Requirements of a coronary heart disease risk factor intervention programme for the coloured population of the Cape Peninsula

The coloured population of the Cape Peninsula has been identified as having a high prevalence of risk factors for coronary heart disease (CHO), notably hypertension, cigarette smoking and hypercholesterolaemia. The need for an appropriate and effective CHO intervention programme, directed at the population as a whole, has become urgent. Three central problem areas relating to hypertension control - diagnosis, management and compliance - will have to be addressed. Hypertension was underdiagnosed among men, particularly those aged 25 - 44 years. Apart from educating this group regarding the need to have their blood pressure measured, detection programmes are therefore needed at the workplace to improve hypertension diagnosis. Inadequate management of hypertension was commonest in women aged over 45 years. Compliance with hypertension treatment regimens was poor in all men as well as in both sexes belonging to the lower socio-economic strata. Establishing easily accessible blood pressure stations for monitoring blood pressure and educating hypertensives regarding their condition could lead to improved management and compliance. Coloureds were found to smoke heavily, and the women had the highest smoking prevalence of all South African women. Furthermore, the age of onset of smoking is decreasing among coloured children. A general anti-smoking campaign directed at all South Africans is necessary to control smoking. Anti-smoking education programmes at primary school level are of particular importance to prevent the onset of the habit. More than 70% of coloureds had a serum cholesterol level imparting CHO risk, few followed a prudent diet and their knowledge of the prudent diet was poor. Health education programmes to promote the prudent diet are required. The need for. appropriately trained health educators in schools, workplaces, health clinics and all hospitals has been identified. An extensive health education service should be expanded by including the use 'of mass media, particularly television, to promote health.S Afr Med J 1990; 78: 78-8

Health actions and disease patterns related to coronary heart disease in the coloured population of the Cape Peninsula

The health-related behaviour of the Cape Peninsula coloured population, which has been shown to have an adverse coronary heart disease (CHO) risk factor profile, is reported. Private medical services were used most often by participants: 54,1% and 51,6% of males and females respectively had made use of these services during the preceding year. Only 17,9% and 21,8% of males and females respectively had attended day hospitals during the year. Blood pressures were measured in 43,8% and 57,1% of male and female participants respectively during the year preceding the study. The results indicated the need for the measurement of blood pressure to determine the true prevalence of hypertension, since patient reporting of the condition was inaccurate. Attempts to give up smoking had been made by 44,4% of male and 47,1% of female smokers. About 75% of the participants were found to have hypercholesterolaemia, yet their knowledge of the prudent diet was poor and few reported appropriate dietary modifications to protect against CHO. Frequent reporting of hypercholesterolaemia, hypertension and constipation by the study population highlights the need for dietary education. Mortality rates (MRs) for CHO and cerebrovascular disease (CVO) for the coloured and the white populations were compared. In all age groups white males had higher MRs for CHO than coloured males, while coloured females older than 34 years had higher rates than their white counterparts. The coloured population had MRs for CVO that were higher than those of whites.S Afr Med J 1990; 78: 73-7

Doctors' attitudes and practices regarding smoking cessation during pregnancy

Objective. To investigate the current smoking cessation practices and attitudes of doctors working in  the public antenatal services, as well as their perceived barriers to addressing the issue in the context of routine care.Study design. The study was qualitative, consisting of 14 semistructured, one-to-one interviews with doctors purposefully sampled from 5 public sector hospitals in Cape Town, South Africa.Results. The doctors in this study regarded HIV, poor nutrition, alcohol abuse and psychosocial stress as equal or higher risks to pregnant women than smoking. They tended to underestimate the magnitude of the risk of smoking during pregnancy. Doctors were unaware of the guidelines offering clinicians brief,  structured approaches to smoking cessation counselling and were generally pessimistic that they could influence the smoking behaviour of pregnant women, especially poor, disadvantaged women who face multiple barriers to achieving health-enhancing behaviour. However, most doctors were concerned about improving their communication with pregnant women about smoking and open to adopting new  approaches or tools that could assist them. Perceived barriers to providing smoking cessation interventions included a lack of counselling skills and educational resources, other pressing priorities, too little time, and the levels of stress currently experienced by doctors and midwives working in public sector hospitals as a result of dramatic staff and budget cuts.Conclusion. The study suggests that doctors working in the public sector antenatal services are not  routinely addressing the issue of smoking during pregnancy or using effective methods to assist women to give up smoking. Doctors need convincing that smoking cessation interventions can be effective. The promotion and provision of evidence-based guidelines such as the Clinical Practice Guideline for Treating Tobacco Use and Dependence (Fiore, 2000), with minimal training, is a possible strategy for integrating smoking cessation interventions into routine antenatal care in South Africa

