A gender-based comparison of coracoid and glenoid anatomy: CT analysis and discussion of potential impact on the Latarjet procedure.

BACKGROUND: The success of the modified Latarjet procedure depends on proper sizing of the coracoid graft. There is no information available regarding the morphometric relationship between the glenoid cavity and the coracoid process for the South African population. This study aims at measuring the relationship between the glenoid and coracoid morphometries and investigates their gender-related differences. METHODS: Glenohumeral computerized tomography scans of 100 consecutive patients were considered for this study. Morphometric measurements were performed after aligning the coracoid and glenoid in their optimum orientation. These measurements were performed by 2 independent observers. The ratio between glenoid and coracoid measurements was calculated and statistically compared using the Mann-Whitney U test. Intraclass correlation coefficients were calculated to analyze interobserver reliability. All the statistical tests were performed in SPSS v.26, and power calculations in G∗Power v.3.1. RESULTS: An average intraclass correlation coefficient value of 0.79 suggested that the interobserver reliability was good. Except for coracoid length, statistically significant (P < .05) gender differences were observed for all the other morphometries. The coracoid width (16.5 ± 1.4 mm vs. 14.7 ± 1.4 mm) and height (13.6 ± 1.6 mm vs. 10.5 ± 1.5 mm) differed between genders by 1.8 and 3.1 mm, respectively. The glenoid anteroposterior (AP) (25.3 ± 2.9 mm vs. 23.2 ± 2.4 mm) and superioinferior (36.9 ± 1.9 mm vs. 33.7 ± 2.6 mm) measurements differed by 2.1 and 3.3 mm, respectively, between the males and the females. The ratio between the AP width of the glenoid and the coracoid height was also found to be significantly different (P < .05) between the gender groups. These morphometric ratios for the coracoid width (0.66 ± 0.09 mm vs. 0.64 ± 0.08 mm) and the coracoid height (0.55 ± 0.09 mm vs. 0.46 ± 0.07 mm) differed between genders by 0.02 and 0.09, respectively. CONCLUSION: Measurements taken from computerized tomography scans showed significant differences between genders in absolute measurements and in the ratio of the coracoid height to the glenoid AP distance. This could have implications on the ability of the Latarjet procedure to compensate for bone loss in female patients.

Newly born low birthweight infants stabilise better in skin-to-skin contact than when separated from their mothers: a randomised controlled trial.

AIM: Routine care of low birthweight (LBW) neonates relies on incubators for stabilisation. An earlier study suggested that skin-to-skin contact achieves better physiological stability in the transition period when compared to incubator care. The aim of this study was to replicate that study with a larger sample. METHODS: A randomised controlled trial with LBW infants (1500-2500 g) randomised at birth, 50 to routine care and 50 to skin-to-skin contact, with stabilisation using the Stability of Cardio-Respiratory system in Preterms (SCRIP) score measured repeatedly over the first six hours of life as the primary outcome. RESULTS: Newly born infants in skin-to-skin contact showed better transition to extra-uterine life (p < 0.02), with the SCRIP score at 360 minutes in skin-to-skin contact being 5.82 (SD 0.66) and in maternal infant separation 5.24 (SD 0.72), p < 0.0001. In extended skin-to-skin contact care, infants had significantly less need for respiratory support, intravenous fluids and antibiotic use during the remainder of the hospital stay. CONCLUSION: Skin-to-skin contact was likely to be an optimal environment for neonates without life-threatening conditions who weighed 1500-2500 g at birth. By preventing instability that requires subsequent medical treatment, it may be life-saving in low-income countries.

HIV Encephalopathy: pediatric case series description and insights from the clinic coalface.

