The association between sense of coherence, emotional intelligence and health behaviour : a salutogenic perspective

Chronic diseases are usually the result of complex interactions between various lifestyle factors, physiological processes and societal factors. While some of these factors are not modifiable, modification of several of these factors have, to a large extent, demonstrated preventative properties against the development or further development of various chronic diseases. Health-related behaviours are modifiable factors. Behaviour plays an important role in both the development and the management of chronic diseases. One way of investigating this role is to evaluate the impact of health-related behaviours on health. Positive health-related behaviours include eating a healthy diet, regularly engaging in physical exercise, having regular screenings and checkups, not smoking, moderate alcohol use, getting vaccinations and seat belt use. Negative health-related behaviours include eating an unhealthy diet, leading a sedentary life style, not having regular screenings and checkups, smoking, excessive alcohol use and irresponsible driving. Various models of health-related behaviour use social cognitive factors as proximal determinants of health-related behaviours. A social cognitive factor that has received little attention in relation to health-related behaviour, that is sense of coherence (SOC), was used in this study. Although personality factors tend to be only distally associated with health-related behaviour, they do however seem to contribute to a better understanding of these behaviours. Trait emotional intelligence (EI) as a lower order personality trait was used in this study. The purpose of this study was to investigate the nature of the relationships between SOC, trait EI and health-related behaviours. A cross-sectional, correlational research design was used. Participants were selected based on convenient and easy access. Participants completed an online questionnaire that consisted of a health behaviour survey as well as the short form of the Orientation to Life Questionnaire and the Trait Emotional Intelligence Questionnaire. The health behaviour survey assessed some aspects of people's health-related behaviour, including diet, sleep and preventive behaviours, alcohol use, exercise and smoking. Health behaviour correlated significantly with both SOC and Trait EI. SOC and Trait EI were also significantly correlated. When controlling for a third variable, neither SOC nor trait EI correlated significantly with health behaviour. Although none of the predictors made significant contributions to the prediction of health behaviour, the basic regression model reached statistical significance. Trait EI made a significant contribution to the prediction of health behaviour in a more parsimonious regression model, which also reached statistical significance.Dissertation (MA (Research Psychology))--University of Pretoria, 2008.Psychologyunrestricte

Gender patterns in the contribution of different types of violence to posttraumatic stress symptoms among South African urban youth

OBJECTIVE: Identifying the comparative contributions of different forms of violence exposure to trauma sequelae can help to prioritize interventions for polyvictimized youth living in contexts of limited mental health resources. This study aimed to establish gender patterns in the independent and comparative contributions of five types of violence exposure to the severity of posttraumatic stress symptoms among Xhosa-speaking South African adolescents. METHOD: Xhosa-speaking adolescents (n = 230) attending a high school in a low-income urban community in South Africa completed measures of violence exposure and posttraumatic stress symptoms. RESULTS: While witnessing of community violence was by far the most common form of violence exposure, for the sample as a whole only sexual victimization and being a direct victim of community violence, together with gender, contributed independently to the severity of posttraumatic stress symptoms. When the contribution of different forms of violence was examined separately for each gender, only increased exposure to community and sexual victimization were associated with symptom severity among girls, while increased exposure to direct victimization in both the community and domestic settings were associated with greater symptom severity in boys. CONCLUSIONS: The findings provide some preliminary motivation for focusing trauma intervention initiatives in this community on girls who have experienced sexual abuse compounded by victimization in the community, and boys who have been direct victims of either domestic or community violence. Further research is required to establish whether the risk factors for posttraumatic stress symptoms identified among adolescents in this study are consistent across different communities in South Africa, as well as across other resource-constrained contexts.IS

A retrospective descriptive analysis of non-physician-performed prehospital endotracheal intubation practices and performance in South Africa

