Prevalence of diabetes mellitus in the rural southern Free State

Background: A worldwide increase in the prevalence of diabetes mellitus (DM) has been reported and an even further increase is expected as a result of lifestyle changes. The objectives of this study were to determine the prevalence of DM in the rural southern Free State and to investigatethe contribution of risk factors such as age, physical activity, body mass index (BMI), waist-to-hip ratio and waist circumference to the developmentof impaired fasting glucose (IFG) or DM.Methods: Fasting venous plasma glucose (FVPG) levels were obtained from a total of 552 participants from Springfontein (n = 195), Trompsburg (n = 162) and Philippolis (n = 180). Participants were between 25 and 64 years of age, with 28.1% male (mean age 47.3 years) and 71.9% female (mean age 46 years). Anthropometric status was determined using standardised techniques. Levels of physical activity were determined using a 24-hour recall of physical activity as well as frequency of performing certain activities. Relative risks (RR) as well as 95% confidence intervals (95%CI) were used to distinguish significant risk factors for having IFG or DM.Results: In the study population the prevalence of DM was 7.6% (5.2% in men and 8.6% in women) and that of IFG was 6.3% (4.5% in men and 7.1% in women). The majority of nondiabetic (34%), IFG (55%) and DM (61%) participants were between the ages of 51 and 60 years. Age was found to be a statistically significant risk factor for having IFG or DM in participants older than 40 years of age (RR 2.3; 95% CI [1.22; 4.34]). Crude measurements (not age- and gender-adjusted) of waist circumference (RR 3.23; 95% CI [1.82; 5.74]), BMI (RR 2.32; 95% CI [1.43; 3.78]) and waist-to-hip ratio (RR 2.51; 95% CI [1.55; 4.07]) were statistically significant risk factors for having IFG or DM. Physical inactivity in men ≥ 40 years was also a statistically significant risk factor (RR 3.23; 95% CI [1.15; 9.05]) for having IFG or DM.Conclusions: In this study, 37.5% of diabetics were newly discovered. A high waist circumference, BMI and waist-to-hip-ratio were associated withan increased risk for developing IFG or DM, with a high waist circumference being the most significant general risk factor. Physically inactive men(≥ 40 years) were also at a higher risk of having IFG or DM. Follow-up FVPG and glucose tolerance tests should be performed on participants in the IFG group. A need for intervention regarding the identification and treatment of DM in these rural areas has been identified.Keywords: impaired fasting glucose; diabetes; risk factors; rura

risk-factor profile for chronic lifestyle diseases in three rural Free State towns

Background: Chronic diseases of lifestyle account for millions of deaths each year globally. These diseases share similar modifiable risk factors, including hypertension, tobacco smoking, diabetes, obesity,  hyperlipidaemia and physical inactivity. In South Africa the burden of noncommunicable disease risk factors is high. To reduce or control as many lifestyle risk factors as possible in a population, the distinct risk-factor profile for that specific community must be identified. Therefore, the aim of this study was to assess the health status in three rural Free State communities and to identify a distinct risk-factor profile for chronic lifestyle diseases in these communities.Methods: This study forms part of the baseline phase of the Assuring Health for All in the Free State project, which is a prospective and longitudinal epidemiological study aimed at determining how living in a rural area can either protect or predispose one to developing chronic lifestyle diseases. The communities of three black and coloured, rural Free State areas, namely Trompsburg, Philippolis and Springfontein, were evaluated. The study population consisted of 499 households, and 658 individuals (including children) participated in the study. Only results of adult participants between 25 and 64 years will be reported in this article. The study group consisted of 29.4% male and 70.6% female participants, with a mean age of 49 years. During interviews with trained researchers, household socio-demographic questionnaires, as well as individual  questionnaires evaluating diet, risk factors (history of hypertension and/or diabetes) and habits (tobacco smoking and physical activity levels), were completed. All participants underwent anthropometric evaluation, medical examination and blood sampling to determine fasting blood glucose levels.Results: Multiple risk factors for noncommunicable diseases were identified in this study population, including high blood pressure, tobacco smoking,high body mass index (BMI), diabetes and physical inactivity. The reported risk-factor profile was ranked. Increased waist circumference was rankedhighest, high blood pressure second, tobacco smoking third, physical inactivity fourth and diabetes fifth. The cumulative risk-factor profile revealed that 35.6 and 21% of this study population had two and three risk factors, respectively.Conclusions: The study demonstrated a high prevalence of risk factors for noncommunicable diseases, e.g. large waist circumference, high BMI,raised blood pressure, tobacco smoking and raised blood glucose levels. Serious consideration should be given to this escalating burden of lifestylediseases in the study population. The development and implementation of relevant health promotion and intervention programmes that will improvethe general health and reduce the risk for noncommunicable diseases in this population are advised.Keywords: risk; lifestyle; chronic disease

