People’s motivation to cling to desirable notions about future outlooks results from interactions between prefrontal cortex regions, according to a human neuroimaging study published in JNeurosci.

Dr Hadiza Bawa-Garba was convicted of manslaughter by gross negligence following the death of a young boy.

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The WHO Global Health Observatory data estimates that there is one psychiatrist per 100 000 of the South African population, and even less (0.4%) in the State sector; this is a situation which is deemed grossly inadequate. By comparison, the United States and the United Kingdom have 12.4 and 14.6 psychiatrists per 100 000 respectively. Of South Africa’s 650 psychiatrists only three are specialist old-age psychiatrists.

Professor Felix Potocnik, of the South African Society of Psychiatrists (SASOP), says the trend of South Africa representing one of the most rapidly ageing countries in Africa, demands an awareness of the challenges and needs facing the elderly.

“We used to have five dedicated psychogeriatric units at our South African universities, but now there is only one, which is at Stikland Hospital in Bellville, Western Cape,” he says. 

“Stikland Hospital is a public hospital and has the only HPCSA-recognised geriatric psychiatry unit and training facility in South Africa. The unit consists of three wards with a bed capacity of 77 (33 male beds and 44 female beds). It is over-subscribed with a waiting list exceeding several weeks. The reason for this is that the Western Cape has some 600 000 elderly of whom an estimated 40 000 (6.6%) are suffering with dementia.”

Growing older population 

South Africa’s elderly population is growing rapidly – but state mental health care is not adequate. About 30% of adults aged 60 and older will at some stage require medication to treat mental conditions.    

The most recent population Census shows an increase from 2.8 million older people in 1996 (7.1% of the total population) to 4.6 million (8.1%) in 2017. Worldwide it is expected that the number of older people will surpass the number of children by 2045, and that the global population of people older than 60 will more than double – from 900-million in 2015 to 2 billion in 2050. By the end of this century, a third of the global population will be elderly.

Challenges of advancing age

Potocnik says greater reliance is placed on family, friends, social support groups, district clinics and regional hospitals to help with providing services for the elderly. In addition, medication is costly.

But why are the elderly at such risk of mental health problems?

Potocnik says the challenges one faces with advancing age create strong emotions such as sadness, anxiety, loneliness and lowered self-esteem. Coupled with physical and/or mental disabilities, it renders the individual more vulnerable and unable to engage in many activities in daily life.

“Older adults who are suffering from depression experience symptoms that disrupt their daily lives, resulting in withdrawal from social activities, friends and family and all the things that used to bring them joy. It’s important for family members to be vigilant and recognise any changes in behaviour and to seek help from medical and allied services.”

Multiple cognitive deficits

In South Africa, about 7% of the elderly population suffer from dementia.

Potocnik says dementia is usually a slow and progressive condition that requires specialised monitoring and treatment from a psychiatrist.

“While some element of forgetfulness accompanies one’s later years, it is important to realise that it is not a disability if you can still make rational decisions and get on with your daily life. Although the key symptoms of dementia include forgetfulness, in the earlier stages it is about multiple cognitive deficits that herald a decline in one’s ability to think abstractly and logically, to use language properly and to make sensible decisions.” 

“The brain’s inability to function properly starts affecting every day activities. The person may present with an inability to keep their attention and focus long enough to meaningfully read a book, an article, or follow a TV programme. An artist might fail in the standard of their art, a person might incessantly fall asleep at work, or there may be a steady increase in pathological hoarding.”

Potocnik says that aberrations of mood are a very early sign of impending dementia. There is usually an underlying current of irritability, often accompanied by emotional outbursts. The patient may also present with relapsing bouts of depression or anxiety which become increasingly difficult to treat and contain.

‘Second childhood’

“The personality may change. This may range from subtle exacerbations of existing characters traits to uncharacteristic behaviour where, for example, a clergyman is found shoplifting, or businessmen making rash decisions quite contrary to their previous behaviour.”

