Browsing by Subject "Risk factor"

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    Distribution of metals exposure and associations with cardiometabolic risk factors in the “Modeling the Epidemiologic Transition Study”
    (2014-11-05) Ettinger, Adrienne S; Bovet, Pascal; Plange-Rhule, Jacob; Forrester, Terrence E; Lambert, Estelle V; Lupoli, Nicola; Shine, James; Dugas, Lara R; Shoham, David; Durazo-Arvizu, Ramon A; Cooper, Richard S; Luke, Amy
    Abstract Background Metals are known endocrine disruptors and have been linked to cardiometabolic diseases via multiple potential mechanisms, yet few human studies have both the exposure variability and biologically-relevant phenotype data available. We sought to examine the distribution of metals exposure and potential associations with cardiometabolic risk factors in the “Modeling the Epidemiologic Transition Study” (METS), a prospective cohort study designed to assess energy balance and change in body weight, diabetes and cardiovascular disease risk in five countries at different stages of social and economic development. Methods Young adults (25–45 years) of African descent were enrolled (N = 500 from each site) in: Ghana, South Africa, Seychelles, Jamaica and the U.S.A. We randomly selected 150 blood samples (N = 30 from each site) to determine concentrations of selected metals (arsenic, cadmium, lead, mercury) in a subset of participants at baseline and to examine associations with cardiometabolic risk factors. Results Median (interquartile range) metal concentrations (μg/L) were: arsenic 8.5 (7.7); cadmium 0.01 (0.8); lead 16.6 (16.1); and mercury 1.5 (5.0). There were significant differences in metals concentrations by: site location, paid employment status, education, marital status, smoking, alcohol use, and fish intake. After adjusting for these covariates plus age and sex, arsenic (OR 4.1, 95% C.I. 1.2, 14.6) and lead (OR 4.0, 95% C.I. 1.6, 9.6) above the median values were significantly associated with elevated fasting glucose. These associations increased when models were further adjusted for percent body fat: arsenic (OR 5.6, 95% C.I. 1.5, 21.2) and lead (OR 5.0, 95% C.I. 2.0, 12.7). Cadmium and mercury were also related with increased odds of elevated fasting glucose, but the associations were not statistically significant. Arsenic was significantly associated with increased odds of low HDL cholesterol both with (OR 8.0, 95% C.I. 1.8, 35.0) and without (OR 5.9, 95% C.I. 1.5, 23.1) adjustment for percent body fat. Conclusions While not consistent for all cardiometabolic disease markers, these results are suggestive of potentially important associations between metals exposure and cardiometabolic risk. Future studies will examine these associations in the larger cohort over time.
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    Household illness, poverty and physical and emotional child abuse victimisation: findings from South Africa's first prospective cohort study
    (Biomed Central Ltd, 2015) Meinck, Franziska; Cluver, Lucie; Boyes, Mark
    BACKGROUND:Physical and emotional abuse of children is a large scale problem in South Africa, with severe negative outcomes for survivors. Although chronic household illness has shown to be a predictor for physical and emotional abuse, no research has thus far investigated the different pathways from household chronic illness to child abuse victimisation in South Africa. METHODS: Confidential self-report questionnaires using internationally utilised measures were completed by children aged 10-17 (n=3515, 56.7% female) using door-to-door sampling in randomly selected areas in rural and urban locations of South Africa. Follow-up surveys were conducted a year later (96.7% retention rate). Using multiple mediation analyses, this study investigated direct and indirect effects of chronic household illness (AIDS or other illness) on frequent (monthly) physical and emotional abuse victimisation with poverty and extent of the ill person's disability as hypothesised mediators. RESULTS: For children in AIDS-ill families, a positive direct effect on physical abuse was obtained. In addition, positive indirect effects through poverty and disability were established. For boys, a positive direct and indirect effect of AIDS-illness on emotional abuse through poverty were detected. For girls, a positive indirect effect through poverty was observed. For children in households with other chronic illness, a negative indirect effect on physical abuse was obtained. In addition, a negative indirect effect through poverty and positive indirect effect through disability was established. For boys, positive and negative indirect effects through poverty and disability were found respectively. For girls, a negative indirect effect through poverty was observed. CONCLUSIONS: These results indicate that children in families affected by AIDS-illness are at higher risk of child abuse victimisation, and this risk is mediated by higher levels of poverty and disability. Children affected by other chronic illness are at lower risk for abuse victimisation unless they are subject to higher levels of household disability. Interventions aiming to reduce poverty and increase family support may help prevent child abuse in families experiencing illness in South Africa.