BACKGROUND: The Human Immune Deficiency Virus (HIV) can manifest neurologically in both adults and children. Early invasion of the central nervous system by the virus, affecting the developing brain, is believed to result in the most common primary HIV-related neurological complication, HIV Encephalopathy (HIVE). In countries such as South Africa where many children have not been initiated on antiretroviral treatment early, HIVE remains a significant clinical problem. METHODS: Children were selected from a clinic for children with neurologic complications of HIV, located at the Red Cross War Memorial Children's Hospital, South Africa 2008-2012. Eligible subjects fulfilled the following inclusion criteria: aged 6 months-13 years; positive diagnosis of HIV infection, vertically infected and HIVE as defined by CDC criteria. Each participant was prospectively assessed by a Pediatric Neurologist using a standardized proforma which collated relevant details of background, clinical and immunological status. RESULTS: The median age of the 87 children was 64 months (interquartile range 27-95 months). All except one child were on antiretroviral treatment, 45% had commenced treatment <12 months of age. Delayed early motor milestones were reported in 80% and delayed early speech in 75% of children in whom we had the information. Twenty percent had a history of one or more seizures and 41% had a history of behavior problems. Forty-eight percent had microcephaly and 63% a spastic diplegia. CD4 percentages followed a normal distribution with mean of 30.3% (SD 8.69). Viral loads were undetectable (

Change in optic nerve sheath diameter as a radiological marker of outcome from endoscopic third ventriculostomy in children.

PURPOSE: The purpose of this study was to investigate the value of the change in optic nerve sheath diameter (ONSD) as a radiological marker of endoscopic third ventriculostomy (ETV) outcome in children. METHODS: Magnetic resonance imaging (MRI) scans of patients on whom ETVs were performed between the periods of January 2009 and June 2013 were reviewed. ONSD measurements on pre- and post-operative images were performed by two blinded observers, and the relationship between the change in these measurements and outcome from ETV were investigated. These findings were then also compared to conventional imaging features associated with ETV outcome. RESULTS: MRI scans of 24 patients were adequate to measure the ONSD pre- and post-operatively. In patients with successful ETV (n = 19), the mean change in ONSD was 0.73 mm and in patients with a failed ETV (n = 5), the mean change in ONSD was 0.18 mm (p = 0.0007). A change in ONSD of 7.5 % of the initial measurement demonstrated a sensitivity of 92.9 % and a sensitivity of 85.7 % for ETV outcome (area under the receiver operating characteristic curve (AUROC) = 0.96). CONCLUSION: Change in ONSD is a useful radiological marker of ETV outcome and may be used in combination with conventional radiological parameters to aid decision-making in this difficult group of patients.

Total elbow arthroplasty: outcomes after triceps-detaching and triceps-sparing approaches.

BACKGROUND: Total elbow arthroplasty (TEA) is associated with high complication rates compared with other large-joint arthroplasties. The frequency and type of complication may differ, depending on the surgical approach. A comparison of outcomes with triceps-off and triceps-on approaches was investigated. METHODS: Seventy-three patients underwent 83 primary TEAs between 2003 and 2012. Forty-six elbows had a triceps-off approach, and 37 had a triceps-on approach. Results were reviewed at a mean of 4.2 years. Cementing technique was graded according to Morrey's criteria, and clinical outcomes were assessed by means of the Mayo Elbow Performance Score. RESULTS: There was no statistically significant difference between the triceps-off and triceps-on groups with regard to the patient's age, gender, preoperative Mayo Elbow Performance Score or range of motion, or previous surgery on the affected elbow. Among patients who underwent a TEA for an inflammatory arthropathy, there was a significant difference in outcome between groups with regard to final flexion, extension, arc of motion, and pronation. Cementing technique in the triceps-off group was adequate in 70%. In the triceps-on group, cementing technique was adequate in 92%. The complication rate in the triceps-off group was 32.6% and included 7 triceps ruptures. Three patients who had attempted repairs of the triceps rupture developed deep infections requiring multiple further surgeries. The complication rate in the triceps-on group was 8.1%. CONCLUSION: A triceps-on approach in TEA results in consistently good clinical outcomes with no risk of triceps rupture, and the approach does not compromise the cement mantle. We believe that this approach will reduce complication rates in TEA.

Escitalopram treatment of depression in human immunodeficiency virus/acquired immunodeficiency syndrome: a randomized, double-blind, placebo-controlled study.

