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Background: Research has shown the value of integrating point-of-care ultrasonography (POCUS) into daily practice and has highlighted the lack of competency in transthoracic echocardiographic (TTE) skill among anaesthesiology registrars. The aim of this study was to determine the level of TTE skill of anaesthesiology registrars at the University of the Witwatersrand (Wits) using an objective structured clinical examination (OSCE).Methods: This research study employed a cross-sectional research design. Convenience sampling was used and 27 registrars were enrolled in this study. The OSCE consisted of two practical stations (Stations 1 and 2) and two clinical pathology stations (Stations 3 and 4). Adequate TTE skill was defined as competency in both the practical and clinical stations and an overall pass score of 70% was used.Results: The overall mean (SD) score obtained for the OSCE was 45.2% (23%). In comparing the TTE skill of registrars who have completed a cardiac rotation and have completed an accredited course with those who have not, no significant differences were found in the pass scores. Registrars who had completed an accredited TTE course performed significantly better in Stations 3 and 4 (p = 0.014). Of the registrars, 37% obtained a pass score for practical stations and 14.8% for the clinical stations with only 11.1% achieving an overall pass score indicating TTE competency. No significant difference in pass scores was found with the different categories of registrars. There was a strong positive significant correlation between completing more TTEs and the scores obtained (r = 0.540, p = 0.004). Completing more TTEs was associated with a higher score.Conclusion: Findings from this study suggest that the current skill level of registrars performing TTEs at our department is not sufficient to achieve clinical competency and that the training may not be initiated early enough in the registrar programme.

Training materials contribute to the effectiveness of community-based projects when they address practical skills training needs. Various types of sewing training materials exist, but their suitability for use in South African rural income generating projects (IGPs) has not been investigated. Our aim was to review existing sewing training materials for their potential appropriateness and application in three selected rural sewing IGPs and to identify prominent sewing training needs. This qualitative study was executed in two phases. The first phase consisted of document analysis of selected currently available books and online sources. The interview-based second phase asked five community facilitators in the three IGPs to comment on the appropriateness of training material presented to them and on training needs encountered in their units. The findings revealed that print and online sources theoretically appropriate for use by IGP participants were less likely to be suitable in practice. The interview data also indicated challenges with practical skills, relating especially to the tasks of taking body measurements and of pattern layout. This study suggests a need to redesign training materials specifically for low-literate end-users in South African community-based rural sewing IGPs. It also offers an initial set of guidelines for reviewing and revising such materials that could give direction for developing training materials for a broader range of IGPs.

The relationship between urbanisation and measles control is examined. In urban settings in developing regions measles is a disease of particular importance, since it tends to affect children at a younger age and with greater severity than in rural settings. A further finding in urban areas, especially peri-urban slums, is the lower measles vaccination coverage rates compared with rural regions. Factors identified as determinants of measles vaccination coverage among children under 2 years of age in urban areas include: home delivery; being born outside the urban setting; and length of stay in the city. These factors are probably related to the low socioeconomic status and lack of social integration experienced by new urban immigrants. A number of additional obstacles such as distance, economic and cultural barriers, and inconvenient clinic hours all prevent parents from gaining easy access to vaccination services. In order to address the problems of measles control in expanding urban settings, a regional approach - with full integration of curative and preventive services - is called for. A more effective use of existing services will probably go a long way towards improving urban vaccination coverage with resultant measles control.

Objective. To evaluate a recently developed low-dose, largefield, direct digital X-ray scanning system for medical use.Method. Radiation dose, image quality, diagnostic capability and clinical utility of the unit were compared with those of conventional radiography.Results. Radiation doses ranged from 3% to 5% of conventional radiographic values, and a mean of 1 line-pair per millimetre could be detected. Ease of use, anatomical coverage and tolerance to patient motion were advantages. However, image quality was inferior to that of conventional radiographs, with limited fine detail visibility and penetration. Only 67 of 156 (42.9%) pathological features seen on conventional radiographs were detected, including 13 of 41 fractures (31.7%) and 11 of 18 pneumothoraces (61.1%).Conclusion. Although image quality and diagnostic performance were not ideal, potential roles in triage, foreign body detection and possibly screening were promising. Radiographic factors may have affected sensitivity. This machine demonstrated useful attributes that may, with improvement, be beneficial in the imaging of trauma and other patients.