Detection and measurement of Hypercholesterolaemia in South Africans attending general practitioners in private practice - The cholesterol monitor

Background. 1bis paper reports data on the detection and management of hypercholesterolaemia in patients attending general practitioners in private practice in South Africa.Methods. The frequency of cholesterol testing and the level at which active therapeutic intervention occurred at medical practices were monitored over a 2-year period. A sample of 200 medical practitioners was selected from private practices in major citie;. Data on patients seen by the selected doctors during a 5-day monitoring period were recorded on a standardised form.Results. 12842 patients were seen by the 200 private practice· GPs. More men (18.7%) than women (10.4%) had coronary heart disease (CHD), and their mean total cholesterol (TC) levels were 5.9 mmol/l and 6.0 mmol/l, respectively. Only 3.1% of the patients were reported to have familial hypercholesterolaemia (FH) and 12.8% were reported to have a family history of CHD. Reported smoking rates were exceptionally high (77.5% of women and 64.4% of men). The most commonly prescribed group of lipid-lowering agents was HMG-CoA reductase inhibitors.Conclusions. Inadequate management of hypercholesterol-· aemia leaves many patients with a high risk of CHD mortality in South Africa. Appropriately investigated patients with hypercholesterolaemia should receive treatment to reduce cardiovascular disease using more effective TC control programmes than are currently used in South Africa

From research to policy in chronic disease prevention: mandatory salt reduction in South Africa

Abstract of a poster that presented at 20th International Congress of Nutrition, Granada, Spain, September 15-20, 2013

Coronary heart disease risk factors in a rural and urban Orange Free State black population

Objective. To determine and compare the prevalence of ischaemic heart disease (IHD) risk factors in a rural and an urban black population.Design. A survey to determine the prevalence of hypertension, diabetes mellitus, smoking, obesity, central obesity and dyslipidaemia in black subjects 25 years and older.Setting. The indigenous black populations of QwaQwa and Mangaung.Participants. A random sample of 950 households was selected from each area. From each household an unrelated male and/or female subject was selected in a standardised way. From QwaQwa 853 subjects (279 men and 574 women) and from Mangaung 758 subjects (290 men and 468 women) participated in the study. The response rate was 68% and 62% respectively for QwaQwa and Mangaung.Main outcome measures. Few urban-rural differences in the prevalence of IHD risk factors were found in this study. A low prevalence of clustering of major IHD risk factors was noted.Results. The age- and sex-adjusted prevalences of hypertension were 29% in QwaQwa and 30,3% in Mangaung. Oiabetes was present in 4,8% of the QwaQwa sample and 6% of the Mangaung sample. The prevalence of heavy smoking in the Mangaung sample was almost double that of the QwaQwa sample and mostly confined to men. High-risk hypercholesterolaemia was present in 12,5% of QwaQwa and 6% of Mangaung men in the  25 - 34-year age group. The corresponding figures for moderate-risk hypercholesterolaemia were 34% and 44,8% and both levels of risk declined with increasing age. The mean body mass index of women in both samples exceeded 25 kg/m2.Conclusion. All the elements for a potential epidemic of atherosclerotic cardiovascular disease are present in the study populations. The similarity of findings in the two samples may be indicative of the advanced stage of urbanisation and westernisation of the rural group. It is alarming that subjects in the younger age groups tendeo to have the highest prevalences of moderate and even high-risk hypercholesterolaemia

