Day: October 24, 2022

Categories : Healthcare Politics and RegulationsTags : 1 Comment

In the Hot Seat: New Gauteng Health MEC Responds to 10 Questions from Spotlight

On By ModernMedia
Nomantu Nkomo-Ralehoko, MEC for Health in Gauteng. Photo: GP Health and Wellness/Twitter

By Spotlight Editors

On 7 October, Gauteng Premier Panyaza Lesufi appointed Nomantu Nkomo-Ralehoko to the position of MEC for Health in the province. Nkomo-Ralehoko replaced Nomathemba Mokgethi, who had been in the job for less than two years.

The position of MEC for Health in Gauteng is one of the most important, and probably one of the toughest public sector health jobs in South Africa. Spotlight sent Nkomo-Ralehoko ten questions about her plans and on the chronic problems plaguing health in Gauteng. We received the below responses via Tshepo Shawa, the MEC’s spokesperson.

1. After the murder of Babita Deokaran, the Gauteng Health Department was very slow to follow up on the alleged corruption that Deokaran had exposed at Tembisa Hospital. What steps will you take as MEC to ensure that the alleged corruption at Tembisa Hospital is fully investigated and that justice is done?

Nkomo-Ralehoko: The Gauteng Provincial Government has already, through the Office of the Premier, taken action to ensure that the Special Investigating Unit (SIU) conducts a forensic investigation into the transactions at Tembisa Hospital. I am also aware that the Hawks are probing the matter.

I have made a commitment that as soon as the SIU concludes the forensic investigation, we will definitely not hesitate to act on the recommendations.

Sometimes, justice might seem delayed, but it is important that we allow law enforcement agencies to complete their work so that firm action can be taken where there is wrongdoing.

2. From PPE-related corruption to alleged corruption at Tembisa Hospital, the Gauteng Department of Health appears to have a chronic and systemic problem with corruption. What steps will you take as MEC to:

i) root out corruption in the department at a systemic level;

ii) and ensure there are consequences for those implicated?

Nkomo-Ralehoko: One of my immediate focus areas is to ensure that the department’s systems across delivery areas such as Finance, Human Resources, Monitoring and Evaluation, Risk Management, etc. are strengthened so that processes are not dependent on human vulnerability but there are clear checks and balances.

An environment that has no consequence management breeds ill-discipline and a culture of ignoring processes and procedures as prescribed in our legislative framework. Our environment is highly regulated through various prescripts and it is important for oversight purposes and for good governance that the distinctive roles in terms of the role of Executive Authority and the role of Accounting Officer are appreciated.

I have already made an undertaking to work with stakeholders internally and externally to ensure that there is accountability and consequence management. Equally so, it will be important to also recognise people that go beyond the call of duty. We need to encourage an environment where we get back to the Batho Pele principles by ensuring that our work is geared towards improving patient experience of care and improving our service offering. We also need to make sure that employees work in an environment that appreciates the service they are rendering to communities and allows them to thrive.

3. The work of restoring Charlotte Maxeke Johannesburg Academic Hospital was handed over to the National Department of Health after the Gauteng government botched the job. What steps will you take as MEC to ensure that Charlotte Maxeke is fully functional again as soon as possible?

(Here, the MEC referred us to a response provided to the provincial legislature regarding the rebuilding of Charlotte Maxeke)

4. There have in recent years been chronic management-level vacancies in the Gauteng Department of Health. What steps will you take as MEC to ensure that all vacancies in the department are filled with suitably qualified people?

Nkomo-Ralehoko: Part of the intervention programme for the remainder of the 6th Administration term of office will be to review the age-old organisational structure which was last updated in 2006 to ensure that it is relevant and fit-for-purpose and takes into consideration the size of the Gauteng healthcare system and the kind of skills that are needed to provide adequate and effective care to the over 16 million people of the province, majority of whom rely on the public healthcare system.

