Estimating the burden of disease attributable to excess body weight in South Africa in 2000

OBJECTIVE: To estimate the burden of disease attributable to excess body weight using the body mass index (BMI), by age and sex, in South Africa in 2000. DESIGN: World Health Organization comparative risk assessment (CRA) methodology was followed. Re-analysis of the 1998 South Africa Demographic and Health Survey data provided mean BMI estimates by age and sex. Population attributable fractions were calculated and applied to revised burden of disease estimates. Monte Carlo simulation-modelling techniques were used for the uncertainty analysis. SETTING: South Africa. SUBJECTS. Adults ≥ 30 years of age. OUTCOME MEASURES. Deaths and disability-adjusted life years (DALYs) from ischaemic heart disease, ischaemic stroke, hypertensive disease, osteoarthritis, type 2 diabetes mellitus, and selected cancers. RESULTS: Overall, 87% of type 2 diabetes, 68% of hypertensive disease, 61% of endometrial cancer, 45% of ischaemic stroke, 38% of ischaemic heart disease, 31% of kidney cancer, 24% of osteoarthritis, 17% of colon cancer, and 13% of postmenopausal breast cancer were attributable to a BMI ≥ 21 kg/m2. Excess body weight is estimated to have caused 36 504 deaths (95% uncertainty interval 31 018 - 38 637) or 7% (95% uncertainty interval 6.0 - 7.4%) of all deaths in 2000, and 462 338 DALYs (95% uncertainty interval 396 512 - 478 847) or 2.9% of all DALYs (95% uncertainty interval 2.4 - 3.0%). The burden in females was approximately double that in males. CONCLUSIONS: This study shows the importance of recognising excess body weight as a major risk to health, particularly among females, highlighting the need to develop, implement and evaluate comprehensive interventions to achieve lasting change in the determinants and impact of excess body weight

Optimising the primary mental health care workforce: how can effective psychological treatments for common mental disorders best be delivered in primary health care?

The research reported in this paper is a project of the Australian Primary Health Care Research Institute, which is supported by a grant from the Australian Government Department of Health and Ageing under the Primary Health Care Research, Evaluation and Development Strategy

Optimising allied health psychological treatments in primary health care: Piloting a randomised controlled trial of social worker training in focused psychological strategies (The SW-fps Study)

The SW-fps Study was part of a broader body of research which aims to improve access to evidence-based psychological treatments in primary health care. Over the last decade, major mental health reforms in Australia, such as the Better Outcomes and Better Access programs, have greatly increased community access to psychological treatments through a range of funding models designed to support provision of psychological treatments by allied health providers. More recently social workers, amongst other allied health professionals, are beginning to utilise the Medicare incentives to provide psychological treatments in primary mentalThe research reported in this paper is a project of the Australian Primary Health Care Research Institute, which is supported by a grant from the Australian Government Department of Health and Ageing under the Primary Health Care Research, Evaluation and Development Strategy

Provincial mortality in South Africa, 2000 - Priority-setting for now and a benchmark for the future

Background. Cause-of-death statistics are an essential component of health information. Despite improvements, underregistration and misclassification of causes make it difficult to interpret the official death statistics. Objective. To estimate consistent cause-specific death rates for the year 2000 and to identify the leading causes of death and premature mortality in the provinces. Methods. Total number of deaths and population size were estimated using the Actuarial Society of South Africa ASSA2000 AIDS and demographic model. Cause-of-death profiles based on Statistics South Africa's 15% sample, adjusted for misclassification of deaths due to ill-defined causes and AIDS deaths due to indicator conditions, were applied to the total deaths by age and sex. Age-standardised rates and years of life lost were calculated using age weighting and discounting. Results. Life expectancy in KwaZulu-Natal and Mpumalanga is about 10 years lower than that in the Western Cape, the province with the lowest mortality rate. HIV/AIDS is the leading cause of premature mortality for all provinces. Mortality due to pre-transitional causes, such as diarrhoea, is more pronounced in the poorer and more rural provinces. In contrast, non-communicable disease mortality is similar across all provinces, although the cause profiles differ. Injury mortality rates are particularly high in provinces with large metropolitan areas and in Mpumalanga. Conclusion. The quadruple burden experienced in all provinces requires a broad range of interventions, including improved access to health care; ensuring that basic needs such as those related to water and sanitation are met; disease and injury prevention; and promotion of a healthy lifestyle. High death rates as a result of HIV/AIDS highlight the urgent need to accelerate the implementation of the treatment and prevention plan. In addition, there is an urgent need to improve the cause-of-death data system to provide reliable cause-of-death statistics at health district level

