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13 Summary of health news: November 2012

13 National health insurance (NHI) & public health

15 News on HIV/AIDS, TB, malaria, & communicable diseases

16 Doctors, nurses, hospitals & training

19 Medical aids

20 Pharmaceuticals

21 Financial news

23 General news

23 Speciality pages

All articles published in Paediatric News have been sourced and approved by SAPPF and PMG. SA Media Holdings takes no respon- sibility for any of the content carried in the publication. Advertiser content and supplier editorial is carried as supplied. 2012
REVOLUTIONARY TECHNOLOGY
2012 APPSOLUTELY !

Does a doctor really need a smartphone ? Ashraf Coovadia FCP (Paeds), Department of Paediatrics and Child Health, Rahima Moosa Mother and Child Hospital University of the Witwatersrand In the last several weeks since acquiring Before I begin, I need to say from the What’s motivated me to write this my new phone...... the iPhone 4S, I have outset that I hold no brief for any of piece ? Well apart from feeling like I’ve had the opportunity to experience the the smartphone manufacturers just discovered a new world of wonder power of such a device. Let me tell you (although they should pay me!). Whilst out there with an app for absolutely that the experience has been nothing most of what I will be revealing will be everything, I have been asked by many short of mind blowing ! Now this might about the iPhone and the ‘apps’ from colleagues and junior staff to share with sound like me getting carried away with the App Store, much of this applies to them my favourite medical apps of a really cool toy, but wait let me try and all other smart phones particularly if which there are many. convince you that this is no longer a they run on the Android operating It really is my pleasure to share with luxury but actually a must have for system if the app is available for this. you my personal favourites with the every practitioner. hope that you enjoy them too.

SMARTPHONES Screen shots ! MY TOP 16 !

I figured the best way to display the apps I have is to take screenshots of my phone. THESE ARE MY TOP 16 MEDICAL This way you can get the actual name of APPS THAT I FIND VERY USEFUL the app. Then I’ll go through each briefly AND GETTING TO INCORPORATE on why I chose them. Take note of the INTO MY CLINICAL PRACTICE AND exact spelling of each app if you intend TEACHING. searching for these. EACH INDIVIDUAL IS CLEARLY GOING TO HAVE THEIR OWN EPOCRATES (FREE) PREFERENCES DEPENDING ON WHAT ONE’S LIKELY TO USE.

This is a MUST HAVE for all Why ? well it gives you information and dosages of an exhaustive list of drugs. A feature I find excellent is drug interactions. You can add as many drugs as you like to see how they will interact. No excuse for us to make any such error EPOCRATES now. It has many medical calculators too.

What about Tablets ? Whatever app one has on one’s iphone IT IS UPDATED REGULARLY AND this can and will be on a paired iPad. This ALSO HAS A NOTIFICATION is synchronized so one need only SERVICE THAT SENDS YOU A SELECTION OF KEY CLINICAL download once and if it’s a paid app, one TRIALS IN AN ABRIDGED FORMAT. pay’s once. If an android device, I think one has to I BELIEVE NO STUDENT OR download onto one’s cellphone and tablet DOCTOR IN MY UNIT SHOULD BE WITHOUT THIS. seperately. Not an expert on Android so stand to be corrected. Whilst I’m an avid fan of the iphone, I have to say that this article is really about promoting the use of smart technology with any smart phone or device (like tablets such as ipad of Galaxy tablets or Windows Surface etc, etc) into our everyday medical practice. INTERACTION !! I see this as not a luxury anymore but rather as a necessity. Schools are increasingly turning to this technology and GIVES YOU A REASON WHY THE even creches are using the power of these INTERACTING DRUGS CANNOT BE USED OR BE USED WITH CAUTION instruments as amazing educational tools. It’s just a matter of time before doctors in the wards will be using tablet devices to enable better patient and record management amongst other uses that it would have in our environment. Paediatric Apps

The popular Frank Shan Drug Doses FRANK SHAN booklet that many carry around in their pockets is now available as an app. Only downside is that it is not cheap. Note you HAS PAEDS DRUG DOSES have to key in “DrugDoses” to bring up app in the App store search. RESUSCITATION DRUGS

PICU GUIDELINES

COST $15.99 PAEDS CALCULATORS

LAB VALUES Growth Charts (WHO) With this app one can input the child’s CARDIAC SURGERY EPONYMS growth parameters after selecting the appropriate gender and exact age and this then displays the centile as we as Z score (in brackets). Additionally it calculates the BMI and provides the average BMI for the child. The weight for height is also provided with a Z score GROWTHCHARTS The simplicity of function and the wealth of information provided instanteously really makes this one of the core apps to have for anyone managing children. USEFUL IN INPUT PATIENTS’ GROWTH PARAMETERS AND SEE There is a lite (free) version as well as a WHAT THEIR Z-SCORES ARE. FOR paid version which allows one to see YOUNGER CHILDREN IT ALSO these values on a graph. INCLUDES THE HEAD CIRCUMFERENCE. WHAT’S GOOD IS Other good features is that it has THAT IT PLOTS IT ONTO A GRAPH milestones on a screen making for easy FOR YOU TOO AND GIVES YOU THE reference as well as BP norms for the age/ WEIGHT FOR HEIGHT TOO. gender selected.

FREE(LITE)

Pedi QuikCalc (put in exact spelling!) This is an example of an app that was not in the South African store but only in the PEDI QUIKCALC US/UK and a few other places. One email to the creator of this good app requesting that it be made available in the South HANDY APP FOR PAEDIATRIC African store was met with a very REGISTRARS AND MEDICAL favourable response and it was in the OFFICERS INCLUDING INTERNS. store in 24hrs from time of request !!! HELPS TO RECHECK YOUR DOSE CALCULATIONS AS WELL AS FLUID So if ever one comes across an app that is INSTRUCTIONS AS IT CALCULATES not in the SA store, write (email) the THIS ONCE YOU’VE ENTERED THE SEX creator/designer and kindly request this. AND WEIGHT OF THE CHILD ON THE Evidently it’s a relatively simple matter on FIRST SCREEN. ALSO HAS their side. ADDITIONAL FEATURES SUCH AS GROWTH CHARTS, BMI AND MID PARTENTAL HEIGHT AMONGST COST $1.99 OTHERS Medical References SKYSCAPE

Skyscape A medical reference app that is free and THIS IS A VERY HANDY has multiple reference tools. I like the REFERENCE APP WHICH IS FREE. MedAlert section with its listing of various medical news from articles or reports ALLOWS ONE TO GET QUICK INFO (such as FDA) that are released weekly. ON DISEASE CONDITIONS. ALSO HAS A DRUGS SECTION AND OTHER USEFUL RESOURCES AND FREE NOTIFICATIONS. GOOD TO HAVE IN ONE’S STABLE !

REGULARLY UPDATES AUTOMATICALLY

MEDSCAPE

Medscape Similarly this app allows one quick access to reference material on a condition and DRUGS arranged as either ‘News’, ‘Reference’ or MEDICAL CONDITIONS ‘Education”. I think if you’re working in the wards you may access this almost daily. PROCEDURES

DRUG INTERACTIONS FREE CALCULATORS

DIRECTORY

PubMed Imagine searching pubmed on your phone in a way that provides you abstracts that PUBMED you can easily read ! Fabulous resource and again one that no clinician should be without. There is the lite version for FREE HAVE YOU EVERY WANTED TO BE and the paid one that allows you access to ABLE TO DO A PUBMED SEARCH all searched references and not juts the WHILST ON A WARD ROUND OR AT A CLINICAL MEETING ? WELL first 20. THIS IS EASIER THAN YOU THINK AND YES THIS COULD HAVE BEEN DONE VIA GOOGLE ON YOUR PHONE BUT WITH THIS APP THE FREE (LITE) INTERFACE FOR READING IS BETTER AND THE OPTION TO GO TO FULL TEXT EVEN BETTER. My top app !!! PEDISTAT No situation provokes greater anxiety than when a child is rushed in as an emergency and requires resuscitation. PICTURE THIS. THE CHILD Added to this stress is the need to make WAITING ON THE BENCH IN THE quick and rationale decisions with as close ADMISSION WARD SUDDENLY to accurate dosing as possible and to STOPS BREATHING. YOU DON’T follow resuscitation algorithms. This app HAVE A WEIGHT AND THE makes it appsolutely possible ! PARENTS CAN ONLY TELL YOU HER AGE. YOU CAN INPUT THIS AND EVERY SINGLE CALCULATION YOU This is a magnificent application that really WOULD NEED IS ALREADY takes the stress out of making the wrong PERFORMED WITH JUST THIS INFO !!! decision or worse still no decision when faced with an emergency as it also incorporates algorithms into it guiding the user step by step.

