South African Medical Journal - Volume 103, Issue 11, 2013
Volumes & issues
Volume 103, Issue 11, 2013
Author Leonie JoubertSource: South African Medical Journal 103, pp 809 –810 (2013)More Less
One morning, in the winter of 2010, I walked into the home of a family living outside Mbabane, Swaziland. There were three young children sitting at the table, aged about six or seven. The table was covered with a plastic tablecloth with really loud fruit printed on it, but there wasn't any fruit in the kitchen. In fact, there wasn't any food in the kitchen at all.
Source: South African Medical Journal 103, pp 810 –811 (2013)More Less
South African statistics on cigarette smoking suggest that there are grounds for some celebration on how rapidly consumption has fallen since the institution of anti-smoking policies started roughly 20 years ago. As with other countries, tax policies that increased the cost of cigarettes will have played the greatest role in the reduction in smoking. These policies have also resulted in strong economic benefits, saving up to 1.5 million lives and put over US$12.5 billion into the economy. The authors of this paper were both very involved in achieving these policies: in 1993, Derek Yach hosted the first national meeting to brief the African National Congress on the need for stronger taxes to address tobacco use, and in that meeting David Sweanor outlined the success taxes had already achieved in his home country of Canada.
Source: South African Medical Journal 103 (2013)More Less
The article on pre-hospital rapid sequence induction (RSI) in the September issue of the SAMJ makes a valuable contribution to our understanding of RSI in this environment in South Africa (SA). However, there are some factual inaccuracies in the article regarding the educational background of those performing the procedure, which I would like to clarify.
Cutaneous adverse drug reactions caused by FDCAs - we need to characterise and manage them urgently : correspondenceSource: South African Medical Journal 103 (2013)More Less
In April 2013, South Africa's Minister of Health launched fixed-dose once-a-day combination antiretrovirals (FDCAs) comprising emtricitabine, efavirenz and tenofovir (Odimune and Tribuss). During the months following the introduction of these drugs, anecdotal reports from clinicians and patients are emerging of cutaneous adverse drug reactions (CADRs) associated with them. We have recently described the clinical characteristics of efavirenz-associated CADRs. Efavirenz is a constituent of the FDCAs, so we have been actively surveying and documenting suspected FDCA-associated CADRs at Groote Schuur Hospital in Cape Town, South Africa.
Source: South African Medical Journal 103, pp 816 –818 (2013)More Less
As long as political parties decide who represents us, corruption-breeding patronage will persist - as is best illustrated by the Eastern Cape's virtually collapsed healthcare delivery system. For provinces which mainly incorporated rural apartheid 'homelands' into their administrations, another albatross around their necks is the historical lack of restitution via pure per capita-based budget allocations from central government.
Source: South African Medical Journal 103, pp 818 –819 (2013)More Less
Can a rechargeable battery, linked to an atomiser and cartridge of liquid nicotine, 'massively' reduce the individual and population risks of traditional cigarette smoking? Or is the increasingly ubiquitous e-cigarette a dubious, poorly-controlled 'aid to quitting', resulting in actual dual use with unacceptably high toxin levels? The jury is out scientifically, with South African role players on either side producing evidence for and against the device.
Source: South African Medical Journal 103, pp 820 –821 (2013)More Less
Though he had narrowly survived his first round of leukaemia chemotherapy, for Peter Paterson* (age 14) the tipping point in choosing to undergo another gruelling nine months of chemo was the fun he'd had with new friends suffering similar conditions on a recent wildlife safari camp.
Author Bridget FarhamSource: South African Medical Journal 103 (2013)More Less
The Women's Health Initiative Randomized Controlled Dietary Modification Trial : an inconvenient finding and the diet-heart hypothesis : forum - critiqueSource: South African Medical Journal 103, pp 824 –825 (2013)More Less
One goal of the US$700 million Women's Health Initiative Randomized Controlled Dietary Modification Trial was to determine whether post-menopausal women who adopted what was regarded as a 'heart healthy' low-fat diet, high in vegetables, fruits and grains, reduced their risk of developing cardiovascular disease. The trial substantially favoured the outcome in the intervention group, who also received an intensive nutritional and behaviour education programme not offered to the control group. These studies neatly disprove the diet-heart hypothesis since adoption of 'heart healthy' eating not only failed to influence future cardiac events in the healthy but it increased such events in the unhealthy and worsened diabetic control in those with type 2 diabetes mellitus.
