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Opinions and experiences of tertiary-level mental health providers regarding the down-referral of patients : a qualitative study
Tjiana, Nomthandazo S.; Nkondo-Ndaba, M.P.; Joubert, Pierre M. (AOSIS, 2025-12-11)
BACKGROUND : Down-referral of patients from tertiary psychiatric hospitals to primary healthcare (PHC) is central to South Africa’s National Mental Health Policy, which advocates for decentralised, accessible and sustainable mental healthcare. This process supports continuity of care, reduces pressure on specialist services and promotes community reintegration. Despite these benefits, challenges such as limited PHC resources, poor medication supply, inadequate staffing and stigma undermine effective implementation. This study explored the opinions and experiences of mental health providers at Weskoppies Psychiatric Hospital, a tertiary psychiatric facility in Pretoria, South Africa, to better understand these challenges, perceptions and potential strategies. METHODS : A qualitative, exploratory design using grounded theory was employed. Purposive sampling was used to recruit 12 healthcare professionals who worked at the outpatient department and were involved in the down-referral process, with data collection continuing until theoretical saturation was reached. Semi-structured interviews were conducted. Data were analysed thematically. RESULTS : Five key themes emerged: (1) The importance of early planning for discharge and down-referral but inconsistently applied; (2) patient resistance, often driven by fear, stigma and distrust of PHC, complicates transitions; (3) perceived challenges at PHC included staff shortages, long waits and poor medication availability; (4) perceived stigmatisation; and (5) recommendations for improving the down-referral process including better communication, dedicated referral coordinators, use of outreach teams, improved documentation and dedicated mental healthcare providers at the PHC level. CONCLUSION : Down-referral is necessary but challenged by systemic and relational gaps. Down-referral can be enhanced by improving PHC capacity, standardising discharge planning and reducing stigma. Patients and their families should be included in care decisions.
Knowledge and perceptions of mental health care users on decriminalisation of cannabis at Weskoppies, a tertiary psychiatric hospital in Gauteng, South Africa
Montoedi, Botshelo P.; Sibanyoni, A.U.D.; Moeketsi, Tshepiso D.; Tosh, Cheryl (AOSIS, 2025-12-11)
BACKGROUND : The decriminalisation of cannabis is gaining support in many countries, including South Africa. Decriminalisation does not make cannabis entirely legal but reduces the severity of punishment for possession and use. This study aimed to explore perceptions and knowledge of cannabis decriminalisation among mental health care users (MHCUs) at a tertiary psychiatric hospital (Weskoppies hospital) in Gauteng, South Africa. METHODS : This was a cross-sectional, quantitative study. Mental health care users with positive cannabis urine tests completed a structured questionnaire. Participation was voluntary and anonymous. Using the cannabis use disorder identification tool (CUDIT-R), participants were categorised into two groups: those with hazardous cannabis use and those with a cannabis use disorder. Both bivariate analyses (t-tests) and logistic regression models were performed to assess associations between knowledge or perceptions and sociodemographic variables (p ≤ 0.05). RESULTS : The study included 90 participants, mostly single male (81%, n = 73), with Grade 12 education. The findings revealed that 6% of participants had accurate knowledge of cannabis, 56% had good knowledge and 38% had poor knowledge. Participants with good knowledge of cannabis had 3.3 (95% confidence interval [CI] 1.54–15.44) greater odds of poor perceptions on decriminalisation of cannabis and a 4.9 (95% CI 1.12–8.23) decreased odds of cannabis use disorders. Additionally, older age (OR: 8.15; 95% CI 0.98–68.52) was statistically significant with increased odds of cannabis use disorders. CONCLUSION : This study highlights the varied levels of knowledge about cannabis among MHCUs and underscores the need for targeted education and rehabilitation services to address cannabis use issues.
Efficient recovery of platinum and palladium by fixed‑bed column adsorption using acylthiourea‑ and amine‑modified silica
Mphahlele, Malehlogonolo R.R.; Mosai, Alseno Kagiso; Tutu, Hlanganani; Kotzé, Izak A. (Springer, 2025-12)
The rising demand and limited natural reserves of platinum group metals (PGMs) have intensified the need for sustainable recovery from secondary sources. This study investigates the continuous fixed-bed column adsorption of platinum (Pt) and palladium (Pd) from aqueous solutions using silica-anchored acylthiourea and amine-modified adsorbents. Adsorption experiments were performed at pH 2 and a flow rate of 2.00 mL/min, with variations in bed height and metal concentration to optimise recovery. Among the four adsorbents tested, DTMSP-BT-SG exhibited the highest adsorption capacities, with Thomas model-derived values reaching 470.67 mg/g for Pt and 382.19 mg/g for Pd. Increasing bed height and metal concentration enhanced both breakthrough capacity and the volume of solution treated, with up to 4775 bed volumes processed. Comparison with batch-mode adsorption revealed that, although equilibrium was achieved more rapidly in batch systems, column mode enabled significantly higher treatment volumes and yielded higher capacities. Breakthrough data were best described by the Thomas and Yoon–Nelson models (R2 > 0.90), while the Bohart–Adams model was less predictive across the full breakthrough profile. The findings confirm the superior performance of acylthiourea-based adsorbents, particularly DTMSP-BT-SG, in large-scale continuous recovery of Pt and Pd from industrial and mining wastewater.