We have put in place an ambitious plan called Turning The Tide: Reclaiming the Jewel of Public Health in Gauteng, which looks at a number of intervention areas. Key amongst these is the Human Resource component.

This is to ensure that we have a structure that responds adequately to clinical, administrative, social, and economic challenges faced by the province. This will enable the department to be able to deliver on the workforce that positively impacts its strategy execution efforts and acceptable levels of organisational performance.

5. Are you in favour of cadre deployment in the provincial health department?

Nkomo-Ralehoko: If by cadre deployment you mean a situation where highly trained and qualified personnel who understand the delivery imperatives of the developmental state and are committed to a high ethical standard embracing a culture and ethos of service, then indeed I am for cadre development.

However, if by cadre development you are referring to bringing incapable and unqualified people into the public service at the expense of delivery, then I can’t support such.

6. Healthcare workers often work under very difficult conditions and surveys have shown that many healthcare facilities are understaffed. What steps will you take as MEC to ensure sufficient numbers of healthcare workers are employed in Gauteng and work under decent working conditions?

Nkomo-Ralehoko: Kindly refer to the response to question 4 above. Additional to that response is that the Turning the Tide plan has also prioritised health infrastructure to ensure that healthcare workers work in a safe environment.

Our Department is now called the Department of Health and Wellness that on its own is a clear indication that issues of wellness will also receive special focus. We can’t preach a message of wellness while our employees are unwell and unhappy. In my first address to the staff at head office on 10 October 2022, I made a commitment to the team that charity will begin at home. For this reason, we will soon be rolling out Wellness Wednesdays, the aim of which is to bring the spotlight on employee wellness and to ensure that we pay more attention to the softer but critical issues that make the workplace a more conducive environment.

7. In your view, what is the key difference between the role of the MEC for health and the HoD of the province’s health department?

Nkomo-Ralehoko: The roles of the Executive Authority (MEC) and Accounting Officer (HoD) are clearly defined by various laws and regulations, such as the Public Service Act, Public Service Regulations, and Public Finance Management Act. The executive authority is the political head and is responsible for policy direction and oversight. The executive authority delegates certain functions to the accounting officer to ensure effective public management and administration.

The accounting officer is the administrative head of the department and is responsible for the day-to-day operations of the department.

8. As MEC, will you listen to and support healthcare workers like Dr Tim de Maayer who blow the whistle when the situation at health facilities becomes untenable, or will you take steps against such people?

Nkomo-Ralehoko: I have made a commitment to staff to work with them to turn the health system around. This means that performance systems and tools will have to be strengthened while we also create a conducive environment that allows employees to be heard. Everyone’s voice matters if it is a voice that seeks to move us forward. We all have a role to play to restore the tarnished image of the Gauteng public health system.

9. As the province’s new MEC for Health, what lessons do you take from the Life Esidemeni tragedy?

Nkomo-Ralehoko: You will appreciate that I am just a few days in office and I am obviously getting appraised with the myriad of issues confronting the healthcare system in the province. One of the commitments made by this 6th Administration was to be a patient-centred, clinician-led, and stakeholder-driven healthcare system. This is a commitment we intend to see through in the remaining period of the term of office. My job is to ensure that patients are at the centre of our work by giving clinicians space to do what they are trained to do while at the same time listening to the voice of the many stakeholders who want to see public health live up to its promise.

10. As we understand, you are not a medical doctor and in a SABC interview you said you are “a politician by accident”. What in your background and experience would you say makes you the right candidate for the role of MEC for Health?

Nkomo-Ralehoko: Yes I said I am a politician by accident given that I was drawn by many lived experiences which harnesses the activist in me that was driven to change things for the better. I am an administrator at heart, but I am also an experienced leader, having led across various structures in society.

I understand the plight of the people of Gauteng and I am committed to putting my skills and knowledge to change things for the better. I may not be a clinician or a nurse, but I do know that the healthcare system is nothing without healthcare workers.

Republished from Spotlight under a Creative Commons 4.0 Licence.