Low-carbohydrate and high-fat intake can manage obesity and associated conditions : occasional survey : forum - a new dietary paradigm?Source: South African Medical Journal 103, pp 826 –830 (2013)More Less
This study analyses 127 communications from individuals self-reporting their weight change following adoption of a low-carbohydrate, high-fat (LCHF) eating plan. Total combined self-reported weight loss was 1 900 kg (range 5 kg gain to 84 kg loss). The mean ± standard deviation weight loss of 15 (±12) kg is among the largest yet described. Sixteen subjects reported the LCHF 'cured' (i.e. medications no longer required) one or more of their medical conditions, most commonly type 2 diabetes mellitus (T2DM) (n=14), hypertension (n=8) and hypercholesterolaemia (n=7). Another 9 subjects with either type 1 diabetes mellitus or T2DM reduced medications as did 7 patients with hypertension; 8 no longer suffered from irritable bowel syndrome. These data show that significant and rapid weight loss is possible on an unsupervised eating plan that severely restricts daily carbohydrate intake to approximately <75 g/day. Better weight loss on a carbohydrate-restricted LCHF eating plan than on an iso-caloric high-carbohydrate, low-fat (HCLF) diet is well described in the literature, probably due to a paradoxical reduction of hunger by carbohydrate restriction. A randomised controlled clinical trial is urgently required to disprove the hypothesis that the LCHF eating plan can reverse cases of T2DM, metabolic syndrome and hypertension without pharmacotherapy.
Author Nkosazana Dlamini ZumaSource: South African Medical Journal 103 (2013)More Less
A comprehensive health promotion approach to tobacco control can work among school-age children in Africa. This is the message from the study by Reddy et al. reported in this month's SAMJ. The data sustaining the message were drawn from four Global Youth Tobacco Surveys (GYTSs) conducted among nationally representative samples of South African (SA) school learners during 1999, 2002, 2008, and 2011. The setting was public schools across the 9 provinces of SA, and the more than 7 000 learners in grades 8 - 10, aged 12 - 20 years. The percentage of learners who admitted to being current smokers (smoked a cigarette on at least one day in the 30 days preceding the survey) declined from 23% in 1999 to 16.9% in 2011 - a 26.5% reduction. Reductions in smoking prevalence, however, were less pronounced among girls and among ethnic black learners.
Author B. AllwoodSource: South African Medical Journal 103, pp 832 –833 (2013)More Less
Electronic cigarettes (e-cigarettes) are relatively new in South Africa and their popularity is increasing. Their appearance coincides with intensifying attempts by government and society to reduce tobacco smoking through stricter limitation on its sale, advertising and use. Debate has been triggered on their use regarding the potential risks of increasing nicotine addiction and encouraging people to start smoking, or whether e-cigarettes might serve rather as an efficient means of treating addiction, thus assisting smokers to quit.
Opinions among doctors regarding e-cigarettes vary, some seeing potential for good, others condemning them outright. Several professional medical societies have taken the stand that, whatever their potential as a smoking-cessation method, they cannot be encouraged since they are produced and promoted by the tobacco industry. Also, that research supported by the manufacturers of e-cigarettes may not be presented at their meetings or in their medical journals.
We present the following arguments for the potential benefit and harms of e-cigarettes, based on the currently available evidence.
Author R.N. Van Zyl-SmitSource: South African Medical Journal 103 (2013)More Less
Should the legislation on the sale and promotion of electronic cigarettes (e-cigarettes) be similar to that for tobacco smoking, or are they different? Is there potential medical benefit in their availability and use? I shall argue that they should be regulated, based on the overwhelming potential for their harm to society, and particularly to those that they are intended to 'help'. Firstly, the evidence for their being an effective method for smoking cessation is unconvincing. Secondly, they are a means for maintaining nicotine addiction and dependence. Thirdly, they may even encourage more habitual use of nicotine, which, in time, might encourage a switch to cigarette smoking.
Source: South African Medical Journal 103 (2013)More Less
The World Health Organization (WHO) recently advocated raising the CD4+ count threshold for initiating antiretroviral therapy (ART) for HIV-infected adults to 500 cells/µl, from the current 350 cells/µl. Following previous WHO guidance, the current South African (SA) strategy of treating everyone with a CD4+ count <350 cells/µl, and all pregnant women and TB patients, has led to remarkable achievements, cutting mother-to-infant transmission dramatically and increasing life expectancy. The question is: should SA follow the latest WHO recommendation?
