The evolution of gout (an old lifestyle disease)

Background: Few diseases that confront the 21st century clinician have documented history which dates back to early human era.Methods: We reviewed how the understanding of the aetiogenesis, symptomatology, diagnosis and treatment of gout including myths have evolved and discussed the implications thereof. Results: Gout has been recognized as a clinical entity before 2000BC with Hippocrates describing the five aphorism of gout. Between the 1st and the 6th century AD, the role of genetics and the association of gout with an indulgent lifestyle and tophi were described. Hemodactyl (a source of colchicines) was also first identified during this period. “Gout” was coined from the Latin word “Gutta” in the 13th century and the microscopy of uric acid crystals and gout symptomatology were the focus of investigations between the 17th and 18th centuries. Several drug treatments were developed between the 19th and 20th centuries including salicylates, probenecid and allopurinol. Gout as a risk factor for metabolic syndrome,NIDDM and cardiovascular disease is a challenge for the 20th century and the future. Conclusion: The understanding of gout has evolved with human development but the challenges for the future will include how to deal with the associated cardiovascular co-morbidities

Awareness and practices of foot self-care in patients with diabetes at Dr Yusuf Dadoo district hospital, Johannesburg

Objectives: To determine awareness and foot self-care practices in patients with diabetes.Design: A cross-sectional descriptive study.Setting and subjects: This study was conducted on 120 consecutive patients with diabetes at the outpatient department of Dr Yusuf Dadoo district hospital, Krugersdorp, Johannesburg. A researcher-administered questionnaire, adapted from the Summary of Diabetic Self-Care Activities, collected information on participants’ demographics, clinical co-morbidities, awareness and foot self-care practices. The researcher also conducted a foot examination to identify foot pathologies. Data analysis included descriptive statistics, chi-square and t-tests, and logistic regression.Outcome measures: Patients’ awareness of, and practices pertaining to, foot self-care.Results: Of the 120 participants, the majority were blacks (59.2%), female (60%) and unemployed (68.3%). The mean age was 56.3 years. Athlete’s foot was the most common foot problem that occurred in 16.2% of participants. While only 24.2% reported awareness of foot self-care, 71.7% had performed foot self-care sometimes in the past, and 69.2% had done so at least one day within the last week. Only 5.8% of participants had had their feet examined by a podiatrist, and 32.5% by a doctor or nurse. Approximately 46.7% regularly soaked their feet in water, 7.5% applied talcum powder to dry their feet, 54.2% inspected their shoes and 25% walked barefoot. Smoking was the only variable that was significantly associated with finding a foot ulcer.Conclusion: Poor participants’ awareness and foot self-care practices highlight critical gaps in the care provided to patients with diabetes. Interventions which empower patients and healthcare professionals to regularly perform foot examinations and foot self-care are required to improve diabetic foot care in South Africa.Keywords: diabetes, awareness, foot, self-care, practice

Drug therapy, lifestyle modification and blood pressure control in a primary care facility, south of Johannesburg, South Africa: an audit of hypertension management

Background: Hypertension management is suboptimal in many settings. We assessed blood pressure (BP) control according to target, the appropriateness of antihypertensive therapy and the extent of   implementing lifestyle modification among hypertensive patients.Method: This study was an audit involving a retrospective review of medical records of hypertensive patients who were 18 years of age and older (n = 300), attended to by doctors or primary health care nurses at a large community health centre, south of Johannesburg, South Africa. Demographic, anthropometric, clinical and management data were extracted from the files of hypertensive patients who met the inclusion criteria. Data analysis included the use of descriptive statistics, thechi-square test and Fisher’s exact test. The main outcome measures were the proportions of patients with controlled BP, who used appropriate antihypertensive drugs and who had documented lifestyle modifications.Results: Most patients were black (75.7%) and female (68.3%). The mean age was 60 years. The majority of the patients (55.7%) were either overweight or obese. Fifty-seven per cent of the patients (n = 171) had BP control meeting the target. Appropriate choice of antihypertensive drugs was documented in 81.3% of patients (n = 244), while 56.3% had lifestylemodification documented in their records. Significantly more women had their BP controlled to target compared to men (P = 0.0028). Factors significantly associated with good BP control were white race (P = 0.0001) and documentation of adherence to therapy (P = 0.000).Conclusion: BP control was achieved in the majority of patients and the vast majority was on appropriate drug therapy. White race, female sex and adherence to treatment documented in the medical record were significantly associated with BP controlled to target

