Background: Health experts are calling sugar the new tobacco (Action on . The WHO recently revise... more Background: Health experts are calling sugar the new tobacco (Action on . The WHO recently revised its recommendations for a maximum daily limit on sugar intake of 25 grams. Yet a 2012 study showed that South African children and adolescents are consuming up to 50 grams and 100 grams per day respectively . Sugar is now recognized for its role, not only in promoting caries, obesity and diabetes, but also in the development of cancers. The World Cancer Report 2014, warns of a 'cancer tidal wave' over the next 20 years (IARC, 2014) Health promotion alone is insufficient; drawing on the example of tobacco control, such as advertising restrictions, legislation is the key to prevention. The sugar-sweetened beverage (SSB) industry is the leader among all sectors in marketing to young people , thus a similar approach is recommended for restricting SSB advertising to reduce chronic disease risk. There is no data regarding SSB advertising and obesogenic environments in South Africa. This pilot study is the first to describe the location, content and characteristics of outdoor print advertisements for SSBs and fast foods in South Africa. Methodology: This is a secondary analysis of data collected as part of a larger 2013 study investigating the obesogenic environment in Soweto, South Africa. All visible outdoor advertising and branding of SSBs and fast food in a five-square kilometer demarcated area were included. Data on content, quantity, location, size and type of advertisements was collected in the field and a photograph was taken for further analysis. Comparisons were drawn to photographs of alcohol advertising in the same area. Data was captured using a coding sheet and was analysed descriptively and using inferential statistics. The advertisements included billboards, banners, posters, pole advertisements, painted signs, branded school signs, branded shop signs, directional signs and branded umbrellas and fridges. A total of 237 photographs were included in the study.
Background: Evidence-informed clinical practice guidelines (CPGs) are useful tools to inform tran... more Background: Evidence-informed clinical practice guidelines (CPGs) are useful tools to inform transparent healthcare decision-making. Consideration of health economic evidence (HEE) during CPG development in a structured manner remains a challenge globally and locally. This study explored the views, current practice, training needs and challenges faced by CPG developers in the production and use of HEE for CPGs in South Africa. Methods: This mixed-methods study comprised an online survey and a focus group discussion. The survey was piloted and subsequently sent to CPG role players -evidence reviewers, CPG panellists, academics involved with training in relevant disciplines like health economics and public health, implementers and funders. The focus group participants hold strategic roles in CPG development and health economic activities nationally. The survey evaluated mean values, measures of variability, and percentages for Likert scales, while narrative components were thematically analysed. Focus group data were manually coded, thematically analysed and verified. The survey (n = 55 respondents to 245 surveys distributed) and one focus group (n = 5 participants from 10 people invited) occurred between October 2018 and February 2019. We found the most consistent reason why HEE should inform CPG decisions was 'making more efficient use of limited financial resources'. This was explained by numerous context and methodological barriers. Focus groups participants noted that consideration of complex HEE are not achievable without bolstering skills in applying evidence-based medicine principles. Further concerns include lack of clarity of standard methods; inequitable and opaque topic selection across private and public sectors; inadequate skills of CPG panel members to use HEE; and the ability of health economists to communicate results in accessible ways. Overall, in the absence of clarity about process and methods, politics and interests may drive CPG decisions about which interventions to implement. Conclusions: HEE should ideally be considered in CPG decisions in South Africa. However, this will remain hampered until the CPG community agree on methods and processes for using HEE in CPGs. Focused investment by national government to address the challenges identified by the study is imperative for a better return on investment as National Health Insurance moves forward.
BackgroundBetween May 2020 and February 2022, South Africa's health system bore strain as it ... more BackgroundBetween May 2020 and February 2022, South Africa's health system bore strain as it battled mitigating the coronavirus pandemic. The country's pandemic response was scrutinized. This period also brought into focus pre-existing shortcomings in the healthcare system and its governing bodies. Contextually, there is a paucity in literature on the experiences of healthcare providers and users. This study aimed to contribute information on COVID-19, with the intention of providing guidance on preparing for future infectious disease outbreaks.MethodsCross sectional exploratory qualitative methodology was employed using semi-structured interviews and focus group discussions with community members (CM) and healthcare workers (HCW) from two South African study sites: (a) rural Bushbuckridge (run by Agincourt Health and Socio-Demographic Surveillance Site) and (b), Regions D and F in Johannesburg Metropole.ResultsAfter interviewing 42 CMs and 43 HCWs, it emerged that mandated ...
