Editorial

Bariatric surgery, addictive-like eating behaviour and obesit

Screening for microvascular complications of diabetes mellitus: missed opportunities

No Abstract

Sarcopaenia: Where do we stand after two decades of research?

No Abstract

Knowledge, attitudes and practices regarding iodine among patients with hyperthyroidism in the Free State, South Africa

Objectives: To gather baseline information on the knowledge, attitudes and practices regarding iodine and iodised salt among patients with hyperthyroidism in the Free State.Subjects and Setting: The study was part of a large cohort study that included the first 96 patients aged 13 years or older diagnosed with hyperthyroidism and referred to Universitas Academic Hospital in Bloemfontein, South Africa during 2005.Methods: The patients were interviewed in their language using a structured validated questionnaire. Descriptive statistics were used fordata analysis.Results: The majority of the patients (86.9%) did not know what iodine was. Similarly, a higher percentage of patients (76.7%) were unaware of the most important or main source of iodine in the food of South Africans. Regarding knowledge of the most important harmful effect on the health of children if they did not get enough iodine, almost all of the patients (89.1%) did not know what it was. Ninety-five per cent of salt was obtained from the local shops, and only 36.1% of the patients read the labelling on the package during purchase. A very small proportion of patients (1.6%) stored salt in closed containers and away from sunlight, while about half of them (49.2%) stored salt in open containers without lids, 36.1% stored it in rigid plastic containers with holes at the top, and 13.1% stored it in the open plastic bags in which the salt was bought.Conclusions: Patients with hyperthyroidism lacked knowledge of iodine, as well as of the storage of iodised salt, and this could have contributed to the persisting endemic goitre reported in previous studies. An aggressive awareness programme, targeting policy makers and the public, is recommended to ensure sustainable elimination of iodine deficiency disorders in South Africa.  Keywords: hyperthyroidism; iodine; iodised salt; knowledge-attitude-practice study; South Afric

The role of private general practitioners in the treatment of alcohol dependence in the Free State province

Objectives: The study was undertaken to investigate the role of private general practitioners (GPs) in the treatment of alcohol dependence in the Free State province.Design: A descriptive cross-sectional study. A questionnaire was used to describe the experiences of GPs with patients with alcohol dependence.Outcome measures: The treatment role of individual participants was defined in terms of the range of services provided and the enablers and obstacles faced in performing interventions in their local context.Setting and subjects: Seventy-seven private GPs were selected by means of a stratified randomised sampling process from areas in the immediate proximity of regional hospitals, district hospitals, or basic environments (without local hospital services), in three geographical areas defined by existing health service delivery boundaries.Results: 29.9% of participants practised medical detoxification, either in hospital or in outpatient settings. Involvement related to the local organisation of treatment services in a geographical area. GPs in resource-constrained environments played an extended role outside of the traditional office-based model of care. Medical scheme funding policies were regarded as an obstacle to involvement in the treatment of alcohol-dependent patients by 76.5% of participants. Other major obstacles were lack of multidisciplinary teams, in-patient facilities and referral structures.Conclusion: Private GPs in the Free State play a context-dependent role in the treatment of alcohol-dependent patients in the province. This compensatory role needs to be acknowledged in service delivery planning in under-resourced areas, especially to ensure access to treatment and cost-effective management.Keywords: private general practitioners, treatment, alcohol, dependence, Free State province, South Afric

Towards universal ARV access: Achievements and challenges in Free State Province, South Africa

Objective. To study the progress and challenges with regard to universal antiretroviral (ARV) access in Free State Province, South Africa. Methods. Data from the first 4 years of the public sector ARV roll-out and selected health system indicators were used. Data were collected from the public sector ARV database in Free State Province for new patients on ARVs, average waiting times and median CD4 counts at the start of treatment. Information on staff training, vacancy rates and funding allocations for the ARV roll-out was obtained from official government reports. Projections were made of expected new ARV enrolments for 2008 and 2009 and compared with goals set by the National Strategic Plan (NSP) to achieve universal access to ARVs by 2011. Results. New ARV enrolments increased annually to 25% of the estimated need by the end of 2007. Average waiting times to enrolment decreased from 5.82 months to 3.24 months. Median CD4 counts at enrolment increased from 89 to 124 cells/μl. There is a staff vacancy rate of 38% in the ARV programme and an inadequate increase in budget allocations. Conclusion. The current vertical model of ARV therapy delivery is unlikely to raise the number of new enrolments sufficiently to achieve the goals of universal access by 2011 as envisaged by the NSP. The Free State is implementing a project (STRETCH trial) to broaden the ARV roll-out in an attempt to increase access to ARVs

