Scielo RSS <![CDATA[SAMJ: South African Medical Journal]]> http://www.scielo.org.za/rss.php?pid=0256-957420170004&lang=pt vol. 107 num. 4 lang. pt <![CDATA[SciELO Logo]]> http://www.scielo.org.za/img/en/fbpelogp.gif http://www.scielo.org.za <![CDATA[<b>Cry, the beloved country ...</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742017000400001&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>Evidence-based decision-making for primary care: The interpretation and role of pragmatic trials</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742017000400002&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>Death by maladministration: An important category of patient mortality</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742017000400003&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>Targeting mothers and selling men what they do not want: A response to 'Missed opportunities for circumcision of boys'</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742017000400004&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>What is the nature of a conflict of interest in a scientific publication?</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742017000400005&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>30 days in medicine</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742017000400006&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>Denise Anne Campbell White</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742017000400007&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>Oliver Raynham</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742017000400008&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>Prevention of childhood injuries (part 2)</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742017000400009&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>Energy poverty, shack fires and childhood burns</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742017000400010&lng=pt&nrm=iso&tlng=pt Burn injuries are a persisting challenge in South Africa. Energy poverty, prevalent in under-resourced communities, is a key contributor to the problem. The energy-poor rely on solid fuels and flammable hydrocarbons, such as paraffin, for energy services. The fuels are burnt in inefficient, leaky and unstable appliances, leading to health losses from pollutant emissions, burns, and conflagrations. Within cramped informal home settings, using flammable fuels and risky combustion technologies, the situation can become devastating, especially for young children. Those who survive fiery incidents have to contend with trauma and property losses that may lead to further impoverishment. Proactive intervention strategies are required and should include the broadening of access to safe and sustainable energy. We advocate greater enforcement of home appliance standards and targeted support for the distribution of proven alternative energy technologies, such as liquefied petroleum gas and solar power. Support and advocacy from professional and citizen groups would be necessary to ensure that government prioritises the safe energy requirements of poor citizens. <![CDATA[<b>Promote buckling up and save a child's life</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742017000400011&lng=pt&nrm=iso&tlng=pt Road traffic crash (RTC) injuries are the leading cause of child mortality and morbidity in South Africa for children between the ages of 1 and 18 years. The World Health Organization's Global Status Report on Road Safety 2015 rated the African continent's roads the world's most dangerous. After pedestrian injuries, passenger injuries are the most lethal. There is no doubt that a seat belt is the single most effective feature in a vehicle to reduce the severity of injury to the vehicle's occupants; wearing a seat belt reduces the risk of fatal injury by up to 50% and 75% for front seat and rear seat occupants, respectively. Children have specific anatomical and physiological limitations that render them more vulnerable to serious injury, but the prevention of childhood RTC injuries has unfortunately not received the deserved attention by the medical fraternity. There is currently ample evidence that the use of seat belts and appropriate child restraint seats has led to a significant reduction in RTC fatalities and injuries. It is, therefore, the duty of every healthcare worker to lead by example by using child restraints correctly, and actively encouraging the use of these devices for all their clients and patients. <![CDATA[<b>Tuberous sclerosis complex in the Western Cape, South Africa: The clinical presentation features</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742017000400012&lng=pt&nrm=iso&tlng=pt Tuberous sclerosis complex (TSC) is a genetic neurocutaneous condition, which affects multiple organ systems. This study aimed to determine the presenting features of children with TSC in Cape Town, South Africa. A cross-sectional study was conducted