COST $2.99 PEDISTAT

Well worth the spend ! I think if there is one app that really ONCE EITHER AGE, LENGTH OR captures the essence of how and why each WEIGHT IS ENTERED, ALL THE practitioner needs to have this close, then REST IS ALREADY CALCULATED this is it. There are a myriad decisions that AND ALL YOU NEED TO DO IS need to be made during an emergency and FOLLOW THE CORRECT the stress of having to make these with ALGORITHM AS DIRECTED. ALL the speed that is required and the EQUIPMENT, DRUG DOSES, FLUID accuracy that is warranted can be AMOUNTS ARE ALL AVAILABLE paralyzing. This need not be the case if one is adequately TRAINED, REHEARSED (usually as part of initial and update training through simulations) and there is preparation for such events within the environment where one operates. So whilst this app is not the be-all and end-all of emergency management, it certainly promises to reduce many of the PEDISTAT stressful thought processes and precise calculations one has to make under the circumstances. OF COURSE THIS DOES NOT REPLACE TRAINING ON THE APLS It requires just the input of a child’s age OR PALS COURSE BUT WOULD OR estimated or known weight OR the CERTAINLY AID ONE (AT LEAST IN child’s height, following which ALL the THEORY) IN THE EVENT OF AN necessary calculations required for that EMERGENCY resuscitation and MORE are provided. This takes less than 15 seconds of input time !!! PICU Numbers PICU Now imagine the child above has needed CALCULATOR to be intubated and sent to the PICU. There are a myriad calculations that one has to do from fluids, to antibiotics, to THIS IS A REALLY REALLY REALLY equipment, to drugs infusions rates to EXCELLENT APP. YOU NEED JUST appreciating the normal ranges. This can TO ENTER THE SEX, AGE AND take a very long time indeed to work out WEIGHT OF A CHILD AND ALL THE and whilst on call one can certainly make PICU CALCULATIONS ONE WOULD errors. I believe this should not only be EVER NEED FOR THE PICU STAY part of every registrars collection of IMCLUDING EQUIPMENT, DRUGS essential apps but must be made available DOSES (INCLUDING ANTIBIOTICS) to the NICU and PICU nurses. Perhaps ETC ARE ALL CALCULATED WITH each ICU and ER needs a tablet device AN INSTANT ! that can do all this. YES , YES I know how will we secure it :(

FREE (LITE) TOXICOLOGY Toxicology It turns out that the little girl above who collapsed and is now in the PICU WHAT A USEFUL RESOURCE TO ventilated had ingested grandma’s anti- HAVE WHEN ONE IS ON CALL. epileptic drugs ! Now what ? Don’t panic, USER-FRIENDLY NAVIGATION AND you have the poison centre info in your PRACTICAL TO THE POINT pocket. See what antidotes and MANAGEMENT GUIDELINES. management guidelines are provided for a multitude of common drugs overdoses ANOTHER ‘MUST HAVE’ FOR ALL REGISTRARS. and more.

FREE

MedCalc This I have found to be the most comprehensive of medical calculators out there. What’s also great about this app is that there are several clinical decision MEDCALC tools that help guide one with references too these to. There is a FREE version as well as a paid WHEN USING THIS APP ONE WILL one called MedCalc PRO. IMMEDIATELY APPRECIATE THE SOFISTICATION BUT ALSO EASE OF USE OF. CERTAINLY A VERY FREE (LITE) PROFESSIONAL DESIGN AND QUITE COMPREHENSIVE.

THE GOOD THING IS THAT IT HAS MOST CALCULATORS IN THE LIST AND SO COULD BE YOUR DEFAULT APP FOR CALCULATORS. Syndromes THE CLINICIAN’S Do you find it hard to come up with a ASSISTANT III differential list of possible syndromes when presented with a few or indeed many dysmorphic features ? Well if you’re THIS IS ONE OF THE MOST like me then you’ll love this gem of an app USEFUL APPS I HAVE THAT HELPS which does all the computing for you and ME WHEN WE HAVE A churns out a list of possible differentials. DYSMORPHIC CHILD. Truly remarkable ! Worth the expense I feel. NOTE THAT YOU NEED TO PUT IN THE WORD “SYNDROMES’ WHEN SERACHING FOR THIS IN THE APP HOW DO I GO ABOUT STORE. NARROWING THE DIFFERENTIAL LIST ?

How it helps you to think When you start looking for the input descriptor so as to come up with a more accurate description of the dysmorphic “SYNDROMES” profile, you begin to understand how this should be looked at when you examine the patient and characterize the features. IT HELPS YOU INPUT VARIOUS the lists under each category help one to DYSMORPHIC FEATURES BASED be more specific about the feature. ON SYSTEM INVOLVED AND THEN COMPUTES WHAT THIS INTO PROBABLE SYNDROMES THIS SO $4.99 AS TO GIVE YOU AN ORDER OF LIKELIHOOD.

A VERY POWERFUL TOOL INDEED !

The Companion I regard the next app called Genetics 4M as a companion to the one above. I say so because it presents the syndromes as a list in alphabetical order that when clicked on displays their individual features in a concise manner. GENETICS 4M One can also type in a feature for instance THIS WONDERFUL APP ALLOWS “Big toe, Broad” and this will then show ONE TO LOOK AT INDIVIDUAL you the differential for this. Navigation SYNDROMES WITH A BRIEF through this app is very easy and fun. DESCRIPTION OF EACH. NICE TO HAVE ON THE WARD ROUND ! FURTHER IT ALSO ALLOWS ONE TO INPUT A CLINICAL FEATURE FREE (“CLUE”) FOR WHICH A DIFFERENTIAL DIAGNOSIS IS REVEALED (VOILA !)

A REALLY COOL FEATURE IS THAT IT ALLOWS ONE TO SEE INDIVIDUAL CHROMOSOMES TO SEE WHAT CONDITIONS ARE ASSOCIATED WITH THEM WHAT ABOUT LABS ?

Lab reference values at your fingertips

LabGear The app also has a hyperlink to the “Lab tests online” website that provides even BILIRUBINOMETER This app contains reference values for just about all medical investigations one more information around each test. 1. EASY TO USE would do. It also has a brief description I think this is an invaluable resource of the test and how to interpret the particularly for our students. 2. ALLOWS MULTIPLE ENTRY result. AGAIN good to have not only when 3. DISPLAYS ACTION GRAPH It has been created by the same reviewing lab results after they have designers of the MedCal app and the been done but also BEFORE to see if it 4. ALLOWS MULTIPLE two apps are linked. By linked I mean makes sense to embark on such a cost. PATIENT RECORDS that one can be directed to the other 5. FOLLOWS THE NICE when in one application. So for instance GUIDES when one does a calculation in MedCal which involves a lab then this can with a 6. ALLOWS FOR SI UNITS click (or rather tap) of the appropriate icon take you into the LabGear app with values you may need. This works the other way around too. RADIOLOGY AND IMAGES

Radiopaedia 3D BRAIN This is a great teaching tool when one The ability to scroll down the side of a has to show radiological abnormalities CT scan image showing cut by cut view 1. EXCELLENT VIEWS OF THE including CT scan findings. is stunning ! One can go back and forth STRUCTURE OF THE BRAIN The images are clear and with the app with such ease as to really appreciate 2. ABILITY TO ROTATE AND one gets a few free images and then the pathology in the quizzes if one takes MOVE IMAGE IN VERTICAL ‘packs’ depending on speciality which the time. AND HORIZONTAL PLANES are for sale. The free 3D Brain app is not amongst 3. LABELLING OF PARTS It is worth it only if you intend learning my top 16 but I have include images of this way or are inclined to teach others this as well as a brief description in the 4. ZOOM FUNCTION and so most useful for Radiology left hand panel so that one may find this a useful free app to try out. The views 5. FREE !!! registrars or consultants I would imagine. are fantastic and I have never appreciated the ventricular structure of I have included this in my top 16 as I the brain as I have seeing these images. find that the images and the radiology Stunning !!! quizzes make for a great way to teach (and learn) this art and science. SUMMARY OF HEALTH NEWS: OCTOBER 2012

yellow fever on public holidays or weekends at OR Tambo Inter- NOVEMBER’S national Airport, as the Gauteng Department of Health does not have the budget to pay their staff overtime. (p5)

NEWS HIGHLIGHTS: Chinese book keeping? The DoH has acknowledged it did not know how many babies were unvaccinated because it had istorical pact: Health Minister Aaron Motsoaledi has only a hazy idea of the size of the population it was targeting. signed a “social pact” with CEOs of 23 companies, According to an annual report, there was a 95,1% coverage rate. Hdescribing it as a historic step towards closer collabora- However, according to the World Health Organisation (WHO) and tion between Government and private enterprise. The 23 CEOs United Nations Children’s Fund (Unicef), only 72% of babies were represent pharmaceutical, private hospital and medical scheme vaccinated. (p2) administration industries, who have committed themselves to providing fi nancial support for the next three years. Turnaround due to pressure by SAPPF and its partners: Due to sustained pressure by the SAPPF and its partners the HPCSA More news regarding cooperation between public and private has rescinded its decision to approve the Guideline tariff for healthcare is that the pharmacy division of Clicks has formed a publication. The board intends to start a new process of develop- public-private partnership with the Western Cape government to ing and publishing a guideline tariff according to section (53)(3) provide vaccines and family planning services next year. (p2) (d) of the Act. (p7).

NHI: The majority of SA’s doctors (56%) believe the country’s The GP dilemma: We all know that one of SA’s biggest problems healthcare system does not have a bright future, and they do not is the “brain drain” of GPs to other countries. Health Minister support Government’s NHI concept, but many are willing to help Aaron Motsoaledi has made many a speech promising all kinds improve it, and most of them said they will not leave the country. of solutions to this problem; BUT: Thousands of matriculants These were a few of the results of a survey released by the Medi- with straight-A’s will not be able to study at any of SA’s medical cal Chronicle and an independent health consultancy Lifechoice. schools: At Wits there were approximately 6 000 applications for (p3) 250 slots in fi rst year medicine; at Pretoria University 11 000 for 240 places; UCT had 4 400 applications for 220 and Stellenbosch Is this possible? There are no screening services available for 1 800 applications for 230 places. (p5)

NATIONAL HEALTH INSURANCE (NHI) & PUBLIC HEALTH

HEALTHCARE HAS A DEPARTMENT BAFFLED POOR PROGNOSIS BY VACCINATION RATES he majority of SA’s doctors believe the country’s healthcare he DoH has acknowledged it did not know system does not have a bright future, but many are willing to how many babies were unvaccinated be- Thelp improve it, according to a survey of medical practitioners Tcause it had only a hazy idea of the size of released by health publication Medical Chronicle and an independent the population it was targeting. health consultancy Lifechoice. Most practitioners (56%) who respond- ed did not support government’s concept of NHI. According to the Expanded Programme of Im- munisation’s annual report, there was a 95,1% They feel strongly that the government’s focus should be on fi xing up coverage rate. The fi gure refers to the benchmark state facilities that are largely ineff ective. Only 12,4% agreed with the DPT3 vaccine that protects children against dip- statement that SA health had a bright future. The majority indicated theria, whooping cough and tetanus. However, ac- that they were likely to stay in the country. Medical schemes were cording to the World Health Organisation (WHO) seen in a negative light by practitioners, who indicated that they were and United Nations Children’s Fund (Unicef), only unconvinced that the schemes had members’ interests at heart. 66% 72% of babies were vaccinated. The DoH reported of specialists thought GPs were not well remunerated, while only 21% a 98% coverage rate for measles in 2009, while of GPs felt that specialists were not well remunerated. WHO reported 62%.