Depression can be a chronic and impairing illness in people with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome. Large randomized studies of newer selective serotonin reuptake inhibitors such as escitalopram in the treatment of depression in HIV, examining comparative treatment efficacy and safety, have yet to be done in HIV-positive patients. This was a fixed-dose, placebo-controlled, randomized, double-blind study to investigate the efficacy of escitalopram in HIV-seropositive subjects with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, major depressive disorder. One hundred two participants were randomly assigned to either 10 mg of escitalopram or placebo for 6 weeks. An analysis of covariance of the completers found that there was no advantage for escitalopram over placebo on the Montgomery-Asberg Depression Rating Scale (p = 0.93). Sixty-two percent responded to escitalopram and 59% responded to placebo on the Clinical Global Impression Scale. Given the relatively high placebo response, future trials in this area need to be selective in participant recruitment and to be adequately powered.

The evaluation of a telephonic wellness coaching intervention for weight reduction and wellness improvement in a community-based cohort of persons with serious mental illness.

Obesity and metabolic disturbances frequently occur in individuals with psychiatric disorders. This study evaluates a telephonically delivered lifestyle coaching intervention aimed at weight reduction and wellness improvement in psychiatric outpatients. A cohort of 761 participants was prospectively followed up for a period of 12 months. Lifestyle coaching was administered telephonically on a weekly basis for the first 3 months and monthly thereafter. During the study period, there was a significant reduction in weight and waist circumference as well as a significant increase in general health in the completer group. A total of 46% of the participants lost 5% or more of their baseline weight. Significant predictors of attrition at baseline were the presence of metabolic syndrome, younger age, chronic illness, and the diagnosis of a mood disorder. Dropout was significantly less in those participants who received support from a nominated caregiver. Telephonic lifestyle coaching is feasible in this population.

Vascular calcification in South African dialysis patients: ethnic variation, prevalence, detection and haemodynamic correlates.

AIM: Studies from the US have shown little effect of ethnicity on vascular calcification in dialysis patients. This has not been examined in the multi-ethnic population of South Africa where genetic and environmental differences may exist. We assessed the extent and severity of vascular calcification in South African dialysis patients according to race and known risk factors. We further evaluated the association of abdominal aorta calcification with coronary artery calcification. METHOD: Seventy-five CKD-5D patients and 20 healthy controls were enrolled consecutively. All subjects underwent chest computed tomography for coronary calcium score and abdominal X-ray for abdominal aorta calcium score. Ambulatory blood pressure monitoring was generated via radial artery applanation tonometry. RESULTS: Coronary calcification was present in 38.6% of patients and was associated with age and prior cardiovascular disease on multivariate analyses. The median coronary calcium score in black patients was 0 (IQR 0) and 66 in non-Blacks (IQR 383, P < 0.001); controls had a coronary calcium score of 0 (IQR 0). Black race remained a significant negative predictor for coronary calcification after adjustment, prevalence ratio = 0.14 and 95% confidence interval (CI): 0.0-0.53. Vascular calcification was not associated with any ambulatory blood pressure parameter. Using receiver operator characteristic curves, an abdominal aorta calcification score of ≥1 showed an area under the curve of 0.83 to predict a coronary calcium score ≥ 10. CONCLUSION: Black race appears to protect from vascular calcification in South African CKD-5D patients and this warrants further study regarding the underlying mechanism. The abdominal X-ray is a useful screening tool for coronary calcification.

HIV-1 seroconversion promotes rapid changes in cervical human papillomavirus (HPV) prevalence and HPV-16 antibodies in female sex workers.

