La Hiemstra

Efficacy and safety of a live attenuated influenza vaccine in adults 60 years of age and older.

This randomized, double-blind, placebo-controlled study investigated the efficacy, safety, and immunogenicity of LAIV in community-dwelling ambulatory adults > or =60 years of age in South Africa in 2001. Nose and throat swabs were obtained for influenza virus culture based on the symptoms of influenza-like illness. A total of 3242 subjects were enrolled, with a mean age of 69.5 years. The efficacy of LAIV against influenza viruses antigenically similar to the vaccine was 42.3% (95% CI, 21.6-57.8%). Efficacy against A/H3N2 viruses was 52.5% (95% CI, 32.1-67.2%); vaccine efficacy was not observed against antigenically similar B strains. In post hoc analyses, efficacy in subjects 60 to <70 years of age was 41.8% and -22.7% against A/H3N2 and B, respectively and 65.7% and 9.9%, respectively, for subjects > or =70 years. Reactogenicity events were higher among LAIV than placebo recipients during 11 days postvaccination (P=0.042), including runny nose/nasal congestion, cough, sore throat, headache, muscle aches, tiredness, and decreased appetite. Rates of serious adverse events were similar for LAIV and placebo recipients. This was the first demonstration of statistically significant protection by LAIV against culture-confirmed influenza in adults > or =60 years of age. These results suggest that LAIV may provide an additional public health tool in the prevention of influenza in the elderly. (ClinicalTrials.gov identifier, NCT00217230.).

A prospective, randomized, open-label trial comparing the safety and efficacy of trivalent live attenuated and inactivated influenza vaccines in adults 60 years of age and older

BACKGROUND Although influenza is a major public health concern among adults ≥60 years of age, few large, prospective studies of influenza vaccines have been conducted in this population. The goal of the present study was to directly compare the safety and efficacy of LAIV and TIV in adults ≥60 years of age. MATERIALS AND METHODS A prospective, randomized, open-label, multicenter trial was conducted in South Africa. In March-April 2002, 3009 community-dwelling ambulatory adults 60-95 years of age were randomized 1:1 to receive a single dose of LAIV or TIV. Surveillance for influenza illness was conducted through November. Serum antibody titers were evaluated in all participants, and interferon-γ enzyme-linked immunosorbent spot assay responses were evaluated in a cohort of subjects. Solicited reactogenicity and adverse events were monitored for days 0-10 postvaccination; serious adverse events were monitored for the entire study. RESULTS Influenza illness caused by vaccine-matched strains was detected in 0.8% (12/1494) and 0.5% (8/1488) of LAIV and TIV recipients, respectively; the relative efficacy of LAIV vs TIV was -49% (95% CI: -259, 35). As expected, greater serum antibody responses were seen with TIV, and greater cellular responses were seen with LAIV (although not for influenza B). Among subjects with culture-confirmed influenza illness, post hoc analyses revealed trends toward less feverishness (LAIV, 14%; TIV, 46%; P=0.05) and less fever (LAIV, 9%; TIV, 31%; P=0.16) among LAIV recipients. In each treatment group, 38-39% and 24-25% of subjects had baseline hemagglutination inhibition titers of ≤4 for A/H1 and A/H3, but 7 of 8 TIV cases and 7 of 12 LAIV cases of matched-strain influenza occurred among these subjects. Runny nose/nasal congestion (+13%), cough (+5%), sore throat (+5%), lethargy (+3%), and decreased appetite (+2%) were reported by more LAIV vs TIV recipients. Injection site reactions were reported by 27% of TIV recipients. SAEs were reported by a similar proportion of LAIV and TIV recipients (9% vs 8%). CONCLUSIONS Given the low incidence of influenza in both groups, no conclusions were possible regarding the relative efficacy of LAIV and TIV. There was a trend toward less feverishness/fever among LAIV recipients who developed influenza compared with TIV recipients with influenza, consistent with results from studies comparing the vaccines in children. A disproportionate number of influenza illnesses occurred among baseline seronegative subjects, particularly for those receiving TIV, which suggests that this subgroup has the greatest need for improved influenza vaccination. The safety profiles of LAIV and TIV were consistent with results from previous studies in older adults and no significant safety concerns were identified. clinicaltrials.gov identifier, NCT00192413.