Estimating the burden of disease attributable to excess body weight in South Africa in 2000

Objective. To estimate the burden of disease attributable to excess body weight using the body mass index (BMI), by age and sex, in South Africa in 2000. Design. World Health Organization comparative risk assessment (CRA) methodology was followed. Re-analysis of the 1998 South Africa Demographic and Health Survey data provided mean BMI estimates by age and sex. Populationattributable fractions were calculated and applied to revised burden of disease estimates. Monte Carlo simulation-modelling techniques were used for the uncertainty analysis. Setting. South Africa. Subjects. Adults 30 years of age. Outcome measures. Deaths and disability-adjusted life years (DALYs) from ischaemic heart disease, ischaemic stroke, hypertensive disease, osteoarthritis, type 2 diabetes mellitus, and selected cancers. Results. Overall, 87% of type 2 diabetes, 68% of hypertensive disease, 61% of endometrial cancer, 45% of ischaemic stroke, 38% of ischaemic heart disease, 31% of kidney cancer, 24% of osteoarthritis, 17% of colon cancer, and 13% of postmenopausal breast cancer were attributable to a BMI 21 kg/m2. Excess body weight is estimated to have caused 36 504 deaths (95% uncertainty interval 31 018 - 38 637) or 7% (95% uncertainty interval 6.0 - 7.4%) of all deaths in 2000, and 462 338 DALYs (95% uncertainty interval 396 512 - 478 847) or 2.9% of all DALYs (95% uncertainty interval 2.4 - 3.0%). The burden in females was approximately double that in males. Conclusions. This study shows the importance of recognising excess body weight as a major risk to health, particularly among females, highlighting the need to develop, implement and evaluate comprehensive interventions to achieve lasting change in the determinants and impact of excess body weight

Evaluation of record linkage of mortality data between a health and demographic surveillance system and national civil registration system in South Africa

Background: Health and Demographic Surveillance Systems (HDSS) collect independent mortality data that could be used for assessing the quality of mortality data in national civil registration (CR) systems in low- and middle-income countries. However, the use of HDSS data for such purposes depends on the quality of record linkage between the two data sources. We describe and evaluate the quality of record linkage between HDSS and CR mortality data in South Africa with HDSS data from Agincourt HDSS.Methods: We applied deterministic and probabilistic record linkage approaches to mortality records from 2006 to 2009 from the Agincourt HDSS and those in the CR system. Quality of the matches generated by the probabilistic approach was evaluated using sensitivity and positive predictive value (PPV) calculated from a subset of records that were linked using national identity number. Matched and unmatched records from the Agincourt HDSS were compared to identify characteristics associated with successful matching. In addition, the distribution of background characteristics in all deaths that occurred in 2009 and those linked to CR records was compared to assess systematic bias in the resulting record-linked dataset in the latest time period.Results: Deterministic and probabilistic record linkage approaches combined linked a total of 2264 out of 3726 (60.8%) mortality records from the Agincourt HDSS to those in the CR system. Probabilistic approaches independently linked 1969 (87.0%) of the linked records. In a subset of 708 records that were linked using national identity number, the probabilistic approaches yielded sensitivity of 90.0% and PPV of 98.5%. Records belonging to more vulnerable people, including poorer persons, young children, and non-South Africans were less likely to be matched. Nevertheless, distribution of most background characteristics was similar between all Agincourt HDSS deaths and those matched to CR records in the latest time period.Conclusion: This study shows that record linkage of mortality data from HDSS and CR systems is possible and can be useful in South Africa. The study identifies predictors for death registration and data items and registration system characteristics that could be improved to achieve more optimal future matching possibilities

Determination of an optimal dose of medetomidine-ketamine-buprenorphine for anaesthesia in the Cape ground squirrel (Xerus inauris)

