean (SD) WCC was 7.8 x 10(9)/L (2.8), with 3.4% of the subjects having a WCC < 3.5 x 10(9)/L. Sedation (82.8%; 95% CI 69.0 - 96.5), hypersalivation (79.3%; 95% CI 64.6 - 94.1) and constipation (44.8%; 95% CI 26.7 - 62.9) were common. The mean QT-interval was 373.8 (35.9) ms and 10% had a corrected QT-interval > 440 ms. There was an association between the duration of clozapine treatment and QT-interval (with Bazett's correction). Conclusion. The high prevalence of metabolic syndrome and undiagnosed diabetes mellitus in this sample points to a need to monitor glucose levels and BMI on a regular basis. A larger study should be done to accurately quantify the differences in prevalence of side-effects between population groups.

PM&R, 2014

Prevention of illness is important for a team physician. However, there are few studies that repo... more Prevention of illness is important for a team physician. However, there are few studies that reported clinical aspects of illness of athletes with impairment. To describe the clinical characteristics of the 385 illnesses reported on the a novel Web-based electronic injury and illness capturing system (WEB-IISS) during the London 2012 Paralympic Games. Part of a large prospective cohort study. London 2012 Paralympic Games. Team physicians of 78 delegations (3329 athletes over 14 days) used WEB-IISS. Each day, information was recorded, which included daily team size and illness details, system affected, final diagnosis, type and onset of symptoms, training and/or competition days lost, and suspected cause. Incidence of illness (illness per 1000 athlete days). The incidence of illness in the cohort was 8.3 per 1000 (95% confidence interval, 7.5-9.1) athlete days, and the percentage of athletes with an illness in this study was 9.2%. Respiratory system illnesses were the most common (39.4%), followed by the digestive system (15.8%), skin and subcutaneous system (11.8%), genitourinary system (8.8%), and nervous system (7.3%). Urinary tract illness was more common in athletes with spinal cord injury (22%) compared with the athletes with other impairments (0%-5%). Skin and subcutaneous illness varied from 0%-18% between impairment categories and was highest for athletes with spinal cord injury. Infections accounted for 40.8% of all illness and 19.5% of illness that resulted in a time loss of ≥1 day. In 34% of illnesses, symptoms were present for ≥1 day before being reported to the team physician. The majority of illnesses affected the respiratory, gastrointestinal, skin and subcutaneous, and genitourinary systems, and were mostly infective in nature. The highest number of all illnesses, including skin and subcutaneous illnesses, and urinary tract illnesses, were of athletes with spinal cord injury. Although most illnesses were not time-loss illnesses, 19.5% of illnesses resulted in ≥1 day lost. Team physicians should be aware that, in many cases of infection reported, the symptoms were already present the day before. A delay in reporting of symptoms >24 hours could have important clinical implications for athletes' medical care.

Journal of Asthma, 2001

This study investigated whether household environmental tobacco smoke (ETS) exposure is associate... more This study investigated whether household environmental tobacco smoke (ETS) exposure is associated with increased bronchial hyperresponsiveness (BHR) in children with asthma. Two hundred forty-nine children, ages 7-11 years, sampled from a larger group with reported asthma or multiple asthma symptoms identified in a community survey in Cape Town, underwent histamine challenge testing and had urinary cotinine measured. Parents were interviewed for information on smoking habits and a variety of covariates. Children with asthma whose mothers smoked had a lower frequency of BHR than asthmatic children of nonsmoking mothers, particularly if the mother smoked > or = 15 cigarettes daily. BHR was also less common among children sharing a house with four or more smokers vs. fewer or none. BHR was unrelated to paternal smoking. In contrast, FEV1 was lower among children whose mothers currently smoked. The findings do not support a mechanism whereby ETS exposure aggravates existing childhood asthma by increasing BHR. This association may be masked, however, by the degree to which mothers of asthmatic children adjust their smoking. The results are consistent with an adverse effect of maternal smoking on lung function in asthmatic children.