at a TSC clinic, and clinical features at presentation were prospectively collected. Thirty-nine children (23 boys; median age 10 (range 1 - 26) years; median diagnosis age 16 (0 - 153) months) were recruited. Twenty-one (54%) children presented with focal seizures. Seven (18%) children had epileptic spasms. Skin manifestations led to a diagnosis in 13 (33%) and neuroimaging in 22 (56%) children. Antenatal screening detected cardiac rhabdomyomas in 3 children. One child had a positive family history. In the paediatric service, TSC diagnosis usually followed neuroimaging, whereas at the neurology service skin manifestations indicated TSC. In conclusion, most children with TSC presented as emergency cases with seizures. Health practitioner awareness of the common TSC clinical signs was lacking, with the diagnosis often delayed. <![CDATA[<b>Systemic lupus erythematosus: A possible cause of non-alcoholic Wernicke's encephalopathy</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742017000400013&lng=pt&nrm=iso&tlng=pt We report a young woman with systemic lupus erythematosus (SLE) and an acute cerebellar ataxia. A history of poor appetite and vomiting preceded the inco-ordination. Ataxia in SLE has been well described, but is nevertheless uncommon. The clinical triad of mild confusion, ataxia and ophthalmoplegia also raised the possibility of Wernicke's encephalopathy (WE). The diagnosis of WE was further supported by the magnetic resonance imaging features. Owing to overlapping causal factors, this case illustrates the complexity of diagnosing and managing neuropsychiatric syndromes in a patient with SLE. The limited published literature on SLE-related cerebellar syndromes adds to the challenge. Gastrointestinal manifestations of SLE are described as being common in SLE, with nausea and vomiting occurring in >50% of cases in some series. Poor eating habits and vomiting are well-described causes of non-alcoholic WE. This is the first description of gastrointestinal SLE as a possible cause of WE. <![CDATA[<b>Lead poisoning in shooting-range workers in Gauteng Province, South Africa: Two case studies</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742017000400014&lng=pt&nrm=iso&tlng=pt BACKGROUND. Lead exposure constitutes a major public health concern globally. Relative to developed nations, lead exposure is understudied and poorly addressed in Africa, and there is a dearth of information available to inform lead poisoning prevention strategies, even in high-risk groups such as workers in shooting ranges who are potentially exposed to lead daily. METHODS. Two workers at a private shooting range in Gauteng, South Africa (SA), had blood lead levels and exposure histories taken. RESULTS. Workers had highly elevated blood lead levels and clinical symptoms associated with elevated blood lead levels. CONCLUSION. Workers in private SA shooting ranges are vulnerable to lead exposure and poisoning, and scaled-up action is required to protect them and their families, as well as shooting-range users, from lead and the related health risks. <![CDATA[<b>Mammary analogue secretory carcinoma: A rare salivary gland tumour</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742017000400015&lng=pt&nrm=iso&tlng=pt Mammary analogue secretory carcinoma (MASC) is a rare and recently described tumour of the salivary glands. MASC has similar histomorphological and immunohistochemical features of secretory carcinoma of the breast. MASC can be mistaken for other salivary gland tumours, especially acinic cell carcinoma. A 28-year-old man was diagnosed with a rare salivary gland tumour in Pretoria, South Africa (SA). To our knowledge, a report of MASC in SA has not previously been published. The surgeons dealing with salivary gland tumours should be aware of the clinical presentation. Current treatment is similar to that of other salivary gland malignancies. <![CDATA[<b>Contraception coverage and methods used among women in South Africa: A national household survey</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742017000400016&lng=pt&nrm=iso&tlng=pt BACKGROUND. Globally, family planning services are being strengthened and the range of contraceptive choices expanded. Data on contraceptive coverage and service gaps could help to shape these initiatives. OBJECTIVE. To assess contraception coverage in South Africa (SA) and identify underserved populations and aspects of programming that require strengthening. METHODS. Data from a 2012 SA household survey assessed contraception coverage among 6 296 women aged 15 - 49 years and identified underserved populations. RESULTS. Two-thirds had an unintended pregnancy in the past 5 years, a quarter of which were contraceptive failures. Most knew of injectable (92.0%) and oral contraception (89.9%), but fewer of intrauterine devices (56.1%) and emergency contraception (47.3%). Contraceptive prevalence was 49.1%, and 41.8% women used modern non-barrier methods. About half had ever used