Knowledge of and attitude towards pain relief during labour of women attending the antenatal clinic of Cecilia Makiwane Hospital, South Africa

Abstract Background This study determined womens knowledge of and attitudes to pain relief during labour. Methods This descriptive study included 151 women, 18 years or older, attending the antenatal clinic of Cecilia Makiwane Hospital. Women were interviewed using a questionnaire that determined their knowledge of and attitudes regarding pain relief. Results The median age of the women was 29 years and most was pregnant for a second or third time. More than half the women (56.3%) indicated that they knew about pain relief and most had received their information from a previous labour experience (56.5%) or from friends and relatives (55.3%). Of the women who had knowledge of pain relief (n=85), 65.9% indicated injections. Half the women (51.7%) believed that they should experience mild pain, however, while 55.7% had experienced severe pain during previous labour and 65.3% of these had found the experience to be unacceptable. Most women (59.8%) who had been pregnant were not told what to expect when in labour. Of those who had been told (n=41), 75.6% found the information useful. The women who had previously delivered in a health facility rated the service received in relieving labour pain as fair (47.3%) and good (31.2%). Most of the women (99.3%) believed that the staff had an important role to play in helping to relieve labour pain. Most of the women (78%) expressed no concern about problems associated with pain relief methods, while a large number (83.4%) expressed little or no confidence in labour pain relief. Conclusion Most of the women gained knowledge regarding pain relief from past experiences or from friends and relatives. Even though the few women who received information about what to expect during labour found the information useful, most expressed little confidence in labour pain relief.

Obstetrical ultrasound training of and practise by general practitioners in the private sector, Free State.

ABSTRACT Background: The aim of the study was to determine the level of obstetrical ultrasound training and practice of general practitioners in the Free State private sector. Methods: In this descriptive study, questionnaires were mailed to all general practitioners in the Free State private sector. The questionnaire included demographic information about the practitioner, the ultrasound profile of the practice, and the type of machine used. Results: Four hundred and eighty-one questionnaires were sent to general practitioners and 229 (47.6%) were returned. Of the 176 practising respondents, 47 (26.8%) used ultrasound. The majority of ultrasound examinations done per month were obstetrical. Eight practitioners had relevant qualifications for using ultrasound and more than a third (18, 38.3%) had no training in ultrasound use. Less than half (19, 40.4%) of the practitioners that use ultrasound were aware of the South African Association of Ultrasound in Obstetrics and Gynaecology (SASUOG). Conclusions: The response to the questionnaire was low and may have influenced the results. The study indicates that there are general practitioners who perform ultrasound examinations without training. As general practitioners mainly do obstetrical ultrasound, it is recommended that the SASUOG play a bigger role in their training. A diploma course in ultrasound and support from medical aid organisations to only pay full fees to doctors who can prove that they have sufficient ultrasound training and competence will be ideal.

Relevance of Schneider's first-rank symptoms in Zulu patients with paranoid schizophrenia

Abstract Background: The aim of this study was to examine the prevalence of Schneiders first-rank symptoms (FRS) in Zulu patients diagnosed with paranoid schizophrenia and to ascertain the diagnostic and prognostic significance of Schneiders FRS in this group. Methods: This descriptive study was done on 75 psychiatric Zulu in- and outpatients diagnosed with paranoid schizophrenia. A questionnaire was completed and included sociodemographic data, Schneiders FRS and a functional assessment. Results: Fifty-three percent of the patients heard voices at some or other time. Most patients (90.7%) confirmed having experienced at least one of the five related symptoms of thought disturbances and 80% of the patients confirmed the presence of passivity phenomena. Most patients (87%) indicated that they had presented at least one type of primary delusion, at the time of the interview. Regarding functional assessment, some (12%) patients were still entirely productive (“no problems”), 28% rated “mild problems”, 45% “moderate problems” and 15% “severe problems”. With regard to social functioning, 8% of the patients scored “no problems”, 25% “mild problems”, 50% “moderate problems” and 17% “severe problems”. Conclusions: The prevalence of Schneiders FRS in these patients is 100%, with a 95% confidence interval [95.2%; 100%]. Even though extremely sensitive for paranoid schizophrenia, the specificity of Schneiders FRS merits further study.

The prevalence of obesity and overweight in patients at a Bloemfontein private practice.

Meyer A, MFamMed Department of Family Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein Nel M, MMedSc Department of Biostatics, Faculty of Health Sciences, University of the Free State, Bloemfontein Hiemstra LA, MPraxMed Department of Family Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein Koning JMM, MMed(Int) Department of Internal Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein

The prevalence of the diagnosis of increased intra-ocular pressure in a general practice

Glaucoma is one of the main causes of blindness. The disease occurs in 3% to 4% of all people over the age of 70 years. As many as 50% of patients suffering from this disease are unaware of their condition until a comparatively late stage, due to the asymptomatic nature of the disease.