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Background: A growing ageing community puts additional demands on the public health system. This will contribute to ethical consequences for the health care sector. A public health ethics framework can contribute towards addressing the ethical challenges faced by the geriatric community. Aim: This article intends to contribute to a public health ethics framework for the geriatric community from a South African perspective. Setting: Twenty-two participants from six geriatric institutions, two each in the three provinces, participated in the research. The provinces are the Free State, Northern Cape and North West. Methods: Fifteen statements were rated using a five-point Likert scale questionnaire. The statements were grouped into three indexes, namely what is ethics, what is public health ethics and what is public health ethics for the geriatric community? Results: Ethical behaviour is observable not only from person to person but also through systems, processes and practices. The need is to understand how to apply ethical principles to the working environment. A public health ethic can be understood from applied, professional and social ethics. Conclusion: Public health ethics is the application of health care principles through a professional ethic resulting in care and relationship-building. The core of what public health is should be the basis to identify a public health ethic where the focus is on the community and improvement of the quality of health and well-being of the community. Contribution: No evidence of a public health ethics framework for the geriatric community could be identified in South Africa.
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BACKGROUND: The elderly population is steadily growing in South Africa. However, there is limited strategic planning or policy initiatives to address this group's vulnerability resulting in several public health ethical issues that need to be considered and addressed. This article aims to develop a public health ethics framework for the geriatric community with the purpose to review ethical implications when working with the geriatric community. METHODS: The Q-methodology was selected for data collection. Fifteen statements were ranked by means of a five-point Likert-scale questionnaire. Twenty-two participants from six geriatric institutions participated in the ranking of the statements. RESULTS: The ranking of the statements confirmed the need for a public health ethics framework to provide guidance when working with the geriatric community and to evaluate decisions about geriatric care. Such a framework should be application-based and practice-oriented which can assist in addressing unfamiliarity with public health ethics in general and can extend the capacity for decision-making. The ranking of these statements contributed to the scope of the planned framework, by considering the vulnerability of healthcare practitioners (as community of practitioners) and the geriatric community as a basis from which to promote justice in public health programmes. CONCLUSION: Based on the ranking of statements, eight building blocks for a public health ethics framework were identified. The building blocks are imbedded in professional ethics and care ethics. The proposed framework can give rise to social justice in public health and the ability to evaluate what the ethical implications are for public health policies, programmes and interventions aimed at the geriatric community.
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Salud Pública , Política Pública , Anciano , Atención a la Salud , Humanos , Principios Morales , SudáfricaRESUMEN
AIM: The purpose of this article is to present the results of a private cardiac surgical practice. This information could also serve as a hermeneutical text for new wisdom. METHODS: A personal database of 1 750 consecutive patients who had had coronary artery bypass graft (CABG) surgery was statistically analysed. Mortality and major morbidity figures were compared with large registries. Risk factors for postoperative death were determined. RESULTS: Over a period of 12 years, 1 344 (76.8%) males and 406 (23.2%) females were operated on. The observed mortality rate was 3.03% and the expected mortality rate (EuroSCORE) was 3.87%. After stepwise logistic regression, independent risk factors for death were urgency (intra-aortic balloon pump), renal impairment (chronic kidney disease, stage III), re-operation and an additional procedure. Apart from the 53 deaths, another 91 patients had major complications. CONCLUSION: Mortality and morbidity rates compared favourably with other international registries. Mortality was related to co-morbidities. This outcome contributes to a hermeneutical understanding focusing on new spiritual wisdom and meaning for the surgeon.
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Puente de Arteria Coronaria , Hermenéutica , Práctica Privada , Adulto , Anciano , Anciano de 80 o más Años , Distribución de Chi-Cuadrado , Comorbilidad , Puente de Arteria Coronaria/efectos adversos , Puente de Arteria Coronaria/mortalidad , Bases de Datos Factuales , Femenino , Humanos , Tiempo de Internación , Modelos Logísticos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/mortalidad , Medición de Riesgo , Factores de Riesgo , Sudáfrica , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND/AIM: Sport and exercise medicine (SEM) is a young, fast growing discipline. The need to broaden its evidence base has been established. The aim of the study was to compile a research-based strategic framework for the development of a sustainable research programme in SEM at a South African university. METHODS: A literature review, internal document analysis, semistructured interviews with role players within the university and a Delphi process utilising a panel of international and national experts in research and SEM, were applied. Results were analysed and categorised regarding foundational aspects and operational components to create a sustainable research programme in SEM. RESULTS: The foundational level of the framework consists of points of departure, premises and resources. Points of departure regarding SEM, the university, management, research and sustainability were identified. The premises for the research programme are relevance, currency, flexibility, implementability and a scientific base. Internal, institutional and external resources required by the programme were identified. The operational level was developed according to the W.K. Kellogg programme logic model. It consists of academic and management inputs; a central hub of activities which drives the programme; desired financial, human and academic outputs, and long-term qualitative and quantitative outcomes. The third level represents a sustainable research programme which is constantly monitored and reviewed. CONCLUSIONS: The strategic framework provides guidelines for the development and sustainable management of an SEM research programme. It will make a substantial contribution to the research, further development, and ultimately the status of SEM in South Africa.