injectable contraception. Contraception was lower in black Africans and younger women, who used a limited range of methods. CONCLUSION. Contraception coverage is higher than many previous estimates. Rates of unintended pregnancy, contraceptive failure and knowledge gaps, however, demonstrate high levels of unmet need, especially among black Africans and young women. <![CDATA[<b>Wound infection secondary to snakebite</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742017000400017&lng=pt&nrm=iso&tlng=pt BACKGROUND. Snakebites can produce severe local and systemic septic complications as well as being associated with significant overall morbidity and even mortality. OBJECTIVE. A prospective audit was undertaken to determine the bacterial causation of wound infection secondary to snakebite, and attempt to quantify the burden of disease. METHODS. The audit was undertaken at Ngwelezane Hospital, which provides both regional and tertiary services for north-eastern KwaZulu-Natal Province, South Africa, over a 4-month period. Records of patients who required surgical debridement for extensive skin and soft-tissue necrosis were analysed. At the time of debridement, tissue samples of necrotic or infected tissue were sent for bacteriological analysis as standard of care. Microbiology results were analysed. RESULTS. A total of 164 patients were admitted to hospital for management of snakebite, of whom 57 required surgical debridement and 42 were included in the final microbiological analysis. Children were found to be the most frequent victims of snakebite; 57.8% of patients in this study were aged <10 years and 73.7% <15 years. Culture showed a single organism in 32/42 cases, two organisms in 8 and no growth in 2. Eight different types of organisms were cultured, five of them more than once. Thirty-five specimens (83.3%) grew Gram-negative Enterobacteriaceae, the most frequent being Morganella morganii and Proteus species. Thirteen specimens (31.0%) grew Enterococcus faecalis. Gram-negative Enterobacteriaceae showed 31.4% sensitivity to ampicillin, 40.0% sensitivity to amoxicillin plus clavulanic acid, 34.3% sensitivity to cefuroxime, 97.1% sensitivity to ceftriaxone, and 100% sensitivity to ciprofloxacin, gentamicin and amikacin. E. faecalis was 92.3% sensitive to amoxicillin, 92.3% sensitive to amoxicillin plus clavulanic acid, 100% sensitive to ciprofloxacin, 92.3% resistant to erythromycin and 100% resistant to ceftriaxone. CONCLUSION. Children are particularly vulnerable to snakebite, and the consequences can be devastating. While the majority of patients in this study were shown to have secondary bacterial infection, debridement and subsequent wound management is considered the mainstay of treatment. Common organisms are Enterobacteriaceae and enterococci. There appears to be a role for antibiotics in the management of these patients. A good antibiotic policy is strongly advocated. <![CDATA[<b>Pulmonary scar carcinoma in South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742017000400018&lng=pt&nrm=iso&tlng=pt BACKGROUND. The association between lung scarring and the subsequent development of cancer remains controversial. South Africa has one of the highest incidences of tuberculosis in the world, and resultant scarring may predispose to malignancy. The country also carries a very high burden of smoking and smoking-related diseases that may be synergistic in malignant transformation. OBJECTIVE. To assess the frequency of pulmonary scarring in patients with lung cancer. METHODS. All patients with confirmed lung cancer and a staging computed tomography (CT) scan of the chest were included in this 2-year retrospective study. Pulmonary scarring was categorised according to location as present in: (i) the same lobe as the primary tumour, (ii) a different lobe of the same lung, or (iii) the contralateral lung; or (iv) as diffuse. Post-obstructive bronchiectasis and other changes secondary to cancer were considered not to represent scarring. RESULTS. We identified 435 cases of primary lung cancer. In total, 95 patients (21.8%) had CT evidence of pulmonary scarring. Eighty-three of 85 patients (97.6%) had focal scarring in the same lobe as the primary tumour. Of these, 37 (43.5%) also had scarring involving a different lobe of the same lung, whereas only one (1.2%; p<0.001) had scarring isolated to a different lobe of the same lung. Moreover, 21 patients (24.7%) also had scarring of the opposite lung, but only one patient (1.2%; p<0.001) had scarring isolated to the contralateral lung. Ten patients had diffuse scarring, caused by bronchiectasis (n=5), idiopathic pulmonary fibrosis (n=4) and silicosis (n=1). CONCLUSION. At least one in five patients with lung cancer had scarring, which was significantly more likely to be present in the same lobe as the tumour, suggesting a predisposition to malignancy. <![CDATA[<b>Hip and knee arthroplasty waiting list -how accurate and fair?