He says memory loss among those suffering from dementia includes the inability to learn new information, losing items of value, and becoming lost in unfamiliar surroundings. In more advanced stages of memory loss, one may forget crucial details and dates as well as not remembering or even recognising family members.

Potocnik says in very advanced stages patients may not even recognise their own reflection in a mirror.  

“Overall, the duration of dementia may be as short as six months, or exceed two decades. While the patient themselves rapidly lose insight and are unaware of any problems they may be causing, this ‘second childhood’ is extremely stressful for the caregiver. Their incidence of depression and other illnesses, need for medication, or even hospital admissions is double that of their peers. The caregiver looking after a dementing spouse has a six times higher rate of dementing themselves (12 times higher for male caregivers) when compared with peers where both partners enjoy normal mental health.”

Preventative measures for Alzheimer’s

He points out that although it is not always known what causes or triggers dementia, there are some preventative measures for Alzheimer’s disease and vascular dementia that may delay the onset and possibly ameliorate the course of the disease itself. It is worth noting that they offer little benefit once the condition has occurred or is advanced:

• Hormone replacement therapy (oestrogen with or without progesterone) is only effective if initiated at the time of menopause where a deficiency in female sex hormones has clearly been established. Treatment should not exceed 2–4 years.
• Vitamin E (<400 IU) and C (400 mg) daily, preferably in combination. Note that continuous high-dose vitamin E (+400 IU daily) supplementation may be associated with an increased mortality risk. 
• Red wine (one unit for women and two for men daily). The benefits are ascribed to resveratrol and other aliphatic compounds.
• Non-steroidal anti-inflammatory drugs (NSAIDs). Conventional NSAIDs such as ibuprofen and voltaren as well as naproxen used for as little as 2–3 years may protect against AD.
• Coffee. Consuming two cups of coffee (not decaffeinated or instant) a day decreases the risk of neurocognitive disorders/Alzheimer’s disease later in life.
• Cocoa. The equivalent of 40 grams of 80% dark chocolate a day has significant benefits.
• A diet rich in vitamins B, C, D and E (fruit and vegetables) and omega-3 fatty acids (fish) and low in high trans fat (processed foods) reflects in beneficial blood nutrient biomarker patterns influencing both cognitive function and brain volume.
• Intellectual stimulation and higher education improve brain reserve by improving synaptic connectivity.
• Reduction in stress. This is also linked to having close friends or confidants, a good social network and leisure activities and hobbies.
• The control of vascular risk factors. These are closely linked to the pathophysiology of Alzheimer’s disease. (Examples are: correct management of hypertension, diabetes and dyslipidaemia, prevention of platelet aggregation, adequate exercise, moderate alcohol use and cessation of smoking).

^{Image credit: iStock}

Zizo Zikali

Not only will the Gauteng Department of Infrastructure Development spend R127-milion to demolish the derelict Kempton Park Hospital, formerly known as Khayalami, they are planning to rebuild it for a whopping R1.3-billion.

This decision has been criticised by civil society organisations, who say the cash-strapped province should rather renovate the abandoned hospital and not waste money.  The DA has promised to “closely monitor” the process.

Costs ‘closely matched’

Defending their decision on why they could not renovate the Ekurhuleni hospital, the department’s spokesperson Theo Nkonki said comparisons were conducted to establish the cost of demolishing the current facility and building a new district hospital on the same site, versus a complete refurbishment and conversion into a district hospital.

“The costs were so closely matched for either option. The cost estimate for renovation and refurbishment was R1.1bn, whereas the cost estimate for a new hospital is R1.3bn, as prepared in 2015,” he said, adding that building the hospital, which closed its doors in 1996, would alleviate pressure on Tembisa Hospital.

“The Tembisa Hospital was upgraded from a regional hospital to a tertiary level facility and is under severe pressure. There is currently no district level hospital near the Tembisa Hospital to support and accommodate level-1 patients.” These are patients who need intensive and long-term care. Nkonki could not say when the demolition and the construction of the new hospital would start, sparking criticism of the department for its sluggishness.