Source: Spotlight

Categories : Metabolic DisordersTags :

How Late-night Eating Triggers Weight Gain and Diabetes

On By ModernMedia
Photo by Ernest Brillo on Unsplash

Northwestern Medicine scientists have uncovered the mechanism behind why eating late at night is linked to weight gain and diabetes. The findings, published in the journal Science, may also help inform chronic care, especially with gastric feeding tubes.

Eating time, sleep and obesity have a well-known but poorly understood link, with research showing that over-nutrition can disrupt circadian rhythms and change fat tissue.

This new Northwestern University research has shown for the first time that energy release may be the molecular mechanism through which the body’s internal clocks control energy balance. From this understanding, the scientists also found that daytime is the ideal time in the light environment of the Earth’s rotation when it is most optimal to dissipate energy as heat. These findings have broad implications from dieting to sleep loss and the way we feed patients who require long-term nutritional assistance.

“It is well known, albeit poorly understood, that insults to the body clock are going to be insults to metabolism,” said corresponding study author Dr. Joseph T. Bass, a professor at Northwestern University Feinberg School of Medicine.

“When animals consume Western style cafeteria diets – high fat, high carb – the clock gets scrambled,” Dr Bass said. “The clock is sensitive to the time people eat, especially in fat tissue, and that sensitivity is thrown off by high-fat diets. We still don’t understand why that is, but what we do know is that as animals become obese, they start to eat more when they should be asleep. This research shows why that matters.”

Scrambling the internal clock

In the study, mice, who are nocturnal, were fed a high-fat diet either exclusively during their inactive (light) period or during their active (dark) period. Within a week, mice fed during light hours gained more weight compared to those fed in the dark. The team also set the temperature to 30 degrees, where mice expend the least energy, to mitigate the effects of temperature on their findings.

“We thought maybe there’s a component of energy balance where mice are expending more energy eating at specific times,” said first author Dr Chelsea Hepler, a postdoctoral fellow in Dr Bass’s lab. “That’s why they can eat the same amount of food at different times of the day and be healthier when they eat during active periods versus when they should be sleeping.”

The increase in energy expenditure led the team to look into metabolism of fat tissue to see if the same effect occurred within the endocrine organ. They found that it did, and mice with genetically enhanced thermogenesis prevented weight gain and improved health.

Dr Hepler also identified futile creatine cycling, in which creatine (a molecule that helps maintain energy) undergoes storage and release of chemical energy, within fat tissues, implying creatine may be the mechanism underlying heat release.

Intermittent fasting and gastric feeding tubes

The science is underpinned by research done by Dr Bass and colleagues at Northwestern more than 20 years ago that found a relationship between the internal molecular clock and body weight, obesity and metabolism in animals.

The challenge for Dr Bass’s lab, which focuses on using genetic approaches to study physiology, has been figuring out what it all means, and finding the control mechanisms that produce the relationship. This study brings them a step closer.

The findings could inform chronic care, Dr Bass said, especially in cases where patients have gastric feeding tubes. Patients are commonly fed at night while they sleep, when they’re releasing the least amount of energy. Rates of diabetes and obesity tend to be high for these patients, and Bass thinks this could explain why. He also wonders how the research could impact Type II Diabetes treatment. Should meal times be considered when insulin is given, for example?

Dr Hepler will continue to research creatine metabolism. “We need to figure out how, mechanistically, the circadian clock controls creatine metabolism so that we can figure out how to boost it,” she said. “Clocks are doing a lot to metabolic health at the level of fat tissue, and we don’t know how much yet.”

Source: Northwestern University

Categories : Mental HealthTags :

The Stigmatisation of Functional Seizures under the Spotlight during Mental Health Awareness Month

On By ModernMedia
Photo by Alex Green on Pexels

Functional seizures (FS) – observable paroxysms of altered behaviour or movement with or without a loss of consciousness – is a serious mental illness and can have negative effects on the quality of life and functioning of people with the disorder and their families.