Source: Business Day, 26 November 2012 Source: Business Day, 19 November 2012

PAEDIATRIC NEWS 13 NATIONAL HEALTH INSURANCE (NHI) & PUBLIC HEALTH

train more doctors, improve the skills of healthcare managers, PUBLIC, PRIVATE and ensure more doctors get specialised training in HIV/AIDS programmes. HEALTHCARE SECTORS R40-m has been committed for the fi rst year. The companies are: Abbott Laboratories, Alcon Labs, Aspen Pharmacare Holdings, SIGN ‘HISTORIC’ PACT Bausch & Lomb, Clicks Holdings, Clinix Health Group, Discovery Holdings, Dischem, Galderma, Roche, Joint Medical Holdings, ealth Minister Aaron Motsoaledi has signed a “social pact” Life Healthcare, Litha Healthcare, MediClinic, Mediscor, Med- with the private sector, describing it as a historic step scheme, Netcare, Novo Nordisk, United Pharmaceutical Distribu- Htowards closer collaboration between Government and tors and Servier Laboratories. private enterprise. The Minister and the CEOs of 23 companies have agreed to meet at least twice a year to discuss issues that • Healthcare executives said this will help build a bridge aff ect them, and have established the Public Health Enhance- between the public and private sectors and enable the two ment Fund to address the skills shortages facing the healthcare to work more closely together; an imperative if NHI is going sector. The fund pools donations from 23 companies from the to work. As the private sector is facing more regulation, the pharmaceutical, private hospital and medical scheme adminis- initiative may ease tense relations with the authorities. tration industries, who have committed to providing fi nancial support for the next three years. The money will be used to Source: Business Day, 9 November; Business Times, 4 November 2012 NHI Academy HSRC CHIEF ‘WORRIED’ to improve the health service ABOUT HEALTH SPENDING DECLINE

rom January 2013 new hospital CEOs and other high-level tate spending on health as a percentage of gross managers responsible for healthcare delivery in SA will domestic product (GDP) would decline from 4,1% in Fundergo specialised training in healthcare management at S2011-’12 to 3,95% in 2013-’14; at a time when more was the newly established Academy for Leadership and Management required to prepare for the NHI scheme, according to Human in Healthcare. The fi rst students will be the new CEOs of the 97 Sciences Research Council (HSRC) CEO Olive Shisana. Public hospitals located in 8 provinces, with the exception of the Western health spending as a percentage of government spend- Cape. The Academy aims to empower hospital CEOs with practical ing was also declining, from 13,7% in 2011-’12 to 13,4% in knowledge about the day-to-day running of hospitals, and giving 2013-’14. The Treasury indicated that an additional R6-bn healthcare workers class-based as well as on-the-job training on would be needed in 2014-’15 but this was not provided for in healthcare delivery, particularly towards the implementation of the the policy statement. Shisana hoped that the release of the NHI scheme. Min. Motsoaledi said no new hospital CEO would start proposed options for revenue for the NHI would shed light on work before he/she had been taken through the necessary paces its fi nancing. Budget allocations to the NHI conditional grant, at the Academy. An advisory committee comprising 12 senior established in April, were too small to allow for testing various local and international experts in healthcare delivery will lead and components of NHI as intended. provide guidance to the Academy. Source: Business Day, 1 November 2012 Source: Health-e News Service, 8 November 2012

believes the NHI will neither Plans and recruitment on track for NHI roll out; bankrupt SA nor lead to ineq- uity. Reid, who is also a member Reform prompts mixed reaction; Doctors have doubts of the Health Minister team on the NHI pilot districts, said the NHI was ideal for everyone as its he DoH says the roll out of NHI is on track, with doctors goal was to provide health services based on patients’ need, and specialists being recruited. Most specialists had been regardless of their ability to pay. IT was the only option that Tappointed and deployed to districts that were piloting the would work for SA’s health system as costs of private health- NHI. care were spiralling out of control and becoming unsustain- able, while the public health sector was struggling on many • GPs were enlisting to help with the implementing of the fronts, especially with quality of care, he said. NHI and the DoH was fi nalising the legal and contractual requirements. However, some doctors are sceptical of the • Jacky Thomas from SA NGO Coalition (Sangoco) said while department’s proposal as many felt they were being dic- the NHI had the potential to transform healthcare across tated to by administrators and the needs of the community SA, this was not guaranteed. She said it was important were not being addressed properly. Some said there was to support and monitor the NHI initiative to ensure that no clarity on doctors’ remuneration or whether they would it achieved universal access to, and quality of essential work from clinics or treat state patients in their rooms. healthcare.

• Prof Steve Reid, the director of primary healthcare at UCT, Source: The Cape Argus, 1 November 2012

14 PAEDIATRIC NEWS NATIONAL HEALTH INSURANCE (NHI) & PUBLIC HEALTH

will be providing babies with government-procured vaccines. Consumers will be able to book a half hour consultation with a nurse for R75. Vaccines will be free. Clicks will also provide family planning services, at R50 per consultation. Western Cape health MEC Theuns Botha said partnering with the private sector was “a practical, sustainable way to expand the reach of public healthcare and enhance the quality of care”. Clicks held 16,2% of the market at he pharmacy division of Clicks has formed a public-private the end of August, and expects to add 20 - 30 new stores next year. partnership with the Western Cape government to provide Tvaccines and family planning services next year. The retailer Source: Business Day, 22 November 2012

NEWS ON HIV/AIDS, TB, MALARIA & COMMUNICABLE DISEASES

AIDS threat recedes as internal spending exceeds foreign help; AIDS council chides UNAIDS’ report; More important to get patients on sustainable, aff ordable drugs; UN lauds SA for HIV fi ght

ow- and middle-income countries have doubled spending on HIV, saying the end of the epidemic was nowhere nigh. He AIDS to $8,6-bn (R76-bn) since 2005, compared with interna- said recurrent drug shortages at public hospitals and clinics Ltional funding for the disease that stalled at $8,2bn last year, were undermining patient confi dence in SA’s health system, the Joint UN Programme on HIV/AIDS, or UNAIDS, said in its annual and increasing the risk they would not stick to their daily pill report. The virus is still spreading in the Middle East, North Africa, regimens. Eastern Europe and central Asia as poorly targeted or inadequately funded programmes fail to check epidemics. The Caribbean expe- • Meanwhile, an HIV specialist, Prof Brian Guzzard from the UK, rienced the steepest decline in new cases, with a fall of 42%. About said it is more important to deal with the costs of the medi- S24-bn a year will be needed by 2015 to meet targets of reducing cines and how to sustain access to it, rather than treatment new infections through sex and needle sharing by half, eliminating outcomes. He said studies from the US showed that patients new infections among children, and expanding treatment to 15 likely to get onto treatment earlier, are those who are wealthy million people. and often less likely to have a high incidence of HIV infection. He said doctors needed to discuss how to give the cheapest The report also stated that the number of new HIV infections last and simplest treatment to the largest number of patients. year was 20% lower than in 2001. He revealed that 15% of all HIV-related deaths were due to cryptococcal meningitis and that current treatment options • The executive director of UNAIDS, Michel Sidibé, praised SA were inferior. for “increasing its HIV treatment by 75% in the last two years”. About 1,7-m of the 5,1-m HIV-positive South Africans now • Government’s HIV/AIDS programme is bearing fruit, with have access to ARVs. There were 100 000 fewer deaths from fewer deaths now than in 2006. Pali Lehohla, Statistics South HIV in SA in 2011 compared with 2010, and the infection rate Africa’s statistician-general, said it looked as though SA had had fallen by 50 000 between 2009 and 2011. However, more turned the corner, probably, in the face of availability of ARVs. than 2,5-m people worldwide were infected with the virus last The report said it was hard to state that AIDS was the cause year. Of the 34-m people living with HIV, about half did not of the majority of deaths prior to 2006 because it was not a know their HIV status. notifi able cause of death.

