36 research outputs found
The prevalence and clustering of non-communicable disease risk factors in a South African financial institution: a challenge to corporate management
No full textNon-communicable diseases (NCDs) are currently a global epidemic, challenging the individual, corporate environment and health professionals in developed as well as developing countries. It is therefore understandable that comprehensive research has already focused on the detrimental outcomes of NCDs on health, productivity and health care costs in various parts of the world. The aim of this study was to determine the prevalence and clustering of various risk factors associated with NCDs in a financial institution in South Africa. Body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol (TC), casual blood glucose (CBG), stress, smoking habits and physical activity (PA) were determined in a total of8 132 employees (3097 males and 5035 females) between ages of 18 and 65 years, covering all provinces in South Africa. Groupings were done according to age (< 44 and ≥ 45 yrs.) and gender. Descriptive statistics, prevalence of NCD risk factor and clustering were analysed. The majority of employees assessed were at risk (moderate and high risk) with regard to most of the variables viz. increased BMI (65.8%), SBP (62.1%), DBP (56.6%), stress (58.3%) as well as being low physically active (55.4%). Older males (≥ 45 yrs.) were the most vulnerable group with moderate or high risk in BMI (43.2% overweight and 25.9% obese), SBP (51.3% prehypertensive & 26.7% hypertensive), DBP (45.6% pre-hypertensive & 28.5% hypertensive), TC (27.9% borderline high & 7.9% high) and CBG (31.3% borderline high & 23.5% high). Older females showed the highest prevalence of obesity (38.1%), TC (13%), borderline high CBG (35.2%) and stress (31.4%). The risk clustering showed that 42.1% of employees had a clustering of 3-4 risk factors, with older male (48.4%) and female (47.8%) employees experiencing a higher prevalence. Employers should consider the implementation of some health promotion strategies in order to minimize the prevalence of risk factors as well as the migration of employees at risk to higher risk stratum. One strategy, already identified to positively affect most NCD risk factors simultaneously, is the enhancing of physical activity amongst employees
Associations between dietary salt, potassium and blood pressure in South African adults: WHO SAGE Wave 2 Salt & Tobacco
No full textBackground & aims
In June 2016, South Africa implemented legislation mandating maximum sodium levels in a range of processed foods with a goal of reducing population salt intake and disease burden from hypertension. Our aim was to explore the relationship between salt and blood pressure (BP) in a subsample of the World Health Organization Study on global AGEing and adult health (SAGE) Wave 2 before implementation of legislation in South Africa.
Methods & results
Blood pressure (BP) was measured in triplicate (n = 2722; median age 56 years; 33% male) and 24-h urine collected in a nested subsample (n = 526) for sodium, potassium and creatinine analysis. Hypertension prevalence was 55% in older adults (50-plus years) and 28% in younger adults (18–49 years). Median salt intake (6.8 g/day) was higher in younger than older adults (8.6 g vs 6.1 g/day; p < 0.001), and in urban compared to rural populations (7.0 g vs 6.0 g/day; p = 0.033). Overall, 69% of participants had salt intakes above 5 g/day. Potassium intakes were generally low (median 35 mmol/day) with significantly lower intakes in rural areas and older adults. Overall, 91% of adults failed to meet the daily potassium recommendation of 90 mmol/d. Salt intakes above 5 g/day, and to a greater extent, a dietary sodium-to-potassium (Na:K) ratio above 2 mmol/mmol, were associated with significantly steeper regression slopes of BP with age.
Conclusion
These preliminary results indicate that high dietary Na:K ratio may lead to a greater increase in BP and hypertension risk with age. Interventions to increase potassium intakes alongside sodium reduction initiatives may be warrante
Infant Development at the Age of 6 Months in Relation to Feeding Practices, Iron Status, and Growth in a Peri-Urban Community of South Africa
No full textBackground: Evidence on the association between feeding practices, iron deficiency, anaemia, stunting, and impaired psychomotor development during infancy is limited. This study assessed the association between psychomotor development with early feeding practices, growth, iron status, and anaemia. Methods: This was cross-sectional baseline data of a randomised controlled trial which included 6-month-old infants and their mothers or primary caregivers (n = 750) in a peri-urban community in the North West province of South Africa. The Kilifi Developmental Inventory and a parent rating scale were used to assess psychomotor development. Feeding practices and anthropometric measurements were based on the World Health Organisation (WHO) guidelines. Anaemia and iron status were determined by blood sample analysis. Results: Prevalence of anaemia and stunting for the infants were 36.4% and 28.5%, respectively. Multiple regression analysis showed that birth weight was related to combined psychomotor scores (β = −3.427 (−4.603, 1.891), p < 0.001), as well as parent rating scores (β = −0.843 (−1.507, −0.180), p = 0.013). Length-for-age z-scores were associated with combined psychomotor scores (β = −1.419 (−2.466, 0.373), p = 0.008), as well as parent rating scores (β = −0.747 (−1.483, −0.010), p = 0.047). Conclusions: In this setting, with high prevalence of anaemia and stunting, important associations between lower psychomotor development scores and birthweight as well as length-for-age z-scores in 6-month-old infants were found. These findings warrant further investigation to develop a greater understanding of factors influencing the association between child growth and psychomotor development within the first 1000 days of lif
Hypertriglyceridaemia and the risk of pancreatitis six months post lopinavir/ritonavir initiation
No full textBackground: Hypertriglyceridaemia (HTG) is an important risk factor for pancreatitis and cardiovascular disease (CVD), depending on severity. Hypertriglyceridaemia is common in human immunodeficiency virus (HIV) infection and is also a common complication of lopinavir/ritonavir (LPV/r).