Meanwhile, residents of Daveyton and the surrounding areas have been waiting for a new hospital for over a decade now. A new hospital was approved and budgeted as far back as 2006.

There is no word as to what is causing the delay.

Poor planning and implementation

Tshwarelo Molaodi, chairperson of the activist organisation the Treatment Action Campaign in the region, said there were a lot of informal settlements and it was not fair that Daveyton – one of the oldest townships in the country – doesn’t have a hospital. “We are really suffering. This is worse for our grannies and children. We are normally referred to the Far East Rand and Boksburg hospitals, which are already overstretched,” she said.

A source with intimate knowledge of the Department of Infrastructure Development said poor planning and implementation had been identified as “key problem areas” for the department, and this often resulted in under- and overspending.

“For instance, the new Natalspruit and Jabulani hospitals were both five years overdue and cost more than double the original budget,” said the source. “There is a great need for a new hospital to serve the growing population in Daveyton, Etwatwa and Benoni, but chronic incompetence means that this will not happen soon.”  

Speaking to Health-e News earlier this year, Lesemang Matuka of the provincial health department said Daveyton Hospital’s project was at the “feasibility stage” and the business cases were being developed. “The business cases are due to be submitted for approval by the National Department of Health… and then the project can proceed to the design stage,” he said, but could not provide further details on the matter.

Meanwhile in an effort to fast track delivery in his department, MEC Jacob Mamabolo has launched a technological intervention called Drone, which he said combines human and business intelligence to ensure projects are delivered in time, within cost and at the right quality.

^{Image credit: iStock}

Ramatamo Sehoai

A victims’ group calls for support after a study highlights suicide attempts following terrorist incidents.

The women say the Essure implant may have caused wide-ranging problems, including chronic pain.

Hours before the rise of the very star it will study, NASA’s Parker Solar Probe launched from Florida Sunday to begin its journey to the Sun, where it will undertake a landmark mission. The spacecraft will transmit its first science observations in December, beginning a revolution in our understanding of the star that makes life on Earth possible.

Everything changed when you saw the two pink lines show up on that pregnancy test – but here you are in the confusing space after a miscarriage with a thousand thoughts swirling around your brain: 

How soon can I try again?

What if this happens again? 

And, let’s be honest: What does this mean for my sex life?

First, know that whatever you’re feeling is completely okay. “Women can have such different reactions to a miscarriage,” says Dr Catherine Monk, professor of medical psychology at Columbia University Medical Center. “I hope that women and their partners understand that the range of feelings are normal.”

Sex after miscarriage is a complicated topic – and what’s “normal” when it comes to feeling physically and mentally ready for sex again can vary widely. Still, there are a few general guidelines that may help make this difficult time in your life a little less confusing.

Your body isn’t ready for sex immediately after miscarriage.

The big concern is that your cervix should be closed to prevent any potential infections, says Dr Zev Williams, chief of the division of reproductive endocrinology and infertility and associate professor of obstetrics and gynaecology. He notes that, after a miscarriage, your cervix opens up (a.k.a. dilates) to let the fetal tissue out. And depending on how many weeks along you were when you miscarried, the closing process can take anywhere from a couple weeks to a couple months.

Your gynae can check your cervix via a physical exam, so be sure to get the go-ahead from her before having sex again.

The one exception here: If you had what’s known as a “chemical pregnancy” – meaning you got a positive pregnancy test but an ultrasound didn’t confirm it, something that can account for as many as 75% of miscarriages – you don’t have to wait to have sex.

Read more: 6 really common things that can cause a miscarriage

Many women find that their libido takes even longer to bounce back.

Just because you’re physically ready to have sex post-miscarriage doesn’t mean you’re ready emotionally. You may be struggling with a sense that your body has failed you somehow – or feel like you’re to blame for your miscarriage (likely not true, by the way, as most first trimester miscarriages are due to chromosomal abnormalities, according to the American Pregnancy Association).

