Hospitalisation of Type 2 diabetes mellitus patients with and without major depressive disorder in a private managed healthcare organisation

Background: The relationship between Type 2 diabetes mellitus (T2DM) and associated co-morbidities, particularly major depressive disorder (MDD), is poorly acknowledged in chronic disease management practices in South Africa. Managed healthcare costs and hospitalisation rates may be influenced by the discrete management of co-morbid conditions. Therefore, the relationship between T2DM and MDD in terms of co-morbidity incidence and hospitalisation resource utilisation was investigated.Method: This retrospective descriptive study analysed the data of 902 adult patients with T2DM from the health system database of a private managed healthcare organisation for 2014.Results: The mean age was 57 ± 15 years and 85% of the identified T2DM patients had at least one recorded co-morbidity. Among this population 17% presented with MDD. A higher percentage of T2DM patients with MDD were admitted to hospital (42%, p = 0.004) compared with those without MDD (30%). The number of overnight admissions was higher among the T2DM with MDD (76%, p = 0.016) compared with T2DM without MDD (66%). The T2DM with MDD group (85%, p = 0.018) had greater non-diabetes related hospital events compared with the T2DM without MDD group (73%). The T2DM patients without MDD were more likely to be hospitalised for diabetes-related events (27%, p = 0.018) at significantly higher admission cost (p = 0.001).Conclusion: Patients with T2DM and MDD present with more co-morbid conditions and had a higher number of hospitalisations than their non-MDD counterparts. However, the hospitalisation costs were significantly higher for diabetes-related admissions in the non-MDD group due to a higher number of macrovascular events. Healthcare organisations need to focus on an integrated approach in the management of chronic conditions with emphasis on active surveillance of T2DM patients, where MDD is identified and treated to lessen the risk of macrovascular complications

Antiphospholipid antibodies in black south africans with hiv and acute coronary syndromes: prevalence and clinical correlates

<p>Abstract</p> <p>Background</p> <p>HIV infection is associated with a high prevalence of antiphospholipid antibodies (aPL) and increased thrombotic events but the aetiopathogenic link between the two is unclear.</p> <p>Findings</p> <p>Prospective single centre study from Soweto, South Africa, comparing the prevalence of aPL in highly active anti-retroviral therapy (HAART) naïve HIV positive and negative patients presenting with Acute Coronary Syndromes (ACS). Between March 2004 and February 2008, 30 consecutive black South African HIV patients with ACS were compared to 30 black HIV negative patients with ACS. The HIV patients were younger (43 ± 7 vs. 54 ± 13, p = 0.004) and besides smoking (73% vs. 33%, p = 0.002) and lower HDL levels (0.8 ± 0.3 vs. 1.1 ± 0.4, p = 0.001) had fewer risk factors than the control group. HIV patients had a higher prevalence of anticardiolipin (aCL) IgG (47% vs. 10%, p = 0.003) and anti-prothrombin (aPT) IgG antibodies (87% vs. 21%, p < 0.001) but there was no difference in the prevalence of the antiphospholipid syndrome (44% vs. 24%, p = N/S) and aPL were not predictive of clinical or angiographic outcomes.</p> <p>Conclusions</p> <p>Treatment naïve black South African HIV patients with ACS are younger with fewer traditional coronary risk factors than HIV negative patients but have a higher prevalence and different expression of aPL which is likely to be an epiphenomenon of the HIV infection rather than causally linked to thrombosis and the pathogenesis of ACS.</p

Personality, depressive symptoms and prior trauma exposure of new recruits at two Metropolitan Police Service academies in South Africa

Background. Police officers are predisposed to trauma exposure. The development of depression and post-traumatic stress disorder (PTSD) may be influenced by personality style, prior exposure to traumatic events and prior depression. Objectives. To describe the personality profiles of new Metropolitan Police Service (MPS) officers, and to determine the association between personality profiles, trauma exposure and depressive symptoms. Methods. We performed a cross-sectional analysis of 139 new recruits at two MPS academies in South Africa. A questionnaire elucidating traumatic life events and personality profiles was developed using the Millon Clinical Multiaxial Inventory-III (MCMI-III). Depressive symptoms were measured using the Hamilton Depression Rating Scale (HAMD). Results. Almost all subjects (99.3%) had previous trauma exposure, most commonly the unexpected death of a loved one and motor vehicle accidents. Prevalence of clinical depression was low (mean HAMD 3.57; standard deviation ±3.37). Personality characteristics revealed a high prevalence of anxiety (64.7%; 95% CI 56.8 - 72.6), depressive clinical patterns (34.5%; 95% CI 26.6 - 42.2), paranoia (33.1 %; 95% CI 26.6 - 42.2) and major depression (10.3%; 95% CI 5.1 - 15.1). There were no significant associations between any of the traumatic events and depressive symptoms, nor were there any significant associations between any of the personality variables and HAMD score (p>0.05). Conclusion. The presence of depressive symptoms among MPS officers was low, with no significant associations between traumatic events, personality variables and depressive symptoms

Role of atrial natriuretic peptide in the dissociation between flow relations with ventricular mass and function in a community with volume-dependent hypertension

BackgroundWhether differential effects of volume load on left ventricular mass (LVM) and function occur in sustained volume-dependent primary hypertension, and the impact of atrial natriuretic peptide (ANP) on these effects, is unknown.MethodsFrom aortic pressure, velocity and diameter measurements and echocardiography, we determined in an African community (n = 772), the impact of systemic flow-induced increases in central pulse pressure (PPc) and circulating ANP (ELISA) on LVM and indexes of function.ResultsStroke volume (SV), but not aortic flow (Q), was associated with LVM and mean wall thickness (MWT) beyond stroke work and confounders (p &lt; 0.0001). Adjustments for SV markedly decreased the relationships between PPc and LVMI or MWT. However, neither SV, nor Q were independently associated with either myocardial s', e', or E/e' (p &gt; 0.14) and adjustments for neither SV nor Q modified relationships between PPc and s', e' or E/e' (p &lt; 0.005 to &lt;0.0001). SV was nevertheless strongly and independently associated with ANP (p &lt; 0.0001) and ANP was similarly strikingly associated with s' (p &lt; 0.0001) and e' (p &lt; 0.0005), but not E/e', independent of confounders and several determinants of afterload. Importantly, ANP concentrations were inversely rather than positively associated with LV diastolic dysfunction (DD) (p &lt; 0.005) and lower rather than higher ANP concentrations contributed markedly to the ability to detect DD in those with, but not without LV hypertrophy.ConclusionIn populations with sustained volume-dependent hypertension, flow (SV)-related increases in PP have a major impact on LV structure, but not on function, an effect attributed to parallel striking beneficial actions of ANP on myocardial function