The moral claim for obligatory dissemination of study results: part one

The process of taking data from a person or community when doing research, and then publishing such data and one’s academic interpretation thereof in an academic journal, is usually well protected and scrutinized by several ethical checks and balances. However, to disseminate research findings back to the community in which the research was conducted is seen as a fundamental principle in ethical research practice that seldom materializes into reality. When researchers appropriately respect their obligation to do this, it is often filled with nuanced challenges. Researchers must consider how to convey complex findings in a way that is understandable and actionable for the community. Different communities have different views on norms, values and communication preferences. Researchers must be culturally sensitive in how they share findings to ensure relevance and respect. Dissemination may require resources such as translation services, community meetings or educational materials. It’s essential to share not only positive results but also negative or inconclusive findings. This avoids bias and helps the community make informed decisions

Oral health and subjective psychological well-being among South African adults : findings from a national household survey

OBJECTIVE : To determine the association between oral health and socioeconomic status with subjective psychological well-being. METHODS : An interviewer-administered questionnaire was conducted during 2011 on a nationally representative sample of South African adults >16 years (n=2,971) who reported on socio-demographic data, past dental visit patterns, number of remaining teeth and oral and general health status. Subjective well-being was computed as the sum of scores obtained from participants' estimates of level of happiness (scale 0-6) and rating of level of satisfaction with life (scale 0-4). Analyses included t-tests and multivariable-adjusted Poisson regression. RESULTS : The average score on a scale of 0-10 for subjective well-being was 6.31 (95%CI=6.17-6.44), which decreased with age, but increased with level of education and frequency of dental visits. Even after controlling for socioeconomic status, those who rated their oral health as good were more likely to report a higher subjective well-being (Prevalence Rate ratio (PRR) =1.14; 95% CI=1.03-1.27). Those who reported visiting a dentist at least every 6 months reported higher subjective well-being (PRR=1.10; 1.04-1.16. CONCLUSIONS : Good oral health is independently associated with greater subjective well-being. This highlights the need to prioritise oral health promotion as an integral part of promoting general health and improving the quality of life of South Africans.http://www.sada.co.zaam201

The effect of lockdown regulations on SARS-CoV-2 infectivity in Gauteng Province, South Africa

Background. On 26 March 2020, the South African (SA) government initiated a 21-day national level 5 lockdown which was subsequently eased off and downgraded to level 4 on 1 May and to level 3 on 1 June. The effect of lockdown measures on SARS-CoV-2 infectivity is currently uncertain. In this article, we analyse the effects of the lockdown measures on the SARS-CoV-2 epidemic in one of the epicentres in SA.Objectives. To measure the effects of lockdown measures introduced in SA on SARS-CoV-2 attack rates (ARs, the percentage of individuals who tested positive in a specified time period) in Gauteng Province during a 4-month period (March - June 2020).Methods. In this retrospective cohort study, we used a comprehensive database from an independent pathology laboratory in Gauteng. We analysed trends of positivity rates of reverse transcription polymerase chain reaction tests done during the 4-month period. The ARs are reported over time (unweighted and age-weighted 14-day moving averages) by age groups, gender, and different regions/districts in Gauteng.Results. A total of 162 528 tests were performed at a private laboratory between 5 March and 30 June 2020, of which 20 574 were positive (overall AR 12.7%). These positive tests constituted 44.8% of all positive cases in the province (20 574/45 944). Sixty-two percent of all tests were done in June during lockdown level 3. There was an exponential increase in the AR in June (18.3%) when lockdown was eased to level 3, in comparison with 4.2% (March), 2.2% (April) and 3.3% (May). The increase in June was seen in all the age groups, although it was more pronounced in the 21 - 60 years age groups than the younger (0 - 20 years) and older (>60 years) age groups. The AR was significantly higher in males (13.2%) compared with females (12.1%) (χ2 test, p<0.0001).Conclusions. The findings of this study testify to the rapid increase in ARs resulting from easing of the lockdown regulations, especially to level 3 in June. Of concern is the upward trend in the AR across all age groups, especially <20 years (15.9%), which was not reported in other parts of the world. Population age dynamics should therefore be considered when taking future decisions about lockdown regulations