</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742017000400019&lng=pt&nrm=iso&tlng=pt BACKGROUND. Resource-intensive procedures require the use of patient waiting lists in an attempt to increase fairness of access to surgery and improve surgical efficiency. Total hip and knee arthroplasty has waiting lists in excess of years. OBJECTIVES. To analyse our tertiary state institution's hip and knee arthroplasty waiting list to assess its accuracy. METHODS. At Groote Schuur Hospital, our hospital-maintained database was compared with the surgeons' personally maintained database. Patients were then telephoned to confirm their contactability, and to discover whether they still wanted the procedure, or if they had already had it. Waiting duration and patient demographics were then calculated. RESULTS. Of the 655 patients on the hospital waiting list, only 454 were contactable. Three hundred and nine patients still wanted the surgery, 93 had already undergone surgery and 52 no longer wanted surgery. The last group was the oldest and had had the longest waiting time. Those still waiting had waited 451 days (minimum - maximum (standard deviation), 90 - 1 593 (228.5)), those that had had surgery 371 days (0 - 1 728 (296)) and those no longer interested 523 days (138 - 1 881 (260.9)). A total of 429 patients were present on the surgeons' list but not on the hospital list. They had had longer waiting times than those on the hospital list. CONCLUSION. The arthroplasty waiting list is inaccurate due to the existence of two concurrent lists and poor data management, particularly of current contact details. The unfairness of a wide range of waiting times was identified, with patients only on the surgeons' personal database disadvantaged. These deficiencies have prompted the introduction of a scoring-based prioritisation system incorporating clinical, radiographic and societal parameters, in an effort to improve fair and appropriate access to this high-cost care. <![CDATA[<b>The benefit of pharmacological venous thromboprophylaxis in foot and ankle surgery</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742017000400020&lng=pt&nrm=iso&tlng=pt BACKGROUND. Ten percent of patients with a deep-vein thrombosis (DVT) will develop a fatal pulmonary embolism (PE), often initially asymptomatic. The risks and benefits of pharmacological thromboprophylaxis are well documented in respect of total joint arthroplasty and hip fractures, but little is understood about the incidence of venous thromboembolism (VTE) or the potential risks and benefits of chemoprophylaxis in foot and ankle surgery. OBJECTIVE. To determine whether prophylactic chemoprophylaxis had any impact on the prevention of VTE in a cohort of foot and ankle surgical patients requiring the combination of below-knee cast immobilisation and non-weightbearing for >4 weeks. METHODS. Between March 2014 and April 2015, a prospective cohort study of 142 patients was performed. All completed a thrombosis risk assessment form prior to surgery and were commenced on rivaroxaban (Xarelto) 10 mg/d postoperatively. The primary outcome measure was clinical VTE confirmed by compression ultrasonography (DVT) or a ventilation/perfusion scan (PE). RESULTS. Three patients (2.1%) developed a clinical DVT. Two did so well beyond the immobilisation and anticoagulation period, and one was non-compliant with therapy. The average risk factor score in this subgroup was 7. No patient had a DVT while on the prescribed regimen of anticoagulant therapy. Five patients (3.5%) developed wound breakdown, two requiring surgical debridement with local skin flap closure. One case of menorrhagia that may have been linked to the anticoagulant therapy was reported. When compared with a previous study, pharmacological thromboprophylaxis significantly reduced VTE risk (p=0.02). CONCLUSIONS. Oral pharmacological thromboprophylaxis significantly reduces the risk of VTE in patients requiring cast immobilisation and non-weightbearing following foot and ankle surgery. The risk/benefit ratio favours this treatment as opposed to the treatment of major morbidity following non-fatal VTE. <![CDATA[<b>Available data sources for monitoring non-communicable diseases and their risk factors in South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742017000400021&lng=pt&nrm=iso&tlng=pt BACKGROUND. Health information systems for monitoring chronic non-communicable diseases (NCDs) in South Africa (SA) are relatively less advanced than those for infectious diseases (particularly tuberculosis and HIV) and for maternal and child health. NCDs are now the largest cause of premature mortality owing to exposure to risk factors arising from obesity that include physical inactivity and accessible, cheap but unhealthy diets. The National Strategic Plan for the Prevention and Control of Non-Communicable Diseases 2013 - 17 developed by the SA National Department of Health outlines targets and monitoring priorities. OBJECTIVES. To assess data sources relevant for monitoring NCDs and