Objective. To determine the risk factors associated with meningococcal disease among children living in Cape Town.Design. A case-control study was conducted from October 1993 to January 1995.Setting. The study population consisted of all children tmder the age of 14 years who were resident in the Cape Town metropolitan region. Cases and controls were selected from Red Cross War Memorial Children's HospitalResults. A total of 70 cases and 210 controls were interviewed. Significant risk factors for meningococcal disease included being breast-fed for less than 3 months (adjusted Odds ratio (OR) 2.4); overcrowding (adjusted OR 2.3); and age less than 4 years (adjusted OR 2.3). Exposure to two or more household members who smoked was also a risk factor, but only in the presence of a recent upper respiratory tract infection (adjusted OR 5.0).Conclusion. This is the first case-control study in South Africa examining risk factors for meningococcal disease. It provides further evidence for reduction of smoking, reduction of overcrowding and promotion of breast-feeding as important public health measures.

Over the last 6 years there has been a decline in the incidence of measles in Cape Town. However, during August 1992 an outbreak occurred, with cases reported at many schools in children presumably immunised. The objectives of this study were to characterise the epidemic in Cape Town and to determine possible reasons for the outbreak. The investigation consisted of two components - a description of the epidemic and an investigation of an outbreak at one primary school. Results indicate that during the last 4 months of the year, 757 cases were notified in Cape Town, com.pared with 144 in the first 8 months. The epidemic affected mainly white and coloured children over 5 years of age (P < 0,001). In contrast, during the period before the epidemic most cases occurred in black children and in those aged less than 1 year (P < 0,001). There was no significant increase in hospitalised cases. Investigation of the outbreak at one school revealed that the attack rate was 7,6% (25/329 children). Immunisation coverage (at least one dose of any measles vaccine) was 91% and vaccine efficacy was estimated to be 79% (95% Cl 55 - 90); it was highest for monovalent measles (100%) and lowest for measles-mumps-rubella (74%). The epidemiology of measles in Cape Town has thus changed as evinced in this epidemic, with an increase in the number of cases occurring in older, previously vaccinated children. The possible reasons for this include both primary and secondary vaccine failure. To prevent epidemics of this nature, immediate reimmunisation of all children at schools where outbreaks were identified is recommended and, in the long term, reimmunisation of all children before they start school should be considered.

Objectives. To evaluate the sensitivity of a syndromic diagnostic procedure in detecting and treating sexually transmitted diseases (STDs) and genital tract infections (GTIs).Methods. All new patients presenting at an STD clinic were sampled systematically by gender over a 6-week period. After the patient's clinical consultation, the clinical records were reviewed. Thereafter all patients were given a thorough genital examination by the research physician, and specimens were collected for laboratory investigations. In a retrospective simulation clinicians' syndromic diagnoses were validated against the laboratory findings, or for genital ulcer syndrome against the findings of the research physician.Results. 170 men and 161 women were included in the sample. Ninety-five per cent of patients were black and the median age was 22 years for women and 26 years for men. In this setting, the Western Cape syndromic diagnostic procedure achieved reasonable levels of sensitivity in detecting Neisseria gonorrhoeae and Chlamydia trachornatis ID men and women, and in detecting Trichomonas vaginalis and bacterial vaginosis ID women. However, it was estimated to be only 36.4% sensitive in detecting genital ulcers ID women, and between 0% and 12.3% sensitive in detecting Candida albicans. With syndromic management 8.2% of men and 32.9% of women would leave the clinic with at least one infection inadequately treated.Conclusions. Despite the introduction of syndromic protocols, it is likely that a proportion of STDs and GTIs are not being detected and treated owing to the high prevalence of multiple syndromes and mixed infections, both symptomatic and asymptomatic.

Vision is an essential sense and crucial throughout a student’s academic career. Reading and writing during formal studies require a basic level of visual skills. Training of visual skills to students may improve the way visual stimuli are processed, and subsequently lead to visual skill-, motor- and cognitive performance enhancement. The visual system processes information by way of ‘hardware’- skills (physical, mechanical properties) and the more trainable ‘software’-skills (perceptual, cognitive abilities). Sports vision skills training in athletes indicated faster response to visual information and ultimately improved performance, particularly in fast-ball sports. The efficiency of two sports vision training programmes were tested and compared in undergraduate physiology students of various ethnicities (aged 18-25 years), during a 6-week training period. Three groups were used. One control group and two experimental groups were used. Two programmes were used for the experimental groups (a vision laboratory executed battery of repeated visual skills vs. ‘Eyedrills’ an available webbased training programme). Both comprised ‘hardware’ and ‘software’ skills, and include: visual acuity, focusing, tracking, vergence, sequencing, eye-hand coordination and visualisation. For pretest/ post-test evaluations of all students the repeated laboratory training programme was executed. The control group was only exposed to the pre- and post-test. Individuals trained in the laboratory indicated the highest improvement in all visual skills, except vergence. The ‘Eyedrills’ group displayed significant improvements in focusing, tracking and eye-hand coordination, with the control group indicating the least improvement in visual skills - ruling out the notion of improvement occurring only due to test familiarity. Visual training was verified an essential method of improving visual skills, and fundamental in the expansion of basic visual abilities of university students for enhanced performance.Keywords: Visual skills training, student visual perceptual skills, sports vision exercises, visual motor skills