Objectives: To evaluate the risk of pancreatitis associated with HTG in patients six months post initiation of LPV/r-based therapy in a regional public hospital.
Methods: Triglyceride (TG), serum amylase (s-amylase) and CD4+ count values were retrospectively investigated six months post LPV/r-based initiation. Age, gender, previous antiretroviral regimen and period since HIV diagnosis were also recorded.
Results: The final sample consisted of 194 patients, 50 males and 144 females; mean (± standard deviation [s.d.]) age was 39.52 (± 9.98) years, and the mean (± s.d.) period since HIV diagnosis was 91.32 (± 25.18) months. Normal TG levels (< 1.70 mmol/L) were detected in only 55% of patients and the rest presented with some degree of HTG. The mean (± s.d.) TG for the entire sample was elevated at 1.94 (± 1.30) mmol/L with the mean (± s.d.) of the males at 2.36 (± 1.74) – statistically higher compared to the females at 1.79 (± 1.08) mmol/L (p = 0.034). No cases of pancreatitis were recorded and the time since HIV diagnosis did not indicate any statistically significant differences in the means of the TG, serum amylase or CD4 count values.
Conclusion: Triglyceride levels were not substantially elevated to induce pancreatitis at six months post initiation of LPV/r, but were elevated above the accepted upper normal limit of 1.70 mmol/L which may have implications for cardiovascular ris
The association between seven-day objectively measured habitual physical activity and 24 h ambulatory blood pressure: the SABPA study
No full textFew studies have examined objective physical activity in relation to 24 h ambulatory blood pressure (BP). We aimed to assess the association of 7-day objectively measured habitual physical activity with ambulatory BP in a sample of African and Caucasian school teachers (n=216, age 49.7 years) from the sympathetic activity and blood pressure in Africans prospective cohort study. Hypertension (ambulatory systolic BP⩾130 and/or diastolic BP⩾80 mm Hg) was prevalent in 53.2% of the sample, particularly in black Africans. The hypertensive group spent significantly more awake time in sedentary activity (51.5% vs 40.8% of waking hours, P=0.001), as well as doing less light- (34.1% vs 38.9%, P=0.043) and moderate-intensity (14.0% vs 19.7%, P=0.032) activities compared with normotensives, respectively. In covariate adjusted models, light-intensity activity time was associated with lower 24 h and daytime ambulatory systolic BP (β=-0.15, 95% confidence interval (CI): -0.26, -0.05, P=0.004; β=-0.14, CI: -0.24, -0.03, P=0.011) and diastolic BP (β=-0.14, CI: -0.25, -0.03, P=0.015; β=-0.13, CI: -0.24, -0.01, P=0.030), as well as resting systolic BP (β=-0.13, CI: -0.24, -0.01, P=0.028). Sedentary time was associated only with 24 h systolic BP (β=0.12; CI: 0.01, 0.22), which was largely driven by night-time recordings. Participants in the upper sedentary tertile were more likely to be 'non-dippers' (odds ratio=2.11, 95% CI: 0.99, 4.46, P=0.052) compared with the lowest sedentary tertile. There were no associations between moderate to vigorous activity and BP. In conclusion, objectively assessed daily light physical activity was associated with ambulatory BP in a mixed ethnic sample
Investigation of the coexistence of CKD and non-communicable chronic diseases in a PBM company in South Africa
No full textBackground: Chronic kidney disease (CKD) is a public health problem, with increasing global prevalence. Several factors could influence the prognosis of CKD, including comorbid chronic conditions. This study investigated the coexistence of CKD and non-communicable chronic diseases in the private health sector of South Africa.
Methods: Retrospective medicine claims data from a pharmaceutical benefit management (PBM) company was used to perform this descriptive, quantitative study. The study population consisted of all patients identified with an ICD-10 code for CKD (N18) during the study period of January 1, 2009 to December 31, 2013.