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

The assessment of crystals derived from Aloe spp. for potential use as an herbal anthelmintic thereby indirectly controlling blowfly strike

Dagginess predisposes sheep to breech strike and can be controlled with management practices (e.g. mulesing, crutching) or by treating the animal with an anthelmintic. The effect of regular treatment with crystals derived from Aloe spp as a natural anthelmintic was assessed in yearling Merino progeny born in 2004 (Trial 1) and 2005 (Trial 2), while the short-term effect of aloe treatment over 14 days was also considered (Trial 3). Animals were randomly allocated to a treatment group (aloe or distilled water). Natural challenge was used to ensure that all animals received an adequate gastro-intestinal nematode challenge, prior to being drenched with an aloe solution, or distilled water as a control treatment. Following treatment, gastro-intestinal nematode egg counts (FEC) were obtained at regular intervals to assess the effect of aloe treatment. Dag scores were also recorded prior to shearing as hoggets. The experimental outlay of all trials was factorial, with aloe treatment and sampling date as main effects. Recordings of FEC were subjected to a cube root transformation prior to analyses to normalise the distribution in all cases. When monthly FEC was considered in Trial 1 and 2, there was also no evidence of a reduced parasite burden in the treated group. No change was accordingly found in Trial 3, where the short-term effect of treatment was considered. The mean dag scores of individuals in Trials 1 and 2 were accordingly not affected by treatment with aloe. Alternative strategies for the reduction of FEC and flystrike thus need to be considered.Keywords: Aloe, anthelmintic, nematode egg counts, Merino, breech strik

Divergent selection for reproduction affects dag score, breech wrinkle score and crutching time in Merinos

AgriwetenskappeVeekundige WetenskappePlease help us populate SUNScholar with the post print version of this article. It can be e-mailed to: [email protected]

Divergent selection for reproduction affects dag score, breech wrinkle score and crutching time in Merinos

AgriwetenskappeVeekundige WetenskappePlease help us populate SUNScholar with the post print version of this article. It can be e-mailed to: [email protected]

Genetic parameters for breech strike indicator traits and yearling production traits in merinos

Please help us populate SUNScholar with the post print version of this article. It can be e-mailed to: [email protected] Wetenskapp

Short communication: Divergent selection for reproduction affects dag score, breech wrinkle score and crutching time in Merinos

Merino lines that were divergently selected from the same base population from 1986 to 2009 for their ability to rear multiples were assessed for dag score in autumn and spring, breech wrinkle score, and crutching time. Animals in the Low (L) line had higher dag and breech wrinkle scores and took longer to be crutched than High (H) line contemporaries. Expressed relative to H line least squares means, means of L line individuals were respectively 54%, 65%, 42% and 40% higher for autumn dag score, spring dag score, breech fold score, and crutching time. Gender effects for dag score were inconclusive, as ewe hoggets were more daggy than rams in autumn, with an opposite trend in spring. Shearer (n = 6) also affected crutching times, with an almost twofold difference in mean crutching time from the quickest shearer (27.7 ± 3.1 seconds) to the slowest shearer (49.4 ± 3.7 seconds). The inclusion of dag score and breech wrinkle score as linear covariates in an analysis on crutching time eliminated the effect of selection line. It thus seems that the quicker crutching times of H line animals may be related to line differences for dag score and, to a lesser extent, for breech wrinkle score.Keywords: Reproduction, selection lines, shearing time, wrinkl

Drug concentration at the site of disease in children with pulmonary tuberculosis

Background Current TB treatment for children is not optimized to provide adequate drug levels in TB lesions. Dose optimization of first-line antituberculosis drugs to increase exposure at the site of disease could facilitate more optimal treatment and future treatment-shortening strategies across the disease spectrum in children with pulmonary TB. Objectives To determine the concentrations of first-line antituberculosis drugs at the site of disease in children with intrathoracic TB. Methods We quantified drug concentrations in tissue samples from 13 children, median age 8.6 months, with complicated forms of pulmonary TB requiring bronchoscopy or transthoracic surgical lymph node decompression in a tertiary hospital in Cape Town, South Africa. Pharmacokinetic models were used to describe drug penetration characteristics and to simulate concentration profiles for bronchoalveolar lavage, homogenized lymph nodes, and cellular and necrotic lymph node lesions. Results Isoniazid, rifampicin and pyrazinamide showed lower penetration in most lymph node areas compared with plasma, while ethambutol accumulated in tissue. None of the drugs studied was able to reach target concentration in necrotic lesions. Conclusions Despite similar penetration characteristics compared with adults, low plasma exposures in children led to low site of disease exposures for all drugs except for isoniazid