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Climate change and control of diarrhoeal diseases in South Africa: Priorities for action.Weather conditions, especially temperature and precipitation, play a critical role in shaping patterns of diarrhoeal diseases. They determine the frequency of outbreaks, and the spatial and seasonal distribution of cases. Not surprisingly, it is anticipated that the burden of diarrhoeal diseases will escalate with climate change, in tandem with gradual increments in mean temperatures, but also during episodic heatwaves. The degree and nature of this escalation will, however, vary with the mix of pathogens in an area, the quality of sanitation services, food hygiene regulations and their enforcement, and the age structure of the population, among other factors. Understanding these patterns can inform the design of measures to prevent and control heat-related diarrhoea. In this editorial, we sum evidence on the heat sensitivity of enteric infections in South Africa (SA) and other parts of sub-Saharan Africa (19 studies), drawing on articles located in a systematic review (methods detailed in Manyuchi et al. [1]), and consider the implications of these findings for control of diarrhoea in SA in the context of climate change.
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Physical activity programs for older people in the community receiving home care services: systematic review and meta-analysis.The proportion of older adults is increasing around the world and most wish to live in their home until they die. To achieve this, many will require services in the home to remain living independently. To maintain function (ie, strength, balance, and endurance), physical activity needs to be undertaken on a regular basis, and is essential as a person ages. Unfortunately, as people age there is a tendency to reduce activity levels, which often leads to loss of function and frailty, and the need for home care services. This updated systematic review includes a mix of study methodologies and meta-analysis, and investigated the effectiveness of physical activity/exercise interventions for older adults receiving home care services. Eighteen studies including ten randomized controlled trials meeting the selection criteria were identified. Many of the studies were multi-factorial interventions with the majority reporting aims beyond solely trying to improve the physical function of home care clients. The meta-analysis showed limited evidence for effectiveness of physical activity for older adults receiving home care services. Future exercise/physical activity studies working with home care populations should consider focusing solely on physical improvements, and need to include a process evaluation of the intervention to gain a better understanding of the association between adherence to the exercise program and other factors influencing effectiveness.
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Social communication deficits and restricted repetitive behavior symptoms in Tourette syndrome.Background: Autism spectrum disorders (ASD) have been found to occur more frequently in individuals with Tourette syndrome (TS) than in the general population. Similarities exist between ASD and TS clinically, which suggests a potential relationship between the two conditions. Purpose: The purpose of this study was to explore the occurrence of autism-related features in ASD and TS, focusing on areas of overlap and difference. Patients and methods: This study examined the nature and extent of autistic traits as measured by the Social Communication Questionnaire (SCQ) in a sample with a diagnosis of TS, a sample diagnosed to have ASD, and a normative general population sample. Results: The TS sample had significantly higher mean SCQ scores than the general population, but generally lower scores than the ASD sample. The group differences in mean SCQ scores between the TS and ASD sample were significant except in the domain of restricted repetitive behaviours (RRB). Conclusion: This suggests that ASD traits occur commonly in the TS population, with a significant overlap in certain clinical features. This was especially the case for complex movements or repetitive behaviours, which may represent either: i) a shared phenotype which is subclinical, ii) a phenocopy where some clinical symptoms mimic each other, or iii) a co-morbidity. Awareness of this association can be useful in identifying these symptoms as part of the comprehensive assessment of TS and addressing these to improve the overall clinical outcomes in these patients.
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Performing diagnostic radial access coronary angiography on uninterrupted direct oral anticoagulant therapy: a prospective analysis.This was a prospective observational analysis of 49 patients undergoing elective diagnostic coronary angiography while receiving uninterrupted anticoagulation with direct oral anticoagulants. This population was compared with a control group of 49 unselected patients presenting to the cardiology service for elective diagnostic coronary angiography. Continuous variables were analysed using the independent samples t-test and categorical variables using Pearson's χ2 test.
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Doctor-Patient Communication in an Outpatient SettingIt is widely recognised that effective doctor-patient communication plays a vital role in patient care. Doctors must aim to develop rapport and build a trusting relationship with the patient. With a focus on explanation and patient-inclusive planning as per the Calgary Cambridge Guide to the Medical Interview, doctors can ensure optimal communication with their patients. Effective communication leads to greater adherence with treatment, greater satisfaction with care and it has also been shown to improve health outcomes. We can see this reflected in gynaecological malignancy where effective physician communication skills have been shown to result in improved patient outcomes following a diagnosis