SEMDSA/ACE-SA Guideline for the Management of Hypothyroidism in Adults

Background: Hypothyroidism is a common clinical condition confronting all healthcare practitioners yet there remains uncertainty about the optimal medication and optimum treatment targets. In addition, many patients remain symptomatic despite using recommended medications and attaining recommended treatment targets.Methods: All endocrinologists in South Africa who consented to be part of the guideline process were assigned various aspects of the management of patients with thyroid disease. In each section the current literature was reviewed and the level of evidence was graded. This information was then presented at a guideline meeting. Where evidence was lacking a consensus among participants was adopted.Results: This guideline provides 11 recommendations for the management of primary hypothyroidism, secondary hypothyroidism and subclinical hypothyroidism in adults.Conclusions: This is the first South African guideline for the management of hypothyroidism in adults and represents a comprehensive review of the current literature in an attempt to provide evidence-based guidance for all healthcare practitioners regarding the many clinical aspects encountered when managing patients with hypothyroidism

A cross-sectional study of vascular risk factors in a rural South African population : data from the Southern African Stroke Prevention Initiative (SASPI)

Background: Rural sub-Saharan Africa is at an early stage of economic and health transition. It is predicted that the 21st century will see a serious added economic burden from non-communicable disease including vascular disease in low-income countries as they progress through the transition. The stage of vascular disease in a population is thought to result from the prevalence of vascular risk factors. Already hypertension and stroke are common in adults in sub-Saharan Africa. Using a multidisciplinary approach we aimed to assess the prevalence of several vascular risk factors in Agincourt, a rural demographic surveillance site in South Africa. Methods: We performed a cross sectional random sample survey of adults aged over 35 in Agincourt (population ≈ 70 000). Participants were visited at home by a trained nurse who administered a questionnaire, carried out clinical measurements and took a blood sample. From this we assessed participants' history of vascular risk, blood pressure using an OMRON 705 CP monitor, waist circumference, body mass index (BMI), ankle brachial index (ABI), and total and HDL cholesterol. Results: 402 people (24% men) participated. There was a high prevalence of smoking in men, but the number of cigarettes smoked was small. There was a striking difference in mean BMI between men and women (22.8 kg/m2 versus 27.2 kg/m2), but levels of blood pressure were very similar. 43% of participants had a blood pressure greater than 140/90 or were on anti-hypertensive treatment and 37% of participants identified with measured high blood pressure were on pharmacological treatment. 12% of participants had an ABI of < 0.9, sugesting the presence of sub-clinical atheroma. 25.6% of participants had a total cholesterol level > 5 mmol/l. Conclusion: We found a high prevalence of hypertension, obesity in women, and a suggestion of subclinical atheroma despite relatively favourable cholesterol levels in a rural South African population. South Africa is facing the challenge of an emerging epidemic of vascular disease. Research to establish the social determinates of these risk factors and interventions to reduce both individual and population risk are required

Cardiovascular disease, chronic kidney disease, and diabetes mortality burden of cardiometabolic risk factors from 1980 to 2010: a comparative risk assessment

Background High blood pressure, blood glucose, serum cholesterol, and BMI are risk factors for cardiovascular diseases and some of these factors also increase the risk of chronic kidney disease and diabetes. We estimated mortality from cardiovascular diseases, chronic kidney disease, and diabetes that was attributable to these four cardiometabolic risk factors for all countries and regions from 1980 to 2010. Methods We used data for exposure to risk factors by country, age group, and sex from pooled analyses of populationbased health surveys. We obtained relative risks for the eff ects of risk factors on cause-specifi c mortality from metaanalyses of large prospective studies. We calculated the population attributable fractions for- each risk factor alone, and for the combination of all risk factors, accounting for multicausality and for mediation of the eff ects of BMI by the other three risks. We calculated attributable deaths by multiplying the cause-specifi c population attributable fractions by the number of disease-specifi c deaths. We obtained cause-specifi c mortality from the Global Burden of Diseases, Injuries, and Risk Factors 2010 Study. We propagated the uncertainties of all the inputs to the fi nal estimates. Findings In 2010, high blood pressure was the leading risk factor for deaths due to cardiovascular diseases, chronic kidney disease, and diabetes in every region, causing more than 40% of worldwide deaths from these diseases; high BMI and glucose were each responsible for about 15% of deaths, and high cholesterol for more than 10%. After accounting for multicausality, 63% (10\ub78 million deaths, 95% CI 10\ub71\u201311\ub75) of deaths from these diseases in 2010 were attributable to the combined eff ect of these four metabolic risk factors, compared with 67% (7\ub71 million deaths, 6\ub76\u20137\ub76) in 1980. The mortality burden of high BMI and glucose nearly doubled from 1980 to 2010. At the country level, age-standardised death rates from these diseases attributable to the combined eff ects of these four risk factors surpassed 925 deaths per 100 000 for men in Belarus, Kazakhstan, and Mongolia, but were less than 130 deaths per 100 000 for women and less than 200 for men in some high-income countries including Australia, Canada, France, Japan, the Netherlands, Singapore, South Korea, and Spain. Interpretation The salient features of the cardiometabolic disease and risk factor epidemic at the beginning of the 21st century are high blood pressure and an increasing eff ect of obesity and diabetes. The mortality burden of cardiometabolic risk factors has shifted from high-income to low-income and middle-income countries. Lowering cardiometabolic risks through dietary, behavioural, and pharmacological interventions should be a part of the globalresponse to non-communicable diseases