Researchers in Community & Health Sciences

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Suicide mortality in NSW: geographic variation.
(CSIRO, 1995) Stewart, Gavin; Chipps, Jennifer; Sayer, Geoffrey
This is the first of a series of articles on the epidemiology of suicide in NSW. We examine pooled suicide mortality data for Area and District Health Services from the time of the introduction of the ICD9-CM cause of death coding in 1979 to the most current complete year for which death data are available (1992).
Suicide mortality in NSW: clients of mental health services.
(CSIRO, 1995) Chipps, Jennifer; Stewart, Gavin; Sayer, Geoffrey
This article examines suicide by clients of mental health services in NSW. Since April1992 the Mental Health Branch of the NSW Health Department has operated an incident monitoring system which requires all public mental health services in NSW to report unexpected deaths, including suicides, of current or former clients. Part I of this article describes the information collected through this monitoring system, and Part II estimates mental health service clients' risk of suicide, compared with that of the NSW population.
Suicide mortality in NSW: an introduction to clinical audits.
(CSIRO, 1996) Stewart, Gavin; Chipps, Jennifer; Sayer, Geoffrey
This article is an introduction to the use of clinical audit to identify possible preventive approaches to suicide. We examine the ethical issues, techniques and feasibility of this method for collecting information on suicides. A more detailed report on the practicalities of clinical audit is being prepared3. For more than three decades psychological autopsies and modified psychological autopsies have been employed worldwide to study risk factors for suicide. The term psychological autopsy most commonly refers to interviews with family and friends of the victim to reconstruct the circumstances of the suicide'. Sometimes the term is limited to the determination of the mental state of the individual, and at other times the modified psychological autopsy or clinical audit includes all the investigations relevant to the suicide, including the review of medical records and the physical autopsy4. Clinical audit in this article encompasses both the psychological autopsy and the physical autopsy, and any other relevant investigations. We prefer to use the term clinical audit to stress that interviewing bereaved people requires clinical skills and because attention should be given to the potential role clinical services may play in prevention.
Suicide attempts in NSW: associated mortality and morbidity.
(CSIRO, 1996) Sayer, Geoffrey; Stewart, Gavin; Chipps, Jennifer
This article is the fifth in a series on suicide in New South Wales by the Mental Health Epidemiology Group. Its aim is to provide a quantitative account of suicide attempts and the associated mortality and morbidity in NSW during 1992 (the most recent year for which data were available) as context for consideration of the overall problem of suicide in NSW.
Admission rates as an indicator of the prevalence of severe asthma in the community
(Wiley, 1998) Jalaludin, Bin; Chey, Tien; Holmwood, Marvin; Chipps, Jennifer; Hanson, Ralph; Corbett, Stephen; Leeder, Stephen
BACKGROUND: A reliable indicator of the prevalence of severe asthma in the community is needed to monitor population-based asthma control strategies. We examined the potential use of asthma admissions to hospital as such an indicator. METHODS: We recruited subjects from the Emergency Department (ED) of a children's hospital. The attending doctor completed the 'physician questionnaire' which included questions on the patient's asthma severity and interval severity/chronicity of asthma. The parent/guardian completed the 'parent questionnaire'. It included questions on demography, asthma knowledge and attitudes, asthma history and social support. We performed univariate and multiple logistic regression to determine predictors for hospital admission. RESULTS: Interval severity of asthma, pre-treatment severity of wheeze and low post-treatment pulse oximetry best predicted whether children presenting with asthma were admitted. Demographic variables, factors associated with access to health services and factors related to the asthma history and management were not significant predictors of admission. DISCUSSION: At the population level, it may be possible to utilise routine hospital admission rates as an indicator of the prevalence of severe asthma in the community, especially within the context of monitoring trends in asthma prevalence. Our study was conducted in a metropolitan tertiary paediatric hospital. The reliability of hospital admission rates as indicators of the prevalence of severe asthma in other hospital settings, in different population groups and over time remains to be established.