But a study conducted by researchers in the Department of Psychology at Stellenbosch University (SU), has found that conditions such as FS are still highly stigmatised with patients often being dismissed as malingering, faking or lying due to a lack of medical causes. The study, ‘Stigma in functional seizures: A scoping review’, was recently published in Seizure, an international journal on epilepsy.

During the month of October – which is Mental Health Awareness Month – there has been a renewed effort to reduce this kind of stigma. “We need to change our attitudes towards mental health to reduce this stigma, and this month is an opportunity to do that collectively,” says Shayni Geffen, Project Leader: Advocacy and Awareness at the South African Federation for Mental Health.

As part of their investigation, the SU researchers conducted a systematic scoping review of academic literature on FS. They found that even though the stigmatisation of FS is prevalent, it remains understudied, especially in low-income countries. “In most data sources stigma was often an afterthought, with very few sources specifically exploring this topic.

“Overall, our data suggested that stigma around FS is more prevalent and pronounced than is the case with epileptic seizures. A lack of knowledge of the disorder contributes to stigma and discriminatory practices. Stigma remains a barrier to receiving a diagnosis and accessing treatment.

“Literature suggests that it can take years for patients to finally get a diagnosis of FS, but once they receive the diagnosis, it is often met with negative stereotypes and perceptions that lead to stigmatisation and treatment resistance.”

According to the researchers, the most prominent theme emerging from their analysis is that of healthcare practitioners stigmatising people with FS.

“Patients with FS indicated that they were ‘rejected and dismissed by doctors as malingerers, time-wasters or attention-seekers’.”

“From our review it became apparent that the negative attitudes of healthcare practitioners towards patients with FS persist, often because of a lack of knowledge, general awareness, understanding and medical training with regards to this disorder.”

But it’s not just health practitioners who treat patients with FS in this way; family members, friends and acquaintances also stigmatise them.

“Patients with FS also experience stigmatisation within their own families and their broader social circles. Their relatives feel burdened and experience more stigma than caregivers of patients who have an epileptic seizure.”

The researchers add that patients with FS can also hold stigmatising views about their diagnosis.

“Some data sources suggested that patients often experience their diagnosis negatively and equate it to being told they are ‘crazy’, ‘faking’, or that it is ‘all in my head’.”

Functional seizures profoundly impact the social functioning of those affected by the condition and make it difficult for them to find a job, the researchers say.

“Furthermore, our review suggests a dearth of knowledge focusing on the nuanced cultural and contextual influences on the stigma around FS, leaving a gap in literature pertaining to the development and implementation of interventions that are culturally and contextually sensitive and aimed at minimising this stigma.”

According to the researchers, a lack of funding and recognition by governments likely contributes to FS remaining poorly understood and stigmatised.

“The stigmatisation of FS is not only a medical or societal issue, but also a governmental matter. If politicians recognise FS as an important and highly prevalent disorder, it would be much easier for patients to access governmental aid and for scientists to have funding for their research.”

They emphasise the need for more research that focuses specifically on the stigmatisation of FS, and on factors that contribute to this, as well as accessible interventions and guidelines addressing it through education and training.

“People with FS must be supported, and we must increase our knowledge about the condition.”

“We also need more investigations into how patients with FS experience stigma, as well as into the perceptions of their family, friends, and caregivers.”

“Finally, healthcare professionals should be educated and trained so that their attitudes, perceptions and quality of interventions regarding patients with FS can improve.”

Provided by: Stellenbosch University

Categories : Obstetrics & GynaecologyTags :

Single-stranded Suture Threads could Prevent Infection Complications in Pregnancy

On By ModernMedia
Pregnant with ultrasound image
Source: Pixabay

Women at risk of pregnancy loss who need a specialist surgical procedure could benefit from a single-stranded suture thread to reduce risk of infection, results from the C-STICH clinical trial found which were published in The Lancet. 

