Karen J. Cloete

Trauma exposure, posttraumatic stress disorder and the effect of explanatory variables in paramedic trainees

BackgroundEmergency healthcare workers, including trainees and individuals in related occupations are at heightened risk of developing posttraumatic stress disorder (PTSD) and depression owing to work-related stressors.We aimed to investigate the type, frequency, and severity of direct trauma exposure, posttraumatic stress symptoms and other psychopathology amongst paramedic trainees. In order to create a risk profile for individuals who are at higher occupational risk of developing PTSD, we examined risk and resilience factors that possibly contributed to the presence and severity of posttraumatic symptomatology.MethodsParamedic trainees (n = 131) were recruited from a local university. A logistic regression analysis was conducted using the explanatory variables age, gender, population group, trauma exposure, depression, alcohol abuse, alcohol dependence, resilience and social support.Results94% of paramedic trainees had directly experienced trauma, with 16% meeting PTSD criteria. A high rate of depression (28%), alcohol abuse (23%) and chronic perceived stress (7%) and low levels of social support was found. The number of previous trauma exposures, depression, resilience and social support significantly predicted PTSD status and depression had a mediating effect.ConclusionThere is a need for efficient, ongoing screening of depressive and PTSD symptomatology in trauma exposed high risk groups so that early psychological supportive interventions can be offered.

Micro‐particle‐induced X‐ray emission mapping of elemental distribution in roots of a Mediterranean‐type sclerophyll, Agathosma betulina (Berg.) Pillans, colonized by Cryptococcus laurentii

The role of rhizosphere yeasts as plant nutrient-scavenging microsymbionts in resource-limited Mediterranean-type heathlands is unknown. This study, therefore, focused on quantitative elemental distribution within the roots of a medicinal sclerophyll, Agathosma betulina (Berg.) Pillans, grown under nutrient-poor conditions, and colonized by Cryptococcus laurentii. Micro-particle-induced X-ray emission (PIXE) was used to assess quantitative elemental distribution within the roots of A. betulina inoculated with viable C. laurentii, as well as within roots of control plants that received autoclaved yeast. To aid in the interpretation of heterogeneous elemental distribution patterns, apoplastic barriers (Casparian bands) in root tissues were located using fluorescence microscopy. In addition, root cross-sections were examined for endophytic C. laurentii using light and transmission electron microscopy (TEM). The average concentrations of P, Fe and Mn were significantly (P < 0.05) higher in roots of yeast-inoculated plants, compared to control plants. Casparian bands were observed in the exodermal cells of both treatments, and the presence of these bands was correlated with elemental enrichment in the epi/exodermal-outer cortical tissues. Light and TEM micrographs revealed that the yeast was not a root endophyte. This is the first report describing the role of a soil yeast as a plant nutrient-scavenging microsymbiont.

Retrospective review of trends in assaults and seclusion at an acute psychiatric ward over a 5-year period

Accessible summary Research on trends in assaults and seclusion over time in developing countries such as South Africa is scant. Here, we assessed trends in assaults and seclusion, stratified by gender, at the acute admission wards in one psychiatric facility over a 5-year period. The results of this study show that continuous monitoring of assaults and seclusions is important to improve quality of care. Abstract In developing countries such as South Africa, not much is known about the prevalence of assaults and seclusion occurring in mental health wards over time. Here, we describe a 5-year trend in assaults and seclusions, stratified by gender, at Stikland Hospital, South Africa. A retrospective review of clinical records of patients admitted to the acute psychiatric admission wards at Stikland and involved in assault and secluded was undertaken between 1 January 2005 and 31 December 2010. Data on the number of patient and staff assaults as well as seclusions, gender, age, marital status, level of education, level of income, duration of hospital admission and primary psychiatric diagnosis were collected. Significantly (P < 0.01) more men than women engaged in patient assaults, while significantly (P < 0.01) more men were secluded than women. On a monthly basis, the number of gender-stratified patient assaults and seclusions significantly increased (P < 0.01) throughout the study period. In conclusion, we show here that gender had a significant effect on both patient assault and seclusion numbers, which increased towards the end of the study period. Monitoring of these events is therefore important to continuously improve quality of care.In developing countries such as South Africa, not much is known about the prevalence of assaults and seclusion occurring in mental health wards over time. Here, we describe a 5-year trend in assaults and seclusions, stratified by gender, at Stikland Hospital, South Africa. A retrospective review of clinical records of patients admitted to the acute psychiatric admission wards at Stikland and involved in assault and secluded was undertaken between 1 January 2005 and 31 December 2010. Data on the number of patient and staff assaults as well as seclusions, gender, age, marital status, level of education, level of income, duration of hospital admission and primary psychiatric diagnosis were collected. Significantly (P < 0.01) more men than women engaged in patient assaults, while significantly (P < 0.01) more men were secluded than women. On a monthly basis, the number of gender-stratified patient assaults and seclusions significantly increased (P < 0.01) throughout the study period. In conclusion, we show here that gender had a significant effect on both patient assault and seclusion numbers, which increased towards the end of the study period. Monitoring of these events is therefore important to continuously improve quality of care.