Suicide in New South Wales: the NSW suicide data report.
(CSIRO, 2001) Ansari, Guncha; Chipps, Jennifer; Stewart, Gavin
The NSW Suicide Prevention Strategy has identified suicide prevention as a high priority for government and the community. Death by suicide is a relatively uncommon event; however, more people in NSW now die from suicide than road injury. Nationally, two per cent of all deaths were attributed to suicide in 1998. This article describes the Suicide in New South Wales—The NSW Suicide Data Report, which has been developed and produced by the Centre for Mental Health, and presents improved information on suicide, hospitalisation following attempted suicide, and risk of suicide, both at a state and an area health service level.
The mental health outcomes and assessment training project: creating the foundations for improved quality of care
(CSIRO, 2002) Chipps, Jennifer; Raphael, Beverley; Coombs, Tim
The NSW Mental Health Outcomes and Assessment Tools Training Project (MH-OAT) is a collaborative and consumer-centred project that aims to strengthen the assessment skills of the mental health care workforce. MH-OAT does this through training that supports the introduction of a process of standard documentation of clinical practice along with measures of outcomes and potential ‘case mix’ (a method of describing the different types of patients treated by the health system, which recognises that different patients require different levels of resources.
How equitable is the scaling up of HIV service provision in South Africa?
(Health and Medical Publishing Group, 2005) Scott, Vera; Chopra, Mickey; Conrad, Liz; Ntuli, Antoinette
OBJECTIVES. To assess the extent of inequalities in availability and utilisation of HIV services across South Africa. DESIGN. Cross-sectional descriptive study. Setting. Three districts reflecting different socio-economic conditions, but with similar levels of HIV infection, were purposively sampled. Outcome measures. Availability and utilisation of HIV services and management and support structures for programmes were assessed through the collection of secondary data supplemented by site visits. RESULTS. There were marked inequalities in service delivery between the three sites. Compared with two poorer sites, clinics at the urban site had greater availability of HIV services, including voluntary counselling and testing (100% v. 52% and 24% respectively), better uptake of this service (59 v. 9 and 5.5 clients per 1 000 adults respectively) and greater distribution of condoms (15.6 v. 8.2 condoms per adult male per year). Extra counsellors had also been employed at the urban site in contrast to the other 2 sites. The urban site also had far more intensive management support and monitoring, with 1 manager per 12 health facilities compared with 1 manager per more than 90 health facilities at the other 2 sites. CONCLUSION. The process of scaling up of HIV services seems to be accentuating inequalities. The urban site in this study was better able to utilise the extra resources. In contrast, the poorer sites have thus far been unable to scale up the response to HIV even with the availability of extra resources. Unless policy makers pay more attention to equity, efficacious interventions may prove to be of limited effectiveness.
Health promotion needs of physically disabled individuals with lower limb amputation in Rwanda
(Taylor and Francis, 2005) Amosun, Seyi Ladele; Mutimura, Eugene; Frantz, Jose M.
PURPOSE. The objectives of the study were to identify the health-related behaviors among physically disabled individuals with lower limb amputation resident in Rwanda, the factors that influenced these behaviors, and the major issues that should be targeted in health promotion programs for physically disabled individuals with lower limb amputation. METHOD. A cross-sectional survey, utilizing a self-administered questionnaire, was carried out among 334 lower limb amputees who volunteered to take part in the study. In addition, a sub-sample of 15 participants was purposively selected for in-depth face-to-face interviews. RESULTS. Many participants did not engage in physical exercises (64.7%). Others abused alcohol on daily basis (14.4%), smoked 11 – 20 cigarettes daily (13.2%), and used recreational drugs such as marijuana, opium and cocaine (9.6%). There were significant associations between the age group of the participants and participation in exercises (P=0.001), and consuming alcohol, tobacco and recreational drugs (P = 0.001). In-depth interviews revealed factors influencing the behavior of participants. CONCLUSIONS. Participants were found to be at risk of secondary complications because of poor lifestyle choices. There is a need to develop and promote wellness-enhancing behaviors in order to enhance the health status of physically disabled individuals in Rwanda who have lower limb amputations.
