South African Family Practice - Volume 53, Issue 4, 2011
Volume 53, Issue 4, 2011
A cross-sectional study of hypertensive outpatients to determine the necessity of asking about erectile dysfunction symptoms : original researchSource: South African Family Practice 53 (2011)More Less
Background: Erectile dysfunction (ED) is common amongst hypertensive men. Hypertensive patients often attribute it to antihypertensive drugs, although conflicting evidence linking ED with antihypertensive medication exists. The objectives were to determine the prevalence and severity of ED, the type of treatment sought, and the risk factors for ED among hypertensive men.
Method: A cross-sectional survey conducted over six months from June to November 2008 at University Kebangsaan, Malaysia Medical Centre, Kuala Lumpur. Inclusion criteria included hypertensive men above 30 years old, with essential hypertension for at least three months. We excluded diabetics, a history of pelvic surgery and known psychiatric illnesses. The International Index of Erectile Function-5 (IIEF-5) assessment was used with a standardised checklist. We analysed data using SPSS, to assess the prevalence and association of ED with selected variables.
Results: Of the 200 participants screened, 35.5% perceived that they had ED. However, prevalence increased to 69% after screening using an IIEF-5 questionnaire. Forty-eight per cent were reported to have moderate-to-severe ED. ED was significantly associated with age (p-value = 0.0001). No significant associations were found between ED and the duration of the hypertension (p-value = 0.505), hypertension control (p-value > 0.05), smoking status (p-value = 0.858) or number of antihypertensive medication taken (p-value > 0.05). Among perceived and proven ED patients, traditional medicines were mainly used for treatment (18.3% and 17.2% respectively).
Conclusion: ED is a problem among hypertensive patients. It was associated with age but not with hypertension duration, control, number of antihypertensive drugs or smoking. Physicians should enquire about ED symptoms in hypertensive patients, as most of them resorted to self-treatment with traditional medicines.
Source: South African Family Practice 53 (2011)More Less
This edition of SAFP is, as usual, packed with interesting articles. The first is the 15th in the series on healthy lifestyle interventions in general practice, and focuses on lower back pain (LBP). LBP is one of the most common medical problems in the adult population, with an estimated lifetime prevalence of 70-85% and a peak onset at age 30-40 years. In the majority of cases, the cause of LBP cannot be attributed to anything specific, although the condition is largely a result of lumbar sprain or strain. Unfortunately, there are little data on the epidemiology of LBP in Africa and, more particularly, in South Africa. This is an indication that there is a need to prioritise epidemiological studies on LBP. The general approach to the diagnosis of LBP, as suggested by the authors, involves focused identification of possible "red flags" that may indicate more serious underlying causes, such as malignancy and infections. The routine use of special investigations, such as MRI and CT, for the diagnosis of non-specific LBP is not recommended. The nonpharmacological management of LBP includes exercise, psychosocial and behavioural intervention, and therapeutic education. This article is worth reading, as it provides a practical framework for the management of LBP.
Healthy lifestyle interventions in general practice : part 15 : lifestyle and lower back pain : CPD articleSource: South African Family Practice 53, pp 304 –311 (2011)More Less
Lower back pain (LBP) is one of the most common medical problems in the adult population. LBP can be defined as pain, muscle tension or stiffness that is localised below the costal margin (inferior rib cage) and above the inferior gluteal folds and that can present either with or without leg pain (sciatica), and it can be classified as "specific" or "non-specific". LBP has a high lifetime prevalence and is associated with a substantial direct and indirect cost to the individual and society. In this review, the focus is on the identification of lifestyle risk factors and interventions that are associated with mainly nonspecific chronic LBP. In addition to pharmacotherapy, the best treatment approach is exercise therapy (including physical reconditioning), psychosocial and behavioural intervention and therapeutic education. Other lifestyle changes include nutritional intervention and smoking cessation.
Author A.W. Van ZylSource: South African Family Practice 53, pp 313 –316 (2011)More Less
Oral malodour may affect up to three billion people worldwide, with millions of dollars spent on treatment. Halitosis is often used synonymously, but oral malodour is the preferred term for any bad breath emanating from the mouth. Oral causes account for the majority of bad breath cases. It is the objective of this article to review the causes, classification and treatment of oral malodour for health care workers.
