Willem A. Hoffmann

Telematic technologies in mental health caring: a web-based psychoeducational program for adolescent suicide survivors.

A significant others completed suicide elicits complex physical, psychological, and social reactions in most suicide survivors. At present, mental health professionals and other caregivers have limited access to clear information and guidelines to meet the postvention needs of these individuals. Telematic technologies offer innovative and creative resources to address their needs by means of a web-based psychoeducational program. The development of a comprehensive web-based program that deals with the lived experiences of adolescent suicide survivors is described. Potential program users include adolescent suicide survivors, social supporters of suicide survivors, mental health professionals and survivor support groups.

The Incidence of Traumatic Events and Trauma-Associated Symptoms/Experiences Amongst Tertiary Students

Few epidemiological studies of traumatic events amongst tertiary students have been conducted in South Africa. The aims of this study were to quantify the number of traumatic events experienced by Technikon Pretoria students in the preceeding year and to record the types of trauma symptoms experienced as a result of these traumatic events. The incidence of 10 traumatic event categories have been measured by means of the Traumatic Stress Schedule in a convenience sample (N = 245). The sample consisted of females (n = 183) and males (n = 61). It was found that more than two thirds (70,6%) of the sample reported one or more traumatic events during the preceeding year, with the most frequent traumatic event categories being the death of a loved one, negative change in life circumstances and witness to injury/death. The least frequent traumatic event categories were natural disasters and motor vehicle accidents. Females reported a significantly higher incidence of unwanted sexual activity than males. Intrusive thoughts, particularly amongst female students, was the most frequent symptom associated with 8 of the 10 traumatic event categories, while physical injuries was the least frequent symptom associated with all the traumatic event categories.

Ethical misconduct by registered psychologists in South Africa during the period 2007–2013

Psychologists are faced with numerous challenges in their daily practices. Literature indicates that the most frequent ethical transgressions in the 1970s–1990s were the invalid presentation of professional qualifications, unprofessional advertisements, and irresponsible public communications. However, at the turn of the century, it has changed to include sexual or dual relationships with patients as well as unprofessional, unethical, or negligent practice. The objective of this research project is to analyse the case content of all guilty verdicts related to professional standard breaches and ethics misconduct against Health Professions Council of South Africa–registered psychologists in the period 2007–2013 via a qualitative research paradigm focusing on a historical research approach. The findings of this study indicate that only a small fraction of psychologists registered with the Health Professions Council of South Africa are annually guilty of ethics misconduct. The results indicate that the majority, around one-third, of transgressions can be regarded as improper professional role conduct. It was followed by negligent and/or incompetent treatment and/or patient care (27%), fraudulent conduct (20%), and disclosure of confidential information without permission (13%). As the age of electronic and social media advances, along with online diagnosis and therapy, clients may have better access to resources of varying authority and reliability, possibly giving them more confidence to question the practices of their service providers.

Effect of metformin therapy and dietary supplements on semen parameters in hyperinsulinaemic males.

Previous reports indicated that hyperinsulinaemic men may exhibit a higher percentage of poorly compacted DNA in their spermatozoa and less success in an IVF programme (Andrologia, 45, 2003, 18; Andrologia, 2014, doi: 10.1111/and.12227). The aim of this study was to investigate the effect of metformin (Glucophage®) and antioxidant treatment (StaminoGro®) on the semen parameters of hyperinsulinaemic men. Nineteen hyperinsulinaemic male patients were treated for 3 months with metformin alone (Group A), and fifteen patients used metformin in combination with the nutritional supplement (Group B). Combined data of the two groups (pre‐ and post‐treatment) differ significantly regarding sperm morphology (P = 0.0003) and CMA3 (P < 0.0001) values. The improvement in sperm morphology after treatment was similar for the two respective groups (P < 0.05). The morphological normal sperm forms increased from the mean percentage of 3.9 to 5.5% and from 4.2 to 5.5% for Group A and B respectively. Where a combination of metformin and the supplement were used (Group B), the combination treatment proved to be superior in obtaining enhanced chromatin packaging quality although not statistically significant (P = 0.5929) when compared with the metformin (Group A) group. The chromatin packaging quality in Group B improved with 10% while the improvement in Group A was approximately 8.3%. Therefore, infertile hyperinsulinaemic men can benefit from metformin treatment and should be advised on the use of nutritional supplements with antioxidant properties.

Ethics misconduct among dietetic practitioners in South Africa (2007-2013)

Abstract Morals refer to a belief-derived system according to which a certain group governs its behaviour, whereas ethics is a broader term whereby belief-system-based behaviour is replaced by a generic code of behaviour, often founded in an international code. In South Africa, the Health Professions Council of South Africa (HPCSA) is a statutory body which was established in terms of the Health Professions Act (No 56 of 1974) to regulate the behaviour of practitioners, and which is committed to serving and protecting the public and providing guidance to registered healthcare practitioners. This study analyses the case content of all guilty verdicts relating to professional standard breaches and ethics misconduct against HPCSA-registered dietitians in the period 2007–2013. One core finding of the study was that a guilty verdict of unethical behaviour against dietitians in South Africa occurs very rarely. Even though dietitians may not be prone to unethical behaviour, it is strongly recommended that thorough, in-depth training in ethics, including bioethics and professional integrity, forms an integral and compulsory part of all undergraduate and postgraduate dietetic programmes.