Background In South Africa, overweight and obesity affect 17% of children aged 15–18. School food... more Background In South Africa, overweight and obesity affect 17% of children aged 15–18. School food environments play a vital role in children’s health, influencing dietary behaviours and resulting in high obesity rates. Interventions targeting schools can contribute to obesity prevention if evidence-based and context-specific. Evidence suggests that current government strategies are inadequate to ensure healthy school food environments. The aim of this study was to identify priority interventions to improve school food environments in urban South Africa using the Behaviour Change Wheel model. Methods A three-phased iterative study design was implemented. First, we identified contextual drivers of unhealthy school food environments through a secondary framework analysis of 26 interviews with primary school staff. Transcripts were deductively coded in MAXQDA software using the Behaviour Change Wheel and the Theoretical Domains Framework. Second, to identify evidence-based interventions...
IntroductionThe first 1000 days of life are a critical period of growth and development that have... more IntroductionThe first 1000 days of life are a critical period of growth and development that have lasting implications for health, cognitive, educational and economic outcomes. In sub-Saharan Africa, gender and social norms are such that many men have little engagement with maternal and child health and nutrition during pregnancy and early childhood. This study explores how men perceive their role in three sites in sub-Saharan Africa.MethodsSecondary qualitative analysis of 10 focus group discussions with 76 men in Burkina Faso, Ghana and South Africa. Data were thematically analysed to explore men’s perceptions of maternal and child health and nutrition.ResultsMen considered themselves ‘providers’ and 'advisors' within their families, particularly of finances, food and medicines. They also indicated that this advice was out of care and concern for their families’ health. There were similarities in how the men perceive their role. Differences between men living in rural and ...
ABSTRACT Background: Nutrition-related non-communicable diseases contribute to approximately half... more ABSTRACT Background: Nutrition-related non-communicable diseases contribute to approximately half of the premature deaths in Namibia. Westernisation and urbanisation of communities have resulted in changing dietary patterns that see people eating more refined and high sugar content foods that are a risk for nutrition-related non-communicable diseases. Sugar-sweetened beverage taxation has been found to influence consumer purchasing behaviour and to raise revenue for health-promoting activity in other low- and middle-income countries. Objectives: To analyse Namibia’s non-communicable diseases prevention policy landscape and assess the readiness of the Government to adopt sugar-sweetened beverage taxation policies for public health. Methods: Government policy documents relating to nutrition-related non-communicable diseases were analysed, utilising predetermined variables based on policy theory. Thirteen key informant interviews were conducted with stakeholders from Government, non-governmental organisations and academic institutions. Data sets were analysed utilising Kingdon’s analytical theory for agenda setting. Results: Nutrition-related non-communicable diseases are an increasing problem that requires immediate action. Diet and lifestyle are recognised as major contributors to non-communicable diseases. The Government has adopted a multisectoral approach to the control and prevention of non-communicable diseases in Namibia. A sugar-sweetened beverage tax is envisaged in policy, but there is no progress towards its enactment. At the highest level of Government, the Ministry of Finance has ruled out immediate action towards sugar-sweetened beverage taxation. There is little publicly available information about the Namibian beverages industry, but it is closely tied to the South African drinking industry and is influenced by policy action in that country. Conclusion: The Government of Namibia has taken positive steps and the policy environment is friendly towards an SSB tax. The proximity of trade and the competitive nature of the Namibian drinks industry with South Africa suggest that a regional perspective to advocacy would be of value.