HIV and COVID-19 co-infection : mild infection or prolonged transmission

BACKGROUND. Comorbid conditions may be associated with severe COVID-19. However, there is no evidence to suggest that people living with HIV have a higher risk of contracting SARS-CoV-2 or, if infected, have more severe disease. OBJECTIVE. To describe three patients with HIV and COVID-19 co-infection. METHOD. The study was conducted in a private hospital in Gauteng Province, South Africa. All three patients were known to have HIV disease and were treated with chronic antiretroviral medication. All patients admitted to the unit were screened for chronic conditions such as HIV, tuberculosis, diabetes and hypertension. They were admitted to the hospital after being diagnosed with COVID-19, this being confirmed by positive reverse transcription polymerase chain reaction (RT-PCR) tests. RESULTS. The combination of HIV and SARS-CoV-2 (HIVCO) with comorbidities in case 1 (dialysis-dependent end-stage renal failure and hypertension) resulted in severe illness, a long hospital stay and protracted viral shedding. The protracted shedding pattern (>60 days) was confirmed by multiple positive RT-PCR tests and positive viral cultures obtained after 60 days. Despite comorbidities, case 2 (Takayasu’s disease in remission, dyslipidaemia and previous deep vein thrombosis) and case 3 (hypertension and diabetes) presented with mild illness. The mild clinical course and negative RT-PCR tests in cases 2 and 3 indicated resolution of infection. CONCLUSION. Patients with HIVCO and comorbidities may present with mild or severe illness. Unusually long SARS-CoV-2 shedding is a risk for disease transmission, and its association with HIV, other immunocompromised conditions and comorbidities is unclear. We describe a shedding classification that may assist in identifying and managing infectious subsets of patients. Multiple SARS-CoV-2 tests and viral cultures may be necessary to confirm protracted shedding.http://www.samj.org.za/index.php/samjam2021School of Health Systems and Public Health (SHSPH

The effect of lockdown regulations on SARS-CoV-2 infectivity in Gauteng Province, South Africa

BACKGROUND. On 26 March 2020, the South African (SA) government initiated a 21-day national level 5 lockdown which was subsequently eased off and downgraded to level 4 on 1 May and to level 3 on 1 June. The effect of lockdown measures on SARS-CoV-2 infectivity is currently uncertain. In this article, we analyse the effects of the lockdown measures on the SARS-CoV-2 epidemic in one of the epicentres in SA. OBJECTIVES. To measure the effects of lockdown measures introduced in SA on SARS-CoV-2 attack rates (ARs, the percentage of individuals who tested positive in a specified time period) in Gauteng Province during a 4-month period (March - June 2020). METHODS. In this retrospective cohort study, we used a comprehensive database from an independent pathology laboratory in Gauteng. We analysed trends of positivity rates of reverse transcription polymerase chain reaction tests done during the 4-month period. The ARs are reported over time (unweighted and age-weighted 14-day moving averages) by age groups, gender, and different regions/districts in Gauteng. RESULTS. A total of 162 528 tests were performed at a private laboratory between 5 March and 30 June 2020, of which 20 574 were positive (overall AR 12.7%). These positive tests constituted 44.8% of all positive cases in the province (20 574/45 944). Sixty-two percent of all tests were done in June during lockdown level 3. There was an exponential increase in the AR in June (18.3%) when lockdown was eased to level 3, in comparison with 4.2% (March), 2.2% (April) and 3.3% (May). The increase in June was seen in all the age groups, although it was more pronounced in the 21 - 60 years age groups than the younger (0 - 20 years) and older (>60 years) age groups. The AR was significantly higher in males (13.2%) compared with females (12.1%) (χ2 test, p<0.0001). CONCLUSIONS. The findings of this study testify to the rapid increase in ARs resulting from easing of the lockdown regulations, especially to level 3 in June. Of concern is the upward trend in the AR across all age groups, especially <20 years (15.9%), which was not reported in other parts of the world. Population age dynamics should therefore be considered when taking future decisions about lockdown regulations.http://www.samj.org.zaam2021School of Health Systems and Public Health (SHSPH

Temporal variation in suicide in peri-urban Pretoria

Background: Suicide is a public health problem, and the third major cause of death in Indian, black and mixed race groups. In whites suicide is the second cause of death. The patterns of suicide vary by time of day, day of the week, month of the year and seasons. As a result of limited and inaccurate data, these variations have not been fully examined in the developing world. This study investigated the diurnality and seasonality of suicide in peri-urban Pretoria, as opposed to studies conducted previously in the country’s metropolitan.Methods: A retrospective analysis of suicides recorded between 2007 and 2019 was undertaken. Data were extracted from the forensic pathology department’s database (university mortuary).Results: Of the 1515 cases of suicides examined, majority were black Africans (95.9%), male (83.9%), aged 21–40 years (50.5%). Hanging was the most common method of suicide irrespective of demographics (72.8%). Diurnal suicide variations were distinct for men and women, occurring at (16:00–20:00) and (08:00–12:00), respectively. Suicide peaked on days preceding and after the weekend (Mondays and Fridays) and in warmer seasons (summer and spring)Conclusion: The overall patterns of suicide in peri-urban Pretoria, mimic local and global trends with regard to methods, demographics and temporal characteristics. The underlying mechanism for these trends is unclear requiring in-depth investigation in order to develop appropriate interventions