A neuronal network model of interictal and recurrent ictal activity

We propose a neuronal network model which undergoes a saddle-node bifurcation on an invariant circle as the mechanism of the transition from the interictal to the ictal (seizure) state. In the vicinity of this transition, the model captures important dynamical features of both interictal and ictal states. We study the nature of interictal spikes and early warnings of the transition predicted by this model. We further demonstrate that recurrent seizures emerge due to the interaction between two networks.Comment: 9 pages, 7 figure

The intervention effects of a community-based hypertension control programme in two rural South African towns: the CORIS study

The objective of the hypertension programme of the Coronary Risk Factor Study (CORlS) was to evaluate the effectiveness of the first 4 years of community-based intervention. The hypertension intervention model comprised a blood pressure station where the whole population was screened for hypertension, non-drug management was provided and hypertensives were monitored after referral to general practitioners for drug therapy. Two levels of intervention were maintained: in the high-intensity intervention town (N =2 278) hypertensives were actively followed up, and in the low-intensity intervention town (N =2 620) no active follow-up procedure existed. A third town acted as control (N= 2 290).In the cohort which was hypertensive at baseline, the net decreases in systolic blood pressure (mean ± SE) after correction for changes in the control town were 0,5 ± 2,2 mmHg (men) and 4,5 ± 2,2 mmHg (women) in the low-intensity intervention town, and 5,6 ± 2,3 mmHg (men) and 7,5 ± 2,2 mmHg (women) in the high-intensity intervention town. The net decrease in diastolic blood pressure was 3,4 ± 1,2 mmHg (men) and 4,4 ± 1,1 mmHg (women) in the low-intensity intervention town, and 6,1 ± 1,2 mmHg (men) and 5,9 ± 1,1 mmHg (women) in the high-intensity intervention town. These reductions were statistically significant with one exception. The changes in the total population in the 3 communities after 4 years of intervention were similar to those found in the hypertensive cohort.Decreases in mean blood pressure were accompanied by marked increases in the proportion of hypertensives on drug treatment and the proportion under control (< 160/95 mmHg).Distribution curves of blood pressure indicated a large effect in the subgroup above the cut-off point for hypertension; however, the entire curve also shifted to the left, indicating, in addition, benefit to the whole population. An increase in the appropriate knowledge and action for hypertension control was observed in the intervention towns compared with the control town.The CORlS community-based hypertension control programme successfully reduced the risk for cardiovascular diseases in the intervention towns compared with the control town

Trends in adult tobacco use from two South African demographic and health surveys conducted in 1998 and 2003

Introduction. Since peaking in the early 1990s in South Africa,tobacco use has declined significantly. The reduction has beenattributed to the governmentfs comprehensive tobacco controlpolicies that were introduced at the time.Objective. To assess the pattern of tobacco use in the SouthAfrican Demographic and Health Surveys of 1998 and 2003.Methods. Multi-stage sampling was used to select approximately 11 000 households in cross-sectional national surveys. Face-to-face interviews, conducted with 13 826 adults (41% men) aged .15 years in 1998, and 8 115 (42% men) in 2003, included questions on tobacco use according to the WHO STEP-wise surveillance programme. Logistic regression analysis was used to assess the independent effects of selected characteristics on smoking prevalence.Results. Daily or occasional smoking prevalence among women remained unchanged at 10 - 11%; it decreased among men from 42% (1998) to 35% (2003). The decline for men was significant among the poorest and those aged 25 - 44 years. Strong age patterns were observed, peaking at 35 - 44 years, which was reduced among men in 2003. Higher income and education were associated with low prevalence of smoking, while living in urban areas was associated with higher rates. Black men and women smoked significantly less than otherpopulation groups.Conclusion. Despite decreased smoking rates in some subgroups, a lapse exists in the efforts to reduce tobacco use, as smoking rates have remained unchanged among women, and also among young adults aged 15 - 24 years