The extent to which human immunodeficiency virus (HIV-1) infection impacts on the ability to mount an effective immune response to HPV is unknown, but is relevant in planning HPV vaccine strategies for HIV-1 infected individuals. This longitudinal study investigated changes shortly after HIV-1 seroconversion on cervical HPV types and HPV-16 antibody responses in serum and at the cervix of female sex workers. Typing of HPV DNA from cervical cells was done prior to HIV-1 seroconversion and within 1 year and greater than 2 years after HIV-1 seroconversion. Antibody determinations on serum and cervico-vaginal rinse samples were by HPV-16 virus-like particle-based, enzyme-linked immunosorbent assay. Of 104 women tested, 40 (38.4%) became HIV-1 seropositive (HIV-positive) during the course of the study. Shortly after HIV-1 seroconversion a significant increase in multiple (>1) HPV infection (OR 4.0, 95% CI 1.3-11.9) was observed compared with HIV-1 seronegative (HIV-negative) women and certain changes in HPV type infection. HIV-1 seroconversion resulted in a reduced prevalence of serum HPV-16 IgA and cervico-vaginal IgA and IgG but an increased prevalence of serum HPV-16 IgG. All HIV-positive women had been exposed to HPV-16 as all displayed serum HPV-16 IgG. Serum HPV-16 responses were maintained at a high magnitude in the presence of HPV-16 infection irrespective of HIV infection, but decreased in the absence of HPV-16 infection. In conclusion, HIV-1 seroconversion in sex workers rapidly increased cervical HPV infection and caused a reduced ability to produce cervical HPV-16 antibodies but a continued ability to generate serum IgG antibodies.

Cervical human papillomavirus (HPV) infection and HPV type 16 antibodies in South African women.

There is a high incidence of cervical cancer in South African women. No large studies to assess human papillomavirus virus (HPV) infection or HPV type 16 (HPV-16) exposure have occurred in the region, a requirement for policy making with regards to HPV screening and the introduction of vaccines. Control women (n = 1,003) enrolled in a case control study of hormonal contraceptives and cervical cancer were tested for 27 cervical HPV types by reverse line blot analysis. The seroprevalence of HPV-16 immunoglobulin G (IgG) and IgA antibodies was assessed by a virus-like particle-based enzyme-linked immunoassay of 908 and 904 control women, respectively, and of 474 women with cervical cancer. The cervical HPV prevalence was 26.1%. The HPV-16 IgG seroprevalence was 44.4% and the HPV-16 IgA seroprevalence was 28.7% in control women, and these levels were significantly higher (61.8% and 52.7%, respectively) for women with cervical cancer (odds ratio [OR], 2.1 and 2.8, respectively). The cervical HPV prevalence showed an association with cervical disease, and the HPV-16 IgG prevalence decreased while the HPV-16 IgA prevalence increased with increasing age (P < 0.05). The prevalence of oncogenic HPV types (including HPV-16) decreased with age, whereas nononcogenic HPV types showed limited association with age. Multivariate analysis revealed cervical HPV infection to be associated with herpes simplex virus type 2 infection (OR, 1.7) and increasing years of education (OR, 1.9). HPV-16 IgG antibodies were inversely associated with current smoking status (OR, 0.6), and the presence of HPV-16 IgA antibodies was inversely associated with the use of alcohol (OR, 2.1) and inversely associated with the use of oral contraceptives (OR, 0.6). High levels of exposure to HPV, and particularly HPV-16, were evident in this population. The apparent increase of serum HPV-16 IgA with increasing age requires further investigation.

Determinants of sexual activity and its relation to cervical cancer risk among South African women.

BACKGROUND: Invasive cervical cancer is the commonest cause of cancer morbidity and mortality in South African women. This study provides information on adult women's sexual activity and cervical cancer risk in South Africa. METHODS: The data were derived from a case-control study of hormonal contraceptives and cervical cancer risk. Information on age of sexual debut and number of lifetime sexual partners was collected from 524 incident cases and 1541 hospital controls. Prevalence ratios and adjusted prevalence ratios were utilised to estimate risk in exposures considered common. Crude and adjusted relative risks were estimated where the outcome was uncommon, using multiple logistic regression analysis. RESULTS: The median age of sexual debut and number of sexual partners was 17 years and 2 respectively. Early sexual debut was associated with lower education, increased number of life time partners and alcohol use. Having a greater number of sexual partners was associated with younger sexual debut, being black, single, higher educational levels and alcohol use. The adjusted odds ratio for sexual debut < 16 years and >/= 4 life-time sexual partners and cervical cancer risk were 1.6 (95% CI 1.2 - 2.2) and 1.7 (95% CI 1.2 - 2.2), respectively. CONCLUSION: Lower socio-economic status, alcohol intake, and being single or black, appear to be determinants of increased sexual activity in South African women. Education had an ambiguous effect. As expected, cervical cancer risk is associated with increased sexual activity. Initiatives to encourage later commencement of sex, and limiting the number of sexual partners would have a favourable impact on risk of cancer of the cervix and other sexually transmitted infections.