Snuff use and the risk for hypertension among black South African women

Background: Snuff or smokeless tobacco, used orally or by nasal application, is the predominant form of tobacco used by black South African women. Little is known about the risk of cardiovascular disease associated with the use of snuff in developing countries. This study therefore sought to determine the association between snuff use and hypertension among black South African women. Methods: This study involved secondary data analysis of a cross-sectional representative sample of black women aged 25 to 70 years (n = 4092) who participated in the 1998 South African Demographic and Health Survey, the largest to date. Data analysis included chi-square statistics, t-tests, ANOVA and multiple logistic regression analysis. The outcome measure was hypertension, defined as presenting with an average blood pressure (BP) of ≥ 160/95 mmHg, and/or reporting the use of antihypertensive medication. Results: The prevalence of snuff use and hypertension was 14.6% and 18.0% respectively. Compared to non-users of snuff, those who used snuff more than eight times a day had significantly higher mean systolic (131 mmHg vs. 121 mmHg) and diastolic (84 mmHg vs. 77 mmHg) BP. Hypertension was more prevalent among snuff users than among non-users of snuff (23.9% vs. 17%;

Perceptions of hospital managers regarding the impact of doctors' community service

Background In South Africa, the distribution of doctors is skewed in favour of the urban areas, but it is not uncommon to find many peri-urban facilities in short supply of doctors. In 1997, the South African government introduced compulsory community service (CS) to address this uneven distribution of doctors in the country. The CS doctors posted to the Letaba-Sekororo hospital complex in Limpopo Province refused to take up their appointments for various reasons, ranging from lack of supervision to poor basic infrastructure. This study is one of the earliest conducted to understand the perceptions of hospital managers on the impact of the national community service on the health service.Methods After ethical approval was obtained from the Research, Ethics and Publications Committee (REPC) of the Medical University of Southern Africa (now University of Limpopo – Medunsa Campus), three focus group interviews were conducted with hospital managers from three purposefully selected hospitals. The interviews were audio-visually taped and supplemented with field notes, transcribed verbatim, with themes identified using the ‘cut and paste' and ‘colour coding' methods. Combined themes were categorised and interpreted within the context of the study and the available literature.ResultsCS has improved health services delivery, alleviated work pressure, and improved the image of hospital managers. In addition, it has provided a constant supply of manpower, and increased the utilisation of health services by the community. The negative perceptions identified included a lack of experience and skills, poor relationships with the rural health team, lack of support structures for CS doctors, poor continuity of care and budgetary constraints. Conclusions Hospital managers perceive CS to have had a positive impact on the supply of needed manpower, health service delivery and patient care. As this was a qualitative study, further quantitative and community-oriented studies are required to validate the results.Keywords:Perceptions; hospital managers; impact; community service doctorsFor full text, click here:SA Fam Pract 2005;47(8):55-5

Uptake and factors that affect enrolment into the prevention of mother-to-child transmission of human immunodeficiency virus programme in rural Limpopo Province

Background: Before 2006, the uptake into the prevention of mother-to-child transmission (PMTCT) for HIV programme was low in South Africa. We determined PMTCT programme uptake, and identified factors that affected enrolment into the PMTCT programme in the rural Limpopo province.Method: This cross-sectional study, conducted from 21 July to 20 August 2008, involved 200 consecutive women who met the inclusion criteria in the immediate postpartum period. An interviewer-administered questionnaire was used to obtain information on participants’ knowledge and experience of, satisfaction with, and motivation for, enrolling in the PMTCT programme. Main outcome measures included voluntary counselling and testing (VCT) and PMTCT programme uptake rates, and factors reported to influence enrolment into the programme.Results: Of the 200 invited women, 169 (84.5%) responded. The mean age of participants was 25 years ± standard deviation. The human immunodeficiency virus prevalence rate was 23.6%. VCT and PMTCT programme uptakes were 96.9% and 90.9% respectively. Participants reported being aware of (95.2%) and satisfied with (81.6-97.4%) various aspects of the PMTCT programme.The safety of their babies was reported by most participants to be their motivation for enrolment (71.1%). Participants in the age-group 20-29 years were more likely than others to enrol in the PMTCT programme (p-value = 0.01).Conclusion: VCT and PMTCT programme uptakes were high and influenced by good knowledge, satisfaction with the PMTCT programme and participants’ concern for the safety of their babies.Keywords: uptake, PMTCT, prevention, transmission, postpartum, enrolmen