The political economy of covid-19 reflects longstanding patterns of resource extraction linked to... more The political economy of covid-19 reflects longstanding patterns of resource extraction linked to racial discrimination, marginalisation, and colonialism, write Jesse Bump and colleagues • Progress in public health requires governance reforms at multilateral institutions and international redistribution mechanisms
Background: National immunization program staff have limited prior training in economics, despite... more Background: National immunization program staff have limited prior training in economics, despite a need to make difficult economic choices in financing and operating their programs. Teaching Vaccine Economics Everywhere (TVEE) is an international consortium of 4 universities that provides vaccine economics and financing training to mid-career immunization program managers and policy-makers in low-and middle-income countries. Since 2017, TVEE has provided short training workshops at four regional hubs using a curriculum developed using real data and scenarios tailored to region-specific needs. The study aims to evaluate program impact of the first 2 years. Methods: The impact of the program was evaluated based on the Kirkpatrick Model. The survey was developed and distributed using Qualtrics to all participants from all
Managing chronic hepatitis C (CHC) is difficult because the majority of those infected have clini... more Managing chronic hepatitis C (CHC) is difficult because the majority of those infected have clinically silent disease. Population screening for HCV followed by direct acting antiviral (DAA) treatment in infected individuals has been shown to be both effective and cost-effective in selected population. The Canadian Task Force on Preventive Health care has recently recommended against any population-level screening, the uncertainty of the budget impact plays an important role in this decision. The objectives of this study are to (1) estimate the prevalence and the undiagnosed proportion of CHC; and (2) estimate the budget-impact of a one-time HCV screening program in Ontario, Canada. METHODS: We developed a back-calculation model that utilizes a Markov-chain-Monte-Carlo algorithm to estimate the prevalence and the undiagnosed proportion of CHC. We then used a state-transition model to evaluate the budget impact between two strategies: (1) "No screening"; and (2) "Screen-and-treat with DAA for the 45-64 year-olds ("baby-boomer") birth cohort. Model data were obtained from the published literature. We used a payer perspective, 14-year time-horizon (matching the WHO viral hepatitis elimination targets) and a 1.5% discount rate. RESULTS: Among 45-64 year-olds, the prevalence of CHC was estimated at 1.30% (1.19 -1.43%) with an undiagnosed proportion of 30.4% (27.2% -33.3%). The original budget impact analysis showed that for Ontario, screening all relatedindividuals for HCV will cost an additional $845-million over 14 years. However, given these new prevalence and undiagnosed proportion estimates, we projected that the budget-impact will be reduced by 27% at $616-million. CONCLUSIONS: By contrasting the budget-impact of the HCV screening strategy with other recommended health services and technologies in Ontario, we conclude that screening for HCV may be considered affordable. In order to generate a reliable budget-impact analysis for population-level screening decision making, accurate methodologies have to be developed to estimate the underling prevalence and the undiagnosed proportion.
• Convene experts across various disciplines including global health, health systems and palliati... more • Convene experts across various disciplines including global health, health systems and palliative care to disseminate and discuss the evidence base and findings of the seminal report of the Lancet Commission on Global Access to Palliative Care and Pain Relief.
Background: The collaboration of scientists between the developed and the developing world is an ... more Background: The collaboration of scientists between the developed and the developing world is an opportunity to reverse the 'brain drain' and to enable 'brain circulation'. Objective: Attracting alumni from the Diaspora to strengthen the development of talented scientists will strengthen research in Africa. Design: In 2010, the Faculty of Health Sciences at the University of the Witwatersrand, South Africa (SA), created an Alumni Diaspora Programme to boost international research collaboration and networking between leading medical and health sciences alumni who now live and work at academic institutions abroad with academic colleagues 'back home'. Based in Johannesburg, a gateway city attracting researchers from all over sub-Saharan Africa, this programme has the potential to capitalise on some of the intellectual capacity that was lost, mostly during the decades of apartheid, and to strengthen capacity, not just in SA, but across the continent. Results and Conclusions: The goal of this review is to highlight how this programme has stimulated collaborations and networking with international alumni.
Journal of the Medical Library Association : JMLA, 2006
The paper identifies the relative amount of research devoted to non-communicable disease in low- ... more The paper identifies the relative amount of research devoted to non-communicable disease in low- and middle-income countries (LMICs). A bibliometric analysis of a subset of journals published in LMICs was performed. Seventy-six peer-reviewed journals focused on general medicine or public health published in 46 LMICs and indexed from 1998 to 2003 in MEDLINE. A total of 24 journals were selected, 4 journals from each of 6 LMIC regions. Searches were refined using 18 non-communicable disease topics with 7,012 articles identified for analysis. More than 40% of articles in LMIC regions focused on non-communicable disease research. The percentage was highest in Eastern Europe/Central Asia (47%) and lowest in Latin America (36%). The percentage of articles published in Sub-Saharan Africa (38%) did not differ significantly from that of Latin America or South Asia. Cardiovascular disease and cancer led the list of the top ten most-indexed published topics by region. Even in regions rampant w...