When to stop treatment arms in a clinical trial assessing time to event with more than two arms against a common control.

Two-arm time-to-event (or survival) trials are powered to continue until a required number of events is reached. The authors discuss how the required number of events should be defined for a study with three or more arms with various pairwise comparisons and a common control arm. They advocate stopping one active arm when the required number of events is observed in the applicable pairwise comparison but continuing with the other active arm and the control arm until the required number of events is observed in that pairwise comparison, thereby ensuring that the study continues until enough events are observed in each pairwise comparison. This article is the result of considerations during the design of a three-arm microbicide trial.

The impact of the use of COL-1492, a nonoxynol-9 vaginal gel, on the presence of cervical human papillomavirus in female sex workers.

This study investigated the effectiveness of a nonoxynol-9 (52.5mg, 3.5%), vaginal gel (Advantage S), in the prevention of human papillomavirus (HPV) infection in female sex workers. We showed by HPV DNA determination in cervico-vaginal rinses a significant increase in multiple (>1) HPV infection in HIV-1 seropositive women compared with HIV-1 seronegative women (OR 4.0, 95% CI 1.3-11.9). We also demonstrated a significant increase in multiple HPV infections in HIV-1 seronegative women using nonoxynol-9 compared with HIV-1 seronegative women using placebo (OR 3.5 95% CI 1.0-11.8). We conclude that the use of nonoxynol-9 did not prevent genital HPV infection and could increase the virus' ability to infect or persist.

HIV and pre-neoplastic and neoplastic lesions of the cervix in South Africa: a case-control study.

BACKGROUND: Cervical cancer and infection with human immunodeficiency virus (HIV) are both major public health problems in South Africa. The aim of this study was to determine the risk of cervical pre-cancer and cancer among HIV positive women in South Africa. METHODS: Data were derived from a case-control study that examined the association between hormonal contraceptives and invasive cervical cancer. The study was conducted in the Western Cape (South Africa), from January 1998 to December 2001. There were 486 women with invasive cervical cancer, 103 control women with atypical squamous cells of undetermined significance (ASCUS), 53 with low-grade squamous intraepithelial lesions (LSIL), 50 with high-grade squamous intraepithelial lesions (HSIL) and 1159 with normal cytology. Odds ratios (OR) and 95% confidence intervals (CI) were calculated using multiple logistic regression. RESULTS: The adjusted odds ratios associated with HIV infection were: 4.4 [95% CI (2.3 - 8.4) for ASCUS, 7.4 (3.5 - 15.7) for LSIL, 5.8 (2.4 - 13.6) for HSIL and 1.17 (0.75 - 1.85) for invasive cervical cancer. HIV positive women were nearly 5 times more likely to have high-risk human papillomavirus infection (HR-HPV) present compared to HIV negative women [OR 4.6 (95 % CI 2.8 - 7.5)]. Women infected with both HIV and high-risk HPV had a more than 40 fold higher risk of SIL than women infected with neither of these viruses. CONCLUSION: HIV positive women were at an increased risk of cervical pre-cancer, but did not demonstrate an excess risk of invasive cervical cancer. An interaction between HIV and HR-HPV infection was demonstrated. Our findings underscore the importance of developing locally relevant screening and management guidelines for HIV positive women in South Africa.

Microbiological yield from induced sputum compared to oropharyngeal swab in young children with cystic fibrosis.