Physical inactivity as one of the chronic disease risk factors among high school learners in public schools in a local community in South Africa
(Stellenbosch University, 2006) Frantz, Jose M.
This study aimed to determine the physical activity levels and existence of risk factors associated with chronic diseases of lifestyle among high school learners. A crosssectional research design was used to obtain information about physical activity levels from 951 learners from two high schools in a local community in the Western Province of South Africa. Physical activity levels were obtained using the KUOPIO Ischaemic Heart Disease 24-hour physical activity record over a seven-day period. Anthropometrical and blood pressure measurements as well as behaviours including cigarette smoking and alcohol use were recorded as risk factors for chronic diseases of lifestyle. Statistical analyses were performed using the Statistical Package for Social Science (2000). Risk factors were identified as obesity, physical inactivity, smoking and hypertension. Variance of analysis (ANOVA) was used to statistically determine differences in groups. The results indicated that 32% of the learners were classified as being physically inactive and that 21% engaged in health risk behaviours. In addition, 35% of the learners had more than one risk factor for chronic diseases of lifestyle present. Since cardiovascular risk factors have been shown to persist into adulthood, health professionals should assume some responsibility for the prevention, detection, and intervention relevant to cardiovascular risk factors in adolescents.
Influence of previous participation in physical activity on its perceptions among tertiary institution students
(Africa Association for Health, Physical Education, Recreation,Sport and Dance/LAM Publications Limited, 2006) Tumusiime, David; Frantz, Jose M.
Physical inactivity is one of the leading causes of the major non-communicable diseases, which contribute substantially to the global burden of diseases, death and disability. The burden of mortality, morbidity and disability attributable to non-communicable diseases is currently greatest and is continually growing in the developing countries. Most declines in physical activity (PA) occur during the transition period when a person goes from high school to College or University. The objectives of this study were to identify perceived benefits of and barriers to PA and determine whether previous participation in PA does have an influence on these perceptions. A cross- sectional and descriptive study with quantitative design was conducted. Five hundred (500) tertiary institution students were randomly sampled from purposively selected departments and classes at each of the five government educational tertiary institutions in Rwanda. A pre-coded self-administered questionnaire with a small number of open-ended questions was administered to the students. A response rate of 425 (85%) was obtained. Descriptive and inferential statistics were used to analyse the data, by means of SAS version 8 software. Frequencies and percentages for mean score values with standard deviations for each perception variable were descriptively obtained. False Discovery Rate (FDR) at 5% for multiple test adjustment and Spearman’s correlation (r) tests were used to identify the significant influence of previous participation on perceptions. More than 70% students were not participating in PA at tertiary level. Psychological benefits of PA were some of the most important perceived benefits cited by the students. Most of the important barriers cited concerned equipment and time constraints to exercising. Associations were found between previous participation and the current perceptions of PA. The findings of this study demonstrate that previous participation can influence perceptions of PA among the students. Physical activity promotion programmes should consider the role of these factors which should be emphasised from childhood.
The effectiveness of in-hospital psychosocial intervention programmes for families of critically ill patients - a systematic review.
