South African Family Practice - Volume 54, Issue 2, 2012
Volume 54, Issue 2, 2012
Prevalence patterns and predictors of alcohol use and abuse among secondary school students in southern KwaZulu-Natal, South Africa : demographic factors and the influence of parents and peers : original researchSource: South African Family Practice 54, pp 132 –138 (2012)More Less
Background: The prevalence and predictors of alcohol use and abuse among school students were investigated with the aim of gaining insight to guide prevention interventions.
Method: A cross-sectional, self-administered survey pertaining to a one-month period was conducted among students in grades 11 and 12 in purposively selected schools with mixed-race groups. Frequencies and χ2 analyses were conducted and forward stepwise, conditional entry logistic regression models were fitted to determine the significant demographic predictors and influence of peers and parents on students' alcohol use and binge drinking.
Results: About 54% of students had used alcohol before, while 14.5% had had their first drink before the age of 13. In the relevant month, 41% used alcohol and 32% engaged in binge drinking. Students who were more likely to have used alcohol in the preceding month were older [odds ratio (OR) = 1.44, P = 0.006], male (OR = 2.1, P < 0.001), white (OR = 5.1, P < 0.001), had often seen their fathers drunk (OR = 1.9, P < 0.001) and had friends who frequently use alcohol (OR = 3.5, P < 0.001). Students who were more likely to report binge drinking in the preceding month were older (OR = 1.6, P < 0.001), male (OR = 2.4, P < 0.001), white (OR = 1.6, P = 0.048), had often seen their fathers (OR = 1.5, P = 0.001) and mothers (OR = 1.4, P = 0.05) drunk and had friends who frequently use alcohol (OR = 3.6, P < 0.001).
Conclusion: The long-term consequences of hazardous drinking patterns initiated during adolescence may have negative effects on achievement in life, health and general well-being, and therefore these patterns are in need of urgent address. While older, white male students are at particular risk, the significant influence of peer and parental alcohol use is highlighted and should be considered when developing prevention interventions in schools.
Emotional intelligence and locus of control of adult patients with breast cancer receiving treatment : original researchSource: South African Family Practice 54, pp 139 –144 (2012)More Less
Background: This article investigates emotional intelligence and locus of control in an adult breast cancer population receiving treatment. Gaining insight into these constructs will contribute to improving breast cancer patients' psychological well-being and to reducing physical vulnerability to disease before and during treatment.
Method: The researcher used an exploratory, descriptive and correlational approach. Nonprobability purposive sampling was employed. Sixty-seven breast cancer patients receiving treatment participated in the research. A biographical questionnaire, the Schutte Emotional Intelligence Scale, and the Rotter Internal-External Locus of Control Scale were used to measure the constructs explored in this article. Descriptive and inferential statistics were used to analyse the data.
Results: The sample yielded above-average levels of emotional intelligence and an internal locus of control. The results indicate a statistically and practically significant negative correlation between emotional intelligence and locus of control. The significant association found between higher and lower emotional intelligence groups and internal and external locus of control groups also confirmed these results.
Conclusion: Having an understanding of the psychosocial variables that impact on individuals diagnosed with a chronic illness, in this case breast cancer, can assist interventionists working in the field of positive psychology. While the stressors and challenges that breast cancer patients face are well documented, this article highlights the strength factors emotional intelligence and locus of control as important mediators in the treatment and management of breast cancer.
The association between depression and adherence to antiretroviral therapy in HIV-positive patients, KwaZulu-Natal, South Africa : original researchSource: South African Family Practice 54, pp 145 –150 (2012)More Less
Background: Depressive disorders are associated with poorer health outcomes in people living with human immunodeficiency virus infection and acquired immunodeficiency syndrome (PLHIV) and have been shown to contribute to non-adherence to antiretroviral therapy (ART) in Western contexts. Limited data from developing countries are available. The aim of this study was to explore whether there was an association between depressive symptoms and adherence to ART among PLHIV in KwaZulu-Natal, South Africa.
Method: A cross-sectional analytical study was undertaken in a population of HIV-positive patients accessing ART at a government funded, semi-urban clinic in the eThekwini Municipal District, KwaZulu-Natal, South Africa. The tools used to measure depressive symptoms and adherence were the Centre for Epidemiology Studies Depression Scale (CES-D) and clinic-based pill counts, respectively. Socio-demographic and clinical data were collected during interviews and from patient records.
Results: Sixty-two per cent of the sample (n = 146) had higher-than-threshold levels on the depression scale, and 32% were less than 95% adherent to ART. High depression scores were associated with lower levels of education [odds ratio (OR) 2.0; 95% confidence interval (CI), 1.0-4.1] and unemployment (OR 2.8; 95% CI, 1.3-6.0), while non-adherence was associated with unemployment (OR 2.4; 95% CI, 1.0-6.1) and mid-range CD4 counts (200-499 cells/μl; OR 3.0; 95% CI, 1.3-6.9). No significant association was found between depressive symptoms and non-adherence to ART (OR 0.5; 95% CI, 0.2-1.2; p-value, 0.125).