• However, the deputy head of the SA National AIDS Council Source: Bloomberg, 21 November; Health-e News Service, 31 October, (Sanac) has taken issue with the “rosy picture” UN joint agency 27 November; Business Day, 28 November; The Times, 21 November on HIV/AIDS (UNAIDS) has painted of the world’s response to 2012

where yellow fever certifi cates were supposed to be inspected had OR Tambo ‘could be conduit for diseases’ also been “disrupted” at both airports due to a shortage of staff and non-payment of overtime and night duty allowances to em- here are no screening services available for yellow fever ployees. OR Tambo’s thermal imagers, used to detect fevers among on public holidays or weekends at OR Tambo International passengers, were out of service because maintenance contracts TAirport, as the Gauteng DoH does not have the budget to had not been paid. DA spokesman for health in parliament, Jack pay overtime to staff . MEC Hope Papo said disinfection services - Bloom, said he had been reliably informed that it had been since spraying visiting aircraft from malaria and yellow-fever endemic May. countries with insecticides to kill mosquitoes - had been “disrupt- ed” at OR Tambo and at Lanseria International Airport. The desks Source: Business Day, 27 November 2012

PAEDIATRIC NEWS 15 NEWS ON HIV/AIDS, TB, MALARIA & COMMUNICABLE DISEASES

TB RATES HAVE NOT CHANGED Wood said a large part of the problem was that the world was stuck on discussing the “ineff ective”, such as Directly IN 100 YEARS; DRUG RESISTANT Observed Treatment Strategies for TB, versus the “unob- tainable”, which involved social development. TB A THREAT; CENTRE EARNS • Research published in the Lancet medical journal in Au- INTERNATIONAL AWARD gust 2012 suggested that MDR TB was becoming increas- ingly prevalent in Africa, Asia, Latin America, and parts of uberculosis transmission rates in SA and more specifi - Europe. MDR TB was 200 times more costly to treat than cally Cape Town have not changed at all over the past 100 TB, and had severe side eff ects. SA had a TB incidence rate Tyears. At the SA HIV Clinicians’ Society conference in Cape of 981 per 100 000 people. In April 2012, the government Town Prof Robin Wood said with the arrival of HIV, survival rates launched a three-year health plan to treat TB alongside HIV dropped like a stone, but in New York, long-term survival had for the fi rst time, with the aim of halving the TB death rate continued. Among HIV-positive patients, a third of TB cases by 2015. were found to be retreatment of TB cases, meaning they had been cured, but infected again. • The Desmond Tutu TB Centre (DTTC), at the University of Stellenbosch, will receive the international R5,6 -m Kochon • According to a novel study children were most at risk in Prize for its research into childhood TB and its pioneering their homes and crèches, with evidence of “quite a bit of community-based approaches to TB and HIV care. risk” when using public transport. Among 18- to 24-year- olds, the risk was less in the household, but very high when Source: The Cape Times, 13 November; SAPA, 4 November; Health-e using public transport and also in some work situations. News Service, 27 November 2012

ing SA, Mexico, Brazil and India, will tackle the scourge of FIGHTING THE SCOURGE OF non-communicable diseases (NCDs), paying particular attention to diabetes. WHO predicts that in the next 15 years the number of people with diabetes in SA will multiply by 300%. Non- NON-COMMUNICABLE communicable diseases are chronic diseases, including heart DISEASES diseases and cancer. The project aims to make direct contact with patients (especially in rural areas) at the primary healthcare he SA phase of the Lilly NCD partnership, a US$30-m clinic level. global project aimed at addressing non-communicable Tdiseases, has recently been launched. The project, involv- Source: Health-e News Service, 13 November 2012

DOCTORS, NURSES, HOSPITALS & TRAINING

Failing healthcare hit FIGHT TO GET INTO Council comes down by double-whammy on tardy medics ccording to lawyer Gary Austin MEDICAL SCHOOL he has won about R30-m from lmost 10 000 healthcare practi- Aprovincial health departments tioners were suspended from the housands of matriculants with in the past seven months. Most of the AHealth Professions Council (HPCSA) straight-A’s aspire to get into medi- allegations are directed at government register for failure to pay their annual fees. cal school - but admission is uncer- hospitals. Gauteng DoH spokesman T They included 1 500 medical and den- tain even among the brightest. At Wits Simon Zwane said the department was tal practitioners, 6 500 emergency care there were approximately 6 000 applica- taking steps to improve healthcare to workers, and almost 600 psychologists. tions for 250 slots in fi rst year medicine; at prevent further problems and to avoid Practitioners had to pay their annual fees Pretoria University 11 000 for 240 places; further lawsuits. Due to legal claims on or before April 1 every year. The money UCT had 4 400 applications for 220 and of R1,4-bn against the Gauteng DoH it is used by the council to act on its mandate Stellenbosch 1 800 applications for 230 could face further budgetary con- of protecting the public and guiding the places. straints. professions. Source: The Citizen, 2 November 2012 Source: The Times, 19 November 2012 Source: SAPA, 5 November 2012

16 PAEDIATRIC NEWS

DOCTORS, NURSES, HOSPITALS & TRAINING

Gauteng: Bara has big problems: Outcry as private ambulances are told to pay e-tolls; Union challenges DoH on claims; Delay tactics on medicines depot fi ndings; Current CEO deemed not fi t enough to manage Bara; Shot in arm for Gauteng healthcare; Bara doctor who charged for free eye operation fi red

he Gauteng DoH has been granted a R2,4-bn bailout to sort ting a new intensive care ward and other infrastructure boosts out the provision of healthcare in hospitals, clinics and other such as lifts and generators being repaired and upgraded. Thealth facilities. The fi nance department also gave the health department an additional R3-m as a once-off for medical services • Controversial CEO Johanna More will vacate her position at during the Africa Cup of Nations. Bara at the end of December after a fall-out with, among oth- ers, the Gauteng portfolio committee on health. • Meanwhile the department is delaying the announcement of fi ndings of a forensic investigation into suspected fi nan- • A doctor at Bara, Dr D Soma, has been fi red for charging a cial irregularities at the provincial medicines supplies depot pensioner R3000 for an operation which is free at public in Auckland Park. The depot’s services cost the department health facilities. Five operations at the hospital had to be can- R250-m per month. According to DA health spokesman Jack celled because of another doctor, who was accused of work- Bloom, corruption and mismanagement at the depot are the ing at a private hospital when he was meant to be at Bara. root causes of the shortage of medicines supplies that hit the province’s health facilities towards the end of last year. • Private emergency services may now have to pay the contro- versial e-tolls to get to accident scenes or risk lives by delays • Chris Hani Baragwanath Academic, the biggest hospital in on response times using alternative routes. Only emergency SA, also has massive problems. These problems needed more vehicles belonging to the Gauteng provincial government, than a patchwork approach if it is to shed its dysfunction, said the City of Jo’burg, the City of Tshwane and Ekurhuleni are Prof Karl von Holdt, director of the Society Work and Develop- automatically exempt from paying e-tolls. Some private ment Institute at Wits, in a lecture about appointing practising emergency services said they had been trying to negotiate clinicians at the helm of hospitals. Von Holdt was involved with Sanral for exemption under the draft regulations to no with the Naledi project that started in 2000 but was shut avail. down in 2010. Source: The Saturday Star, 3, 24 November; The Star, 7 November; • The Gauteng DoH recently announced that Bara will be get- SAPA, 13, 27 November; Health-e News 2, 20 November 2012

WESTERN CAPE: R130M IN CLAIMS FOR HEALTH EASTERN CAPE STRIKE estern Cape DoH could end up paying more than R130-m in medico-legal and civil claims if litigation against its health Wworkers is successful. According to the auditor-general’s MAKES CLINICS BLEED 2011/2012 report, new claims worth R62,3-m relating to botched medical treatment and procedures were registered during this period, n the Eastern Cape more than 100 rural clinics while civil and legal claims amounted to R1,1-m. Just over 9 300 med- and a number of hospitals have been aff ected ico-legal cases were admitted. The report also revealed an increase in Iby the strike by administrative staff . About cases of corruption, nepotism, fraud, fi nancial and human resource 4-m people depend on the aff ected services and irregularities at the department. About 60 people were dismissed in large parts of the aff ected area fall under the OR the 2011/2012 fi nancial year due to theft, bribery and absenteeism. Tambo District, a NHI pilot site. Dr Karl le Roux at Zithulele Hospital, said the strikers were holding • During the discussion of the report, the department was also the sick and poor at ransom in order to get a pay quizzed on its policy for the proposed NHI, which contradicted rise. Clinics were running out of essential medi- that of the national DoH. Health MEC Theuns Botha told the com- cines such as ARVs and antibiotics. mittee that the department had communicated the province’s model to the national Health Minister, Aaron Motsoaledi who Source: Health-e News Service, 2 November 2012 backed a pilot operation at Eden in the Western Cape.

Source: The Cape Argus, 5 November 2012

18 PAEDIATRIC NEWS DOCTORS, NURSES, HOSPITALS & TRAINING

professionals, and insuffi cient maintenance and infrastructure MPUMALANGA: SAHRC TO PROBE development at the hospitals. HOSPITALS; LIMPOPO: OFFICIALS • Health Minister Aaron Motsoaledi said the Limpopo health department’s extensive failings were because of mismanage- ‘BEHIND HEALTH WOES’ ment, not a shortage of money. An investigation by the DoH had identifi ed a host of shortcomings in the way Limpopo DA complaint about the state of 32 hospitals in Mpumalan- had been running its aff airs. Among the problems were pilfer- ga will be investigated by the SA Human Rights Commission age, theft, corruption, expired medicines and poor logistics A(SAHRC). SAHRC provincial manager Eric Mokonyama said it (about R14-m worth of medicines in Limpopo had expired). would undertake to probe the state of aff airs at the hospitals, look- ing at: a moratorium on the fi lling of vacancies, shortages of health Source: SAPA, 8 November; Business Day, 27 November 2012