Objective. Short-course antiretroviral therapy (ART) has been shown to be effective in reducing mother-to-child transmission (MTCT) of HIV-1. This article details the public health lessons learnt from a district-based pilot programme where a short-murse zidovudine (ZDV) regimen has been used in a typical South African peri-urban setting.Methods. The pilot programme was initiated at two midwife obstetric units in January 1999. Lay counsellors conducted pre- and post-test counselling and nurses took blood for HIV enzyme-linked imrnunosorbent assay (EUSA) testing. Shortcourse ZDV was administered antenatally (from 36 weeks gestation) and during labour. Mother-infant pairs were followed up at eight child health clinics where free formula feed was dispensed weekly. Infants received co-trimoxazole prophylaxis and were EUSA tested for HIV at 9 and 18 months. After 17 months protocol changes aimed at eliminating weaknesses included initiation of ZDV at 34 weeks, self-administration of the first dose of ZDV with the onset of labour, and rapid HIV testing for both mothers and infants.Results. Voluntary counselling and testing was shown to be highly acceptable, with individual counselling more effective than group counselling. Based on less than optimal availability of records, ZDV utilisation was encouraging with up to 59% of subjects initiating treatment, 3 weeks' median duration of ZDV use, and up to 88% receiving at least one intrapartum ZDV dose. Self-administration of the intrapartum dose reached 41%.Conclusions. Short-course antenatal and intrapartum ART to prevent MTCT of HIV1 was shown to be feasible.

Currently, knowledge is limited about how high school rugby players experience cognitive and somatic anxiety when playing competitive rugby. The first aim of the study was to determine if high school rugby players displayed significant differences in cognitive and somatic anxiety before and after an important rugby match. The second aim sought to determine to what extent the important rugby match alters the cognitive and somatic anxiety experienced by high school rugby players. In order to realize these aims, high school rugby players were compared to male adolescents who were not participating in any type of sport. A purposeful sample of 10 first team high school rugby players and 10 male adolescents not participating in any type of sport was drawn from a high school situated in the Gauteng Province of South Africa. Cognitive anxiety was measured through the administration of the State and Trait Anxiety subscales of the State-Trait Personality Inventory Form Y (STPI-Y) and the Sport Competition Anxiety Test (SCAT). Somatic anxiety was measured by investigating the salivary cortisol levels of the rugby players. A baseline measure, along with measures on the day of an important rugby match and one week after the important rugby match were taken. Statistical analysis within the group of rugby players revealed that significant differences occurred in the state anxiety and SCAT scores. No significant differences occurred within the cortisol measures. When the rugby players were compared to adolescents not participating in any type of sport, significant differences were observed between the two groups on state anxiety and SCAT scores. No differences with regards to cortisol levels had occurred. It was concluded that the rugby players had experienced cognitive but not somatic anxiety.Keywords: Cognitive anxiety, somatic anxiety, state anxiety, trait anxiety, cortisol.

Scuba diving, an expensive form of extreme sport, remains popular despite the world wide economic recess. Part of its popularity is ascribed to the fact that it allows for sensation seekers to experience novel experiences. Research has indicated that novel experiences induce stress responses in human beings. Amongst scuba divers, this stress response was often measured with psychometric instruments after dives had occurred. The problem, however, is that to understand the stress response one must not only study the psychological dimension, but also needs to investigate its physiological impact on the body. In the scuba diving environment though, it not preferable to measure it after a scuba dive had occurred. Researchers have discovered that anticipating being confronted with a novel experience could elicit a physiological stress response. Because of this, it is theorized that scuba divers would experience a stress response by merely anticipating being underwater. The aim of the present study was to determine if a physiological stress response occurred in a group of beginner divers. Since these divers are also confronted with a series of novel experiences during their training, another aim of the study was to investigate how the stress response manifested physiologically as the course progressed. Sixty divers participated in the study. Heart rate measurements and salivary specimen were taken on three occasions: at rest (baseline), before entering the pool to practice scuba skills and before participating in the first open water dive. Cortisol was extracted from the salivary specimen. The results indicated that significant differences occurred in cortisol levels between the baseline and before entering the pool measurements. Significant differences were also observed between the baseline and before the open water dive measurements. Heart rate yielded significant differences between the baseline and before the pool measurements, as well as between the pool and before the open water dive measures. The findings indicated that beginner divers experienced a physiological stress response as a result of anticipating taking part in a novel experience. It further suggested that, as their training progressed, the stress response did not disappear but was controlled or inhibited after the first encounter with the underwater environment. The reason for this is that different systems in the sympathetic nervous system are responsible for the activation of cortisol and heart rate.Keywords: Extreme sport, recreational Scuba diving, beginner Scuba divers, heart rate, cortisol.