their risk factors by identifying the strengths and weaknesses, including usability and availability, of surveys and routine systems focusing at national and certain sub-national levels. METHODS. Publicly available survey and routine data sources were assessed for variables collected, their characteristics, frequency of data collection, geographical coverage and data availability. RESULTS. Survey data sources were found to be quite different in the way data variables are collected, their geographical coverage and also availability, while the main weakness of routine data sources was poor quality of data. CONCLUSIONS. To provide a sound basis for monitoring progress of NCDs and related risk factors, we recommend harmonising and strengthening available SA data sources in terms of data quality, definitions, categories used, timeliness, disease coverage and biomarker measurement. <![CDATA[<b>Perceptions of healthcare professionals regarding their own body weight in selected public hospitals in Mpumalanga Province, South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742017000400022&lng=pt&nrm=iso&tlng=pt BACKGROUND. Obesity has been cited as a public health problem in both developing and developed countries. There is evidence that rates of obesity have increased among healthcare workers (HCWs) in South Africa (SA), especially those who do night shifts, with a negative effect on health. Perceptions of body weight contribute significantly to the desire to lose weight or not to do so. OBJECTIVE. To determine perceptions of HCWs regarding their own body weight in selected public hospitals in Mpumalanga Province, SA. METHODS. The study design was a cross-sectional survey. A total of 210 HCWs were sampled. Data were collected using self-administered questionnaires. Anthropometric measurements such as weight and height were objectively measured and body mass indices (BMIs) were calculated. RESULTS. Of the sample of HCWs 82.4% were females, with a mean age of 37.8 years. About half (51.9%) were obese and 21.4% were overweight. They tended to misperceive their body weight compared with actual BMI classification, with the majority of obese and overweight individuals considering themselves to be of normal weight. CONCLUSIONS. The results indicate that HCWs misclassify their own body weight, which is a risk factor for obesity. It is important to focus on the health of this group of workers, on whom the health of South Africans depends and who should be the drivers of healthy living for all. Correct classification of their own body weight will encourage people to take action in a bid to combat their own and others' obesity. <![CDATA[<b>Cross-sectional evaluation of the Bronchitis Severity Score in Egyptian children: A move to reduce antibiotics</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742017000400023&lng=pt&nrm=iso&tlng=pt BACKGROUND. Despite evidence of limited benefit of antibiotics in acute bronchitis, most paediatric patients are prescribed them. OBJECTIVES. To assess the validity of the Bronchitis Severity Score (BSS) in assessing the clinical response to treatment of acute bronchitis, and determine whether clinical data and basic laboratory measurements can be used to guide antibiotic prescription. METHODS. We enrolled 200 patients (age range 6 months - 12 years) with clinically diagnosed acute bronchitis. They were divided into three groups according to age. All patients were evaluated three times during the bronchitis episode (days 0, 5 and 7). The primary outcome measurement was the change in the BSS from day 0 to day 7. RESULTS. On the initial visit, the mean (standard deviation (SD)) BSS was 8.36 (2.6), indicating moderate severity of bronchitis. The mean BSS decreased to 4.03 (2.3) on day 5 and to 2.36 (1.45) on day 7. Initial blood tests showed anaemia (80%), leucocytosis (6%), bandaemia (3%) and lymphocytosis (52%). Only four patients were positive for C-reactive protein, while the erythrocyte sedimentation rate was elevated in 98% of cases. There were significant correlations between bandaemia, fever grade (p<0.001) and white blood cell count with clinical variables such as the presence of secretions on chest auscultation (p<0.05) and toxic facies on general examination (p<0.05). CONCLUSIONS. Acute bronchitis in children is a self-limiting disease that does not require routine administration of antibiotics. The BSS is a simple and practical clinical scoring system that is useful in evaluating disease severity and monitoring disease resolution in acute bronchitis. <![CDATA[<b>Prevalence of hepatitis B, hepatitis C and human immunodeficiency viruses, and evaluation of risk factors for transmission: Report of a population screening in Nigeria</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742017000400024&lng=pt&nrm=iso&tlng=pt BACKGROUND. Hepatitis B virus (HBV), hepatitis C virus (HCV) and HIV are common blood-borne infections unevenly distributed across regions in Nigeria. Few population-based