Evaluation & the Health Professions, 2013

Interviewers administered the Rosenberg Self-Esteem scale (RSES) to five groups of Black (formal ... more Interviewers administered the Rosenberg Self-Esteem scale (RSES) to five groups of Black (formal township and informal settlement), White, Indian, and mixed race adult residents of Greater Pretoria. The results demonstrated that the RSES was psychometrically sound for the five groups. The minimal effects of sociodemographic characteristics on global self-esteem showed that the RSES and its two dimensions, self-competence (SC) and self-liking (SL), were suitable in this setting. All five groups scored above the theoretical midpoint of the RSES, indicating that generally positive self-evaluations appear to be universal. The relationships between positively and negatively worded items, SC, and SL attested to the following: internal structure reliability, congruence between positive and negative items, no negative biases in response, and concordance between SC and SL dimensions. The significant differences between informal settlement residents and the other four groups on global self-esteem, positively and negatively worded items, and SC and SL were possibly due to physiological needs taking precedence over higher order needs.

European Neuropsychopharmacology, 2010

Environmental Research, 2000

The purpose of this study was to remeasure in vivo tibia lead levels in a lead+acid battery manuf... more The purpose of this study was to remeasure in vivo tibia lead levels in a lead+acid battery manufacturing workforce measured in a previous survey and believed to be unrealistically high. Tibia lead levels were measured by K-shell X-ray Buorescence (XRF) spectroscopy in a stratiAed random sample (n‫؍‬ 40) of the original study group (n‫؍‬ 381). The repeat survey showed much lower tibia lead levels (median"54.3 g lead/g bone mineral, compared to 217.9 g lead/g bone mineral, n‫؍‬ 40). Tibia lead levels were signiAcantly correlated with duration of occupational exposure, zinc protoporphyrin levels, and cumulative blood lead index, but not with current blood lead levels. Thirty-eight of the 40 subjects underwent two consecutive tibia lead measurements to assess the test+retest repeatability of the XRF tibia lead measurement technique. The intraclass correlation coefAcient between repeated measurements was 0.926 (P(0.0001). Three measurement pairs differed by more than 20 g/g. There was no Axed or proportional bias between the two sets of measurements. We conclude that the technique offers a highly repeatable measurement of tibia bone lead. However, care needs to be taken to avoid contamination when performing measurements on active lead workers.

Early Child Development and Care, 2011

... Olivier c , Johanna de Waal c & Caroline Poole c pages 463-474. ... Underreporting is mos... more ... Olivier c , Johanna de Waal c & Caroline Poole c pages 463-474. ... Underreporting is mostly due to the mistrust within the clinic settings between nurses and clients (Jewkes, Abrahams, & Mvo, 199813. Jewkes, R., Abrahams, N. and Mvo, Z. 1998. Why do nurses abuse patients? ...

Curationis, 2004

The management of aggressive behaviour has always been a critical issue in psychiatry. Finding me... more The management of aggressive behaviour has always been a critical issue in psychiatry. Finding measures that can be used to accurately predict the likelihood of assaultative behaviour and thus ensure timeous appropriate pharmacological management remains a dilemma. The study objective was to investigate the naturalistic, pharmacological management of inpatient aggressive behaviour in a group of 50 schizophrenic subjects with a view to determine: (1) whether a presenting history of recent violence lead to altered pharmacological management and (2) whether the NOSIE could be regarded as a useful assessment tool with regards to inpatient behaviour management. No significant difference could be demonstrated between the 2 subsets of subjects (history of violence vs none) with respect to total doses of medication administered. No statistical correlation could be found between the total NOSIE score and the dose of psychotropic medication used. The relationship between a subset of NOSIE-items and the total dose of medication was more complex and a clear linear relationship could be demonstrated for a total score of 0 to 5. In this particular ward setting a presenting history of recent violent behaviour did not influence the administration of medication and neither could the clinical judgement employed by the nursing staff to manage inpatient behaviour be captured by the NOSIE. However, a five-item subset of the NOSIE with questions relating to aggression and irritability warrants further scrutiny in this regard.

