Challenges for dedicated smoking cessation services in developing countries.

BACKGROUND: South Africa, ranked as the world's second most stressful country to live in, has an estimated 7 million smokers. A dedicated smoking cessation clinic established at Groote Schuur Hospital, Cape Town, provides the only clinical service and training centre in the country. OBJECTIVES: To evaluate the smokers attending the clinic, in order to better understand the requirements of smoking cessation services in resource-limited settings. METHODS: Demographic and smoking-related data were collected prospectively from all clinic attendees since its inception. Nicotine dependence, depression scores and exhaled carbon monoxide levels were formally evaluated. Consent was provided to review the data collected. RESULTS: Ninety-seven smokers were evaluated. Their mean (standard deviation) age was 50.9 (10.7) years, and 59% (57/97) were male. The median age of smoking initiation was 16 years (interquartile range (IQR) 8 - 28), with a current median daily consumption of 12 cigarettes (IQR 7 - 20). Overall, men smoked more than women, with a median of 20 cigarettes per day (IQR 10 - 20) v. 12 (IQR 5 - 20), respectively (p=0.001). The median Fagerström nicotine dependence score was 5 (IQR 3 - 7), with scores of 6 (IQR 4 - 8) for men and 5 (2 - 7) for women (p=0.06); 50% of smokers had a Fagerström score <6 (low to above-average dependence) and 22% a score ≥8 (extreme dependence). The median Patient Health Questionnnaire-9 (PHQ-9) depression score was 8 (IQR 4 - 11), and 49% of smokers had symptoms of at least minor depression (score ≥10). The clinic could not provide pharmacotherapy. The self-reported quit rate was 28% at median follow-up of 22 months (IQR 14 - 39). CONCLUSIONS: In smokers attempting to quit, moderate levels of nicotine dependence coexist with significant depression and anxiety symptoms. These data inform resource allocation and public health strategies, suggesting that in resource-limited smoking cessation services, psychological/behavioural support focusing on depressive symptoms may be a greater priority than simple pharmacotherapy

Farm land and tenure security : new policy and legislative developments

CITATION: Pienaar, J.M. & Kamkuemah, A. 2011. Law and Poverty: Perspectives from South Africa and beyond. Stellenbosch Law Review, 22(3):724-741.The original publication is available at https://journals.co.za/content/journal/jlc_slrOn 24 December 2010 a new Draft Tenure Security Policy and concomitant Draft Land Tenure Security Bill were published for comment. These new measures focus on farm land in particular and have specific implications for the Extension of Security of Tenure Act 62 of 1997 (“ESTA”) and the Land Reform (Labour Tenant) Act 3 of 1996. This contribution briefly explores the reasons for the introduction of these new measures at this point in time, thereafter the Policy and Bill are analysed in detail. In light of our finding that the three main objectives of the tenure reform programme, namely (a) rationalisation; (b) increased security; and (c) the embodiment of constitutional imperatives, have not been achieved, some kind of intervention seventeen years after the tenure reform programme was embarked on, is to be expected. However, it is questionable whether the proposed Policy and Bill in their present formats will address the prevalent short-comings sufficiently. In this regard the contribution identifies two main problem areas: (a) a glaring lack of synergy between the Policy and the Bill; and (b) inherent flaws in the Bill itself. Regarding the first problem, various concepts and contructs identified in the Policy remain unattended to in the Bill. Accordingly, new initiatives proposed in the Policy, for example, the introduction of a permit system, have not been given effect to in the Bill. In fact, neither the acquisition, nor the recording or transfer of rights, have been dealt with in the Bill. The Bill is furthermore drafted poorly, thereby resulting in confusing and ambiguous provisions, for example, relating to the service of notice in eviction proceedings and matters surrounding resettlement areas. In this regard numerous questions remain unanswered. The conclusion is reached that, although intervention in the tenure programme is necessary, the most recent proposals do not embody an allencompassing approach, resulting in numerous lacunae leaving important issues unaddressed.Publishers versio

High prevalence of multimorbidity and non-communicable disease risk factors in South African adolescents and youth living with HIV: Implications for integrated prevention.