Results: CKD patients represented 0.10% to 0.14% of the total patients on the database from 2009 to 2013. The mean age of the CKD patients over the study period varied between 58 and 61 years. Prevalence was higher in males (male-to-female ratio 1:0.8) and in patients aged 35–64 years (p = 0.014; Cramer’s V = 0.039). The occurrence of chronic conditions in the CKD population was prevalent, with hypertension occurring in more than half the CKD patients.
Conclusion: Several chronic conditions, especially those regarding atherosclerotic risk factors, frequently co-occurred with CKD. Lifestyle management and frequent screening tests of these patients are of the utmost importance to improve the outcome of CK
Assessment of post-operative pain medication adherence after day case orthopaedic surgery: a prospective, cross-sectional study
No full textBackground and aim
Patients struggle to adhere to prescribed pain medication after surgery because of, inter alia, side effects, sleep disturbances and pain severity. This study aimed to determine the influence of various factors on, the extent of adherence to prescribed post-operative pain medication (POPM) measured by participant-reported pill count (PRPC) following day case orthopaedic surgery at a private South African hospital.
Methods
This prospective, quantitative cross-sectional study involving 120 participants (51 males, 69 females), used a structured questionnaire completed through a telephonic survey, 4 days after orthopaedic surgery. Measurements included PRPC adherence (adherent vs. non-adherent), in relation to post-operative adherence behaviour (POAB), normal medicine adherence behaviour (NMAB), pain severity affecting sleep and mobility, treatment side effects and patient demographic characteristics.
Results
Based on PRPC measurement 56.7% (n = 68) of participants were adherent. PRPC was significantly associated with severe pain affecting falling sleep (p = .001), pain causing awakening from sleep (p = .035) and POAB (p .300), NMAB (p = .601) and the treatment regimen (i.e. unimodal vs. bimodal or multimodal) (p = .511).
Conclusion
Non-adherence (overuse or misuse) of prescribed POPM can be a result of severe pain, influencing sleep and movement after orthopaedic surgery, indicating a need for the review of these regimens in order to optimise car
Appropriate and non-medical use of methylphenidate by residence students at a South African tertiary institution
No full textThe purpose was to determine to what degree residence students
from a tertiary academic
institution use methylphenidate in both non-medical and appropr
iate manners in the South
African context. Reasons for use, doses consumed and side effec
ts experienced were
investigated. The study followed a quantitative cross-sectional
design and used a structured
questionnaire to gather data. Appropriate users were defined as
students who have only used
methylphenidate as prescribed, whereas non-medical users were d
efined as those using
methylphenidate without a prescription, or using prescribed met
hylphenidate in a non-medical
manner (for example in excessive doses). One in four residence
students in the study population
(N=328) have used methylphenidate at least once in their lives.
Only 7.3% (n=24) were
appropriate users, whereas 16.8% (n=55) were non-medical users.
Half of the appropriate users
have never been diagnosed with Attention Deficit/Hyperactivity
Disorder (ADHD). All non-
medical users used methylphenidate to study or concentrate; how
ever, 4 participants used it for
euphoria and 8 participants to
party. The preferred product, es
pecially by non-medical users, was
extended release methylphenidate
(72.7%). The most common side
effects experienced were
sleep difficulties (69.0%) and reduced appetite (67.1%). There
is evidence to suggest that
methylphenidate is being used in non-medical ways by residence
students in the study population
and that these students may experience more adverse events. Non
-medical stimulant use has been
considered an indicator of problematic behaviours in students.
