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Revitalising psychiatry: Stevens, A and Price, J (1996) Evolutionary psychiatry. London: Routledge. ISBN 0-415-13840-X pbk. xi+267 pages
No full textThe central tenet of this book is that psychiatry will be revitalised, and will assume its place within a new science of humanity, by application of the understanding that there is, importantly, an evolved component to expressed human nature. This stance, which might once have attracted strong opprobrium from the psychiatric community for its acknowledgement of biology, is now comfortably situated within the increasingly established domain of evolutionary psychology and is, more immediately, an explicit extension of the ideas of Randolph Nesse and George Williams. Nesse and Williams, the latter a distinguished evolutionist in his own right, have established a field of enquiry they call Darwinian medicine (see Evolution and healing: The new science of Darwinian medicine, Orion Press, 1996) and which is an attempt to find evolutionary explanations for vulnerabilities to disease in order to better direct treatment. If the human body is selected to perform efficiently within a particular environment, then we might expect problems to manifest themselves once the environment is sufficiently altered. Since the basic features of the human body and, more controversially, the human mind are held to reflect selection pressures operating during the paleolithic, it is not surprising that the extraordinary changes in human lifestyle contingent on the emergence of agriculture ten thousand years ago have had far-reaching consequences for us. We have a physiological craving for sugar, fat and salt, for example, because these are very valuable but scarce components of the standard hunter-gatherer diet. The undesirable corollary, in times of plenty, is the epidemic of obesity with all its attendant health problems, that plagues the developed world and fuels a colossal fast food industry. Ironically, even the generally improved health of most modem populations reveals the constraints of our past. The degenerative muscle disease, Huntingdon's Chorea, is due to the action of a late expressing gene. It doesn't manifest itself prior to the age of forty, by which time its original carriers would have been post-reproductive if not dead. Since it could therefore not have been selected against by the improved reproductive success of non-carriers, it survives to haunt us in these times of greatly increased longevity
MULTIPLE MASCULINITIES IN A CHANGING SOUTH AFRICA: Morrell, R {ed} (2001) Changing men In Southern Africa. Pietermaritzburg: University of Natal Press. London: Zed Press. ISBN 0 86980 983 0 pbk. Pages xv + 356.
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REPETITION, EMOTION, MEMORY
No full textIn this article we attempt to articulate a self that is marked by repetition, a notion that seeks to take seriously the lack of metaphysical foundations in social, psychological and ethical life; that seeks to counter those understandings that hope to escape the ravages of time and the unexpected movements of life. After presenting a poststructuralist reading of the Kierkegaardian notion of repetition in relation to the thorny problem of the self, we attempt, first, to substantiate this self through a reading of emotion and memory as deeply socially embedded and as not pre-social and natural, and secondly, to develop an understanding of repression as an essential feature of life that does not infer distortion or denial. At this point we will introduce the notion of replacements. Replacements, as a feature of this form of repression, are culturally valid narratives that respect the particularities of memory and draw the person in as an embodied thinker. We illustrate this understanding of the self by delineating a role for psychotherapy as a place where the sculpting of such replacements may take place, thus enabling persons to continue with the ethical task of achieving a self
Burnout in South African dialysis practitioners: a mixed methods study
No full textIntroduction: Provision of dialysis to patients with kidney failure relies on skilled dialysis practitioners (DPs), about whom little is known of the effect on burnout of workplace stressors, resource limitations, and the COVID-19 pandemic, which have increased the condition in other nursing specialities. We therefore analysed burnout in South African DPs working in the public sector.
Methods: Sixty-four anonymous volunteers were recruited from three public sector treatment centres in Johannesburg. Burnout was assessed using the Maslach Burnout Inventory–Human Services Survey (MBI–HSS); the study population additionally completed surveys recording their workplace and COVID-19 experiences. The effect of respondent demographics, workplace, and pandemic experiences on burnout was determined using regression modelling.
Results: Burnout occurred in 22%. Workplace challenges affected 97% of our sample; staffing shortages (97%), insufficient pay (75%), and perceived lack of management support (70%) were frequently cited. Sixty-four percent reported deteriorated perception of their career following COVID-19. Age (ß –0.29 ± 0.12, P = 0.015), longer time in current position (ß 0.38 ± 0.15, P = 0.012), lack of management support (ß 2.76 ± 0.93, P = 0.003), and lower career perception following COVID-19 (ß 3.68 ± 0.91, P < 0.001) increased emotional exhaustion; inadequate pay reduced personal sense of accomplishment (ß –1.12 ± 0.54, P = 0.036). Impaired career perception following COVID-19 independently increased burnout (OR 2.07, 95% CI 1.06–4.06, P = 0.033).
