No abstract

Many children with achalasia relapse after initial treatment, undergoing multiple, different procedures, despite which symptoms persist and impact on quality of life. Symptoms develop earlier in patients with triple A syndrome, but the diagnosis is delayed and this has substantial nutritional impact.

Background: Reverse logistics (RL) practices have previously been viewed as a cost drain, but have received greater attention from practitioners because of increasing competition and dwindling margins.Purpose: The purpose of this generic qualitative study was to uncover the main internal and external drivers and barriers of RL within major South African grocery retailers.Method: Eleven face-to-face, semi-structured interviews and one telephonic interview were conducted with participants from four large grocery retailers.Findings: Optimising profitability and cost reduction goals are the identified internal drivers, whereas the main external driver was to reduce the organisations’ environmental impact. A lack of information systems – such as enterprise resource planning systems or warehouse management system software – and infrastructure were revealed as the main internal barriers for organisations’ RL practices, whereas supplier non-compliance and transportation inefficiencies were the main external barriers exposed.Managerial implications: In order to optimise the efficiency of the reverse flow, managers are recommended to devote more capital to RL infrastructure, develop policies to manage supplier behaviour, focus on RL as a revenue generating stream as well as implement information systems to manage the entire reverse flow.Conclusion: All participating grocery retailers follow similar RL processes. Growth in RL practices as well as infrastructure to perform those practices is a future priority for all the reviewed grocery retailers. RL is no longer only a key cost driver, but also provides organisations with many additional opportunities.

Post-print version. Full reference: Feucht UD, Meyer A, Thomas WN, Forsyth BWC, Kruger M. Early diagnosis is critical to ensure good outcomes in HIV-infected children -Outlining barriers to care. Published: AIDS Care. 2015. doi: 10.1080/09540121.2015.1066748 Abstract HIV-infected children require early initiation of antiretroviral therapy (ART) to ensure good outcomes. The aim was to investigate missed opportunities in childhood HIV diagnosis leading to delayed ART initiation.Baseline data was reviewed of all children aged <15 years referred over a one-year period for ART initiation to the Kalafong Hospital HIV services in Gauteng, South Africa. Of the 250 children, one quarter (24.5%) were of school-going age, 34.5% in the preschool group, 18% between 6-12 months old and 23% below six months of age (median age=1.5 years [IQR 0.5-4.8]). Most children (82%) presented with advanced/severe HIV disease, particularly those aged 6-12 months (95%). Malnutrition was prominent and referrals were mostly from hospital inpatient services (61%).A structured caregiver interview was conducted in a subgroup, with detailed review of medical records and HIV results. The majority (≥89%) of the 65 interviewed caregivers reported good access to routine healthcare, except for postnatal care (26%). Maternal HIV-testing was mostly done during the 2 nd & 3 rd pregnancy trimesters (69%). Maternal non-disclosure of HIV status was common (63%) and 83% of mothers reported a lack of psychosocial support. Routine infant HIV-testing was not done in 66%, and inadequate reporting on patient-held records (Road-toHealth Cards/Booklets) occurred frequently (74%). Children with symptomatic HIV disease were not investigated at primary healthcare in 53%, and in 68% of families the siblings were not tested. One-third of children (35%) had a previous HIV diagnosis, with 77% of caregivers aware of these prior results, while 50% acknowledged failing to attend ART-services despite referral.In conclusion, a clear strategy on paediatric HIV case finding, especially at primary healthcare, is vital. Multiple barriers need to be overcome in the HIV care pathway to reach high uptake of services, of which especially maternal reasons for not attending paediatric ART services need further exploration.