BACKGROUND: Standard respiratory sampling in young children with cystic fibrosis (CF) is by oropharyngeal swab (OPS) as they cannot spontaneously expectorate. Sputum induction (IS) has been poorly investigated in this population. We aimed to compare the bacteriological yield of OPS vs. IS in young children with CF. METHODS: Sequentially paired OPS followed by IS samples was collected in children <5years of age attending a CF clinic in Cape Town, South Africa. RESULTS: IS was successfully paired with OPS in 98/113 (85%) attempts in 32 children (mean±SD 19±16months), with no serious adverse events. IS culture yield for any CF-associated bacteria from IS was 46% vs. 28% from OPS (p=0.01). The sensitivity, specificity, PPV and NPV of OPS compared to IS in isolating CF-associated bacteria were 56%, 96%, 93%, and 72% respectively. CONCLUSION: Sputum induction is feasible, safe and superior to OPS for detecting CF-associated bacteria in young children with CF.

Effect of cloth stoma covers on tracheal climate of laryngectomy patients.

BACKGROUND: The purpose of this study was to evaluate the efficacy of cloth stoma covers (bibs) to compensate for breathing unconditioned air after laryngectomy and loss of heat-moisture-exchange (HME) functions of the upper airways, which, to the best of our knowledge, has never been reported. In addition, we compared the efficacy of inexpensive, simple, locally made, noncommercial fabric bibs with commercial bibs and stick-over-the-stoma HME devices and to determine whether wetting the bib improves the tracheal climate. METHODS: Tracheal temperature and humidity were studied in 25 patients who underwent a laryngectomy with a purpose-built sampling device. RESULTS: Noncommercial and commercial bibs effectively heat and humidify inspired air (p < .05). Both bibs compare favorably with commercial HME devices. There is no benefit in using a commercially produced Buchanan Bib over an inexpensive noncommercial bib. Wetting a bib proved to be counterproductive. CONCLUSION: Inexpensive, noncommercial bibs are effective and improve tracheal climate and benefit patients with laryngectomies. © 2015 Wiley Periodicals, Inc. Head Neck 38: E480-E487, 2016.

Ethnic differences in allelic distribution of IFN-g in South African women but no link with cervical cancer.

BACKGROUND: The failure of specific types of human papillomaviruses (HPV) to raise effective immune responses may be important in the pathogenesis of cervical cancer, the second most common cancer in South African women. Polymorphisms of a number of cytokine genes have been implicated in inducing susceptibility or resistance to cancers caused by infectious agents owing to their role in determining host immune response. Polymorphisms of IL-10 and IFN-gamma genes are believed to influence the expression and/or secretion levels of their respective cytokines. METHODS AND RESULTS: In this study, women with histologically proven cancer of the cervix (n = 458) and hospital-based controls (n = 587) were investigated for bi-allelic -1082 (A/G) polymorphisms of IL-10 and the bi-allelic +874(A/T) polymorphisms of IFN-gamma. In addition, the distributions of the allelic frequencies were stratified in both the African and mixed race population groups of South Africa. We found striking differences in the allele distribution of IFN-gamma (X2 = 0.02) among the two ethnic groups. A significant increase in the allele distribution of the IFN-gamma AA genotype was found in the African group compared to the mixed population group (OR, 0.5; 95% CI, 0.2-1.0). For IL-10 there were no significant allelic differences between the two South African ethnic groups. Furthermore, when the ethnic groups were combined the IL-10 allelic frequencies in the combined South African data were similar to those observed in an Oriental population from Southern China and in an Italian population. However, the allele frequencies of the IFN-gamma genotype among the two South African ethnic groups were different when compared to an Italian Caucasoid group. While crude analysis of these data showed both statistically significantly increased and diminished risks of cervical cancer among high producers of INF-gamma and low producers of IL-10 respectively, these associations were no longer significant when the data were adjusted for confounding factors. CONCLUSION: These findings demonstrate a clear correlation between ethnicity and IFN-gamma polymorphism across different population groups. However, these differences in ethnicity and gene polymorphisms in the aforementioned cytokines are suggested not to influence the development of invasive cervical cancer but may represent an important susceptibility biomarker for other diseases and should be explored further.