To investigate the evolution of deeply located high-signal-intensity abnormalities of the brain o... more To investigate the evolution of deeply located high-signal-intensity abnormalities of the brain on T2-weighted MR images of patients with neurofibromatosis type 1 (NF-1). The study consists of two patient groups: 1) retrospective evaluation of MR scans of 24 symptomatic NF-1 patients, 10 of whom were sequentially studied, and 2) prospective MR evaluations of 20 asymptomatic NF-1 subjects from 14 families; 2 of these families were sequentially studied. Deeply located, high-signal-intensity abnormalities on T2-weighted images were noted in 34 of 44 NF-1 subjects (77%). If NF-1 patients are grouped according to age, 28 of 30 subjects (93%) younger than 15 years had the lesions, whereas 4 of 7 subjects (57%) between 16 and 30 years, and 2 of 7 subjects (29%) older than 31 years had lesions. High-signal lesions in basal ganglia and brain stem were demonstrated in all decades with relatively high frequency. Lesions in the cerebellar white matter and dentate nuclei were mainly found in the...
We offered cystic fibrosis (CF) carrier testing to reproductive-age enrollees in an HMO, in order... more We offered cystic fibrosis (CF) carrier testing to reproductive-age enrollees in an HMO, in order to determine factors associated with test utilization in a primarily nonpregnant population. Male and female enrollees either were mailed an invitation to have the test after attending an educational session (N = 2,713) or were approached in waiting rooms at the HMO sites and given the opportunity to have the test without making an additional visit (N = 608). Uptake was considerably higher when testing could be obtained without making an additional visit (23.5%) than when attendance at an educational session was required as a prerequisite for having the test (3.7%). Utilization was higher among respondents who were planning children. Caucasians, and those with higher educational attainment. Among respondents planning to have children, individuals with higher tolerance for test uncertainty, lower fear of stigma, and higher perceived risk of being a carrier were significantly more likely ...
We declare that we have no competing interests. We thank Alice Baumgartner for comments on an ear... more We declare that we have no competing interests. We thank Alice Baumgartner for comments on an earlier draft.
Background: Health experts are calling sugar the new tobacco (Action on . The WHO recently revise... more Background: Health experts are calling sugar the new tobacco (Action on . The WHO recently revised its recommendations for a maximum daily limit on sugar intake of 25 grams. Yet a 2012 study showed that South African children and adolescents are consuming up to 50 grams and 100 grams per day respectively . Sugar is now recognized for its role, not only in promoting caries, obesity and diabetes, but also in the development of cancers. The World Cancer Report 2014, warns of a 'cancer tidal wave' over the next 20 years (IARC, 2014) Health promotion alone is insufficient; drawing on the example of tobacco control, such as advertising restrictions, legislation is the key to prevention. The sugar-sweetened beverage (SSB) industry is the leader among all sectors in marketing to young people , thus a similar approach is recommended for restricting SSB advertising to reduce chronic disease risk. There is no data regarding SSB advertising and obesogenic environments in South Africa. This pilot study is the first to describe the location, content and characteristics of outdoor print advertisements for SSBs and fast foods in South Africa. Methodology: This is a secondary analysis of data collected as part of a larger 2013 study investigating the obesogenic environment in Soweto, South Africa. All visible outdoor advertising and branding of SSBs and fast food in a five-square kilometer demarcated area were included. Data on content, quantity, location, size and type of advertisements was collected in the field and a photograph was taken for further analysis. Comparisons were drawn to photographs of alcohol advertising in the same area. Data was captured using a coding sheet and was analysed descriptively and using inferential statistics. The advertisements included billboards, banners, posters, pole advertisements, painted signs, branded school signs, branded shop signs, directional signs and branded umbrellas and fridges. A total of 237 photographs were included in the study.