British Journal of Sports Medicine, 2012

Illness accounts for a significant proportion of consultations with a team physician travelling w... more Illness accounts for a significant proportion of consultations with a team physician travelling with elite athletes. To determine if international travel increases the incidence of illness in rugby union players participating in a 16-week tournament. 2010 Super 14 Rugby Union tournament. 259 elite rugby players from eight teams were followed daily over the 16-week competition period (22 676 player-days). Team physicians completed a logbook detailing the daily squad size and illness in any player (system affected, final diagnosis, type and onset of symptoms, training/match days lost and suspected cause) with 100% compliance. Time periods during the tournament were divided as follows: located and playing in the home country before travelling (baseline), located and playing abroad in countries >5 h time zone difference (travel) and located back in the home country following international travel (return). Incidence of illness (illness per 1000 player-days) during baseline, travel and return. The overall incidence of illness in the cohort was 20.7 (95% CI 18.5 to 23.1). For all teams, the incidence of illness according to location and travelling was significantly higher in the time period following international travel (32.6; 95% CI 19.6 to 53.5) compared with the baseline (15.4; 95% CI 8.7 to 27.0) or after returning to their home country (10.6; 95% CI 6.1 to 18.2). There is a higher incidence of illness in athletes following international travel to a foreign country that is >5 h time difference and this returns to baseline on return to the home country.

BJOG: An International Journal of Obstetrics & Gynaecology, 2007

Objective To determine the effects of magnesium supplementation in pregnancy on the incidence of ... more Objective To determine the effects of magnesium supplementation in pregnancy on the incidence of hypoxic-ischaemic encephalopathy (HIE).

American Journal of Respiratory and Critical Care Medicine, 1996

To identify modifiable risk factors for wheezing illness in childhood, the associations between c... more To identify modifiable risk factors for wheezing illness in childhood, the associations between current asthma or wheezing and factors such as household smoking, damp and dietary salt preference were measured in a questionnaire-based prevalence study of schoolchildren 7 to 9 yr of age in Cape Town. In a random sample of 15 schools, questionnaires were completed by parents of 1,955 children, from which 368 cases and 294 controls were selected on the basis of reported asthma diagnosis or symptoms. Urinary cotinine concentrations were measured, and the parents were interviewed. An exposureresponse relationship between the urinary cotinine creatinine ratio and asthma/wheeze was observed.

African Journal of Psychiatry, 2012

The use of endophenotypes, such as neurological soft signs (NSS), is advocated as one possible me... more The use of endophenotypes, such as neurological soft signs (NSS), is advocated as one possible method to elucidate the heterogeneity of schizophrenia. Exploring the associations between NSS and specific illness symptoms has revealed some trends, although results have been conflicting. To date, such studies have been conducted largely on Caucasian populations and our pilot study represents the first attempt to gather such data in a homogenous African population. Fifty-one patients, all of Xhosa ethnicity and participating in a larger schizophrenia genetic study were recruited. NSS were evaluated using a modified Neurological Evaluation Scale. Data were analysed using SPSS with the strength of the overall relationships between NES groups and SANS and SAPS components analyzed by means of canonical correlation analysis. The canonical correlation of SANS domains (excluding asociality) with the NES conceptual groups was 0.53 (SE=0.11, p=0.024) and of the SAPS domains 0.38 (SE=0.13, p=0.943). Our results suggest a correlation between negative symptoms of schizophrenia and the presence of NSS, supporting the recruitment of a larger sample to more comprehensively evaluate a possible role for NSS as an endophenotype in the Xhosa schizophrenia population. Taking into account that NSS evaluations allow for inexpensive, relatively easy-to-do objective evaluations, this method presents us with a valuable research tool that can be used effectively within our under-resourced environment to help inform on the neurobiological substrate of schizophrenia.