Author D.J. BlomSource: South African Family Practice 53, pp 317 –323 (2011)More Less
Plasma lipid levels are determined by the interplay of environmental and genetic factors. Occasionally environmental factors may alter lipid levels significantly, resulting in secondary dyslipidaemia. The lipid phenotype in secondary dyslipidaemia is very variable (e.g. predominant hypercholesterolaemia, hypertriglyceridaemia or changes in high-density lipoprotein cholesterol) and is dependent on the inciting secondary factor and the genetic and metabolic background. Some common causes of secondary hyperlipidaemia include hypothyroidism, diabetes, nephrotic syndrome, cholestatic liver disease and drugs such as retinoids, antiretroviral medications and glucocorticoids. Secondary dyslipidaemia should be addressed before lipid-lowering drugs are prescribed.
Author W.M. SimmondsSource: South African Family Practice 53, pp 326 –331 (2011)More Less
Up to 70% of patients with typical symptoms of gastro-oesophageal reflux disease have neither definite endoscopic oesophageal erosions nor Barrett's oesophagus on upper endoscopy. These patients suffer from nonerosive reflux disease (NERD). There is no gold standard for the diagnosis of NERD, but a well-taken history is usually sufficient to confirm the diagnosis and initiate therapy. A sensitive tool for the diagnosis of NERD is a proton-pump inhibitor (PPI) trial of therapy. The aims of NERD therapy are acute and long-term symptom relief, maintenance of clinical remission and restoration of quality of life. PPIs in full doses are the treatment of choice for NERD patients, who often need long-term therapy for symptom control. For the family physician, identification of the relevant symptoms and initiation of treatment, where alarm symptoms have been excluded, is important in the effective management of NERD.
Source: South African Family Practice 53, pp 333 –335 (2011)More Less
Asthma is the most common chronic disease of South African children, affecting growth and development and quality of life. Features supporting the diagnosis are a family or personal history of atopy, night cough, exercise-induced cough and/or wheeze and seasonal variation in symptoms. Asthma is on the increase in both developed and developing countries, in both rural and urban communities. The first part of this series aims to give a brief overview of the epidemiology, pathophysiology and diagnosis of childhood asthma.
Author James A. KerSource: South African Family Practice 53, pp 336 –339 (2011)More Less
Approximately one in four adults has hypertension, a prevalence that increases with age and may reach to two out of three adults older than 70 years of age. In the Framingham Heart Study 65-75% of hypertension in the elderly is of the isolated systolic hypertension variety. Hypertension causes a two- to threefold increased risk of atherosclerotic cardiovascular events. Hypertension clusters with dyslipidaemia, insulin resistance, glucose intolerance and obesity in more than 80% of cases. The great majority of hypertensives thus have additional cardiovascular risk factors. The global cardiovascular risk, of which hypertension is but one component, is best appreciated by the use of risk charts such as the Framingham Risk Score.
Source: South African Family Practice 53, pp 340 –346 (2011)More Less
Atopic dermatitis (AD), the dermatological manifestation of the atopic diathesis, has a variety of clinical presentations. It is a chronic and relapsing inflammatory disorder, requiring a multifaceted treatment approach. Topical corticosteroids are the backbone of therapy. However, concerns over adverse drug reactions associated with their long-term application limit their use. Tacrolimus, on the other hand, has been shown to be effective in stabilising the symptoms of AD in the long-term setting, without the side-effects that hamper the use of topical corticosteroids. Long-term safety data up to ten years are available in the literature. Despite this, the US Food and Drug Administration (FDA) black box warning of possible malignancies has resulted in much debate among experts. The main focus of this article is to compare the safety and efficacy of topical corticosteroids to calcineurin inhibitors, particularly tacrolimus. Furthermore, the aim is to evaluate the place of tacrolimus in AD therapy. A brief overview of the condition and other treatment modalities will also be discussed.
Author V.M. De AndradeSource: South African Family Practice 53, pp 352 –354 (2011)More Less
In South Africa's multicultural and multiethnic population, many people consult with traditional health practitioners in order to receive treatment for a variety of problems. However, the semantics around the term "traditional health practitioner" need to be explored. This is because it is argued that allopathic health practitioners are also often traditional health practitioners, not with regard to the health care that they dispense, but in the way in which they engage with their clients. Traditional values of respect for the person, compassion and empathy are, and should be, routinely included in interactions with clients. This introduces a "traditional" character to "modern" interventions. This paper proposes that traditional healing terminology is not only limited to "traditional health practitioners," but also extends to "modern health practitioners," and that traditional medicine should not be supercilious in the way it considers itself to be more humane than allopathic medicine.