Background: Evidence-informed clinical practice guidelines (CPGs) are useful tools to inform tran... more Background: Evidence-informed clinical practice guidelines (CPGs) are useful tools to inform transparent healthcare decision-making. Consideration of health economic evidence (HEE) during CPG development in a structured manner remains a challenge globally and locally. This study explored the views, current practice, training needs and challenges faced by CPG developers in the production and use of HEE for CPGs in South Africa. Methods: This mixed-methods study comprised an online survey and a focus group discussion. The survey was piloted and subsequently sent to CPG role players -evidence reviewers, CPG panellists, academics involved with training in relevant disciplines like health economics and public health, implementers and funders. The focus group participants hold strategic roles in CPG development and health economic activities nationally. The survey evaluated mean values, measures of variability, and percentages for Likert scales, while narrative components were thematically analysed. Focus group data were manually coded, thematically analysed and verified. The survey (n = 55 respondents to 245 surveys distributed) and one focus group (n = 5 participants from 10 people invited) occurred between October 2018 and February 2019. We found the most consistent reason why HEE should inform CPG decisions was 'making more efficient use of limited financial resources'. This was explained by numerous context and methodological barriers. Focus groups participants noted that consideration of complex HEE are not achievable without bolstering skills in applying evidence-based medicine principles. Further concerns include lack of clarity of standard methods; inequitable and opaque topic selection across private and public sectors; inadequate skills of CPG panel members to use HEE; and the ability of health economists to communicate results in accessible ways. Overall, in the absence of clarity about process and methods, politics and interests may drive CPG decisions about which interventions to implement. Conclusions: HEE should ideally be considered in CPG decisions in South Africa. However, this will remain hampered until the CPG community agree on methods and processes for using HEE in CPGs. Focused investment by national government to address the challenges identified by the study is imperative for a better return on investment as National Health Insurance moves forward.
BackgroundBetween May 2020 and February 2022, South Africa's health system bore strain as it ... more BackgroundBetween May 2020 and February 2022, South Africa's health system bore strain as it battled mitigating the coronavirus pandemic. The country's pandemic response was scrutinized. This period also brought into focus pre-existing shortcomings in the healthcare system and its governing bodies. Contextually, there is a paucity in literature on the experiences of healthcare providers and users. This study aimed to contribute information on COVID-19, with the intention of providing guidance on preparing for future infectious disease outbreaks.MethodsCross sectional exploratory qualitative methodology was employed using semi-structured interviews and focus group discussions with community members (CM) and healthcare workers (HCW) from two South African study sites: (a) rural Bushbuckridge (run by Agincourt Health and Socio-Demographic Surveillance Site) and (b), Regions D and F in Johannesburg Metropole.ResultsAfter interviewing 42 CMs and 43 HCWs, it emerged that mandated ...
Background In South Africa, overweight and obesity affect 17% of children aged 15–18. School food... more Background In South Africa, overweight and obesity affect 17% of children aged 15–18. School food environments play a vital role in children’s health, influencing dietary behaviours and resulting in high obesity rates. Interventions targeting schools can contribute to obesity prevention if evidence-based and context-specific. Evidence suggests that current government strategies are inadequate to ensure healthy school food environments. The aim of this study was to identify priority interventions to improve school food environments in urban South Africa using the Behaviour Change Wheel model. Methods A three-phased iterative study design was implemented. First, we identified contextual drivers of unhealthy school food environments through a secondary framework analysis of 26 interviews with primary school staff. Transcripts were deductively coded in MAXQDA software using the Behaviour Change Wheel and the Theoretical Domains Framework. Second, to identify evidence-based interventions...
IntroductionThe first 1000 days of life are a critical period of growth and development that have... more IntroductionThe first 1000 days of life are a critical period of growth and development that have lasting implications for health, cognitive, educational and economic outcomes. In sub-Saharan Africa, gender and social norms are such that many men have little engagement with maternal and child health and nutrition during pregnancy and early childhood. This study explores how men perceive their role in three sites in sub-Saharan Africa.MethodsSecondary qualitative analysis of 10 focus group discussions with 76 men in Burkina Faso, Ghana and South Africa. Data were thematically analysed to explore men’s perceptions of maternal and child health and nutrition.ResultsMen considered themselves ‘providers’ and 'advisors' within their families, particularly of finances, food and medicines. They also indicated that this advice was out of care and concern for their families’ health. There were similarities in how the men perceive their role. Differences between men living in rural and ...