This study also presented
emerging evidence of off-label methylphenidate prescriptions; t
he safety of which has not been
establishe
Prescribing patterns of non-steroidal anti-inflammatory drugs in chronic kidney disease patients in the South African private sector
No full textBackground Non-steroidal anti-inflammatory drugs (NSAIDs) are among the most commonly used pharmaceutical agents worldwide. NSAIDs are considered nephrotoxic and should therefore be used with caution or be avoided completely in high risk patients, such as chronic kidney disease (CKD) patients. Objective This study aimed to investigate the prescribing of NSAIDs in CKD patients in order to generate awareness and improve the outcome of these patients. Setting The study was conducted using medicine claims data in the private health sector of South Africa. Method A descriptive, quantitative study was performed, using retrospective data obtained from a Pharmaceutical Benefit Management company. Data from 1 January 2009 to 31 December 2013 were analysed. The study population consisted of all patients with an ICD-10 code for a CKD (N18), in association with a paid claim for an NSAID. Main outcome measure The stratification of NSAID prescribing volume among the CKD population in terms of gender, age, NSAID type, dosage and prescriber type. Results The prescribing of NSAIDs in CKD patients varied between 26 and 40 % over the 5 year study period. No association between gender and CKD patients who received NSAIDs versus those who did not was found, with p > 0.05 and Cramer’s V < 0.1 for each year of the study. The association between age groups and CKD patients who received NSAIDs versus those who did not was statistically significant, but practically weak (p < 0.05; Cramer’s V ≥ 0.1). Most NSAID prescriptions (52–63 %) were for patients aged 35–64 years. Diclofenac (34.25 %) was the single most frequently prescribed NSAID, but the COX-2-inhibitors (celecoxib, meloxicam and etoricoxib) were the preferred NSAID class to be prescribed. The majority (61.6 %) of the NSAIDs were prescribed by general medical practitioners in dosages meeting and even exceeding the recommended daily dosage of patients with normal kidney function. Conclusions Even though NSAIDs are regarded as nephrotoxic drugs, they are still being prescribed to at-risk CKD patients, in particular, the elderl
Sympathetic Activity and Ambulatory Blood Pressure in Africans study
No full textMSc (Physiology), North-West University, Potchefstroom Campus, 2016Argument: Hypertension contributes to the development of cardiovascular diseases. Several factors contribute to the development of hypertension, such as obesity, alcohol abuse and psychological distress. Black Africans suffer from hypertension due to life-style changes or urbanisation which can possibly increase psychological distress. Chronic distress can trigger sympathetic hyperactivity to activate the hypothalamic-pituitary-adrenal axis (HPAA) stress channel which releases the stress hormone, cortisol, which can increase cardiometabolic risk during chronic conditions. Double product (DP) is ideal for measuring workload of the heart since it is the product of systolic blood pressure and heart rate which serves as an index of oxygen consumption. DP, which also incorporates heart rate, can have a stronger relation with metabolic factors where an increased heart rate can contribute to increased cardiometabolic risk during sympathetic over-activity.
Aim: We aim at assessing associations between DP, silent myocardial ischemia (ST), cortisol and Adrenocorticotropic hormone (ACTH) in different ethnic sex groups, and at assessing associations between DP, cortisol and ST during psychological distress.
Methodology: Our sub-study is founded on the Sympathetic activity and Ambulatory Blood Pressure in Africans (SABPA) study (2008-2009). The sample group comprised a Socio-economically matching population of 409 teachers of the Dr Kenneth Kaunda Education District in North-West Province of South Africa. Cortisone users (n=3), participants diagnosed with atrial fibrillation (n=16) and clinically diagnosed diabetes (n=12) were excluded. The final group comprised 378 individuals which consisted of 92 Black men, 94 Black women, 94 White men and 102 White women. Ambulatory blood pressure, electrocardiogram and physical activity level values were obtained during the 48-hour clinical data collection process. Fasting Blood samples were collected and included gamma glutamyl transferase, high sensitivity C-reactive protein (CRP), cotinine, HbA1c, cortisol and corticotropin samples. Independent t-tests and Chi-square tests were used with a view to compare Black and White groups, followed by a covariance analyses (ANCOVA). ANCOVAs were corrected for a priori variables (age, waste circumference, physical activity, gamma glutamyl transferase and cotinine). Independent associations between DP, silent ischemic incidents, cortisol and cardiometabolic risk markers were determined in the total cohort as well as in moderate to severely depressive ethnic gender groups.
Results: Blacks demonstrated a poorer cardiovascular profile with higher blood pressure values, an increased heart rate, higher HbA1c levels, more ischemia as well as more low-grade inflammation (CRP > 3 mg/l) than the White gender group. Lower cortisol as well as higher ACTH values occurred in Black men than in other ethnic and gender groups. Waist circumference was lower in Black men and higher in Black women than in White men and women. Stratification on race x gender groups showed low cortisol and higher ACTH as well as more silent ischemia in Black men, but in none of the other groups. The Black women, similar to the black men, showed higher ACTH values than was the case with White women. Associations were found between waist circumference and double product in Black men [Adj R2 0.36; β 0.35 (0.17,0.51); p<0.001], Black women [Adj R2 0.11; β 0.27 (0.06,0.48); p=0.014]; White men [Adj R2 0.33; β 0.52 (0.35,0.69) p<0.001]; and in White women [Adj R2 0.36; β 0.37 (0.10,0.60); p=0.007]. Following stratification of the participants in moderate and severely depressive (MDED) and non-MDED groups, associations were demonstrated between DP and silent ischemia (ST) [Adj R2 0.19; β 0.41 (0.40,0.42); P = 0.025] as well as between ST and cortisol [Adj R2 0.19; β 0.37 (0.25,0.48); P = 0.043] only in Black men.
Conclusion: Emotional distress can facilitate autonomous dysfunction or sympathetic hyperactivity in the current Black male group. Hence, during chronic distress cortisol levels can influence double product negatively. It can increase the occurrence of ST, which increases down-regulation of the HPA axis and risk for cardiovascular disease. This indicates that higher emotional demands can influence cardiometabolic health where susceptibility to emotional distress can be an underlying factor for the observed differences in the group of Black men.Master