MEDICAL AIDS

BATTLE: DISCOVERY VERSUS TRANSNET; DISCOVERY APOLOGISES FOR ‘WRONG’ RULES

iscovery alleges that Transnet, Transmed and healthcare Dr Monwabisi Gantsho, Registrar of Medical Schemes, says his brokers Aon are conspiring to bankrupt Discovery by offi ce will not tolerate discrimination against medical scheme Dencouraging the wholesale transfer of Transmed members members. to the scheme. Since Transnet and Transmed decided to close a low-cost option Ubuntu option in 2009 a fl ood of older Transmed • Discovery Health Medical Scheme has apologised for members wanted to join Discovery’s low-cost KeyCare plans. A rul- misleading its 2,4-m members about the requirements for ing by the Appeal Committee last month revealed that DHMS is of convening a special general meeting, saying the rules on its the view that it is being forced to take on the Transmed members website, which contain more stringent requirements than after both DHMS and the Government Employees’ Medical Scheme those actually registered with the CMS, had been put there (GEMS) declined off ers to merge with Transmed. Discovery was by mistake. The issue is important in the light of growing ordered to admit a Transmed member who had applied to join consumer activism among the medical scheme’s members DHMS. DHMS says it received 2 500 membership applications from involving the fees the scheme pays its administrator, Discov- Transmed members, mainly for its KeyCare options. The Medical ery Health, a subsidiary of JSE-listed DHMS. DHMS’ proposed Schemes Act obliges open schemes to admit anyone who wants to changes to rules for special meetings were rejected in April join, whereas restricted schemes are entitled to limit their mem- by the Council for Medical Schemes (CMS) because Discovery bership to a group. had not consulted its members via ballot or annual general meeting. According to Discovery an infl ux of members from Transmed will unfairly transfer the risk and liability for these members from Source: Personal Finance, 3 November; Business Day, 22 November Transmed and Transnet to DHMS and its current members. 2012

cation. The board intends to start a new process of developing TURNAROUND DUE TO and publishing a guideline tariff according to section (53)(3)(d) PRESSURE BY SAPPF of the Act. SAPPF et al objected to the fact that they had not been en- AND ITS PARTNERS gaged meaningfully in the development and determination of the tariff which limited their rights to fair administrative action n a press statement the South African Professional Practi- and therefore rendered the tariff unconstitutional and unlawful. tioners Forum (SAPPF) announced that due to sustained SAPPF states it will insist that a guideline tariff be developed Ipressure by the forum and its partners (SADA and SAMA, that prevent overcharging; takes into consideration the true together with the Anaesthetic and Radiological Associations, costs of providing services; and the tariff be developed within the National Pathology Group and the GP IPA Foundation,) the parameters permitted by the Competition Act. the Health Professions Council of South Africa (HPCSA) has rescinded its decision to approve the Guideline tariff for publi- Source: SAPPF media release

PAEDIATRIC NEWS 19 MEDICAL AIDS

‘Bhabhaza’ MORE OPTING OUT OF MEDICAL SCHEMES AS scam leaves patients without medical aid COSTS RISE ata from Alexander Forbes Health’s Annual Diagnosis benefi ts showed that the cost of belonging to a private medical Daid was becoming less aff ordable and people were edical aid scheme fraud by doctors in cahoots with either downgrading their cover or opting not to be part of members has lead to a new scam bhabhaza (sick) a scheme at all. Medical treatment costs and medical aid where a doctor gives medical scheme members cash, M contribution costs had risen on average over the past 12 years then claims the money - and more - back from the medical at 2,5% and 1,7% higher than CPI (consumer price infl ation) aid, even though he may not have treated the patient. The respectively. Fewer people joining schemes meant increased scam was said to be rife among civil servants. These irregular pressure on state-run hospitals, and increased vulnerability activities and the over-use of funds cost the medical scheme for schemes. The report also warned against the rise of an oli- industry R5-bn to gopoly of the most prominent funds (Discovery: 1,075-m, and Bonitas: 275 780 principal members). R8-bn a year. The worst-hit scheme appears to be GEMS. Source: The Star, 23 November 2012 Source: The Star, 19 November 2012

earlier this year. GEMS now covers about 62% of all eligible public GOVERNMENT WORKERS’ service employees.

• The decision by National Treasury to move the pensioners to MEDICAL SCHEME GEMS in March this year was expected to result in a saving for government in the subsidy, for which it is liable in terms of CONTRIBUTIONS TO RISE an agreement with these former employees. 96,6% of these pensioners (average age 82) were users of chronic medicines, MORE THAN 10% while 95% claimed benefi ts on a monthly basis. • Other large open schemes that have announced increases EMS has announced an average increase in contributions higher than 10% are Discovery: 10,9%; Liberty Health, Medi- for next year of 10,26% as a result of its need to build help and Resolution Health. Greserves and its intake of about 16 000 pensioners (former state employees, Medihelp-members, who retired before 1992) Source: Personal Finance, 17 November 2012

PHARMACEUTICALS

would be worth about R1,95-bn. But analysts argued that Cipla Indian bid for Cipla Medpro Medpro was worth more than that.

• Meanwhile Cipla has announced that it has appointed two ‘derisory’; Cipla Medpro new deputy CEOs; the fi rst step towards restoring good cor- porate governance. Dr Skhumbuzo Ngozwana: regulatory and pharmaceutical industry aff airs, and Mark James: fi nance and appoints two deputy CEOs corporate governance issues.

ndian pharmaceutical company Cipla made a bid for a 51% • Cipla has been the talk of the pharmaceutical industry since stake in SA’s Cipla Medpro at R8,55 a share. Cipla Medpro was mid-August, when its board suspended Smith. Allegations Ifounded by former CEO Jerome Smith in 1993 and is SA’s third- against Smith included awarding himself R3,6-m in unautho- largest generic drugs pharmaceutical fi rm. Smith, who resigned rised bonuses and taking undeclared interest-free loans from last month after Cipla Medpro’s board suspended him and charged the fi rm. him with a string of alleged fi nancial irregularities, dismissed speculation that he might return to the company should Cipla In- Source: Business Day, 5, 22 November; The Financial Mail, 23 Novem- dia’s bid succeed. With 4,465-m shares in issue, the proposed deal ber 2012

20 PAEDIATRIC NEWS PHARMACEUTICALS

MUMBAI INDIA DOCUMENTING WHAT THE REVOKES ROCHE HEPATITIS DRUG PATENT HEALERS ALREADY KNEW

ndia has dealt a fresh blow to the international pharmaceutical he discovery of old notebooks belonging to an adventur- industry as its patents appeal board revoked a patent granted ous Norwegian Dr Henrik Blessing, who lived and worked Isix years ago on Roche’s hepatitis C drug Pegasys. The Intel- Tin the now-known as KwaZulu-Natal in the 1800’s, culmi- lectual Property Appellate Board cited a lack of evidence that the nated in the launch of a book detailing the traditional uses of drug was any better than existing treatments and its high price nearly 100 medicinal plants from that region. SA Traditional as reasons for the decision. The revocation will rekindle tensions Medicinal Plants from KwaZulu-Natal catalogues traditional between New Delhi and global drugmakers worried by the coun- uses of the plants and modern scientifi c records of their eff ects. try’s tough stance. The decision follows another high-profi le ruling Traditional medicines are widely used in SA, with politicians in March, when India granted the fi rst ever compulsory licence to frequently claiming that up to 80% of the population uses domestic drugmaker Natco to sell cheap copies of Bayer’s cancer them. More than 300 local plants are traded with an economic drug Nexavar. Generic medicines account for more than 90% of value of R4-bn a year according to the University of the Western drug sales in India. Cape’s.

Source: Reuters, 4 November 2012 Source: Business Day, 14 November 2012

ILLEGAL SUBSTANCES Solal: Bitter pill to IN OTC DIET PILLS swallow as ASA rules on ean Genie’s JS Slim slimming capsules and Lifestyle Tradelink’s Fruits & Vegeta- anti-ageing claims Lbles capsules, sold countrywide as “100% natural” have been found to contain sibutra- he Advertising Standards Authority (ASA) has ordered Solal Technologies, a SA mine and phenolphthalein. Sibutramine is a company professing to be “leaders in anti-ageing, integrative and preventative schedule-fi ve drug that can cause serious side Tmedicine”, to stop making misleading claims about several of its key products. eff ects such as heart palpitations and high In hearings the ASA found the company had failed to provide adequate substan- blood pressure and increase the chances of a tiation for some of its claims. In the case of Solal’s Anti-Aging Pill, the company heart attack or stroke in people with a history has been ordered to stop using the name of the product, as it was unable, in the of cardiovascular disease. Phenolphthalein is directorate’s view, to provide evidence to back up the expectation that the name a laxative that could potentially cause cancer created in consumers’ minds. Complainant Dr Harris Steinman told the ASA there in humans. It was withdrawn from the market was no single study that tested this product formulation on humans. SA Directorate more than 10 years ago. also ruled against two other Solal products’ claims: 24-in-1 Super Fruit & Veg Drink and Solal’s Flu Bacteris. Source: Health24, 20 November 2012 Source: The Star, 28 November 2012

FINANCIAL NEWS

previous period. Including a once-off item of a R185-m gain on for- eign exchange forward contracts taken out ahead of the comple- MEDICLINIC FOCUSES tion of its deal to refi nance its Swiss debt, headline earnings per share increased 83% to 141,5c. Growth was driven by increased ad- missions of seriously ill patients who stayed in hospital for longer ON NHI ROLLOUT COSTS and required more expensive technology, and a weaker rand. Rev- enue increased 12% to R11,7-bn; and normalised earnings before interest, tax, depreciation and amortisation rose 14% to R2,49-bn. ediclinic and its rivals hope the NHI scheme will provide In Switzerland, 13 out of 14 of its Hirslanden hospitals had been opportunities to sell their services to the state, as private accredited to provide services funded by their respective cantons. Mhospital group Netcare did in the UK, said group CEO The company is expanding in SA as well as southern Africa. Danie Meintjes. Mediclinic International reported a 45% rise in normalised headline earnings per share to 112c, up from 72c in the Source: Business Day, 7 November 2012

PAEDIATRIC NEWS 21 FINANCIAL NEWS GlaxoSmithKline to raise stakes in India, STRIKE, COSTS TAKE THEIR TOLL ON LITHA; LIFE PLANS FOR Nigeria units 1 000 MORE HOSPITAL BEDS laxoSmithKline (GSK) plans to buy about 321-m shares of GSK Consumer Nigeria itha Healthcare has reported its fi rst set of quarterly results following Gfor a total of $100-m, the London-based its acquisition by Canadian fi rm Paladin earlier this year, disclosing a company said. Glaxo also off ered to buy as many as Ldisappointing three-month period. It was the fi rst time the group was 13,4-m shares of India’s GSK Consumer Healthcare reporting in line with Paladin’s requirements. A transport strike, the weaken- for $940-m. The off er price in both cases is about ing rand and lower than expected sales of pneumococcal vaccines aff ected 28% above the previous last close for the shares. If performance. CEO Michael Flemming said Life’s operating profi t rose 17% to Glaxo buys the maximum amount of shares in the R2,54-bn, up from R2,17-bn in the previous fi nancial year. A fi nal dividend of off ers, the company’s stake in the India unit will 60c, up slightly on last year’s 54c was announced. rise to 75% and its holding of the Nigeria operation will climb to 80%. Indian law requires a minimum Litha was still in talks over a technology transfer agreement for fl u vaccines. public shareholding of 25%, while 20% is needed It is the only JSE-listed pharmaceutical company to have invested in vaccine for a Nigerian stock listing. Glaxo’s pharmaceutical production, through its joint venture with the government, called Biovac. It sales fell 2% at constant exchange rates in the fi rst also plans to open 1 000 more beds within the next four years, anticipating a nine months of this year. growing demand from an increasingly sick population.