(Health and Medical Publishing Group, 2006) Brysiewicz, Petra; Chipps, Jennifer
Background. A review of in-hospital psychosocial intervention studies for families with a relative in a critical care unit was conducted. Purpose of review. To review the literature on studies addressing the topic, discuss research methods critically, describe clinical outcomes and make recommendations for future research efforts. In doing so, empirically tested interventions producing positive outcomes may be applied to support families who have a relative in a critical care unit. Data sources. Research citations from 1991 to 2006 from CINAHL, Medline, Pubmed, PsycInfo, SABINET, Cochrane and SCOPUS databases, Internet search engines and unpublished abstracts through NEXUS were searched. Review methods. Citations were reviewed and evaluated for sample, design, intervention, threats to validity and outcomes. Review studies were limited to those that evaluated in-hospital interventions in family members of patients in a critical care unit. Results. Six studies were reviewed. Positive outcomes were reported for all of the intervention strategies. All but one of the studies reviewed studied small samples and single critical care units, and were poor in design. Conclusions. The paucity of interventional studies and the lack of systemic empirical precision to evaluate effectiveness of these interventions necessitate that future studies be methodologically rigorous.
Stress and smoking among university students at the University of the Western Cape
(University of the Western Cape, 2006) Frantz, Jose M.
INTRODUCTION: Stress is one of the most commonly reported reasons for smoking and generally smokers are perceived to experience more stress than non-smokers. Reducing stress may thus be an important part of smoking cessation. OBJECTIVES: The aim of the current study was to determine the prevalence of smoking and stress among university students attending the University of the Western Cape. METHODS: A cross-sectional descriptive survey study design was used to describe and identify smoking habits of university students as well as their stress levels. The data was captured on Excel and SPSS was used to analyse the data. PARTICIPANTS: Nine hundred and twelve university students. Setting: Students enrolled at six faculties at the University of the Western Cape. Intervention: Self-answered questionnaire RESULTS: Slightly more than half (53%) of the students had smoked previously but only, 61% of these reported having smoked in the last month (current smokers). Females reported to experience more stress than males (stress score 21.6 vs 16.6). The main reasons for smoking included helping to relax, just enjoying smoking , coping with stress and smoking because friends smoke. CONCLUSION: Students need to know that increased stress levels are associated with smoking. Groups at higher risk are: those being older than 30 years; female; of the coloured ethnic group; in the fourth year of study and studying in the law faculty .
Fluid use in mountain bikers – self-reported practices.
(Health medical publishing group (HMPG), 2007) Rose, S; Chipps, Jennifer; Peters, E
BACKGROUND AND OBJECTIVES. Little is known of the fluid replacement habits of participants in mountain bike (MTB)endurance events. This survey set out to determine the current perceptions and practices of this group of endurance athletes. Method. Four hundred and twelve participants in the 3-day 2006 Sani2C (MTB) race completed questionnaires that elicited information regarding their regular fluid intake practices during competitive MTB endurance events. This included their general approach to fluid replacement, their fluid intake practices (type, amount and frequency), urine output and hydration status. RESULTS. While 70% (N = 290) reported that they based their fluid intake practices on personal past experiences, less than half the group (N = 177, 43%) were aware of official sport-specific guidelines. Although 86% (N = 354) reported making use of commercially available sport-specific drinks, consumption of water alone was reported by 34% of respondents (N = 140). The majority (N = 225, 55%) of the mountain bikers reported drinking every 16 - 30 minutes during an endurance ride, while 35% (N =144) reported drinking every 0 - 15 minutes. Fifty-three per cent (N = 182) of the male respondents and 45% (N= 23) of female respondents reported a routine intake of ≥ 750 ml per hour during endurance rides. This included 2 women who reported regular intakes of between 1 500 and 2 000 ml/hr. Only 7 (2%) reported receiving medical care for dehydration following their participation in previous MTB rides. CONCLUSIONS. This survey indicates that although more than half of the mountain bikers did not acknowledge specific awareness of the official fluid replacement guidelines, over 80% reported drinking regularly during a race, and 52% (N = 212) reported a usual intake of ≥ 750 ml/hr during endurance races. Until scientific studies have carefully examined the hydration status and fluid replacement needs of mountain bikers, MTB cyclists are cautioned against the practice of over-hydrating.