Introduction Prehospital advanced airway management, including endotracheal intubation (ETI), is one of the most commonly performed advanced life support skills. In South Africa, prehospital ETI is performed by non-physician prehospital providers. This practice has recently come under scrutiny due to lower first pass (FPS) and overall success rates, a high incidence of adverse events (AEs), and limited evidence regarding the impact of ETI on mortality. The aim of this study was to describe non-physician ETI in a South African national sample in terms of patient demographics, indications for intubation, means of intubation and success rates. A secondary aim was to determine what factors were predictive of first pass success. Methods This study was a retrospective chart review of prehospital ETIs performed by non-physician prehospital providers, between 01 January 2017 and 31 December 2017. Two national private Emergency Medical Services (EMS) and one provincial public EMS were sampled. Data were analysed descriptively and summarised. Logistic regression was performed to evaluate factors that affect the likelihood of FPS. Results A total of 926 cases were included. The majority of cases were adults (n = 781, 84.3%) and male (n = 553, 57.6%). The most common pathologies requiring emergency treatment were head injury, including traumatic brain injury (n = 328, 35.4%), followed by cardiac arrest (n = 204, 22.0%). The mean time on scene was 46 minutes (SD = 28.3). The most cited indication for intubation was decreased level of consciousness (n = 515, 55.6%), followed by cardiac arrest (n = 242, 26.9%) and ineffective ventilation (n = 96, 10.4%). Rapid sequence intubation (RSI, n = 344, 37.2%) was the most common approach. The FPS rate was 75.3%, with an overall success rate of 95.7%. Intubation failed in 33 (3.6%) patients. The need for ventilation was inversely associated with FPS (OR = 0.42, 95% CI: 0.20–0.88, p = 0.02); while deep sedation (OR = 0.56, 95% CI: 0.36–0.88, p = 0.13) and no drugs (OR = 0.47, 95% CI: 0.25–0.90, p = 0.02) compared to RSI was less likely to result in FPS. Increased scene time (OR = 0.99, 95% CI: 0.985–0.997, p < 0.01) was inversely associated FPS. Conclusion This is one of the first and largest studies evaluating prehospital ETI in Africa. In this sample of ground-based EMS non-physician ETI, we found success rates similar to those reported in the literature. More research is needed to determine AE rates and the impact of ETI on patient outcome. There is an urgent need to standardise prehospital ETI reporting in South Africa to facilitate future research

Association of vitamin D status with arterial blood pressure and hypertension risk : a mendelian randomisation study

Peer reviewe

New genetic loci link adipose and insulin biology to body fat distribution.

Body fat distribution is a heritable trait and a well-established predictor of adverse metabolic outcomes, independent of overall adiposity. To increase our understanding of the genetic basis of body fat distribution and its molecular links to cardiometabolic traits, here we conduct genome-wide association meta-analyses of traits related to waist and hip circumferences in up to 224,459 individuals. We identify 49 loci (33 new) associated with waist-to-hip ratio adjusted for body mass index (BMI), and an additional 19 loci newly associated with related waist and hip circumference measures (P < 5 × 10(-8)). In total, 20 of the 49 waist-to-hip ratio adjusted for BMI loci show significant sexual dimorphism, 19 of which display a stronger effect in women. The identified loci were enriched for genes expressed in adipose tissue and for putative regulatory elements in adipocytes. Pathway analyses implicated adipogenesis, angiogenesis, transcriptional regulation and insulin resistance as processes affecting fat distribution, providing insight into potential pathophysiological mechanisms

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Social support, violence exposure and mental health among young South African adolescents

Objective: Cumulative violence exposure has been associated with both internalising and externalising difficulties in youth. Therefore, it is important to identify protective factors that may ameliorate both exposure to and the impact of cumulative violence. This study aimed to identify sources of perceived social support amongst early adolescents in a low-income, high-violence community in South Africa, and to examine the association of perceived support with exposure to violence and with the severity of depression, aggression and conduct disorder symptoms.Method: A sample of 615 Grade 7 learners completed measures of perceived social support, different types of violence exposure and symptoms of depression, aggression and conduct disorder.Results: Maternal, paternal and overall family support were weakly associated with a reduced risk of domestic violence, but not with other forms of violence exposure, and were also weakly associated with a reduced risk of mental health difficulties. Peer support was associated with higher symptomatology across all mental health outcomes while teacher support was associated with greater severity of depression.Conclusions: The stress-buffering effects of social support may not be maintained in contexts of high exposure to violence. Implications for interventions to enhance youth safety and resilience in high-violence contexts are considered.