Source: Reuters, 26 November 2012 Source: Business Day, 14, 19 November 2012

Netcare LENMED: VENTURE writes down value of INTO AFRICA UK business by R11-bn; hile SA’s top private hospital groups seem to prefer developed mar- Famous Brands to run kets, a smaller competitor, Lenmed Health, is targeting Africa. After Wbedding down two acquisitions, in Botswana and Mozambique, the Netcare coff ee shops group is in discussions to enter Nigeria and Ghana. Lenmed is a community- orientated group founded by the residents of Lenasia in 1984. It has grown etcare has reported a R9,3-bn loss for the signifi cantly under Devchand, a fi nalist in last year’s Ernst & Young World year to September as it wrote down the Entrepreneur Awards. It will have nine hospitals by year-end, with 1 300 beds. Nvalue of its UK business by R10,7-bn and saw a decline in its most profi table patients. Netcare Source: The Financial Mail, 23 November 2012 owns a stake in the UK’s biggest private hospital group, General Healthcare Group (GHG). Analysts said the health insurance market in the UK reacted pro-cyclically to economic downturns because everyone had universal free access to the National Health Service and they dropped private insurance Adcock full-year when household budgets were squeezed. In the UK, earnings before interest, tax, depreciation and amortisation (ebitda) fell 6,6 % to £176,1-m; in SA a operating profi t slides 10,8% increase in ebitda to R2,8-bn was reported. dcock Ingram reported a 19% drop in operating profi t to R869-m for Netcare also provides pharmacy, emergency and the year to September 30, as consumers opted for cheaper products primary healthcare services. Aand the cost of imported ingredients rose because of the weak rand. Adcock Ingram faced steeper input costs thanks to higher water, electricity, • Famous Brands has won a tender to provide transport and labour bills Adcock Ingram reported a 2,4% increase in revenue Netcare hospitals with catering and retail. to R4,64-bn for the period under review. Headline earnings per share fell The group’s franchise, Creative Coff ee, was spe- 9% to 422,4c, while earnings before interest, tax, depreciation and amortisa- cially tailored for Netcare’s Net Café contract. tion (ebitda) dropped 16% to R986-m.Turnover in its prescription business The format of these cafés would comprise a decreased by 6,9%; over-the-counter turnover rose 11,4% to R1,79-bn. The fully-fl edged convenience retail and restaurant upgrade at the Aeroton facility and construction of the high-volume liquids off ering. facility at Clayville were both completed, with capital expenditure in the year amounting to R512m. Source: Business Day, 20 November; Fin24.com, 19 November; Business Report, 23 November 2012 Source: Business Day, 28 November; Business Report, 28 November 2012

22 PAEDIATRIC NEWS GENERAL NEWS

Clinical trials Springs woman leads battle ‘need more African cash’ in British court to get paid

uropean research, innovation and science commissioner out for agonising operation Máire Geoghegan-Quinn asked African countries to Ecommit funds to the European and Developing Coun- n 2007 Martie Botha had a hip replacement that was sup- tries Clinical Trials Partnership programme, which channels posed to last 20 years, but 5 years later she had to have a European Union (EU) funding to health research in Africa. Isecond replacement after months of debilitating pain. Botha Health Minister Motsoaledi said Africa could not continue and 70 other South Africans are seeking compensation through to depend on “handouts”. He noted that while SA received the courts from UK-based healthcare manufacturing company donor funding for its HIV treatment programmes, it had DePuy Orthopaedics. DePuy’s ASR Hip System - a metal head drawn more than 80% of the required budget from the fi scus. fi tted into a metal cup to form a socket - was recommended Geoghegan-Quinn said the European Commission would specifi cally for many younger patients like Botha because of its propose a fi vefold increase in the EU’s funding for clinical supposed long life. But in 2010 DePuy issued a recall as studies trials in Africa to €1-bn, on condition that EU member states, showed the system had a failure rate of 13% within the fi rst fi ve the private sector, philanthropic organisations and African years. By that time, there were 93 000 ASR patients worldwide; 3 countries also contributed. 400 of them were from SA.

Source: Business Day, 6 November 2012 Source: The Star, 7 November 2012

SPECIALITY PAGES

annual sleep study and are evalu- ated for potential adenotonsil- ADENOTONSILLECTOMY lectomy if obstructive apnoea events are present. To evaluate the MAY HELP RESOLVE SLEEP APNOEA IN effi cacy of adenotonsillectomy in the treatment of sleep apnoea in Prader-Willi syndrome, investiga- KIDS WITH PRADER-WILLI SYNDROME tors performed a retrospective chart review. Thirteen patients met the study criteria and were cat- hildren with Prader-Willi syndrome may receive relief from egorised based on severe, moderate or mild apnoea/hypopnoea sleep disorders after undergoing an adenotonsillectomy, indexes and obstructive hypoxia. Caccording to a study published in the November print issue of the Archives of Otolaryngology-Head and Neck Surgery. Findings showed that 89% of the patients with mild-to-moderate obstructive sleep apnoea or obstructive hypoventilation nor- “Patients with Prader-Willi syndrome are at risk for sleep disor- malised after receiving adenotonsillectomy. Of the four children dered breathing as growth hormone commonly used to treat their with severe obstructive sleep apnoea, 2 normalised after surgery condition can cause the tonsils and adenoids to enlarge,” said lead and 2 continued to have severe apnoeas. author Kris Jatana, MD, Otolaryngology Head & Neck Surgery, Nationwide Children’s Hospital, Columbus, Ohio. “These fi ndings suggest that adenotonsillectomy is eff ective in most children with Prader-Willi syndrome who demonstrate mild “Growth hormone in a low dose is extremely benefi cial to most to moderate obstructive sleep apnoea, but may not be curative in patients with Prader-Willi syndrome,” said David Repaske, MD, children with severe forms of the condition,” said Dr. Jatana. Prader Willi Center, Nationwide Children’s Hospital. “This benefi - cial eff ect has nothing to do with growth, but rather, it markedly The researchers stressed that patients should receive a repeat improves patients’ ability to eat, sit, stand, walk or run depending sleep study 6 to 8 weeks postoperatively since an increase in on their developmental stage and due to a positive eff ect on their central apnoeas can occur in some Prader-Willi children after upper low muscle tone.” airway surgical intervention.

At Nationwide Children’s, patients with Prader-Willi undergo an Source: Nationwide Children’s Hospital

PAEDIATRIC NEWS 23 SPECIALITY PAGES

n a sobering study published in the journal Environmental Perhaps most disturbing, preschool-age children had higher expo- Health, researchers at UC Davis and UCLA measured food- sure to more than half the toxic compounds being measured. Even Iborne toxin exposure in children and adults by pinpointing relatively low exposures can greatly increase the risk of cancer or foods with high levels of toxic compounds and determining neurological impairment. how much of these foods were consumed. The researchers found that family members in the study, and preschool children “We need to be especially careful about children, because they in particular, are at high risk for exposure to arsenic, dieldrin, tend to be more vulnerable to many of these chemicals and their DDE (a DDT metabolite), dioxins and acrylamide. These com- eff ects on the developing brain,” says Hertz-Picciotto. pounds have been linked to cancer, developmental disabilities, birth defects and other conditions. However, the study also Though these results are cause for concern, the study also outlines points to dietary modifi cations that could mitigate risk. strategies to lower family exposure. For example, organic produce has lower pesticide levels. In addition, toxin types vary in diff erent “Contaminants get into our food in a variety of ways,” said study foods. Certain pesticides may be found in lettuce and broccoli, principal investigator Irva Hertz-Picciotto, professor and chief of while others aff ect peaches and apples. the Division of Environmental and Occupational Health at UC Davis. “They can be chemicals that have nothing to do with the “Varying our diet and our children’s diet could help reduce ex- food or byproducts from processing. We wanted to understand posure,” said Hertz-Picciotto. “Because diff erent foods are treated the dietary pathway pesticides, metals and other toxins take to diff erently at the source, dietary variation can help protect us from get into the body.” accumulating too much of any one toxin.”