HIV/AIDS education in South Africa: knowledge, attitudes and beliefs of high school learners in Paarl and Wellington
(University of the Western Cape, 2007) Pharaoh, Hamilton; Frantz, Jose M.; Rhoda, Anthea
INTRODUCTION: In South Africa about 1500 people become HIV infected every day. More than half of these new infections occur in young people. HIV/AIDS programmes have been implemented to combat the disease, but yet the incidences are still on the increase. AIM: The aim of this study was to determine the knowledge, attitudes and beliefs of high school learners about HIV/AIDS in the Paarl and Wellington area. Methodology: This study made use of a quantitative study design, by means of a self-administered questionnaire in order to reflect the knowledge, attitudes and beliefs of high school learners in the Paarl and Wellington areas regarding HIV/AIDS. Convenient sampling was used to obtain a large enough sample size to represent the learner population represented by the high schools in Paarl and Wellington. Data analysis was done using the SPSS version 10.0 to obtain frequencies, means and percentages. Cross-tabulations were done to determine relationships between variables. RESULTS: This study confirms that the learners have basic knowledge regarding HIV/AIDS. The learners make use of this knowledge during some stages of their decision-making but a lack of more in-depth knowledge in certain areas may put them at risk of becoming HIV infected. They might not perceive themselves to be at risk. Their beliefs and attitudes in some instances did afford them the opportunity to make certain safer choices regarding their sexual health. CONCLUSION: It is evident that the HIV/AIDS education programmes is making an impact to improve the knowledge of the learners. Further research is however needed to find even more effectives means to provide learners and the rest of the population with more in-depth knowledge regarding HIV/AIDS
Challenges facing physiotherapy education in Africa
(Nova Southeastern University, 2007) Frantz, Jose M.
Health care is changing and the demands put on health professionals are increasing. Physiotherapy education should reflect the health and social priorities of the nation. The World Confederation of Physical Therapy (WCPT) is committed to assisting physiotherapy associations in developing educational standards. Physiotherapy education in Africa however, seems to have a real need for assistance from the WCPT. The aim of this paper is to highlight the challenges facing physiotherapy education in Africa. The Delphi methodology was used to obtain information from key informants involved in the area of physiotherapy education from a variety of African countries. The majority of the participants were people who have experienced physiotherapy education in Africa either as graduates or current teachers. Data were analyzed into themes and sent back to respondents for confirmation. The most important challenges highlighted were: lack of undergraduate training opportunities, limited number of therapists, upgrading of physiotherapy educators, research as a major component of physiotherapy education, and recognition of physiotherapy as an essential service. It is concluded that assistance is needed for physiotherapists from Africa to take their rightful place in the health team and higher education institutions should look at improving diploma qualifications of physiotherapists in African countries.
Effects of strength-training trials for children and adolescents with spastic cerebral palsy: a systematic review
(University of the Western Cape, 2007) Matheri, Joseph Mwangi; Frantz, Jose M.
OBJECTIVE: To evaluate the effects of strength-training on lower limb muscles and motor activity among children and adolescents with spastic Cerebral Palsy. METHODS: A comprehensive search of full text published studies in English was performed. Electronic databases were searched with no limit for year of publication. Terms used included: exercise, children, youth, disability, treatment, strength training, spastic cerebral palsy, muscle strength, training program, therapeutic exercise, gait training, and physical function. Reference lists of retrieved articles were also examined to identify additional studies. To be included, studies had to be: randomised controlled trials evaluating strength training outcomes on children and adolescents with spastic CP. Those with intellectual disability were excluded. Evaluation for quality: Trials were rated for methodological quality using the PEDro scale independently by the 2 researchers. RESULTS: Of 4 selected trials, 1 an abstract was excluded, 3 full articles were included. Trials methodological quality ranged from 6 to 8 on PEDro scale. Two studies reported significant muscle strength changes following strength training, with effect sizes ranging from d equal to 1.17 to 1.78 and another reported improved gait and perceived body image. CONCLUSION: Trials demonstrate that strength-training improves strength of targeted muscle and motor functioning. More rigorous trials on larger samples should evaluate the impact of specificity in strength-training and cost-effectiveness of programs.