African Journal of Psychiatry, 2012

There are several methods of evaluating medical students' performance, such as written ex... more There are several methods of evaluating medical students' performance, such as written examination, oral examination and objective structured clinical examination (OSCE). Many studies have focused on the reliability and validity of these methods but few studies have explored comparison between these methods. Psychiatry is the only subject at the University of Stellenbosch where the final assessment consists of solely an oral component. The aim of the study was to compare students' final overall and discipline specific examination marks (i.e. in the other subjects) with the examination marks in psychiatry, and to determine if content or structure (e,g. oral, written or OSCE format) of examination impacts more on the student performance in the examination. 343 final year medical students were included. All undertook their psychiatry rotation at the University of Stellenbosch, South Africa during 2008 and 2009. Data of marks obtained in all the disciplines during 2008 and 2009 were collected and class marks were compared with their final examination marks across all disciplines. Bland-Altman plots were used to assess the level of agreement between the class and examination marks. Cases below the lower threshold were compared to all other cases across all disciplines. The odds ratio for group status was calculated for gender distribution of examiners. The psychiatry class mark and final oral examination mark provided similar measures within a width of 31.5. Cases below the threshold had poorer performance in two other disciplines. The gender distribution of the examiners (female-female) significantly increased the odds ratio for poorer performance in the oral examination. The results suggest that a group of students underperform in their final examination independent of method of evaluation and that the gender of examiners impacts on examination marks. Therefore future research should focus on identifying and modifying factors (including choice of examiner combinations) that contribute to the poor performance of medical students in their final examination, in order to help students perform better. Gender distribution of examiners should also be considered when examinations are structured and designed.

We examined the cardiovascular physiology of guilt and pride to elucidate physiological substrate... more We examined the cardiovascular physiology of guilt and pride to elucidate physiological substrates underpinning the behavioral motivations of these moral emotions. Although both emotions motivate prosocial behavior, guilt typically inhibits ongoing behavior, whereas pride reinforces current behavior. To succeed in eliciting real emotions, we used a novel social interaction task. We found dissociable sympathetic activation during guilt and pride; specifically, Guilt participants experienced prolonged cardiac sympathetic arousal as measured by preejection period (PEP), whereas Pride participants experienced transient non-cardiac somatic arousal and a shift to low frequency (LF) power in the cardiac spectrogram. This dissociation supports their distinctive motivational functions. Higher self-reported Behavioral Inhibition System (BIS) sensitivity was furthermore uniquely associated with guilt, supporting its function as a punishment cue.

South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde

Manual Therapy, 2015

There is evidence that consistent sitting for prolonged periods is associated with upper quadrant... more There is evidence that consistent sitting for prolonged periods is associated with upper quadrant musculoskeletal pain (UQMP). It is unclear whether postural alignment is a significant risk factor. The aim of the prospective study (2010-2011) was to ascertain if three-dimensional sitting postural angles, measured in a real-life school computer classroom setting, predict seated-related UQMP. Asymptomatic Grade 10 high-school students, aged 15-17 years, undertaking Computer Application Technology, were eligible to participate. Using the 3D Posture Analysis Tool, sitting posture was measured while students used desk-top computers. Posture was reported as five upper quadrant angles (Head flexion, Neck flexion; Craniocervical angle, Trunk flexion and Head lateral bending). The Computer Usage Questionnaire measured seated-related UQMP and hours of computer use. The Beck Depression Inventory and the Multidimensional Anxiety Scale for Children assessed psychosocial factors. Sitting posture, computer use and psychosocial factors were measured at baseline. UQMP was measured at six months and one-year follow-up. 211, 190 and 153 students participated at baseline, six months and one-year follow-up respectively. 34.2% students complained of seated-related UQMP during the follow-up period. Increased head flexion (HF) predicted seated-related UQMP developing over time for a small group of students with pain scores greater than the 90th pain percentile, adjusted for age, gender, BMI, computer use and psychosocial factors (p = 0.003). The pain score increased 0.22 points per 1° increase in HF. Classroom ergonomics and postural hygiene should therefore focus on reducing large HF angles among computing adolescents.