Frequency and correlates of anxiety and mood disorders among TB- and HIV-infected Zambians

We determined the frequency and correlates of current common mental disorders (CMDs) in a consecutive series of 649 adult patients with human immunodeficiency virus (HIV), tuberculosis (TB) or both receiving treatment at 16 primary health care centres across Zambia. Data on socio-demographic variables, clinical disease features, anxiety and mood disorders were collected. The frequency of any anxiety disorder (AD) was 30.8% and major depressive disorder (MDD) 11.3%. Although differences by disease group did not reach statistical significance, rates of suicidality (34.8%) and panic disorder (4.1%) were highest for the TB–HIV group (n = 269), while rates of generalised AD (13.3%), obsessive compulsive disorder (7.6%), posttraumatic stress disorder (7.4%) and any AD (37.8%) were highest for the HIV group (n = 149). Female gender (p = 0.004) predicted any current AD as well as current suicidality (p = 0.009), while lower education status (p < 0.001) predicted current MDD. World Health Organisation (WHO) clinical staging and antiretroviral treatment status were not significantly associated with MDD or anxiety in the HIV and co-infected groups. This study indicates the importance of early identification of CMDs in TB, HIV and co-infected patients, especially women and uneducated patients, newly initiated on treatment in primary care settings.

The Child Posttraumatic Stress Disorder Checklist in a sample of South African youth: establishing factorial validity.

Abstract To address the diverse health effects of posttraumatic stress disorder (PTSD) in youth, reliable and valid screening and diagnostic instruments that can be adapted to the specific context in which they are used, are required. Here, we assessed the psychometric properties (factorial validity, concurrent validity, and internal consistency) of the Child PTSD Checklist in treatment-seeking youth using secondary data. The scale demonstrated high internal consistency (Cronbach &agr; = 0.93). Exploratory factor analysis revealed a three-factor structure (anxiety and avoidance, anger and dissociation, and depressive symptoms) that accounted for 41.9% of the total variance. Concurrent validity was fair between the Child PTSD Checklist and the diagnostic Kiddie Schedule for Affective Disorders and Schizophrenia, Present and Lifetime version when assessing for PTSD. The Child PTSD Checklist seems to be a promising tool for assessing PTSD in trauma-exposed youth in clinic settings. However, further studies are needed to address the checklist’s broader utility.

Fungi associated with the skin of a southern right whale (Eubalaena australis) from South Africa

Abstract Cutaneous fungi are known to affect parts of the outermost skin layers of mammals, including the epidermis, stratum spinosum and stratum corneum, as well as mucocutaneous membranes, genitalia or external ears. Relatively little is known about fungal infections of Mysticete cetaceans and studies are needed to determine the fungal diversity associated with these marine mammals. This case report was aimed at identifying the fungi associated with the skin of a diseased neonatal southern right whale (Eubalaena australis) found stranded in the Western Cape Province of South Africa. Initial physical examination on site revealed hyperplasia of the follicular and epidermal epithelium. Preliminary examination of skin biopsies using scanning electron microscopy indicated that the skin was colonized by fungal hyphae. Isolation methods yielded a number of fungal isolates, which were identified using standard morphology and rDNA sequence data. These analyses confirmed colonization of the cutaneous layers by species belonging to the genera Fusarium, Chaetomium and Penicillium. Moreover, all isolates were capable of degrading keratin, indicating that skin may act as a natural substrate for these fungi. This study is the first report of the association of these fungi with southern right whale skin.

Effect of the soil yeast Cryptococcus laurentii on the photosynthetic water and nutrient-use efficiency and respiratory carbon costs of a Mediterranean sclerophyll, Agathosma betulina (Berg.) Pillans

Nothing is known about the effect of soil yeasts on the photosynthetic resource-use and carbon dynamics of plants. Here, we determined the effect of a plant growth-promoting isolate of Cryptococcus laurentii on the photosynthetic water and nutrient-use efficiencies, as well as the carbon economy of a Mediterranean sclerophyll, Agathosma betulina, grown under axenic conditions. The data showed that the higher photosynthetic water-use efficiency in yeast-inoculated plants was a consequence of higher maximum rates of CO2 assimilation, which was not related to foliar N and P content. We propose that photosynthetic stimulation in yeast-inoculated plants was a result of the increased demand for photosynthates of the yeast-root symbiosis.