Research PaperRisk factors for premature termination of treatment at a child and family mental health clinic

Objective: Premature termination of treatment amongst children and families attending mental health services is a significant problem for both outcomes research and clinical practice in South Africa and elsewhere. This study investigated factors that are associated with premature termination of treatment at a public service child and family clinic in Cape Town.Method: A retrospective archival analysis of clinic files from 2002&ndash;2009 was conducted. Administrative, child and family factors, and type of treatment were explored as risk factors for premature termination.Results: A single-parent household and the presence of a child or oppositional defiant disorder were risk factors for premature termination of treatment, while the presence of a maternal psychiatric diagnosis was associated with a lower likelihood of terminating treatment prematurely. Conducting a scholastic assessment with the child was associated with a lower risk of premature termination, while there was a trend towards a higher risk of premature termination when individual child therapy was the recommended treatment.Conclusions: This study offers recommendations for how these findings could assist South African clinicians to enhance client retention in child and family mental health services, and suggestions for future research.Journal of Child and Adolescent Mental Health 2011, 23(2): 155&ndash;16

Inclusion of disability issues in teaching and research in higher education

Evidence suggests that the lack of inclusion of disability issues in the curricula of higher education institutions may result in the perpetuation of practices that discriminate against disabled people in the broader society. In light of this claim, this article investigates whether and how disability issues are included in the teaching and research of three faculties at the University of Cape Town (UCT), namely the faculties of Health Sciences, Humanities, and Engineering and the Built Environment. A survey of disability inclusion was conducted across the faculties, followed by interviews with selected participants. The study revealed low levels of disability inclusion, and that disability is not viewed as an issue of social justice and transformation overall. However, there are pockets of inclusion, the nature of which differs for each faculty. In the Faculty of Engineering and the Built Environment, disability is included as an issue of legislation, space and environment, while the Faculty of Humanities focuses on the sociocultural and socio-economic impact of disability, and the Faculty of Health Sciences introduces disability with an emphasis on individual impairment, environmental effects, community-based rehabilitation and inclusive development, as well as the prevention and management of disability. We propose the creation of an institutional system that will build the capacity of lecturers to include disability in teaching and research across faculties, in line with UCT’s transformation agenda

Dementia subtypes, cognitive decline and survival among older adults attending a memory clinic in Cape Town, South Africa: a retrospective study

Abstract Background There are no published longitudinal studies from Africa of people with dementia seen in memory clinics. The aim of this study was to determine the proportions of the different dementia subtypes, rates of cognitive decline, and predictors of survival in patients diagnosed with dementia and seen in a memory clinic. Methods Data were collected retrospectively from clinic records of patients aged ≥ 60 seen in the memory clinic at Groote Schuur Hospital, Cape Town, South Africa over a 10-year period. Diagnostic and Statistical Manual of Mental Disorders (DSM–5) criteria were used to identify patients with Major Neurocognitive Disorders (dementia). Additional diagnostic criteria were used to determine the specific subtypes of dementia. Linear regression analysis was used to determine crude rates of cognitive decline, expressed as mini-mental state examination (MMSE) points lost per year. Changes in MMSE scores were derived using mixed effects modelling to curvilinear models of cognitive change, with time as the dependent variable. Multivariable cox survival analysis was used to determine factors at baseline that predicted mortality. Results Of the 165 patients who met inclusion criteria, 117(70.9%) had Major Neurocognitive Disorder due to Alzheimer’s disease (AD), 24(14.6%) Vascular Neurocognitive Disorder (VND), 6(3.6%) Dementia with Lewy Bodies (DLB), 5(3%) Parkinson disease-associated dementia (PDD), 3(1.8%) fronto-temporal dementia, 4(2.4%) mixed dementia and 6(3.6%) other types of dementia. The average annual decline in MMSE points was 2.2(DLB/PDD), 2.1(AD) and 1.3(VND). Cognitive scores at baseline were significantly lower in patients with 8 compared to 13 years of education and in those with VND compared with AD. Factors associated with shorter survival included age at onset greater than 65 (HR = 1.82, 95% C.I. 1.11, 2.99, p = 0.017), lower baseline MMSE (HR = 1.05, 95% C.I. 1.01, 1.10, p = 0.029), Charlson’s comorbidity scores of 3 to 4 (HR = 1.88, 95% C.I. 1.14, 3.10, p = 0.014), scores of 5 or more (HR = 1.97, 95% C.I. 1.16, 3.34, p = 0.012) and DLB/PDD (HR = 3.07, 95% C.I. 1.50, 6.29, p = 0.002). Being female (HR = 0.59, 95% C.I.0.36, 0.95, p = 0.029) was associated with longer survival. Conclusions Knowledge of dementia subtypes, the rate and factors affecting cognitive decline and survival outcomes will help inform decisions about patient selection for potential future therapies and for planning dementia services in resource-poor settings