Identification of ocular surface squamous neoplasia by in vivo staining with methylene blue.

AIM: To evaluate the diagnostic accuracy of methylene blue used as a non-invasive in vivo stain to detect ocular surface squamous neoplasia (OSSN). METHODS: A test validation study was performed according to Standards for the reporting of diagnostic accuracy studies (STARD) guidelines on 75 consecutive patients who presented with ocular surface lesions suspicious of OSSN. Methylene blue 1% was instilled in vivo following local anaesthetic. Stain results were documented photographically and read by an independent observer. Lesions were excised at the same visit and evaluated histologically by pathologists who were blind to the stain results. Sensitivity, specificity, positive and negative predictive values were determined. RESULTS: Thirty-three patients had histologically malignant lesions, of which 32 stained with methylene blue, and 42 patients had benign or premalignant lesions, of which 21 stained with methylene blue. Methylene blue had a sensitivity of 97%, specificity of 50% and positive and negative predictive values of 60% and 96%, respectively. CONCLUSIONS: The topical application of methylene blue is a simple, inexpensive, non-invasive diagnostic test that can be helpful in excluding malignant ocular surface lesions but cannot replace histology as gold standard for diagnosis of OSSN.

Problem solving styles among people who use alcohol and other drugs in South Africa.

The present study examines the relationship between problem-solving styles, socio-demographic variables and risk of alcohol and other drug (AOD)-related problems among a South African population. The Social Problem-Solving Inventory-Revised, Center for Epidemiologic Studies Depression Scale (CES-D) and the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) were administered to a convenience sample of 1000 respondents. According to the ASSIST, 32% and 49% of respondents met criteria for moderate to high risk of alcohol use and illicit drug use respectively. After adjusting for the effects of other variables in the model, respondents who were of "Coloured" ancestry (PR=1.20, 95% CI 1.0-1.4), male (PR=1.19, 95% CI 1.04-1.37), older (PR=1.01, 95% CI 1.00-1.02), who adopted an avoidance style of coping with problems (PR=1.03, 95% CI 1.01-1.05) and who met criteria for depression (PR=1.42, 95% CI 1.12-1.79) were more likely to be classified as having risky AOD use. This suggests that interventions to improve problem solving and provide people with cognitive strategies to cope better with their problems may hold promise for reducing risky AOD use.

Vascular calcification is not associated with increased ambulatory central aortic systolic pressure in prevalent dialysis patients.

INTRODUCTION: Central aortic systolic pressure (CASP) strongly predicts cardiovascular outcomes. We undertook to measure ambulatory CASP in 74 prevalent dialysis patients using the BPro (HealthStats, Singapore) device. We also determined whether coronary or abdominal aortic calcification was associated with changes in CASP and whether interdialytic CASP predicted ambulatory measurement. METHODS: All patients underwent computed tomography for coronary calcium score, lateral abdominal radiography for aortic calcium score, echocardiography for left ventricular mass index and ambulatory blood pressure measurement using BPro calibrated to brachial blood pressure. HealthStats was able to convert standard BPro SOFT(®) data into ambulatory CASP. RESULTS: Ambulatory CASP was not different in those without and with coronary (137.6 vs 141.8 mmHg, respectively, p = 0.6) or aortic (136.6 vs 145.6 mmHg, respectively, p = 0.2) calcification. Furthermore, when expressed as a percentage of brachial systolic blood pressure to control for peripheral blood pressure, any difference in CASP was abolished: CASP: brachial systolic blood pressure ratio = 0.9 across all categories regardless of the presence of coronary or aortic calcification (p = 0.2 and 0.4, respectively). Supporting this finding, left ventricular mass index was also not different in those with or without vascular calcification (p = 0.7 and 0.8 for coronary and aortic calcification). Inter-dialytic office blood pressure and CASP correlated excellently with ambulatory measurements (r = 0.9 for both). CONCLUSION: Vascular calcification was not associated with changes in ambulatory central aortic systolic pressure in this cohort of prevalent dialysis patients. Inter-dialytic blood pressure and CASP correlated very well with ambulatory measurement.