“It can be tough to turn on your intimate side when you’re dealing with these feelings,” says Dr Monk.

You have to give yourself room and self-compassion to mourn in the way that’s right for you, she adds.

If your experience makes you want to avoid sex for right now, that’s okay. If you’re counting down the days until the doc gives you the go-ahead to get busy again, that’s fine, too. Or, you may feel both: Wanting to try sex again, but also being totally freaked out by it.

There’s no shame in seeking help from a qualified therapist, particularly one who has experience with women and this type of loss. They can help you work through your feelings on the topic and give you tips for communicating with your partner.

After all, they’re likely mourning in their own way, too (and may not feel ready to have sex again themselves). Openly talking about it may help you both set expectations for intimacy and what each of you are comfortable with.

Read more: 3 women describe what it’s actually like to have a miscarriage

What do I need to know about getting pregnant again?

You’ve probably heard the oft-given guideline to wait three or six months after a miscarriage, but there’s little data to back that up. “Research comparing waiting three months or trying sooner [shows that] women who waited longer ended up taking longer to get pregnant,” says Dr Williams.

That doesn’t mean you should necessarily try right away, though. “After a loss, you want to make sure your body returns back to its pre-pregnancy state,” he says.

In addition to verifying that your cervix has closed, you’ll want confirm (via a blood test) that your levels of hCG, or the “pregnancy hormone”, are back to baseline. This ensures you don’t confuse a potential new pregnancy with your old one.

One caveat: If you’ve had multiple losses, you’ll want to consider getting an evaluation from a reproductive endocrinologist to identify if there’s an underlying problem – many of which can be dealt with effectively via treatment.

Regardless of your exact circumstances – and how you’ve reacted so far – “miscarriage is a mourning process, and we all cope differently,” says Dr Monk. “There’s no right or wrong way to do it.”

^{This article was originally published on www.womenshealthmag.com}

^{Image credit: iStock} 

Jessica Migala

Reader: My boyfriend wants to have a threesome, but I don’t know if I’m ready. I’m all for having some fun with a girl, but I’m the jealous type, so I don’t know how I’d react if we actually went through with it. I don’t want him to see the other girl again after it’s over, and he says he’s okay with a one-night stand situation, but I’m still nervous.

Jade: If you’re not sure, then don’t do it. Tell your boyfriend that you don’t like or feel comfortable with the idea. If you do decide to have a threesome, set boundaries. Say how far he’s allowed to go with the other woman when it comes to oral sex, penetration and so on. And remember to use protection. Your feelings of jealousy at the idea of your boyfriend being with someone else are normal. I suggest you do it on a getaway, away from home and all refrain from exchanging numbers and you must be the one to pick the third.

Reader: I am 55 years old and had a heart attack six months ago. I am now well and back at work with no chest pain. I would like to go back to having sex with my wife, as we had a good sex life before I was ill. But my wife is frightened it will bring on another heart attack. Will this happen and if not, how do I convince her?
Jade: I’m glad you are feeling and doing better. There is no causal link between sex and heart conditions. Your doctor has your full medical history so consult your doctor and perhaps take your wife along and have your doctor reassure her of your health. It’s natural for her to be fearful because she cares about you and your well-being. Ultimately it should be your doctor that should have the final say about whether they believe you would be in a condition to have sex again.

Reader: I’m 18 and have never had sex before. Recently I tried to have sex with my new girlfriend, but I went soft before I got in. She laughed at me and when I tried again the following night and another night thereafter, I couldn’t even get hard. What’s wrong with me? I am worried that something serious had happened to me, but when I tried masturbating, that was fine. What can I do?
Jade: It sounds like nerves to me since you are able to maintain an erection during masturbation. Try and relax. Your girlfriend laughing at you must have been a stab to your confidence and it certainly didn’t help matters. You are young, try to relax and develop a confidence in your sexual capabilities. And most important, remember to use protection.

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Jade Zwane