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    Presenting features of primary angle-closure glaucoma in patients of mixed ethnic background
    (1993) SALMON, J
    The relative frequency with which patients present with acute or chronic angle-closure glaucoma depends on their ethnic background. In order to examine the presenting features and effects of primary angle-closure glaucoma in people of mixed ethnicity, we reviewed all «coloured» patients who presented to Groote Schuur Hospital with this diagnosis during a 5-year period. Of the 92 patients, 33 (36%) presented with acute angle-closure glaucoma and 59 (64%) with chronic angleclosure glaucoma. The level of intra-ocular pressure on presentation correlated well with the number of quadrants of angle closure (correlation coefficient: r=0,73, P<0,001). When individual eyes were assessed, a mean cup/disc ratio of ≥0,8 was present in 35% (65/184) and glaucomatous visual field loss was present in 56,5% (104/184).The relative frequency with which patients present with acute or chronic angle-closure glaucoma depends on their ethnic background. In order to examine the presenting features and effects of primary angle-closure glaucoma in people of mixed ethnicity, we reviewed all «coloured» patients who presented to Groote Schuur Hospital with this diagnosis during a 5-year period. Of the 92 patients, 33 (36%) presented with acute angle-closure glaucoma and 59 (64%) with chronic angleclosure glaucoma. The level of intra-ocular pressure on presentation correlated well with the number of quadrants of angle closure (correlation coefficient: r=0,73, P<0,001). When individual eyes were assessed, a mean cup/disc ratio of ≥0,8 was present in 35% (65/184) and glaucomatous visual field loss was present in 56,5% (104/184).
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    Single-dose benzathine penicillin in infants at risk of congenital syphilis : results of a randomised study
    (1997) Radcliffe, M; Meÿer, M; Roditi, D; Malan, A
    OBJECTIVE: To determine the efficacy of single-dose benzathine penicillin G in infants at high risk of congenital syphilis. DESIGN: Randomised study comparing benzathine penicillin with no therapy. SETTING: Peninsula Maternal and Neonatal Service, Cape Town. SUBJECTS: Asymptomatic infants born to mothers with untreated syphilis whose VDRL titre was 32 or more. OUTCOME MEASURES: The number of cases of congenital syphilis was determined by results of IgM Western blots and follow-up VDRL titres. RESULTS AND CONCLUSIONS: Of 8 patients followed up in the non-treatment group, 4 had congenital syphilis while 0/11 had the disease (P = 0.035) in the group receiving benzathine penicillin. Although the exact failure rate is unknown, benzathine penicillin is effective in preventing symptomatic congenital syphilis when administered to high-risk newborns.
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    The 'dop' system around Stellenbosch--results of a farm survey
    (1998)
    OBJECTIVES: To document the number of farms operating a 'dop' system (payment of workers with alcohol instead of wages), to estimate the number of farm workers affected, to describe how the system operated and to characterise adverse social conditions on the farms. POPULATION: Farms served by the mobile clinics of the Cape Metropolitan Council's Health Department in the Stellenbosch area. METHODS: Cross-sectional prevalence survey. Nurses collected data from patients attending mobile clinics. RESULTS: A prevalence of 9.5% was detected in respect of farms operating the dop system, with an estimated 780 workers affected. The most common practice was a daily provision of 750 ml wine to male workers. Social conditions on the farms in question were poor and wages were low. Child malnutrition was the most common health problem identified. CONCLUSION: The dop system, although illegal, has been documented to occur in the Stellenbosch area. Programmes to address the dop system and alcohol abuse, based on a primary health care approach, are a priority in the rural areas of the Western Cape.