Background: Conjoint analysis involves the measurement of consumer preferences between choice alternatives. Aims and objectives: To investigate the use of conjoint analysis in facilitating and understanding choice of growth hormone injection devices. Method and subjects: 56 patients and their parents participated in an electronic, computer-based interview. The interview took a median time of 18 min (range 12-30) and allowed an immediate matching of injection devices to the family's preferences. Results: Amongst the key drivers of choice, lack of bruising was rated highest and designated an index of 100. Compared to this, the remaining attributes in order of desirability were: auto-injector (98), lack of pain (93), lightweight (88), silent (82), ready-mixed (77), ease of holding (69), telephone helpline (66), needle-free (62), small size (60), nurse support (47), hidden needle (45), stored in fridge (13) and home delivery (6). Out of the 17 families who had already chosen a device previously by discussion with the clinic nurse, the computer model placed their device either as first or second out of seven devices tested. Conclusion: Adaptive or interactive conjoint analysis applied at the patient level can facilitate the choicemaking process whilst providing an insight into the relative importance of the key features that influence choice.

The aim of this study was to assess body composition in children with chronic renal failure (CRF) and post renal transplantation (Tx), and to compare it to body mass index (BMI) and nutritional intake. Dietary assessment using 3-day diaries, total and regional body composition assessment by dual x-ray energy absorptiometry of 50 CRF children (29M, 21F), median age 8.9 yrs and 50 Tx children (32M, 18F), median age 12.9 yrs. BMI, percentage fat mass (%FM) and lean mass (LM) were corrected for height and expressed as SDS (HSDS). In both groups, BMIHSDS was lower than %FMHSDS and higher than LMHSDS (p<0.05). In the Tx group, there were associations on bivariate analysis between energy & protein intake and BMIHSDS & %FMHSDS (r,0.5, p<0.05), and between LMHSDS and protein intake (r,0.5, p<0.05). On multivariate analysis, there was an association between LMHSDS and time since transplantation (r,-0.4, p<0.05). Children in the CRF and Tx groups had a high percentage predicted trunk:leg FM ratio of 148% and 157%, respectively. Children with CRF and Tx have discordant body composition with a relatively high FM and low LM, which is not reflected by BMI. In addition, they appear to have an increased level of central adiposity that may predispose them to increased morbidity in later life.

SF and serum JIA samples can impair bone growth at the growth plate. In synovial fluid, the effect is variable but resistant to treatment with IL-1beta, IL-6 and TNF-alpha specific antibodies and IGF-1, suggesting that other factors in this biological fluid may also have an effect on longitudinal growth through IGF-1-independent mechanisms.

End-of-life care and organ and tissue donation in South Africa-it's time for a national policy to lead the way To the Editor: We refer to the guest editorial in the July SAMJ, [1] which appealed for a national policy to optimise organ donation. The authors highlighted a concerning 'sense of uncertainty regarding the roles of healthcare professionals in the end-of-life care of terminal patients and procurement of organs from deceased donors'. They also identified the alarming cost to a system that relies on dialysis in the setting of a kidney transplant rate of only 4.1 per million population, and call on the government to create a more effective organ donation policy via so-called 'national self-sufficiency'. We applaud the authors for promoting improved education for nurses to increase the rates of organ donation in South Africa (SA). Nevertheless, the South African Burn Society was disappointed to note that tissue donation, and specifically donation of skin, was not mentioned, despite the fact that 'organs and tissue' should always be introduced together when permission is sought for deceased donation. While organ transplantation and burn surgery are regarded as advanced, centralised subspecialties internationally, only organ transplantation has truly been afforded that status in SA. Burn surgery continues to be poorly resourced and under-staffed despite the extremely high incidence of burn injuries in this country, and there appears to be little desire to improve the situation. Every year more than 3.2 per 1 000 South Africans sustain burn injuries requiring medical attention, and a considerable proportion of these patients are young and/or economically active at the time of their burn. While many refer to SA's healthcare service as cripplingly underresourced, there is no doubt that poor resource allocation is also responsible, evident from the perspective of burn services by the fact that other surgical specialties, for example, benefit from considerably more operating time, staffing at all levels, surgical instrumentation and beds in tertiary facilities relative to clinical demand. Misconceptions of the complex interdisciplinary resources required to optimise burn care and outcomes persist. For example, where burn centres do not have their own intensive care facilities, many state-funded intensive care units in SA continue to enforce a policy of denying access to patients with burn injuries, owing to perceived poor outcomes and misplaced concerns about infection prevention and control. It is well recognised that deceased donor allograft is a fundamental resource for the burn surgeon to improve the standard of care of patients with major burn injuries. [2-5] Cadaver skin, when available, has been shown to reduce both mortality and morbidity, and can contribute to reductions in hospital stays and successful societal reintegration. This relies on ready access via skin procurement, processing, banking and distribution. SA has recently established such a skin bank, [4] but cadaver skin continues to be in extremel...