As part of the formative phase of screening and brief interventions (SBIs) for substance use amongst patients presenting for emergency services in South Africa, the present study explored health care providers' attitudes and perceptions towards SBI. Twenty-four health care providers working in two 24-hour emergency departments (EDs) were interviewed using an open-ended semi-structured interview schedule designed to identify factors that may hinder or promote the implementation of SBI for substance use in these settings. All respondents felt that screening patients for substance use in EDs is possible; however, they emphasised the need for an additional staff member dedicated to these activities. Secondly, they felt this dedicated individual should meet certain educational criteria and be from a specific socio-demographic background in order to increase the likelihood of intervention uptake. Thirdly, a number of patient- and clinic-level barriers were revealed that could potentially hinder the successful implementation of SBIs in EDs.
Substance use disorders are highly prevalent in South Africa. General practitioners are often the first point of contact and play an essential role in correctly identifying the substance use problem. This article provides an overview of the importance of screening for and assessing substance use disorders and identifying the severity of the substance use disorder, so that the right level of management can be ensured. It also examines associated co-morbidities and provides a general overview of the management of substance use disorders.
The concept of positive mental health is doubtless "too important to ignore".At the same time, as Vaillant states in his thought-provoking paper, "the study of positive mental health requires safeguards".Here I wish to emphasize two points: that positive mental health remains a fuzzy and contested construct,
Read moreObjectives: Understand the relationship between preoperative vitamin D deficiency and post‐total‐thyroidectomy hypocalcemia. Methods: Retrospective study examining 264 total and completion thyroidectomies between 2007‐2011. Included patients had a recorded 25OH‐D level within 21 days prior to or 1 day following surgery, were not taking ergocalciferol (D2) at the time of their lab draw, did not have a primary parathyroid gland disorder, and were not taking calcitriol (1,25 dihydroxy‐D3) prior to surgery. Some patients were repleted preoperatively if a low 25OH‐D level was identified. Preoperative 25OH‐D, concurrent neck dissection, integrity of parathyroid glands, final pathology, postoperative parathyroid hormone (PTH), calcium nadir and repletion, and length of stay were examined. Results: In this cohort, a mean of 3 parathyroid glands were identified during surgery. Multinodular goiter and papillary thyroid carcinoma were the most common pathologies. Hypocalcemia, defined as a corrected calcium <8.4 mg/dL, and drain placement were the most common reasons for length of stay >1 night. The average preoperative 25OH‐D for all patients was 24.98 ng/mL and the overall rate of hypocalcemia was 37.5%. Low preoperative 25OH‐D did not predict postoperative hypocalcemia ( P = 0.96), however, it did predict the need for postoperative calcitriol administration (p=0.01). Lower postoperative PTH levels ( P = 0.001) predicted postoperative hypocalcemia. Conclusions. Lower postoperative PTH predicts post total thyroidectomy hypocalcemia. Preoperative 25OH‐D did not predict hypocalcemia as has been previously described although it did predict the use of calcitriol postoperatively. We recommend that 25OH‐D be assessed and, if indicated, repleted preoperatively in patients undergoing total thyroidectomy.
Read moreAbstract Insofar as South Africa underwent a rapid transformation from apartheid to democracy, it may provide a unique laboratory for investigating aspects of revenge and forgiveness. Here we suggest that observations and data from South Africa are partially consistent with the hypotheses generated by MCullough and colleagues. At the same time, the rich range of revenge and forgiveness phenomena in real-life settings is likely to require explanatory concepts other than specialized modules and their computational outputs.
Read moreThere is little research from low- and middle-income countries examining the psychometric properties of a screening tool for social anxiety disorder. The sensitivity and specificity of the Social Anxiety Screening Questionnaire against the Mini-International Neuropsychiatric Interview as a gold standard in social phobia diagnosis were investigated using analyses of receiver operating characteristics. The "best subsets" selection procedure was conducted to determine the best three to five questions. Three questions on the screening questionnaire that best discriminate between a positive and negative diagnosis of social anxiety disorder on the MINI module were identified. Answering yes to all three of these questions gives a false-positive rate of 0.44 and a false negative rate of 0.11. For this combination, the sensitivity was 0.84, and specificity was 0.67. Additional work is needed to develop a more accurate scale that could help increase the percentage of people who receive appropriate treatment of this debilitating disorder.
Read moreRecent rodent research has shown that the basolateral amygdala (BLA) inhibits unconditioned, or innate, fear. It is, however, unknown whether the BLA acts in similar ways in humans. In a group of five subjects with a rare genetic syndrome, that is, Urbach-Wiethe disease (UWD), we used a combination of structural and functional neuroimaging, and established focal, bilateral BLA damage, while other amygdala sub-regions are functionally intact. We tested the translational hypothesis that these BLA-damaged UWD-subjects are hypervigilant to facial expressions of fear, which are prototypical innate threat cues in humans. Our data indeed repeatedly confirm fear hypervigilance in these UWD subjects. They show hypervigilant responses to unconsciously presented fearful faces in a modified Stroop task. They attend longer to the eyes of dynamically displayed fearful faces in an eye-tracked emotion recognition task, and in that task recognize facial fear significantly better than control subjects. These findings provide the first direct evidence in humans in support of an inhibitory function of the BLA on the brain's threat vigilance system, which has important implications for the understanding of the amygdala's role in the disorders of fear and anxiety.
Read moreTrauma exposure of itself may be sufficient to cause structural changes in adolescents regardless of PTSD development.
Read moreTrends in risk and causes of middle-age death from 1951-2010 showed important variation among the five Nordic countries and between men and women.
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