ABSTRACT Background: Nutrition-related non-communicable diseases contribute to approximately half... more ABSTRACT Background: Nutrition-related non-communicable diseases contribute to approximately half of the premature deaths in Namibia. Westernisation and urbanisation of communities have resulted in changing dietary patterns that see people eating more refined and high sugar content foods that are a risk for nutrition-related non-communicable diseases. Sugar-sweetened beverage taxation has been found to influence consumer purchasing behaviour and to raise revenue for health-promoting activity in other low- and middle-income countries. Objectives: To analyse Namibia’s non-communicable diseases prevention policy landscape and assess the readiness of the Government to adopt sugar-sweetened beverage taxation policies for public health. Methods: Government policy documents relating to nutrition-related non-communicable diseases were analysed, utilising predetermined variables based on policy theory. Thirteen key informant interviews were conducted with stakeholders from Government, non-governmental organisations and academic institutions. Data sets were analysed utilising Kingdon’s analytical theory for agenda setting. Results: Nutrition-related non-communicable diseases are an increasing problem that requires immediate action. Diet and lifestyle are recognised as major contributors to non-communicable diseases. The Government has adopted a multisectoral approach to the control and prevention of non-communicable diseases in Namibia. A sugar-sweetened beverage tax is envisaged in policy, but there is no progress towards its enactment. At the highest level of Government, the Ministry of Finance has ruled out immediate action towards sugar-sweetened beverage taxation. There is little publicly available information about the Namibian beverages industry, but it is closely tied to the South African drinking industry and is influenced by policy action in that country. Conclusion: The Government of Namibia has taken positive steps and the policy environment is friendly towards an SSB tax. The proximity of trade and the competitive nature of the Namibian drinks industry with South Africa suggest that a regional perspective to advocacy would be of value.
The political economy of covid-19 reflects longstanding patterns of resource extraction linked to... more The political economy of covid-19 reflects longstanding patterns of resource extraction linked to racial discrimination, marginalisation, and colonialism, write Jesse Bump and colleagues • Progress in public health requires governance reforms at multilateral institutions and international redistribution mechanisms
Background: National immunization program staff have limited prior training in economics, despite... more Background: National immunization program staff have limited prior training in economics, despite a need to make difficult economic choices in financing and operating their programs. Teaching Vaccine Economics Everywhere (TVEE) is an international consortium of 4 universities that provides vaccine economics and financing training to mid-career immunization program managers and policy-makers in low-and middle-income countries. Since 2017, TVEE has provided short training workshops at four regional hubs using a curriculum developed using real data and scenarios tailored to region-specific needs. The study aims to evaluate program impact of the first 2 years. Methods: The impact of the program was evaluated based on the Kirkpatrick Model. The survey was developed and distributed using Qualtrics to all participants from all
Managing chronic hepatitis C (CHC) is difficult because the majority of those infected have clini... more Managing chronic hepatitis C (CHC) is difficult because the majority of those infected have clinically silent disease. Population screening for HCV followed by direct acting antiviral (DAA) treatment in infected individuals has been shown to be both effective and cost-effective in selected population. The Canadian Task Force on Preventive Health care has recently recommended against any population-level screening, the uncertainty of the budget impact plays an important role in this decision. The objectives of this study are to (1) estimate the prevalence and the undiagnosed proportion of CHC; and (2) estimate the budget-impact of a one-time HCV screening program in Ontario, Canada. METHODS: We developed a back-calculation model that utilizes a Markov-chain-Monte-Carlo algorithm to estimate the prevalence and the undiagnosed proportion of CHC. We then used a state-transition model to evaluate the budget impact between two strategies: (1) "No screening"; and (2) "Screen-and-treat with DAA for the 45-64 year-olds ("baby-boomer") birth cohort. Model data were obtained from the published literature. We used a payer perspective, 14-year time-horizon (matching the WHO viral hepatitis elimination targets) and a 1.5% discount rate. RESULTS: Among 45-64 year-olds, the prevalence of CHC was estimated at 1.30% (1.19 -1.43%) with an undiagnosed proportion of 30.4% (27.2% -33.3%). The original budget impact analysis showed that for Ontario, screening all relatedindividuals for HCV will cost an additional $845-million over 14 years. However, given these new prevalence and undiagnosed proportion estimates, we projected that the budget-impact will be reduced by 27% at $616-million. CONCLUSIONS: By contrasting the budget-impact of the HCV screening strategy with other recommended health services and technologies in Ontario, we conclude that screening for HCV may be considered affordable. In order to generate a reliable budget-impact analysis for population-level screening decision making, accurate methodologies have to be developed to estimate the underling prevalence and the undiagnosed proportion.