Conclusion: The large percentage of participants who scored high on the CES-D suggests a high prevalence of major depression in the study population. No significant association was found between high depression scores and nonadherence to ART. Depressive symptoms were significantly linked to lower levels of education and unemployment, while non-adherence was associated with unemployment and mid-range CD4 counts (200-499 cells/μl). The study had some limitations. Further studies are needed to determine the prevalence and causes of depression and its impact on PLHIV in this population and in the developing world.
The effect of the introduction of a standard monitoring protocol on the investigations performed on the metabolic control of type 2 diabetes at Addington Hospital Medical Outpatients Department, Durban, South Africa : original researchSource: South African Family Practice 54, pp 151 –155 (2012)More Less
Background: A comprehensive approach to the control of type 2 diabetes is required to reduce mortality and morbidity. To improve diabetes management, in 2005 a protocol for the monitoring and management of type 2 diabetes, aligned to the 2003 Society for Endocrinology, Metabolism and Diabetes of South Africa (SEMDSA) guidelines, was introduced at Addington Hospital Medical Outpatients Department, Durban, South Africa.
Method: Data were collected from 120 randomly selected patients with type 2 diabetes. The number of glycated haemoglobin (HbA1c) and lipid estimations, blood pressure (BP) measurements and body mass indices (BMIs) recorded in 2005 was compared with those recorded in 2008 and 2009. The mean levels of these parameters and the number of patients reaching goal in 2008 were compared with the figures for 2009.
Results: In 2005, 18.8% of patients had HbA1c levels measured compared with 82.9% in 2009 (P < 0.01). The mean HbA1c was 6.9% (± 1.9) in 2008 and 6.4% (± 2.0) in 2009 (P = 0.1). BP and BMI was measured in over 93% of patients in 2005, 2008 and 2009. BP goals were attained by 21% of patients in 2008 and 30% in 2009 (P = 0.65). The mean BMI in 2008 was 29.4 kg/m2 (24% achieved goal), and in 2009 it was 28.6kg/m2 (29% achieved goal; P = 0.267). Lipid estimations rose significantly from 26% in 2005 to 73% in 2009 (P < 0.01). There was no improvement in the number of patients reaching target lipid levels between 2008 and 2009.
Conclusion: The monitoring protocol improved adherence to the SEMDSA 2003 guidelines from 2005 to 2009. Overall glycaemic control was within target, but attainment of most nonglycaemic goals was suboptimal and did not improve over the study period.
Drug therapy, lifestyle modification and blood pressure control in a primary care facility, south of Johannesburg,South Africa : an audit of hypertension management : original researchSource: South African Family Practice 54, pp 156 –161 (2012)More Less
Background: Hypertension management is suboptimal in many settings. We assessed blood pressure (BP) control according to target, the appropriateness of antihypertensive therapy and the extent of implementing lifestyle modification among hypertensive patients.
Method: This study was an audit involving a retrospective review of medical records of hypertensive patients who were 18 years of age and older (n = 300), attended to by doctors or primary health care nurses at a large community health centre, south of Johannesburg, South Africa. Demographic, anthropometric, clinical and management data were extracted from the files of hypertensive patients who met the inclusion criteria. Data analysis included the use of descriptive statistics, the chi-square test and Fisher's exact test. The main outcome measures were the proportions of patients with controlled BP, who used appropriate antihypertensive drugs and who had documented lifestyle modifications.
Results: Most patients were black (75.7%) and female (68.3%). The mean age was 60 years. The majority of the patients (55.7%) were either overweight or obese. Fifty-seven per cent of the patients (n = 171) had BP control meeting the target. Appropriate choice of antihypertensive drugs was documented in 81.3% of patients (n = 244), while 56.3% had lifestyle modification documented in their records. Significantly more women had their BP controlled to target compared to men (P = 0.0028). Factors significantly associated with good BP control were white race (P = 0.0001) and documentation of adherence to therapy (P = 0.000).
Conclusion: BP control was achieved in the majority of patients and the vast majority was on appropriate drug therapy. White race, female sex and adherence to treatment documented in the medical record were significantly associated with BP controlled to target.
Source: South African Family Practice 54, pp 163 –166 (2012)More Less
In recent years, southern Africa has experienced a widespread measles outbreak. Given the high human immunodeficiency virus (HIV) prevalence in the region, the particular features of measles in HIV-infected individuals are of interest to clinicians, especially as regards children, as are measles immunisation strategies for this population. This review discusses a case of severe measles in an HIV-infected child in Botswana, focusing on its implications for clinical case management in Botswana and similar settings and for policies on measles immunisation.
Source: South African Family Practice 54, pp 167 –168 (2012)More Less
After reading the editorial of the recent issue of the South African Family Practice, my thoughts went back to almost 12 years ago when I retired as Head of the Department of Family Medicine at the University of the Free State. One of the "goodbye" letters I received then was from Pierre de Villiers. With this letter, I want to return the compliment and say goodbye to Pierre.