'What I've noticed what they need is the stats': lay HIV counsellors' reports of working in a task-orientated health care system.

Counselling has been recognized as an important component of HIV and AIDS care, and an essential part of HIV testing. In South Africa, a commonly used model is for lay counsellors to be trained by non-governmental organizations and then to work alongside professionals in public health clinics. In studies of counselling in health care settings in the context of HIV, there has been a relative lack of attention to the organizational and systemic issues faced by counsellors and counselling programmes.

Indoor exposures to air pollutants and allergens in the homes of asthmatic children in inner-city Baltimore.

This paper presents indoor air pollutant concentrations and allergen levels collected from the homes of 100 Baltimore city asthmatic children participating in an asthma intervention trial. Particulate matter (PM), NO2, and O3 samples were collected over 72 h in the child's sleeping room. Time-resolved PM was also assessed using a portable direct-reading nephelometer.

Methods and issues in conducting a community-based environmental randomized trial.

The environment is suspected to play an important role in the prevalence and severity of asthma in inner-city children. This paper describes the implementation and baseline data of an inner-city community-based participatory research clinical trial designed to test the effectiveness of a pollutant and allergen control strategy on children's asthma morbidity. Participants were 100 elementary-school-aged children with asthma, graduates of a school-based asthma education program in East Baltimore.

Mouse allergen exposure and mouse skin test sensitivity in suburban, middle-class children with asthma.

Background: Exposure to mouse allergen is prevalent in inner-city homes and is associated with an increased risk of mouse skin test sensitivity in inner-city children with asthma.

Objective: To determine the distribution of mouse allergen and its relationship to mouse skin test sensitivity in a primarily suburban, middle-class population of asthmatic children.

Methods: Children with asthma, 6 to 17 years old, were recruited from 3 pediatric practices located in counties surrounding the city of Baltimore and from 1 practice located within the city limits.

Cockroach allergen exposure and sensitization in suburban middle-class children with asthma.

Background: Exposure to cockroach allergen is prevalent in inner-city homes and is associated with an increased risk of cockroach sensitization.

Objective: We sought to determine the prevalence of cockroach allergen exposure in suburban middle-class homes and to study its relationship to cockroach sensitization.

Methods: Children with asthma, 6 to 17 years of age, were recruited from 3 pediatric practices located in counties surrounding Baltimore city and from 1 practice located within Baltimore city limits.

Knowledge and practice of dust mite control by specialty care.

Background: Dust mites are the primary indoor allergen risk for increasing asthma attacks and morbidity. Adherence to allergen avoidance recommendations decreases bronchial reactivity and asthma morbidity.

Objective: This study compared the knowledge and practice of environmental control advice of families of children with asthma seen by an allergist or a pediatrician.

Primary health care in the era of HIV/AIDS. some implications for health systems reform.

In this article it is argued that the current emphasis on third generation reforms to health systems places at risk the empowering comprehensive agenda of second generation reforms. Using the HIV/AIDS epidemic in South Africa as an exemplar, the authors demonstrate the importance of retaining this agenda. They suggest that the emphasis on 'packaged' priority programmes with measurable outcomes, which characterizes third generation reforms, needs to be accompanied by the reorientation of primary health care providers towards an empowering comprehensive approach to care.

The paradoxical use of interpreting in psychiatry.

Changes in the official status of African languages in South Africa suggested an examination of the impact of multi-lingualism on the practice of institutional psychiatry. For a range of theoretical and institutional reasons, a 'language gap' between clinician and patient can be rendered irrelevant in terms of the routine production of psychiatric texts in which 'symptoms' are described and 'cases' are constructed. In contrast to the way in which the role of interpreting is obscured in some hospital settings, it is highlighted in forensic settings.

Task orientated nursing in a tuberculosis control programme in South Africa: where does it come from and what keeps it going?

Task oriented nursing is associated with traditional hospital ward organisational practice. This paper describes task orientation in a tuberculosis control programme which forms part of the public health system in Cape Town, South Africa. Task oriented practice is illustrated with clinical data from a focused ethnography on the work of nurses in a tuberculosis control programme.

Impact of a mother-infant intervention in an indigent peri-urban South African context: pilot study.

Background: A high rate of maternal depression and associated disturbance in the mother-infant relationship has been found in an indigent peri-urban South African community, Khayelitsha. The question arises whether a community-based intervention could be beneficial.

Aims: To train community workers to deliver an intervention to mothers and infants in Khayelitsha, and to compare mothers and infants receiving this intervention with a sample receiving no such intervention.

The determination of phosphorus in Haemophilus influenzae type b conjugate vaccines by inductively coupled plasma-atomic emission spectrometry.

This study describes a method for the determination of phosphorus in lyophilized Haemophilus influenzae type b conjugate vaccines by inductively coupled plasma-atomic emission spectroscopy (ICP-AES). The concentration of polysaccharide is directly related to the concentration of phosphorus as measured in the laboratory. Phosphorus is present in the polyribosyl-ribitol phosphate (PRP) group of the Haemophilus influenzae type b conjugate vaccine.

The cultural construction of healing in the Truth and Reconciliation Commission: implications for mental health practice.

The Truth and Reconciliation Commission (TRC) has been widely hailed by mental health practitioners and others as a source of psychological healing. In this article we consider this claim and its relevance to clinical practice. Recent research in anthropology and related disciplines in South Africa and elsewhere raises questions about the cultural construction of traumatic memory and healing.

Post-partum depression and the mother-infant relationship in a South African peri-urban settlement.

Background: Post-partum depression in the developing world has received little research attention, and its association with disturbances in the mother-infant relationship is unknown.

Aims: To determine the prevalence of post-partum depression and associated disturbances in the mother-infant relationship in Khayelitsha, a South African peri-urban settlement.

Method: The mental state of 147 women who had delivered two months previously was assessed, and the quality of their engagement with their infants was determined.

Prevalence of psychiatric morbidity in the adult population of a rural South African village.

We report on the first South African two-stage community prevalence study of psychiatric morbidity, conducted in Mamre, a rural "coloured' village, 50 km from Cape Town. Randomly selected adults (N = 481) were assessed using the Self-Reporting Questionnaire (SRQ) as a first-stage screen and the Present State Examination (PSE-9) was administered to a proportion of the sample (N = 121) as the second-stage criterion. Demographic, health care utilization, and substance abuse data were also collected.

Reports of the experience of epilepsy in a rural South African village.

It has become increasingly acknowledge that the social and psychological consequences of epilepsy may be more debilitating than the epileptic seizures themselves. This study, which formed part of an ongoing community health project which was carried out in the South African village of Mamre, was aimed at gaining an understanding of some of these psychosocial aspects. Sixteen respondents were as well as their families, had accepted the epilepsy and learnt to cope with it, although some respondents felt stigmatized by the epilepsy and made various attempts to conceal it from outsiders.

Professional constructions of a 'lay' illness: 'nerves' in a rural 'coloured' community in South Africa.

As part of a larger study, medical practitioners working in Mamre, a 'coloured' village close to Cape Town, South Africa, were interviewed concerning their use of the term 'nerves' in interaction with their patients. Contrary to the initial perception of researchers and some clinicians, the term is not simply a folk category. It does, however, represent a medium through which psychosocial issues are discussed in the clinical encounter.