Scielo RSS <![CDATA[SAMJ: South African Medical Journal]]> vol. 98 num. 5 lang. en <![CDATA[SciELO Logo]]> <![CDATA[<b>Task shifting or power shedding?</b>]]> <![CDATA[<b>Editor's Choice</b>]]> <![CDATA[<b>Humans - a threat to humanity</b>]]> <![CDATA[<b>Suggestions for <i>SAMJ</i> editorial policies</b>]]> <![CDATA[<b>The season cometh ... yet again!</b>]]> <![CDATA[<b>Access to parenteral phenobarbitone</b>]]> <![CDATA[<b>End-of-life decisions</b>]]> <![CDATA[<b>State doctor recruitment - key official in corruption probe</b>]]> <![CDATA[<b>Ivan Toms - a selfless model of social conscience</b>]]> <![CDATA[<b>Probe into alleged treatment refusal</b>]]> <![CDATA[<b>No disasters yet, please - we're catching up</b>]]> <![CDATA[<b>When Best Practice is Bad Medicine</b>: <b>A new approach to rationing tertiary health services in South Africa</b>]]> <![CDATA[<b>Improving injection safety</b>]]> <![CDATA[<b>Spinal tuberculosis</b>: <b>Diagnostic biopsy is mandatory</b>]]> <![CDATA[<b>An alcoholic's series of unfortunate events</b>]]> <![CDATA[<b>J M L Klopper</b>]]> <![CDATA[<b>NICE rationing of specialised health care services for South Africa?</b>]]> <![CDATA[<b>Survival after massive intentional overdose of paraquat</b>]]> <![CDATA[<b>Coronary spasm and thrombosis in a bodybuilder using a nutritional supplement containing synephrine, octopamine, tyramine and caffeine</b>]]> <![CDATA[<b>Involving African traditional health practitioners in HIV/ AIDS interventions</b>]]> <![CDATA[<b>Determinants and treatment of hypertension in South Africans</b>: <b>The first Demographic and Health Survey</b>]]> OBJECTIVES: To identify the groups of patients with high prevalence and poor control of hypertension in South Africa. METHODS: In the first national Demographic and Health Survey, 12 952 randomly selected South Africans aged 15 years and older were surveyed. Trained interviewers completed questionnaires on socio-demographic characteristics, lifestyle and the management of hypertension. This cross-sectional survey included blood pressure, height and weight measurements. Logistic regression analyses identified the determinants of hypertension and the treatment status. RESULTS: A high risk of hypertension was associated with less than tertiary education, older age groups, overweight and obese people, excess alcohol use, and a family history of stroke and hypertension. Hypertension risk was lowest in rural blacks and significantly higher in obese black women than in women with a normal body mass index. Improved hypertension control was found in the wealthy, women, older persons, Asians, and persons with medical insurance. CONCLUSIONS: Rural black people had lower hypertension prevalence rates than the other groups. Poorer, younger men without health insurance had the worst level of hypertension control. <![CDATA[<b>Association of tooth loss with hypertension</b>]]> OBJECTIVE: Hypertension may result from changes in dietary quality and nutrient intake. We therefore sought to determine the epidemiological association between tooth loss and hypertension in South African adults. METHODS: This is a secondary data analysis of a cross-sectional survey of a nationally representative sample of adults aged 25 - 70 years who participated in the South African Demographic and Health Survey during 1998 (N=9 098). The primary data were collected using a validated questionnaire, which included information on past experience of tooth loss (partial or complete), use of dental services, tobacco use and other known risk factors for hypertension. Hypertension was defined as having a measured average blood pressure (BP) &gt;160/95 mmHg and/or taking antihypertensive medication. RESULTS: The prevalences of hypertension, any tooth loss and complete edentulousness were 18.1%, 72.2% and 9.4% respectively. Tooth loss was more common among overweight/obese respondents than among those with a normal body mass index (76.7% v. 66.7%; p<0.01). Compared with the fully dentate respondents, the completely edentulous respondents had mean systolic and diastolic BPs that were respectively 12 mmHg and 5 mmHg higher. After adjusting for known risk factors for hypertension in a multiple logistic regression model, being completely edentulous remained significantly associated with hypertension (odds ratio 1.35, 