No association between cumulative traumatic experiences and sex in risk for posttraumatic stress disorder among human immunodeficiency virus-positive adults

Abstract This study examined the association between the type and number of traumatic experiences and the conditional risk for posttraumatic stress disorder (PTSD), stratified by sex, in human immunodeficiency virus (HIV). We evaluated 465 (114 male and 350 female) HIV-positive adults attending HIV clinics in Cape Town, South Africa. Demographic and clinical data were collected, and the participants were screened for current PTSD and traumatic event exposure using the Mini-International Neuropsychiatric Interview and the Life Events Checklist, respectively. The highest attributable risk for PTSD was derived from sexual assault (17.4%) and transport accidents (16.9%). Only sexual assault was significantly (p = 0.002) associated with current PTSD. Although sex had no effect on the prediction of current PTSD, HIV-infected men tended to experience more lifetime traumas than HIV-infected women, with the men having significantly higher rates of exposure than women to physical assault (p = 0.018) and assault with a weapon (p = 0.001). These data highlight the importance of considering trauma type in contributing to the burden of PTSD in HIV-infected adults.

Frequency and correlates of comorbid psychiatric illness in patients with heroin use disorder admitted to Stikland Opioid Detoxification Unit, South Africa

Background . There is a lack of studies addressing the frequency and correlates of comorbidities among heroin users admitted for treatment in South Africa (SA). Objective. To assess the frequency and correlates of psychiatric comorbidity among patients with heroin use disorder admitted to the Opioid Detoxification Unit at Stikland Hospital in the Western Cape, SA. Method. Participants ( N =141) were assessed for psychiatric illness (Mini International Neuropsychiatric Interview), comorbid substance use disorders (World Health Organization’s Alcohol Smoking Substance Involvement Screening Tool), and legal and social problems (Maudsley Addiction Profile). Demographic, personal, psychiatric and substance-use history, in addition to mental state examination on admission, were collected from the case notes. Results. The largest group of patients ( n =56, 40%) had not been abstinent from heroin use since drug debut, and most had been arrested for drug-related activities ( n =117, 83%) and had family conflicts related to use (n =135, 96%). Nicotine was the most common comorbid substance of dependence ( n =137, 97%) and methamphetamine was the most common comorbid substance abused ( n =73, 52%). The most common comorbid psychiatric illness was previous substance-induced psychosis ( n =42, 30%) and current major depressive disorder ( n =37, 26%). Current major depressive disorder was significantly associated with females (p=0.03), intravenous drug use ( p =0.03), alcohol use ( p =0.02), and a higher number of previous rehabilitation attempts ( p =0.008). Conclusion. Patients with heroin use disorders present with high rates of psychiatric comorbidities, which underscores the need for substance treatment services with the capacity to diagnose and manage these comorbidities.

The clinical utility and cost effectiveness of routine thyroid screening in adult psychiatric patients presenting at Stikland Hospital, Cape Town, South Africa.

OBJECTIVE The use of thyroid tests to assess psychiatric patients remains debatable. Therefore, this study was conducted to examine the utility and cost effectiveness of the current protocol used in thyroid testing in adult psychiatric patients presenting at Stikland Hospital, Cape Town, South Africa. METHOD This was a retrospective chart review conducted at Stikland Hospital between 1 January 2000 and 31 December 2005. The following data was recorded: demographic variables, clinical diagnoses at admission and discharge, number of days from admission to a thyroid test request, the reason for thyroid screening, number of thyroid tests, their yield and costs involved, as well as the action taken following an abnormal thyroid test result. RESULTS The mean age of patients (n = 1080: n = 364 male, n = 716 female) was 42.8 years (SD ± 16.6). Pre-existing thyroid disease was documented in 70 (6%) of patients. Normal Thyroid Stimulating Hormone (TSH) test results significantly (p = 0.0001) increased, whilst abnormal TSH test results significantly (p = 0.0001) decreased from baseline to follow-up. Except for gender, the outcome of TSH screening was independent of demographic and clinical diagnoses. Only 16% of TSH tests yielded clinically significant results. CONCLUSION The findings of this study do not support the early, routine screening for thyroid dysfunction in psychiatric patients at this facility. It is possible that thyroid screening may present with transient abnormalities of no particular clinical significance, and would therefore not be a cost effective practice.