prevalence studies have been done in Nigeria. OBJECTIVE. To determine the prevalence of HBV, HCV and HIV and risk factors for infection with these viruses in a Nigerian population. METHODS. Hepatitis B surface antigen, anti-HCV and HIV were assayed in 1 498 healthy adult participants. A structured questionnaire was used to assess risk factors for viral acquisition. Bivariate analysis was used to compare differences in sociodemographic characteristics. Significant risk factors were identified by stepwise logistic regression. A p-value <0.05 was considered significant. RESULTS. The prevalences of HBV, HCV and HIV were 8.8%, 10.0% and 12.9%, respectively, with urban/rural disparity. HBV/HCV positivity was higher among males than females. The reverse was true for HIV. Age was significantly associated with being HBV-, HCV- or HIVpositive. Communal use of a toothbrush was significantly associated with HBV positivity in the final model (odds ratio 2.46, 95% confidence interval 1.45 - 4.18). CONCLUSIONS. The prevalence of HBV, HCV and HIV infection is high in Nigeria, with urban/rural disparity. HCV may be more of a public health concern than HBV in some communities. Population-based studies are required to provide vital data to inform optimal national control strategies. <![CDATA[<b>Problematic alcohol and other substance use among patients presenting to emergency services in South Africa: Who is ready for change?</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742017000400025&lng=pt&nrm=iso&tlng=pt BACKGROUND. Studies that identify factors associated with intervention uptake are urgently needed in poorly resourced healthcare systems. This is important, as knowing who is likely to engage may lead to intervention targeting, which is an efficient use of scarce health resources. OBJECTIVE. To identify patient characteristics that predict the acceptance of a brief intervention for substance use delivered in emergency departments (EDs). METHODS. Patients presenting to three EDs were screened for substance use using the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST). All patients identified as at risk for substance use problems were offered a brief psychotherapy intervention focused on substance user education. Data were collected on patients' age, sex, presenting condition (injury/no injury), type of substance used, and severity of substance use. Logistic regression analysis was used to identify variables that predicted acceptance of the offer of a brief intervention. RESULTS. Being between the ages of 25 and 39 years increased the likelihood of accepting an offer of help compared with 18 - 24-year-olds. Polysubstance users were less likely to accept an offer of help than patients with problematic alcohol use only, while patients with higher ASSIST scores were more likely to accept an offer of help than those with lower scores. CONCLUSIONS. Findings suggest that more work is needed to understand the mechanisms underlying treatment acceptance. Brief interventions delivered in ED services in countries such as South Africa should target alcohol users with higher ASSIST scores in order to ensure the efficient use of scarce health resources. <![CDATA[<b>CPD question 13, March 2017</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742017000400026&lng=pt&nrm=iso&tlng=pt BACKGROUND. Studies that identify factors associated with intervention uptake are urgently needed in poorly resourced healthcare systems. This is important, as knowing who is likely to engage may lead to intervention targeting, which is an efficient use of scarce health resources. OBJECTIVE. To identify patient characteristics that predict the acceptance of a brief intervention for substance use delivered in emergency departments (EDs). METHODS. Patients presenting to three EDs were screened for substance use using the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST). All patients identified as at risk for substance use problems were offered a brief psychotherapy intervention focused on substance user education. Data were collected on patients' age, sex, presenting condition (injury/no injury), type of substance used, and severity of substance use. Logistic regression analysis was used to identify variables that predicted acceptance of the offer of a brief intervention. RESULTS. Being between the ages of 25 and 39 years increased the likelihood of accepting an offer of help compared with 18 - 24-year-olds. Polysubstance users were less likely to accept an offer of help than patients with problematic alcohol use only, while patients with higher ASSIST scores were more likely to accept an offer of help than those with lower scores. CONCLUSIONS. Findings suggest that more work is needed to understand the mechanisms underlying treatment acceptance. Brief interventions delivered in ED services in countries such as South Africa should target alcohol users with higher ASSIST scores in order to ensure the efficient use of scarce health resources.