The trial involved more than 2000 expectant mothers who needed a procedure called a cerclage, where a purse string suture is placed around the cervix during their pregnancy. Women were randomly allocated to have the surgical procedure performed using either a single stranded thread or a braided thread.

Researchers tested whether there would be any difference in miscarriage or stillbirth, due to an increased risk of infection, from using a braided suture thread. The research shows that single stranded sutures could potentially improve outcomes for mothers at risk of preterm birth.

The team, led by researchers from the University of Birmingham and Birmingham Women’s and Children’s Hospital, found that the mothers treated with single stranded threads had no differences in pregnancy loss or preterm birth but reported fewer instances of infection and sepsis. This could have important implications for the health outcomes of mothers and babies who are treated with a cervical cerclage in their pregnancy.

Dr Vicky Hodgetts-Morton, NIHR Clinical Lecturer in Obstetrics at the University of Birmingham and Birmingham Women’s Hospital explained the implications of the trial results. Dr Hodgetts-Morton said:

“Preterm birth is a significant problem, complicating approximately one in ten pregnancies around the world. The consequences of preterm birth may be significant with some babies being born too early to survive, and those that survive are at increased risk of health complications. One cause for preterm birth is cervical insufficiency, occurring in 0.5% to 1% of pregnant women for which the placement of a vaginal cervical cerclage can be an effective treatment.

“Suture thread choice has the potential to improve how well a cerclage works in preventing miscarriage, stillbirth and preterm birth. Both single stranded and braided threads are commonly used to perform cerclages and our findings show no differences in pregnancy loss and preterm birth. The C-STICH trial results did show an increased risk of infections in labour and around the time of delivery with braided threads and this supported our hypothesis that a single stranded thread could reduce the risk of infection developing during the pregnancy.”

Source: University of Birmingham

Categories : AddictionTags :

Virtual Reality can Aid Addiction Recovery by Imagining the Future

On By ModernMedia
Photo by Jeshoots.com on Unsplash

A pilot study published in the journal Discover Mental Health suggests that virtual reality simulation of imagined realities using realistic avatars of the participants can aid substance use disorder recovery by lowering the risk of relapse rates and increasing their future self-connectedness.

The Indiana University researchers have recently received over $4.9 million from the National Institutes of Health and launched an IU-affiliated startup company to test and further develop the technology.

Led by Brandon Oberlin, an assistant professor of psychiatry at the IU School of Medicine, IU researchers have built a virtual environment using “future-self avatars” to help people recover from substance use disorders. These avatars are life-sized, fully animated and nearly photorealistic. People can converse with their avatars, who speak in their same voice using personal details in alternate futures.

“VR technology is clinically effective and increasingly common for treating a variety of mental health conditions, such as phobias, post-traumatic stress disorder and post-operative pain, but has yet to find wide use in substance use disorders intervention or recovery,” A/Prof Oberlin said. “Capitalising on VR’s ability to deliver an immersive experience showing otherwise-impossible scenarios, we created a way for people to interact with different versions of their future selves in the context of substance use and recovery.”

“This experience enables people in recovery to have a personalised virtual experience, in alternate futures resulting from the choices they made,” Oberlin said. “We believe this could be a revolutionary intervention for early substance use disorders recovery, with perhaps even further-reaching mental health applications.”

The technology is particularly well-suited for people in early recovery, when relapse risk high, because the immersive experiences can help them choose long-term rewards over immediate gratification by deepening connections to their future selves, he said.

In the past five months, A/Prof Oberlin’s team was awarded numerous grants. These will be used to support clinical trials that test efficacy on relapse prevention, brain activation and other important elements related to substance use disorder treatment, A/Prof Oberlin said. For example, one study will deliver virtual reality experiences remotely via wireless headsets for participants to use at home, as remote delivery of mental health interventions addresses a pressing need for people unable or unwilling to engage in an in-person clinical setting.

Source: Indiana University