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SAMJ: South African Medical Journal

versão On-line ISSN 2078-5135
versão impressa ISSN 0256-9574

SAMJ, S. Afr. med. j. vol.108 no.5 Pretoria Mai. 2018




30 days in medicine



Lose weight before puberty to reduce risk of type 2 diabetes

Losing weight before puberty will reduce the risk of type 2 diabetes in adulthood, according to a study published in the New England Journal of Medicine. The study looked at 62 565 Danish men whose weights and heights had been measured at 7 and 13 years of age and in early adulthood (17 to 26 years). Data from a diabetes registry provided follow-up on 6 710 men aged >30 years.

Being overweight at 7 and then still overweight at 13 or in early adulthood was positively associated with the risk of type 2 diabetes, with stronger associations at older ages at overweight and younger ages at diagnosis of the disease. However, those who lost weight before they turned 13 had the same risk of type 2 diabetes as those who had never been overweight.

Bjerregaard LG, Jensen BW, Angquist L, et aL Change in overweight from childhood to early adulthood and risk of type 2 diabetes. Ν Engl J Med 2018,378.1302-1312.


Start antiretrovirals the day of diagnosis to improve later linkage to care

HIV-positive adults in Lesotho offered same-day home-based antiretroviral initiation had signficantly improved linkage to care at 3 months as well as HIV viral suppression at 12 months. These are the findings of an open-label, two-group, randomised clinical trial involving six healthcare facilities in northern Lesotho. During home-based HIV testing, 6 655 households were enrolled and 138 participants randomly assigned to be offered same-day home-based antiretroviral initiation andfollow-up at intervals of 1.5, 3, 6, 9 and 12 months or to receive usual care (n=140), with referral to the nearest health centre for counselling followed by antiretroviral initiation and monthly follow-up.

At 3 months, 68.6% of patients in the same-day group had linked to care, as opposed to 43.1% in the usual-care group. Viral suppression at 12 months was achieved by 50.4%, compared with 34.3% in the usual-care group.

Labhardt ND, Ringera I, Lejone TI, et al. Effect of offering same-day ART vs usual health facility referral during home-based HIV testing on linkage to care and viral suppression among adults with HIV in Lesotho. The CASCADE Randomized Clinical Trial. JAMA 2018,319(11).1103-1112.


Sexual violence against children leads to serious health problems

Sexual violence is widespread among both girls and boys in South Africa (SA) and is associated with serious health problems. These are the findings of a nationally representative, cross-sectional study in SA, sampling from 5 631 households and schools. Physical abuse emotional abuse, neglect, family violence and other victimisations were all strongly associated with sexual victimisation. School enrolment, living in a rural area, having a flush toilet, parental substance misuse, being disabled, female caregiver's poor knowledge of the child's whereabouts, friends and activities, and poor quality of relationship with the child all predisposed to sexual abuse.

Ward CL, Artz L, Leoschut L, Kassanjee R, Burton P. Sexual violence against children in South Africa. A nationally representative cross-sectional study of prevalence and correlates. Lancet Glob Health 2018!6(4).e460-e468.


B Farham


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