Factors associated with undernutrition and overweight in elderly patients presenting at a primary care clinic in Nigeria : original researchSource: South African Family Practice 53, pp 355 –360 (2011)More Less
Background: Undernutrition and overweight are commonly overlooked health problems of the elderly, often due to the implicit assumption that undernutrition is a rare occurrence in old age and overweight is an invariable consequence of ageing.
Method: A cross-sectional descriptive study of 500 patients aged 60 years and above who presented consecutively at the general outpatient department, University College Hospital, Ibadan, between September and October 2009, was undertaken. The main outcome measures were prevalence of nutritional problems (undernutrition and overweight), healthcare utilisation pattern and morbidities. The Mini Nutritional Assessment (MNA) tool was used to assess undernutrition, while body mass index was used to assess body weight.
Results: The prevalence of undernutrition and overweight was 7.8% and 54.1%, respectively. Previous hospital admission (p < 0.001) and chronic morbidities like hypertension (p < 0.001), osteoarthritis (p < 0.001) and psychosomatic disease (p < 0.001) were significantly associated with undernutrition, but not with overweight. Logistic regression analysis showed that previous hospital admission (OR = 2.105, 95% CI 1.479-2.996) and hypertension (OR = 0.122, 95% CI 0.048-0.306) were the most important factors contributing to the development of undernutrition.
Conclusion: Nutritional problems were prevalent among the elderly in this setting. Co-morbidities in the elderly constitute risk factors to be addressed in order to reduce the occurrence of nutritional problems. Health workers should always assess the elderly for nutritional problems, together with other morbidities with which they may present, and institute appropriate management.
Author Pierre J.T. De VilliersSource: South African Family Practice 53 (2011)More Less
In this issue of SAFP, there is an interesting opinion piece by Ronald Ingle. He writes about the benefits and harms of pharmaceutical advertising in medical journals and is concerned about the advertising practices applied to this journal, in particular the placement of advertising on the front cover. He has commented on this issue before. SAFP formulated an advertising policy, which has been applied ever since. His article and this editorial are published in the interest of transparency and debate, because, as he rightly points out, this matter has not been discussed adequately in South Africa.
A preliminary study of the effects of aircraft noise on families who reside in close proximity to an airport : original researchSource: South African Family Practice 53, pp 361 –365 (2011)More Less
Background: The use of air transportation has grown in the last century, escalating the noise exposure of families residing in close proximity to airports. The audiological effects need to be assessed to determine the impact of this increase on children and young adults living near to airports in South Africa.
Method: Hearing patterns for these individuals were compared to those residing 30 km away from the airport. Sixty people, between the ages of 12-30 years, were assessed. Participants completed a questionnaire and were subjected to a diagnostic audiological test battery and tested using diagnostic distortion product oto-acoustic emissions (DPOAEs).
Results: Participants residing in close proximity to the airport presented with a notch configuration in the high frequencies, as opposed to those who lived further away. DPOAEs indicated a change in hearing in the high frequencies between the test populations. The positive relationship between the pure tone results and the DPOAEs strengthens the claim that aircraft noise has an effect on the hearing patterns of individuals living near to airports. Participants also experienced annoyance resulting from such noise.
Conclusion: The results highlight the need for investigation into the hearing of individuals who reside in close proximity to airports. Comprehensive studies will be informative and beneficial to the field of audiology in South Africa. The highlighted health and safety issues require in-depth study to formulate a stronger argument for monitoring the hearing of families who are exposed to aircraft noise.
The prevalence and perception of obesity and its association with the lifestyle of women at the Mangaung University Community Partnership Project healthcare centre, Bloemfontein : original researchSource: South African Family Practice 53, pp 366 –372 (2011)More Less
Background: This investigation was prompted by the increase of obesity in developing countries with the simultaneous increased risk of preventable noncommunicable diseases. We aimed to determine the prevalence of obesity among women serving a predominantly black peri-urban community, who visited a healthcare centre in Bloemfontein. We also wanted to establish their perceived weight status, and any correlation between obesity, level of education, employment status and monthly income.
Method: A cross-sectional analytical design was used. In June 2007, clinic-attending women aged 18-50 years were selected by a systematic sampling method to participate in the study. A self-administered questionnaire investigated participants' socio-economic status, body image perception, psychological well-being, self-reported health status and physical activity. Body mass indices (BMIs) were calculated from weight and height measurements.