The optimal dose of medetomidine-ketamine-buprenorphine was determined in 25 Cape ground squirrels (Xerus inauris) undergoing surgical implantation of a temperature logger into the abdominal cavity. At the end of anaesthesia, the squirrels were given atipamezole intramuscularly to reverse the effects of medetomidine. The mean dose of medetomidine was 67.6±9.2 μg/kg, ketamine 13.6±1.9 mg/kg and buprenorphine 0.5±0.06 μg/kg. Induction time was 3.1 ± 1.4 min. This produced surgical anaesthesia for 21± 4.2 min. Atipamezole 232±92 μg/kg produced a rapid recovery. Squirrels were sternally recumbent in 3.5 ± 2.2 min.http://www.journals.co.za/ej/ejour_savet.htm

Experiencing transitions in life of mothers of young children

V magistrskem delu smo raziskovali doživljanje življenjskih prehodov mater majhnih otrok. Teoretični del je bil namenjen pregledu literature s področja blagostanja, življenjskih prehodov in materinstva. Za raziskovanje doživljanja življenjskih prehodov je bil uporabljen psihološko fenomenološki pristop. V skladu s tem smo pridobili vpogled v doživljanje šestih udeleženk, hkrati pa vnaprej nismo predvidevali rezultatov ali postavljali hipotez. Cilj psihološko fenomenološke metode je bil oblikovati splošni opis bistvenih značilnosti doživljanja oziroma osnovne strukture, ki določa raziskovano doživljanje. Na podlagi intervjujev smo oblikovali splošno strukturo doživljanja življenjskih prehodov pri materah majhnih otrok. Ugotovili smo, da je za polovico udeleženk materinstvo najpomembnejši prehod v življenju, za ostale tri pa je na drugem mestu. Bistvene spremembe prehoda v materinstvo je mogoče razdeliti na dva dela: povzamejo občutenje, ki se dotika drugih in okolice ter občutenje, ki jih ima ženska do same sebe. Prav tako materinstvo pomembno zaznamuje doživljanje na področju telesnega, relacijskega, čustvenega in duhovnega blagostanja. Vpogled v doživljanje življenjskih prehodov pri materah majhnih otrok, ki ga daje ta raziskava, je lahko uporabna in v pomoč ljudem, ki profesionalno delujejo na področju psihologije, psihoterapije ali na katerem drugem profesionalnem področju, ki vključuje delo z ljudmi, še posebej z ženskami. Kot tako, bo lahko omogočilo pripravo strokovnih smernic programov za ženske, priprave na starševstvo ali podporne skupine za ženske. Verjamemo pa, da bo delo v pomoč tudi tistim, ki si želijo pridobiti vedenje in znanje o tej tematiki, saj lahko služi kot pomoč pri razumevanju doživljanja žensk, ko se te soočajo z življenjskimi prehodi, predvsem s prehodom v materinstvo.This Masters thesis researches how mothers with young children dealt with and experienced their life transition to the role of being a mother. The theoretical part of the thesis focuses on the literature review from the fields of welfare, life transitions and motherhood. A psychological-phenomenological approach has been used to research the life transitions. Based on this an insight into the transition experience of six women has been received, whereas there were no predictions on the outcome or setting hypothesis. The goal of the psychological-phenomenological method is to form a general description of key characteristics or the basic structure, which describe the researched transition. Based on performed interviews a general structure of experiencing the life transitions with mothers with young children has been made. The results show that for half of women experiencing motherhood is the most important transition in life, whereas the other three placed it to the second position in importance of life transitions. Key changes in the transition to the motherhood can be divided to feelings referring to the surrounding and others and secondly, feelings which a woman experiences with regard to herself. Motherhood also significantly affects woman’s relations to physical, relational, emotional and spiritual well-being. Insight to experiencing the life transitions with mothers with young children which this research offers, is useful and of help to anyone who is professionally involved in the fields of psychology, psychotherapy or any other related field which involves working with people, especially women. As such the thesis can enable preparation of professional guidelines and programs for women, parenthood preparations or support groups for women. We believe, that thesis will also assist to those, that would like to develop knowledge on this topic as it can serve as outreach at understanding of experiencing of women, when these are deal with different life transitions, particulary transition to the motherhood