Researchers assessed risk by comparing toxin consumption to Families also can reduce their consumption of animal meat and established benchmarks for cancer risk and non-cancer health fats, which may contain high levels of DDE and other persistent or- risks. All 364 children in the study (207 preschool children ganic pollutants, and switch to organic milk. While mercury is most between two and seven and 157 school-age children between often found in fi sh, accumulation varies greatly by species. Smaller fi ve and seven) exceeded cancer benchmarks for arsenic, diel- fi sh, lower on the food chain, generally have lower mercury levels. drin, DDE and dioxins. In addition, more than 95 percent of pre- In addition, acrilomides are relatively easy to remove from the diet. school children exceeded non-cancer risk levels for acrylamide, a cooking byproduct often found in processed foods like “Acrilomides come from chips and other processed grains, said potato and tortilla chips. Pesticide exposure was particularly co-author Deborah Bennett, associate professor of Environmental high in tomatoes, peaches, apples, peppers, grapes, lettuce, and Occupational Health at UC Davis. “Even if we set aside the broccoli, strawberries, spinach, dairy, pears, green beans and potential toxins in these foods, we probably shouldn’t be eating celery. large amounts of them anyway. However, we should be eating fruits, vegetables and fi sh, which are generally healthy foods. We “We focused on children because early exposure can have just need to be more careful in how we approach them.” long-term eff ects on disease outcomes,” said Rainbow Vogt, lead author of the study. “Currently, the U.S. Environmental The study also highlights a number of policy issues, such as how Protection Agency only measures risk based on exposures of we grow our food and the approval process for potentially toxic individual contaminants. We wanted to understand the cumu- compounds. Though the pesticide DDT was banned 40 years ago, lative risk from dietary contaminants. The results of this study the study showed signifi cant risk of DDE exposure. demonstrate a need to prevent exposure to multiple toxins in young children to lower their cancer risk.” “Given the signifi cant exposure to legacy pollutants, society should be concerned about the persistence of compounds we are cur- The researchers used data from the 2007 Study of Use of Prod- rently introducing into the environment,” said Bennett. “If we later ucts and Exposure-Related Behavior (SUPERB), which surveyed discover a chemical has signifi cant health risks, it will be decades households in California with children between two and fi ve before it’s completely removed from the ecosystem.” to determine how their diets, and other factors, contribute to toxic exposure. Specifi cally, SUPERB homed in on 44 foods While the study has profound implications for dietary habits, more known to have high concentrations of toxic compounds: met- work needs to be done to quantify risk. Specifi cally, researchers als, arsenic, lead and mercury; pesticides chlorpyrifos, perme- need to determine how these food-borne toxins interact collec- thrin and endosulfan; persistent organic pollutants dioxin, DDT, tively in the body. dieldrin and chlordane; and the food processing by product acrylamide. Toxin levels in specifi c foods were determined To continue reading this article click here: throughthe Total Diet Study and other databases. http://www.medicalnewstoday.com/releases/252811.php

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ophthalmologists, and the results were compared with their previ- ous medical records (eye exams and other medical care).

No signifi cant correlation was found between the presence of headache and the need for vision correction. For just over 75% of the children, eye health and vision test results remained normal or hicago, Illinois — Vision and other eye problems are not unchanged from earlier exams, Dr. Roth reported. linked to recurring headaches in children, even if the Cheadaches strike while the child is doing schoolwork or Children who already wore glasses were not found to require new other visual tasks, according to a study presented at the American prescriptions at the time they presented with headaches. Although Academy of Ophthalmology (AAO) and Asia-Pacifi c Academy of 14% reported that their headaches occurred while doing visual Ophthalmology 2012 Joint Meeting. tasks such as homework, and 90% reported visual symptoms as- sociated with their headaches, the researchers determined that a The investigators conducted a retrospective review of 158 children need for vision correction was not a signifi cant factor. 18 years old and younger who presented to a pediatric ophthal- mology practice complaining of headaches between 2002 and Approximately 30% of the children had ophthalmologic conditions 2011. that surpassed the need for simple vision correction, including strabismus, amblyopia, and other, more serious conditions. A fam- “Our idea was to compare children for whom glasses were indi- ily history of migraine was present in 17%. cated to those who did not need glasses, and see if the headaches got better [with corrected vision]…. Ultimately, those 2 groups had Most headaches resolved over time. By parental report, 76.4% of the same outcomes. Whether or not the child had a refractive error all subjects improved, including those with refractive correction that warranted correction, the presence or absence of headache (71.9%) and those without new prescriptions (78.2%), for an insig- remained the same. From this, we concluded that refractive error is nifi cant diff erence between these 2 groups of P = .38. The study not playing a large role in pediatric headaches,” said Zachary Roth, did not assess the actual cause of the headaches. MD, from the Albany Medical Center, New York, who presented the fi ndings. Similarly, children who received new prescriptions were not more likely than others to have resolution of their headaches, Dr. Roth “This information should be passed along to paediatricians,” he reported. added. To continue reading this article click here: All of the children had received complete eye exams by the clinic’s http://www.medscape.com/viewarticle/774459 EVEN MODERATE DRINKING IN PREGNANCY CAN AFFECT A CHILD’S IQ

elatively small levels of exposure to alcohol while in the 4,167 children were strongly related to lower IQ at age eight. The womb can infl uence a child’s IQ, according to a new study, child’s IQ was on average almost two points lower per genetic Rpublished today in PLOS ONE, by researchers from the modifi cation they possessed. Universities of Bristol and Oxford using Children of the 90s study (ALSPAC) data from over 4,000 mothers and their off spring. But this eff ect was only seen among the children of women who were moderate drinkers. There was no eff ect evident among Current advice to pregnant women about moderate alcohol children whose mothers abstained during pregnancy, strongly consumption during pregnancy is contradictory, with some offi cial suggesting that it was the exposure to alcohol in the womb that guidelines recommending complete abstinence and others sug- was leading to the diff erence in child IQ. Heavy drinkers were not gesting that moderate use is safe. Previous studies have produced included in the study. confl icting and inconsistent evidence on the eff ects of moderate alcohol intake on a child’s IQ. This may be because it is diffi cult When a person drinks alcohol, ethanol is converted to acetalde- to separate the eff ects of moderate alcohol consumption from hyde by a group of enzymes. Variations in the genes that ‘encode’ other lifestyle and social factors, such as smoking, diet, affl uence, these enzymes lead to diff erences in their ability to metabolise mother’s age and education. ethanol. In ‘slow metabolisers’, peak alcohol levels may be higher and persist for longer than in ‘fast metabolisers’. This study, believed to be the fi rst substantial one of its kind, used genetic variation to investigate the eff ects of moderate (<1-6 units It is believed that the ‘fast’ metabolism of ethanol protects against of alcohol per week) drinking during pregnancy among a large abnormal brain development in infants because less alcohol is group of women and their children. Since the individual variations delivered to the fetus, although the exact mechanisms are still that people have in their DNA are not connected to lifestyle and unclear. social factors, the approach removes that potential complication. To continue reading this article click here: Four genetic variants in alcohol-metabolising genes among the http://www.bizcommunity.com/Article/196/158/85637.html

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Are there benefi ts to not assessing blame? In medicine, many people work together for a common goal. The best systems acknowledge that, due to the By David H. Sohn, JD, MD human element, occasional errors will occur. Accord- ingly, they implement a series of checks and re-checks Most patients injured in medicine are not eligible for com- to catch and contain errors. For example, airline workers pensation, a fact often lost in discussions of medical liability might, even when diligent, occasionally mistake an tort reform. Only patients whose injuries were caused by oxygen tank for a nitrogen tank. Rather than punish negligence on the part of the physician or other healthcare the workers, a better solution would be to use diff erent provider can seek compensation. Most injuries in medicine, couplers for these two gases, so a nitrogen tank cannot however, are due to either system errors or nonnegligent be hooked up in place of the oxygen tank. reasons. Actual negligence is rarely present in most alleged An adverse event, for example, is an injury caused by medi- cases of medical malpractice. In one study of New York cal management, such as a patient’s unforeseeable allergic hospitalizations, adverse events were reported in 3.7 reaction to a prescribed antibiotic. Negligence is the failure percent of all hospitalizations. In more than 70 percent to provide a standard level of care. The physician’s failure to of these cases, however, no negligence was present. In check the patient’s chart, which listed the patient’s allergy to another closed claim study performed at Harvard, only the antibiotic, would be negligence. 15 percent of medical liability cases actually contained negligence. And in a 2005 Congressional Report, more How common is negligence? than 80 percent of malpractice cases reviewed con- tained no negligence. A rational oversight system will Many adverse events occur in the practice of medicine, but devote more energy toward the more commonly made relatively few are due to negligence. For example, a Harvard errors. Public Health Study estimated that only 27 percent of ad- verse events were due to negligence (Fig. 1). Medicine is not The current U.S. system an exact science, and complications are an inherent feature of any procedure or medical intervention. For example, sur- In the United States, medical errors are compensated gical procedures generally carry a 3 percent to 4 percent risk under the tort system, which seeks to deter negligence of infection, despite the use of sterile techniques, preopera- by monetarily punishing negligent providers and tive cleansing, and prophylactic antibiotics. compensating the injured parties with those monies. According to Prosser and Keaton on Torts, the goals of Punishing adverse events per se would have a chilling eff ect the litigation system are as follows: on treating complex or diffi cult procedures, such as liver transplants or neurosurgery. It would also discourage care of 1. to compensate plaintiff s injured by negligence high-risk patients with multiple comorbidities. An ideal over- sight system would not punish adverse events, but rather 2. to discourage the practice of negligence would identify and target medical errors. 3. to exact corrective justice It is also important to understand the diff erence between negligence and system error. A system error will occur The system, however, has some important limitations. from time to time simply because healthcare providers are Because the litigation system can only deter negligence human. They are made unintentionally and are not deci- and compensate patients for injuries attributable to sion errors. Good organizations recognize the human error negligence, most patients who experience adverse component and safeguard against it. A good system can events will have no recourse through the litigation sys- reduce these errors by instituting processes such as using tem. This, however, does not prevent them from suing. computerized medication orders to prevent dosage mix-ups Many patients sue when an injury occurs because they or identifi cation bracelets to prevent confusion between fail to understand the fundamental diff erences between patients with similar names. an adverse event and a medical error or the diff erence between system errors and true negligence. As a result, According to the Institute of Medicine, most medical errors an overwhelming amount of time and money is spent are the result of unavoidable human errors, which can only on fruitless litigation that serves neither to compensate be reduced through system changes. Punishing the indi- the injured patient nor to improve health care. vidual who made the error will not reduce future errors and make a safer system. It might, however, encourage workers To continue reading this article click here: to hide, rather than report, errors. http://www.aaos.org/news/aaosnow/nov12/managing6.asp

26 PAEDIATRIC NEWS SPECIALITY PAGES

MFMs were also less likely to see a need for FCP inclusion in cases involving antiseizure medications (62.1% vs 32.8%; OR, 3.3; 95% CI, 2.2 - 5.0) or diabetes (56.5% vs 27.4%; OR, 3.5; 95% CI, 2.3 - 5.4; P < .001 for all).