95% confidence interval 1.02 - 1.78). The estimated population-attributable fraction of hypertension resulting from complete edentulousness was 10%. CONCLUSIONS: The findings suggest that complete edentulousness is a risk indicator for hypertension in South Africa and highlights the importance of primary care practitioner involvement in oral health promotion. <![CDATA[<b>A contrast-enhanced ultrasound study of benign and malignant breast tissue</b>]]> OBJECTIVE:. To determine the diagnostic value of haemodynamic contrast-enhanced ultrasound assessment in benign and malignant breast tissue, using histological examination as the reference standard. METHODS: An HDI 5000 Phillips ultrasound scanner with microvascular imaging software and 2.5 ml SonoVue (Bracco spa, Milan) contrast was used to scan 50 consecutive patients (32 malignant and 18 benign, 49 with histologically confirmed breast lesions). Time-intensity curves of the regions of interest (ROI) placed over the lesional and normal breast tissues were acquired using QLAB software. The area under the curve (AUC), time to peak (TTP), in-flow gradient (IFG) and peak enhancement (PE) were determined in a standardised manner for each focal breast lesion and the control/normal breast. IFG and AUC in the periphery, and PE and AUC in the centre of the lesions, differed significantly between malignant and benign tumours. In a logistical regression model, AUC in the periphery and the ratio of PE at the tumour centre to that of normal breast were independently predictive of malignancy (p<0.001), achieving a diagnostic sensitivity of 97% and a specificity of 80% in the 41 tumours in which central vessels could be distinguished. CONCLUSION: Haemodynamic contrast-enhanced ultrasound assessment can be used to distinguish between benign and malignant breast lesions. <![CDATA[<b>Multiple sclerosis in South Africa</b>]]> Since there are no well-documented epidemiological studies on multiple sclerosis (MS) in South Africa, we devised a questionnaire to determine qualitative data. Responses were obtained from 430 patients: 91% had magnetic resonance imaging (MRI) scans, 64% had lumbar punctures and 49% had evoked potentials to establish the diagnosis of MS. A total of 71% of the respondents were aged 30 - 59 years, 73% were female, and 89% were white. In terms of MS type, 46% had relapsing-remitting MS, 13 % secondary progressive MS, 12% primary progressive MS, 12% benign MS, and 17% not known. Disease-modifying treatment was not used by 32% of respondents, and 30% were treated with methotrexate and 22% with interferon beta. These findings are similar to those in the literature, except for the under-utilisation of interferons as disease-modifying treatment. <![CDATA[<b>Risky sexual behaviours of high-school pupils in an era of HIV and AIDS</b>]]> OBJECTIVE: To identify risky sexual behaviours and demographic factors that place high-school pupils at risk of HIV and AIDS. METHODS: A cross-sectional study was undertaken to explore factors influencing the sexual behaviour of high-school pupils (mean age 15.4 years; SD 1.11). Structured self-reported questionnaires were completed by all grade 10 pupils (N=805) at all the Wentworth, Durban, public high schools. RESULTS: Significant gender differences in sexual practices were reported, such as males being more likely to engage in sexual activity than females (OR 4.92; p<0.001). More males (24.8%) initiated sex before age 12, compared with more females (30%) who initiated sex between 16 to 20 years of age (p<0.001). Significantly more males preferred older partners than females (p=0.002), more females were forced to have sex than males (p =0.009), and more males used alcohol on the last occasion of sex than females (p=0.04). Religious affiliation and parental supervision were found to have a significant effect on sexual activity among pupils. CONCLUSIONS: High-school pupils are at high risk of HIV and AIDS, yet they continue to engage in risky sexual behaviours. Preventive efforts therefore need to be aggressively up-scaled and redirected towards specific risky practices, taking gender differences into account. Contextual factors such as religious norms and parental supervision also require greater attention. Risky sexual behaviours are reflective of a broader crisis in society.