A decade of tobacco control : the South African case of politics, health policy, health promotion and behaviour change : researchSource: South African Medical Journal 103, pp 835 –840 (2013)More Less
Background. The South African (SA) government has implemented comprehensive tobacco control measures in line with the requirements of the Framework Convention on Tobacco Control. The effect of these measures on smoking prevalence and smoking-related attitudes, particularly among young people, is largely unknown.
Objective. To describe the impact of a comprehensive health promotion approach to tobacco control amongst SA school learners.
Methods. Four successive cross-sectional Global Youth Tobacco Surveys (GYTSs) were conducted in 1999, 2002, 2008 and 2011 among nationally representative samples of SA grades 8 - 10 school learners. We assessed the prevalence of current smoking (having smoked a cigarette on ≥1 day in the 30 days preceding the survey) and smoking-related attitudes and behaviours.
Results. Over the 12-year survey period current smoking among learners declined from 23.0% (1999) to 16.9% (2011) - a 26.5% reduction. Reductions in smoking prevalence were less pronounced amongst girls and amongst black learners. We observed an increase in smoking prevalence amongst learners between 2008 and 2011. Smoking-related attitudes and behaviours showed favourable changes over the survey period.
Conclusion. These surveys demonstrate that the comprehensive and inter-sectorial tobacco control health promotion strategies implemented in SA have led to a gradual reduction in cigarette use amongst school learners. Of concern, however, are the smaller reductions in smoking prevalence amongst girls and black learners and an increase in smoking prevalence from 2008 to 2011. Additional efforts, especially for girls, are needed to ensure continued reduction in smoking prevalence amongst SA youth.
The effects of obesity, smoking, and excessive alcohol intake on healthcare expenditure in a comprehensive medical scheme : researchSource: South African Medical Journal 103, pp 840 –844 (2013)More Less
Background. Health risks such as tobacco use, excessive alcohol consumption and unhealthy body weight contribute to the development of chronic health problems.
Objective. To estimate the associations of tobacco use, excessive alcohol consumption and obesity with healthcare expenditure and chronic diseases among South Africans on a comprehensive medical scheme.
Methods. We performed a cross-sectional analysis of health survey and medical claims data for 70 000 South Africans during 2010.
Results. Moderately obese individuals, with a body mass index (BMI) of 30 - 35 kg/m2 averaged R2 300 (11%) higher annual medical expenditure in the year 2010 than never-smokers with a BMI <30 kg/m2. This increase is comparable with being a current or past smoker (expenditure increase by R2 600; 13%). Severely obese individuals (BMI >35 kg/m2), however, had increased healthcare costs of R4 400 (23% increase). This exceeds the difference between a 40- and a 50-year-old (increase of R3 200). Being overweight or excessive consumption of alcohol was not significantly associated with medical expenditures. Absolute and relative excess expenditures associated with these health risks are higher among older individuals. In the 54 - 69-year age group, estimated additional expenses were R6 200 for smoking (20% increase over never-smokers with BMI <30 kg/m2), R6 600 for moderate obesity (21%) and R15 800 for severe obesity (51% increase). Overweight or heavy drinking was not statistically significantly associated with healthcare expenditure.
Conclusion. Obesity and tobacco use are associated with significantly increased healthcare expenditure. Severe obesity doubles these excess costs.
The extent of problematic alcohol and other drug use within selected South African workplaces : researchSource: South African Medical Journal 103, pp 845 –847 (2013)More Less
Background. The use of alcohol and other drugs (AODs) in the workplace has a major impact on the health and productivity of the workforce globally. Yet information on this issue is limited in South Africa (SA).
Objective. To describe the nature and extent of AOD problems in selected workplace settings in SA.
Methods. Secondary data analysis was conducted on a large dataset compiled by an Employee Assistance Programme (EAP) service provider in SA. As part of an EAP risk audit, assessments for AOD-related problems were completed for each employee accessing EAP services (n=10 428) between 2005 and 2011. Data on the socio-demographic profiles, AOD use and impact of AOD use on the work performance of employees were analysed.
Results. Findings indicate that employed men are more likely to experience alcohol-related problems than women, the latter demonstrating a higher percentage of drug-related problems. The majority of referrals to the EAPs emanate from the public, industrial and financial sectors. AOD-related problems were also found to significantly impact on employee work performance.
Conclusions. The study begins to address the knowledge gap on the extent of AOD use in SA workplaces and points to the need for further investigations into the exact nature of AOD use. In addition, the study highlights the need for intervention programmes and policies suited to the workplace.