BACKGROUND: Adolescents and youth living with HIV (AYLHIV) face an elevated non-communicable disease (NCD) risk resulting from HIV, psychosocial challenges, and the complications of antiretroviral therapy. OBJECTIVES: To investigate the prevalence of common NCDs and their risk factors among AYLHIV in urban Cape Town, South Africa, in order to inform an integrated approach to NCD screening and prevention in AYLHIV. METHODS: We conducted a cross-sectional study in six primary care facilities in Cape Town between March 2019 and January 2020. We collected sociodemographic information, and assessed dietary intake, physical activity and nutritional knowledge. We also screened for pre-existing and previously unidentified NCDs and modifiable risk factors in 92 adolescents and youth receiving treatment for HIV in primary care settings using self-report and objective measures. Differences between sexes and age groups were compared using parametric and non-parametric statistical tests. RESULTS: Three out of four participants were female, and the median (interquartile range) age was 20.5 (18.9 - 22.9) years. More than a quarter were not in education, employment or training, and 44% were multidimensionally poor. Five percent of participants had measured hypertension, and 37% had central obesity. AYLHIV self-reported high levels of household food insecurity (70%), low daily fruit and vegetable consumption (28% and 52%, respectively), high refined sugar and sugar-sweetened beverage intake (31% and 29% daily intake, respectively), regularly skipping breakfast (42%), low nutritional knowledge (37% average score) and insufficient weekly physical activity levels (31%). A third (30%) were current smokers, and 24% engaged in binge drinking. CONCLUSIONS: Our findings of a high prevalence of NCDs and risk factors in AYLHIV highlight the importance of NCD risk screening as part of HIV care for AYLHIV. Such integrated approaches are needed to achieve the dual purpose of improving outcomes through early diagnosis of pre-existing NCDs as well as the prevention of NCD multimorbidity in AYLHIV. This study further demonstrates the need for early intervention on the social, environmental and economic determinants of NCDs targeting adolescents and youth

Integrated Query of the Hidden Web

There is a need for software that can access multiple Websites through a single, common interface. This would allow users, for example, to compare flights for a particular trip across all relevant airline sites by posing a single query. This paper investigates automating this process in the case of airline databases hidden behind the Web (the so-called Deep Web or Hidden Web). We first constructed a prototype for integrated query of a handful of pre-determined airline sites. This proved useful in detecting commonalities and differences in the sites, and in selecting the most suitable technologies for working with multiple forms. A generic system was then designed and components of the prototype incrementally replaced by domain-specific tools able to handle arbitrary airline sites. Our results were promising as regards result interpretation, with 89% of response pages successfully handled. However query formulation presented many problems, with only 39% of query interfaces automatically interpreted correctly, and even fewer amenable to automated query propagation. We conclude that integrated access to the Hidden Web is considerably more challenging than crawling the Surface Web, and that domain-specific systems are a promising approach to full automation

Diabetes and Multiple Long-term Conditions: A Review of Our Current Global Health Challenge

Use of effective treatments and management programs is leading to longer survival of people with diabetes. This, in combination with obesity, is thus contributing to a rise in people living with more than one condition, known as multiple long-term conditions (MLTC or multimorbidity). MLTC is defined as the presence of two or more long-term conditions, with possible combinations of physical, infectious, or mental health conditions, where no one condition is considered as the index. These include a range of conditions such as cardiovascular diseases, cancer, chronic kidney disease, arthritis, depression, dementia, and severe mental health illnesses. MLTC has major implications for the individual such as poor quality of life, worse health outcomes, fragmented care, polypharmacy, poor treatment adherence, mortality, and a significant impact on health care services. MLTC is a challenge, where interventions for prevention and management are lacking a robust evidence base. The key research directions for diabetes and MLTC from a global perspective include system delivery and care coordination, lifestyle interventions and therapeutic interventions