Results: A total of 304 women completed the study, of whom 98 (32.2%) were overweight and 134 (44.1%) were obese, with a mean BMI of 30.1 kg/m2 [standard deviation (SD) 6.9 kg/m2]. More than half (53.4%) of the obese women perceived themselves as not obese. Approximately 84% of the participants were educated to secondary level, or higher. A significant difference in the employment status of the obese and non-obese participants (26.9% and 16.5% employed, respectively) was noted (p-value = 0.0013). The obese participants reported significantly less low self-esteem (29.5%) than the nonobese participants (42.4%) (p-value = 0.0250).
Conclusion: The high prevalence of overweight and obesity, and the fact that 53.4% of the obese participants did not perceive themselves as such, poses a challenge for healthcare providers. Health-promotion strategies should aim to inform women about the health risks of overweight and obesity, and address misconceptions regarding perceived weight status.
Medical student participation in community-based experiential learning : reflections from first exposure to making the diagnosis : original researchSource: South African Family Practice 53, pp 373 –379 (2011)More Less
Background: Fifth-year medical students from the University of Pretoria participated in a four-week rotation in the primary care clinics of a large metropolitan centre. An academic service-learning (ASL) approach was introduced into this rotation to improve the integration of theoretical learning and clinical practice through relevant community service and structured reflection.
Methods: Students wrote semi-structured reflective journals as a means to gaining greater insight into their learning experiences. These reflections were analysed qualitatively with a view to improving the community-based curriculum.
Results: Four major themes were identified: expectations and the reality of primary care; service and learning; becoming a doctor; and making a difference.
Conclusion: While students gained a deeper insight into their development as clinicians, using an ASL approach also assisted the faculty in making an informed educational diagnosis of the curriculum.
Prevalence and determinants of burnout syndrome among primary healthcare physicians in Qatar : original researchSource: South African Family Practice 53, pp 380 –383 (2011)More Less
Background: General practitioners (GPs) in particular are prone to developing burnout syndrome, as they are frequently overloaded with the demands of caring for sick patients. This study was conducted to estimate the prevalence of burnout syndrome among primary healthcare physicians in Qatar, and to identify its determinants.
Methods: A cross-sectional survey targeting all GPs working in 21 primary healthcare centres in Qatar was conducted by using a self-administered Astudillo and Mendinueta questionnaire that covered socio-demographic data and job characteristics of the physician. It included a list of symptoms of burnout syndrome. Burnout syndrome assessment scores were calculated as a summation of answers to all 16 items, with a total minimum score of 0 and a total maximum score of 48. Physicians who scored more than 19 were classified as burned out.
Results: Out of the 230 GPs recruited, 183 responded, which represents a response rate of 79.5%. Of all the GPs, 12.6% were burned out. The burnout syndrome was higher among female GPs (28.1%) than male GPs (6.9%). This difference was statistically significant (p-value < 0.001). In terms of nationality, 37.8% of the Qatari GPs were burned out, compared to 11.6% of the foreign GPs (p-value < 0.004). Burnout syndrome was reversibly associated with years of experience and age. Fatigue, the use of analgesics and irritability were the most common symptoms.
Conclusion: Burnout syndrome is common among female and young GPs working in primary healthcare centres in Qatar. The improvement of GPs' coping skills and their work conditions are recommended to prevent burnout.
Medical ethics, law and human rights : a South African perspective, Keymanthri Moodley (Ed.) : book reviewSource: South African Family Practice 53 (2011)More Less
Ethics is defined as the "study of morality: a careful and systematic reflection on and analysis of moral decisions and behaviour, whether past, present or future." This book uses case studies to assist the healthcare practitioner to identify and analyse ethical, moral and value concepts, and to apply these to scenarios that they may encounter in real life.
Author R.F. IngleSource: South African Family Practice 53, pp 392 –393 (2011)More Less
The issue of advertising in medical journals by the pharmaceutical industry has been thoroughly debated on both sides of the Atlantic, but not, as far as I can discover, in South African literature. Recently, there have been extensive investigations, with conclusions of consequence, into the quality and transparency of the pharmaceutical industry's research. The quality of the industry's marketing and advertising clearly depends upon this.
Author Chris EllisSource: South African Family Practice 53 (2011)More Less
Last week I made a house call in one of our older suburbs called Boughton. It is on the outskirts of town and straddles the road that meanders up to Sweetwaters. I always feel that I am going back in time when I visit the area, as it is very quiet and the houses are fairly old and must have been built around the time of the Second World War. The shrubs and trees in the area are all slightly overgrown, dogs are lying asleep in the sun on verandahs and you can hear the clipping of the gardener at the back.