Physical activities reflect the ability of man to exist within his environment. The benefits of physical activity have been extolled throughout western history, but it was not until the second half of the twentieth century that scientific evidence supporting these beliefs began to accumulate. Epidemiological data suggest that activity levels generally increase from middle childhood into early adolescence, and then they tend to decline. Adolescence is a critical period in which initiation and formation of health behaviours occur, which can continue into adulthood. The purpose of the study is thus to investigate sport and physical recreation participation (physical activity) in the transition from the completion of school education to the completion of the third year of university study. A total of 410 third year students at a university participated in a questionnaire survey. The results indicated that there is a serious decline in the participation in physical recreation and sport from Grade 12 to the third year of university. This is especially relevant to competitive sport and accentuates the importance of establishing physical activity patterns in early adolescence (and not necessarily participation in highly competitive sport). The motivation of a society from political, administrative and especially educational points of view to develop an infrastructure for the enhancement and development of sport from a recreational to an elite level of participation is of the utmost importance to address this problem. Physical education at school can and must contribute to the initiation and formation of lifelong physical behaviour patters. African Journal for Physical, Health Education, Recreation & Dance Vol. 13 (2) 2007: pp. 149-161

This report provides a summary of the results of the various studies completed in the Partnered Pavement Research Program (PPRC) during the period 2000–2004. In addition, preliminary findings of investigations, initiated but not yet implemented during this period, are included. The results are based on the combined results of analytical developments, laboratory testing of pavement materials, and HVS tests of full-scale pavement test sections. Summaries of developments in the following areas are included: 1. Asphalt Mixes — Materials and Flexible Pavement Studies. These include studies of mix fatigue, moisture sensitivity, reflection cracking, performance of drained and undrained pavements, and those associated with I-710 freeway rehabilitation. 2. Concrete — Materials and Rigid Pavement Studies. These include: evaluation of long-life rehabilitation strategies, results of the SR-14 (Palmdale), HVS rigid pavement studies, dowel retrofit investigations on US-101 and the SR-14 test pavements, studies of the physical properties of fast-setting hydraulic cement concrete (FSHCC),alkali-silica reaction (ASR) accelerated pavement testing, evaluation of maturity method for concrete flexural strength, and HIPERPAV for early age cracking in plain jointed concrete pavements. Also included are: construction-related activities including pay factors for asphalt mixes and use of CA4PRS; M-E pavement design and rehabilitation; a summary of databases containing the results of the various investigations; deep in-situ recycling (DISR); pavement management-related activities; permanent deformation response of asphalt mixes; and implementation and technology transfer activities during the 2000–2004 period.

Bibliography: leaves 37-38., Malaria is a major public health problem in Namibia and this problem warrants special attention in terms of monitoring the trends and formulating controls and prevention strategies at all levels of the health care system and the community. Malaria accounts for more than 40 % of the diagnosed outpatients cases in the health facilities. Malaria is the leading cause of ill health and deaths among both children and adults, particularly in the northern regions of Namibia where about 60% of the population lives. This disease is seasonal with the potential for epidemic proportions, which are related to exceptionally heavy rainfall. There is increasing evidence that malaria cases are poorly managed and the staffs is poorly supervised, especially at clinic levels where all malaria cases are clinically diagnosed A number of health workers have been trained in various aspects of malaria control including case management; there is a need to evaluate their performance in order to sustain high quality care. Their performance must be evaluated regularly and feedback given so that practices could be adjusted and improved. What is required is a validated, acceptable, applicable and useful instrument that can be used routinely for assessment clinic based quality care performance. The Ministry of Health and Social Services developed a national guideline for malaria case management used at different facilities and levels in the country. There is no affordable and applicable continuous assessment instrument of the quality of health care that can be used by primary health care supervisors to assess the quality of malaria case management at health care clinics. The aim of this study is to develop and pilot a performance based quality assessment instrument for routine quality assessment of malaria case management to be used by district supervisors in public health care clinics in Namibia. The instrument developed was found to be useful by the district supervisors and the clinic staff interviewed during the assessment period. Poor referral systems, lack of training on malaria case management and poor supervision were the major problems identified in this pilot study. These problems have been discussed with the clinic staffs and the district supervisors concerned for appropriate action. The developed instrument has enabled me to obtain a rapid and general overview of the clinic performances related to quality services provided to malaria patients. The information obtained evidenced the usefulness of this instrument. This pilot study has established the baseline information for quality assessment of malaria case management for the primary health care clinics assessed. However, it has been noted that continuous assessment of health services performances is very important if the quality of malaria case management is to be achieved.