Prevalence of hyperinsulinaemia among normozoospermic donors at Medfem Clinic, South Africa.

The aim of this study was to investigate the prevalence of hyperinsulinaemia in a group of normozoospermic donors and the influence of insulin levels on in vitro fertilisation (IVF) outcome. Fasting insulin and 2 h post‐eating insulin levels were determined for a group of thirty‐four sperm donors. They were divided into three groups according to their insulin profiles. The association between insulin levels and embryo quality was determined in a clinical study for the different groups. The prevalence of raised insulin in the donor group was 44% with a 95% confidence interval of 27.2% and 62.1%. Donors with normal insulin levels produced more good quality blastocysts in the IVF programme than those with abnormal insulin levels. These differences were not statistically significant (P = 0.8638). Embryo quality in an IVF programme may be influenced by male insulin levels. The role of insulin in male fertility needs to be investigated.

Ethical misconduct by registered physiotherapists in South Africa (2007–2013): A mixed methods approach

Background The role of ethics in a medical context is to protect the interests of patients. Thus, it is critically important to understand the guilty verdicts related to professional standard breaches and ethics misconduct of physiotherapists. Aim To analyse the case content and penalties of all guilty verdicts related to ethics misconduct against registered physiotherapists in South Africa. Methods A mixed methods approach was followed consisting of epidemiological data analysis and qualitative content analysis. The data documents were formal annual lists (2007–2013) of guilty verdicts related to ethical misconduct. Quantitative data analysis focused on annual frequencies of guilty verdicts, transgression categories and the imposed penalties. Qualitative data analysis focused on content analysis of the case content for each guilty verdict. Results Relatively few physiotherapists (0.05%) are annually found guilty of ethical misconduct. The two most frequent penalties were fines of R5000.00 and fines of R8000.00 – R10 000.00. The majority of transgressions involved fraudulent conduct (70.3%), followed by performance of procedures without patient consent (10.8%). Fraudulent conduct involved issuing misleading, inaccurate or false medical statements, and false or inaccurate medical aid scheme claims. Conclusion Unethical conduct by physiotherapists in South Africa occurs rarely. The majority of penalties imposed on sanctioned physiotherapists were monetary penalties.

Influence of male hyperinsulinaemia on IVF outcome

The IVF outcome of a group of hyperinsulinaemic men (group B) was compared with a group of IVF males with normal insulin levels (group A). The participating females in the study groups were younger than 38 years old, had blocked Fallopian tubes and/or endometriosis, had normal insulin levels and produced five or more ova on stimulation. The male participants in both groups were normozoospermic with motility above 50% and sperm morphology between 5 and 13% normal forms (G‐pattern according to Tygerberg strict criteria). The two groups did not differ statistically in terms of age or semen parameters (P = 0.39; P < 0.05).The group of men that presented with normal insulin levels had a higher fertilisation rate (79.15% versus 74.57%) and superior embryo quality on day 3 (55.77% versus 50.39%) than the group that presented with hyperinsulinaemia, but these differences were not statistically significant (P = 0.28, P = 0.40; P < 0.05). The clinical pregnancy rate of the group with normal insulin was significantly higher than that of the hyperinsulinaemic group, 57.9% versus 31.8% respectively (P = 0.03). The results suggest that hyperinsulinaemia had a negative impact on IVF outcome and patients should be advised accordingly.

Healthcare provider and patient perspectives on diagnostic imaging investigations

Background: Much has been written about the patient-centred approach in doctor–patient consultations. Little is known about interactions and communication processes regarding healthcare providers’ and patients’ perspectives on expectations and experiences of diagnostic imaging investigations within the medical encounter. Patients journey through the health system from the point of referral to the imaging investigation itself and then to the post-imaging consultation. Aim and setting: To explore healthcare provider and patient perspectives on interaction and communication processes during diagnostic imaging investigations as part of their clinical journey through a healthcare complex. Methods: A qualitative study was conducted, with two phases of data collection. Twenty-four patients were conveniently selected at a public district hospital complex and were followed throughout their journey in the hospital system, from admission to discharge. The second phase entailed focus group interviews conducted with providers in the district hospital and adjacent academic hospital (medical officers and family physicians, nurses, radiographers, radiology consultants and registrars). Results: Two main themes guided our analysis: (1) provider perspectives; and (2) patient dispositions and reactions. Golden threads that cut across these themes are interactions and communication processes in the context of expectations, experiences of the imaging investigations and the outcomes thereof. Conclusion: Insights from this study provide a better understanding of the complexity of the processes and interactions between providers and patients during the imaging investigations conducted as part of their clinical pathway. The interactions and communication processes are provider–patient centred when a referral for a diagnostic imaging investigation is included.

Bioethics and Its Development on the African Continent

What makes a good person good? Can a wrong action be a good action and consequently can a right action be a bad action? These are questions which have plagued philosophers and wise persons of antiquity and is still relevant all over the world, including Africa. The aim of this chapter is to position African ethics within the framework of Global Bioethics and initiate the conversation that although ethics in Africa is often still practiced from a Western paradigm, African ethics have developed significantly in the post-colonial era to inform healthcare delivery on the continent. Whilst the chapter will not focus on the development of historical ethical theories, it will take a critical look at Western contributions to the modern-day discipline and how this has influenced ethics on the continent of Africa. This chapter will attempt to sketch the development and influence of ethics in Africa and what the future looks like for the discipline in Africa.