• Convene experts across various disciplines including global health, health systems and palliati... more • Convene experts across various disciplines including global health, health systems and palliative care to disseminate and discuss the evidence base and findings of the seminal report of the Lancet Commission on Global Access to Palliative Care and Pain Relief.
Background: The collaboration of scientists between the developed and the developing world is an ... more Background: The collaboration of scientists between the developed and the developing world is an opportunity to reverse the 'brain drain' and to enable 'brain circulation'. Objective: Attracting alumni from the Diaspora to strengthen the development of talented scientists will strengthen research in Africa. Design: In 2010, the Faculty of Health Sciences at the University of the Witwatersrand, South Africa (SA), created an Alumni Diaspora Programme to boost international research collaboration and networking between leading medical and health sciences alumni who now live and work at academic institutions abroad with academic colleagues 'back home'. Based in Johannesburg, a gateway city attracting researchers from all over sub-Saharan Africa, this programme has the potential to capitalise on some of the intellectual capacity that was lost, mostly during the decades of apartheid, and to strengthen capacity, not just in SA, but across the continent. Results and Conclusions: The goal of this review is to highlight how this programme has stimulated collaborations and networking with international alumni.
Journal of the Medical Library Association : JMLA, 2006
The paper identifies the relative amount of research devoted to non-communicable disease in low- ... more The paper identifies the relative amount of research devoted to non-communicable disease in low- and middle-income countries (LMICs). A bibliometric analysis of a subset of journals published in LMICs was performed. Seventy-six peer-reviewed journals focused on general medicine or public health published in 46 LMICs and indexed from 1998 to 2003 in MEDLINE. A total of 24 journals were selected, 4 journals from each of 6 LMIC regions. Searches were refined using 18 non-communicable disease topics with 7,012 articles identified for analysis. More than 40% of articles in LMIC regions focused on non-communicable disease research. The percentage was highest in Eastern Europe/Central Asia (47%) and lowest in Latin America (36%). The percentage of articles published in Sub-Saharan Africa (38%) did not differ significantly from that of Latin America or South Asia. Cardiovascular disease and cancer led the list of the top ten most-indexed published topics by region. Even in regions rampant w...
To investigate the evolution of deeply located high-signal-intensity abnormalities of the brain o... more To investigate the evolution of deeply located high-signal-intensity abnormalities of the brain on T2-weighted MR images of patients with neurofibromatosis type 1 (NF-1). The study consists of two patient groups: 1) retrospective evaluation of MR scans of 24 symptomatic NF-1 patients, 10 of whom were sequentially studied, and 2) prospective MR evaluations of 20 asymptomatic NF-1 subjects from 14 families; 2 of these families were sequentially studied. Deeply located, high-signal-intensity abnormalities on T2-weighted images were noted in 34 of 44 NF-1 subjects (77%). If NF-1 patients are grouped according to age, 28 of 30 subjects (93%) younger than 15 years had the lesions, whereas 4 of 7 subjects (57%) between 16 and 30 years, and 2 of 7 subjects (29%) older than 31 years had lesions. High-signal lesions in basal ganglia and brain stem were demonstrated in all decades with relatively high frequency. Lesions in the cerebellar white matter and dentate nuclei were mainly found in the...
We offered cystic fibrosis (CF) carrier testing to reproductive-age enrollees in an HMO, in order... more We offered cystic fibrosis (CF) carrier testing to reproductive-age enrollees in an HMO, in order to determine factors associated with test utilization in a primarily nonpregnant population. Male and female enrollees either were mailed an invitation to have the test after attending an educational session (N = 2,713) or were approached in waiting rooms at the HMO sites and given the opportunity to have the test without making an additional visit (N = 608). Uptake was considerably higher when testing could be obtained without making an additional visit (23.5%) than when attendance at an educational session was required as a prerequisite for having the test (3.7%). Utilization was higher among respondents who were planning children. Caucasians, and those with higher educational attainment. Among respondents planning to have children, individuals with higher tolerance for test uncertainty, lower fear of stigma, and higher perceived risk of being a carrier were significantly more likely ...
We declare that we have no competing interests. We thank Alice Baumgartner for comments on an ear... more We declare that we have no competing interests. We thank Alice Baumgartner for comments on an earlier draft.
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Papers by Karen Hofman