Conclusions: Burnout rates in South African DPs are high and exceed those of many other regions. Perceived inadequate remuneration and poor management support are important factors underlying the condition. COVID-19 experiences continue to exert a significant effect on career appraisal and burnout
Prolonged intermittent kidney replacement therapy: overcoming challenges in the critically ill patient in low-resource settings
No full textAcute kidney injury is a frequent complication of critical illness in intensive care units and has a negative prognostic impact. Kidney replacement therapy (KRT) is frequently needed and the treatment modalities used in these settings include continuous kidney replacement therapy (CKRT), intermittent haemodialysis (IHD) and peritoneal dialysis (PD). Haemodynamic instability is common in critically ill patients and the different KRT modalities affect haemodynamics in different ways. CKRT is often considered the modality of choice due to its lower dialysate flow, extracorporeal blood flow and ultrafiltration rates, leading to better haemodynamic stability. In poor socio-economic settings, however, the high cost of CKRT is a major barrier limiting its widespread use.
This brief narrative review makes the case for increased use of prolonged intermittent kidney replacement therapy (PIKRT), frequently called sustained low-efficiency dialysis (SLED), a form of KRT that uses standard IHD machines to deliver prolonged dialysis sessions at reduced flow rates, with good haemodynamic stability, and at a lower cost. PIKRT is an effective alternative for treating acute kidney injury in critically ill patients in low-resource settings
Welcome to the year 2026 and volume 29: Time for the “Know thy eGFR and urine protein – and act” campaign
No full textOn behalf of the Editorial Board of the African Journal of Nephrology (AJN), I wish all AJN contributors and readers a very happy and productive year 2026.
Last year, following AJN accreditation with the CAMES (Conseil Africain et Malgache pour l’enseignement Supérieur), we witnessed a significant increase in the submission of French manuscripts. To the contributors of these French manuscripts, we thank you for your submissions, which make AJN a truly bilingual journal.
This year, we aim to move AJN to a new hosting platform that will enable us to apply for accreditation for Scopus and PubMed. We take this opportunity to thank all contributors for the large number of submitted manuscripts, and reviewers for evaluating these manuscripts and providing valuable feedback.
In volume 28, we noted several highlights: a scoping review by Ngema et al. revealed the extent of depression in dialysis patients and Davidson et al. reported on the stability of the peritonitis rate in Cape Town despite extreme conditions such as a severe drought and the COVID-19 pandemic. Finally, Ndinya et al. reported that unexplained hyperkalaemia is associated with low rates of in-hospital death.
This year, World Kidney Day will take place on 12 March 2026 with the following theme: “Kidney health for all – caring for people, protecting the planet”.
Several nephrology bodies have recommended that serum urea and creatinine results be reported together with estimated glomerular filtration rate (eGFR), estimated using widely accepted equations. We should commend commercial laboratories for routinely providing eGFR results. In HIV medicine, patients are educated to be informed about their CD4 count and viral load. In nephrology, eGFR and proteinuria provide an essential evaluation of kidney function. Each adult should know their eGFR and the status of their proteinuria, with these tests being done at least annually.
We need to democratise this knowledge, empower patients to own it and help them participate in the management of their kidney function, as shown in an algorithm adapted from the International Society of Nephrology [1]. Let us give them the tools to help themselves. With a strategy that includes a healthy diet, inhibition of the renin-angiotensin-aldosterone system and the control of comorbidities, we can delay or avoid dialysis for at least two-thirds of patients.
Therefore, let us start the “Know thy eGFR and urine protein – and act” campaign
In response to "white hands": Nicholas, Land Cooper, S (eds) (1990) Psychology and Apartheid: Essays on the struggle for psychology and the mind in South Africa. Johannesburg: A Vision/Madiba Publication.
No full textPsychology and Apartheid, contains edited versions of some of the papers that were delivered at the Psychology and Apartheid Conference which was held at the University of the Western Cape in March 1989. The conference set out to articulate the ways in which psychology was used historically, in South Africa, to perpetuate domination of the majority by the minority white regime. The tone of the conference (and which is reflected in the book) was one of outrage, in the first instance, and an attempt, in the second to begin a discourse that would respond to the perceived needs of the majority of South Africans
Psychological Disorders in Primary Care: Cross-Cultural Comparisons
No full textEpidemiological investigations of psychological disorder have had a strong boost in the past decade by the adoption of new methods of epidemiological investigation. The adoption of definitional approaches to the study of psychopathology has clearly demonstrated the high prevalence of psychological disorders, and particularly the high rates of psychological disorder among primary care patients (Goldberg & Huxley, 1980). This general finding has been commented upon in various reviews, with one of the most recent reviews arguing for an increasing focus upon primary care (Shepherd & Wilkinson, 1988).
The high prevalence of psychological disorders in primary care settings has also been shown in many different cultures, which is supportive of the general model developed by Goldberg and Huxley (1980). Cross-cultural comparison has often been a method for establishing the limits of models, and the present paper examines the findings from epidemiology in order to indicate the limitations of the Goldberg model