FCPs were also more likely to favor seeking court interventions for maternal refusal to enter cocaine detox (72.2% vs 32.9%; OR, bstetricians may be resisting pediatricians’ input when 5.8; 95% CI, 3.7 - 9.0), refusal of azidothymidine therapy to prevent managing certain maternal conditions that can aff ect a perinatal HIV transmission (79.9% vs 41.3%; OR, 6.6; 95% CI, 4.1 Obaby’s health, according to the results of a survey pub- - 10.7), and refusal of percutaneous transfusion for fetal anemia lished online November 5 in Pediatrics. (62.2% vs 28.0%; OR, 4.4; 95% CI, 2.9 - 6.8; P < .001 for all).

“Pediatric specialists at the forefront of prenatal diagnosis and “[O]ur demonstrated diff erences between FCPs and MFMs regard- therapy have long claimed that medical innovations in prenatal ing pediatric consultation for maternal conditions may not only diagnosis and therapy will ultimately blur the boundaries between refl ect diff erent understandings about the conditions per se, but obstetrics and pediatrics, insofar as the well-being of the fetus also, the likelihood of postnatal consequences,” the authors sug- and future child are concerned,” write Stephen D. Brown, MD, from gest. Boston Children’s Hospital in Massachusetts, and colleagues. Need for Teamwork For the study, investigators mailed confi dential, self-administered, 106-item questionnaires to 454 maternal-fetal medicine specialists “As fetal care evolves, pediatric and obstetric practitioners (and (MFMs) and 416 fetal care pediatric specialists (FCPs). their respective institutions and professional organizations) should recognize gaps in knowledge, understanding, and values, and Analysis of data from 434 respondents showed that FCPs would work toward consensus refl ecting best medical evidence and legal like to counsel mothers before continuing or interrupting preg- precedent,” the authors write, noting the importance of support- nancies complicated by alcohol abuse, cocaine abuse, antiseizure ing patients’ abilities to make well-informed decisions according to medication, or diabetes, but MFMs do not see the need. their own values and free from coercion.

MFMs were more than twice as likely to deny a need for FCP in- On the surface, MFMs and FCPs agree that collaboration between volvement before continuing or interrupting pregnancies compli- their fi elds is in the best interest of mother and baby. cated by alcohol abuse (63.1% vs 35.9%; odds ratio [OR], 3.5; 95% confi dence interval [CI], 2.2 - 5.4) or cocaine abuse (59.7% vs 31.9%; To continue reading this article click here: OR, 3.5; 95% CI, 2.3 - 5.4). http://www.medscape.com/viewarticle/774803

are common and the procedure often fails, meaning that children often need repeated surgeries. “This disease is devastating and costly (almost $2 billion annually), and current treatment options are extremely limited,” says Carter, who also is a National Science Foundation graduate research fel- low. “Development of non-invasive therapies would revolutionize treatment of this condition.” esearchers at the University of Iowa have discovered a new cause of hydrocephalus, a devastating neurological disorder Carter notes that reducing the size of the ventricles in mice is a Rthat aff ects between one and three of every 1,000 babies clinically signifi cant accomplishment because reducing ventricu- born. Working in mice, the researchers identifi ed a cell signaling lar size in humans is associated with better patient outcome. defect, which disrupts immature brain cells involved in normal brain development. By bypassing the defect with a drug treat- Working in a mouse model of hydrocephalus, the research team ment, the team was able to correct one aspect of the cells’ devel- honed in on a specifi c group of immature cells called neural opment and reduce the severity of the hydrocephalus. The fi ndings precursor cells (NPCs) that give rise to most types of brain cells, were published online Nov. 18 in the journal Nature Medicine. including neurons and glia cells. One particular subgroup of NPCs, which has only recently been identifi ed and is involved in the “Our fi ndings identify a new molecular mechanism underlying the development of normal ventricles, became the focus of the team’s development of neonatal hydrocephalus,” says Calvin Carter, a stu- study. dent in the UI Graduate Program in Neuroscience and fi rst author on the study. “By targeting this defective signaling pathway in mice During brain development, this population of immature cells pro- using an FDA-approved drug, we were able to successfully treat liferates and dies off in a precisely coordinated process to produce this disease non-invasively.” normal ventricles.

Hydrocephalus, sometimes called water on the brain, involves The team discovered an imbalance in the proliferation and sur- build-up of fl uid inside brain spaces known as ventricles. If the ex- vival of these cells, which leads to hydrocephalus in the experi- cess fl uid is not removed, the ventricles expand, which can cause mental mouse model. serious brain damage or death. Although hydrocephalus is one of the most common types of brain abnormality in newborn infants, To continue reading this article click here: treatment has not changed much over the last half century and http://www.news-medical.net/news/20121120/Researchers-discover- involves invasive brain surgery to drain the fl uid. Complications new-cause-of-hydrocephalus.aspx

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utism spectrum disorder (ASD) is of multiple systems — motor, cognitive, On the other hand, children with later- a neurodevelopmental disorder social, and language — in the fi rst 3 years onset ASD do have some signs of devel- Acharacterized by impaired social of life in children with and without ASD opmental delay at 14 months, but these reciprocity and communication, as well could shed light on the susceptibility of signs are not specifi c to ASD and include as repetitive and stereotyped patterns the developing brain to the impact of motor and communications delays. of behavior and interests. According to genetic, epigenetic, and environmental However, by 36 months, both groups are retrospective studies, it appears that ASD factors in children with ASD. comparable in their social and develop- becomes clinically apparent after a period mental characteristics, she added. of relatively healthy development. Two Therefore, the investigators examined major classes of ASD are defi ned as early language and motor development in “Many pediatricians screen for autism or later age of onset. children aged 6 to 36 months and social at around 18 months, as the American development from 14 to 24 months, the Academy of Pediatrics recommends, but The objective of this study by Landa and time during which ASD regression usually they don’t continue screening after that,” colleagues was to compare developmen- occurs. Dr. Landa said. tal trajectories of 3 groups of children studied prospectively: those without Participants included 204 infant siblings of “But screening should be repeated ASD, those with early ASD (onset by 14 children with autism as well as 31 infants through early childhood, and if months), and those with later ASD (later with no family history of autism. concerning signs of delay associated age of onset). with ASD are observed in a child who The Mullen Scales of Early Learning pro- scores normally on standardized tests, STUDY SYNOPSIS AND PERSPECTIVE vided measures of motor and language further assessment is warranted.” functioning, and the Communication and Infants who go on to develop ASD are Symbolic Behavior Scales Developmen- NEED FOR EARLY INTERVENTION developmentally normal by the age of 6 tal Profi le provided measures of 2 social months, and the earliest signs of devel- functions related to the diagnostic criteria Deborah Fein, PhD, University of opmental disruption are subtle and not for ASD. Connecticut, in Storrs, told Medscape specifi c to autism, prospective longitudi- Medical News that it is important nal data show. By 14 months, the early-onset group to appreciate that the ASD children exhibited signifi cantly lower expressive included in this study were infant In the largest prospective, longitudinal language and shared positive aff ect siblings of children with ASD. study to date comparing children with scores than the later ASD group (P < .001 early and later diagnosis of ASD with for both endpoints). As such, “this is not the population at children without ASD, Rebecca Landa, large, so these fi ndings might not be PhD, Kennedy Krieger Institute, Baltimore, By 18 months, the early ASD group also generalizable,” Dr. Fein said. Maryland, and colleagues found that the had greater delays in receptive (P < .001) earliest signs of developmental disruption and expressive language development On the other hand, infant siblings of in children with ASD are likely to be non- (P = .001) compared with the later-onset children with ASD are a small enough specifi c to ASD, such as communication or group. population that they could be fol- motor delay. lowed very closely throughout their GAP CLOSES preschool years, and subtle delays in At 6 months, development within both motor or social communication devel- the early-onset ASD children and those At 24 months, however, “the gap between opment could be identifi ed. with later-onset ASD was comparable the Early- and Later-ASD groups had both to each other and to Non-ASD con- closed, and no diff erences from the Later- Other children at risk for ASD, includ- trol children. ASD group were detected at subsequent ing premature infants or infants who ages,” the investigators write. have had obstetric complications, “The standard clinical tools that we use to These fi ndings indicate that the Early- are also at risk for ASD and could be assess early development are not identify- ASD group manifested earlier develop- similarly followed, she added. ing abnormalities in babies midinfancy ment disruption, especially as it aff ected that go on and have autism,” Dr. Landa language and social functioning, than “There are preclinical signs of ASD, told Medscape Medical News. children with later-onset ASD but that but in a sense, it doesn’t matter “So the assumption that any infant who is they were no more severely aff ected than because if you know a child has some going to have autism would be obviously later-onset ASD children at either 30 or 36 mild delay in cognitive or motor or autistic in midinfancy is a myth because months. social communication function, you this just isn’t happening.” still want to deliver early interven- “There are diff erent developmental path- tions,” she said. The study was published online October ways to ASD,” said Dr. Landa. 30 in Child Development. “Then if full-blown autism does emerge, Children who manifest symptoms by their you’ll be on top of it.” DEVELOPMENTAL TRAJECTORY fi rst birthday are more globally impaired at 14 months than children who have Source: http://www.medscape.org/view- Studying the developmental trajectory later manifestations of ASD. article/773706

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