Distinguishing developmental dyslexia from foundational delay : reading proficiency of Afrikaans learners after COVID-19 lockdowns
Stark, Sandra; Geertsema, Salome; Le Roux, Mia; Graham, Marien Alet (Education Association of South Africa, 2026-02)
The COVID-19 lockdowns and related school closures severely disrupted early literacy development worldwide. In this study we examined the long-term impact of these disruptions on Afrikaans-speaking learners in South Africa who were in the Foundation Phase (Grades 1–3) during the lockdowns and were later assessed in Grades 5, 6, and 7. Grounded in the simple view of reading (SVR), which defines reading comprehension as the product of decoding and language comprehension, we explored how delayed acquisition of foundational skills may be misinterpreted as developmental dyslexia (DD). We propose the concept of foundational delay phenomenon (FDP), a novel term describing persistent literacy difficulties stemming from disrupted foundational instruction, which do not align with established classifications such as developmental dyslexia (DD) or general learning delays. The results show that learners in all 3 grades – especially those in Grade 7 – performed well below chronological age expectations in reading and spelling, with some deficits exceeding 30 to 40 months. While a subset met DD criteria, a larger group displayed compounded foundational delays consistent with FDP. These findings highlight the urgent need for refined diagnostic practices to differentiate between reading disorders and entrenched instructional delays caused by the COVID-19 education disruptions.
A comprehensive scoping review of existing carotid duplex ultrasound scanning and reporting protocols : identifying gaps and opportunities for standardization of practice in low-income countries
Mukabagorora, Theonille; Mbonambi, Linda; Lockhat, Zarina I.; Musafiri, Amiable; Kekana, Ramadimetja (Springer, 2025-12)
BACKGROUND : Duplex carotid ultrasound is a non-invasive imaging test that is essential for assessing carotid artery disease, particularly in determining the presence and severity of atherosclerosis and the risk of cerebrovascular events. However, the interpretation of ultrasound results can differ widely due to variations in diagnostic criteria, lack of standardization in scanning methods, and differing approaches to evaluating carotid intimal medial thickness (CIMT), plaques, and stenosis. These inconsistencies create challenges in clinical practice and the reproducibility of results. While various protocols for CIMT, plaque measurement, and stenosis grading are available in the literature, a standardized global protocol is still lacking. This article presents a scoping review of current carotid duplex ultrasound scanning and reporting protocols. It aims to identify existing protocols and guidelines for carotid ultrasound scanning and reporting, highlight variations, and propose a standardized approach to enhance diagnostic accuracy and clinical outcomes in carotid atherosclerosis. METHODS : Using predefined search protocols developed in collaboration with the specialized librarian from the University of Pretoria, we searched different databases and gray literature to identify existing protocols on carotid ultrasound including scanning technique, carotid intimal medial thickness, carotid plaques, and carotid stenosis grading. Due to limitations in the length of the review, and the existence of a large number of protocols, this review focused on the protocols developed and published by institutions and professional societies rather than individual articles. RESULTS : Among 2496 articles identified from databases and 22 from other sources, 17 articles met the criteria for this review. The most common criteria that was found following this review are those established by the Society of Radiologists in Ultrasound (SRU) in 2003. The researchers further noted that these criteria were, however, been criticized for relying heavily on peak systolic velocities, a measurement that, when used alone, can be misleading. Literature further demonstrated that other researchers and professional societies have called for consensus on unified criteria for the diagnosis of carotid atherosclerosis. CONCLUSION : While carotid ultrasound is an important, non-invasive, and widely available method for evaluating carotid atherosclerosis, the variations in scanning techniques, measurements, and cut-off values underscore the need for standardized diagnostic criteria. Standardization is essential to provide consistent patient care and ensure accurate examination in various clinical settings. This will lead to the reduction of stroke and cardiovascular incidence which are the leading causes of death worldwide and more prevalent in low-income countries.