Health-promotion needs of youth with a spinal cord injury in South Africa
(Informa Healthcare, 2007) Njoki, Emma; Frantz, Jose M.; Mpofu, Ratie
Purpose. To determine the health promotion needs through an exploration of health-related behaviours and the factors that influence the behaviour of physically disabled youth with spinal cord injury. Methods. A descriptive and exploratory study that utilized a qualitative approach was carried out among ten participants aged between 15 and 29 years who were purposely selected. Information was obtained from individual face-to-face interviews and a focus-group discussion. Results. The participants were involved in risky health behaviours including sedentary lifestyles, use of alcohol, tobacco, and drugs. Various factors that influenced their participation in these behaviours were identified including personal struggles with identity and adjustment issues. Conclusions. The results emphasize that participants were involved in health-risk behaviours, which are associated with development of secondary conditions such as respiratory problems, heart diseases, and stroke. Health-promotion strategies employed for these individuals should address the psychological impact of spinal cord injury (SCI) on the individual as an influence to participation in health risk behaviours.
Medical coverage at soccer sessions
(University of the Western Cape, 2007) Twizere, J.; Frantz, Jose M.
INTRODUCTION: Soccer in Rwanda exposes soccer players to the risk of injury warranting a need for medical coverage at both training and competitive sessions. This study aims to identify the prevalence, period of injury occurrence, and severity of common soccer injuries among the 1st and 2nd division soccer teams in Rwanda. METHODS: A cross-sectional retrospective quantitative study design was used. Simple random sampling, clustered within teams, was used to get a sample of this study. During sample selection, the random order was determined using the random number generator in Microsoft Excel. Data for soccer players was gathered, using a close-ended questionnaire. The data from soccer players were captured and analyzed with the Microsoft Excel package. RESULTS: The study revealed 68.1 % injury prevalence with a significantly high rate of injuries occurring during training (p< 0.005). Most of the training injuries were moderate followed by major, minor and severe injuries while most injuries during competition were major-moderate, followed by severe-minor. CONCLUSION: The prevalence, period of injury occurrence and severity of injuries in Rwanda indeed warrants medical coverage as a first preventive strategy.
Student evaluation of a Clinical Self-Study Laboratory
(Elsevier, 2007) Saakane, Keetsemang; Mugarurwa, John; Shahidi, Timothe'e; Maputhege, Maphosa; Chipps, Jennifer; Brysiewicz, Petra
INTRODUCTION: Being clinically competent is an essential component of any nursing curricula to ensure that on completion the nursing graduates are able to practice safely and effectively as a nurse. Clinical Self-Study Laboratories have become increasingly popular in nursing education in recent years as a way of ensuring a variety of skills are taught to the nursing students. These clinical skills laboratories are used to teach communication and interpersonal skills, psychomotor skills, promote the development of collaborative skills required in nursing as well as being able to help integrate theory and practice [Morgan, R., 2006. Using clinical skills laboratories to promote theory–practice integration during first practice placement: an Irish perspective.However, it is essential that these programs be subject to routine quality assurance and effectiveness evaluation. METHODOLOGY: The purpose of the study was to conduct a process evaluation of the implementation of the Clinical Self-Study Laboratory (CSSL) in the School of Nursing, University of KwaZulu-Natal. The process evaluation included a descriptive quantitative satisfaction survey of first and third year Bachelor of Nursing students, a checklist to assess the quality of the CSSL equipment and a retrospective record review of utilisation of the CSSL by students. RESULTS: The CSSL appears to be well implemented and utilized by students. Students reported that it was accessible and that the equipment in the laboratory was of a reasonable quality. A few students reported dissatisfaction with some of the equipment and requested that more equipment and trained personnel be made available.

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