Do partial thickness, bursal side cuff tears affect outcome following arthroscopic subacromial decompression? A prospective comparative cohort study.

BACKGROUND: The present study aimed to compare medium-term clinical outcomes of patients following arthroscopic subacromial decompression (ASAD): those with intact rotator cuff with two groups of increasing size of partial thickness bursal-side tears. METHODS: Patients undergoing shoulder arthroscopy by a single surgeon had pre- and postoperative Constant scores prospectively recorded. Arthroscopic surgery included the assessment of any supraspinatus tears using the Ellman criteria, as well as ASAD and cuff debridement. Groups were created based on the status of rotator cuff and size of bursal tear. Outcome in these patient groups was then compared and analyzed. RESULTS: Seventy-four patients were suitable for inclusion in the study: 32 patients without a cuff tear; 21 patients with a cuff tear of 9 mm or less in length; and 21 patients with a cuff tear of 10 mm or more in length. Baseline characteristics of the three groups were similar. All three groups showed a significant improvement in their Constant scores following surgery. There was, however, no significant difference in Constant scores between the three groups. CONCLUSIONS: The results of the present study show that patients with varying sizes of bursal-side tears respond to ASAD as well as those with no rotator cuff tear.

Community-based tobacco control program: the Mamre study, a demonstration project.

OBJECTIVES: To assess the feasibility of a 5-year community-based tobacco control program in the community of Mamre in South Africa, while measuring the smoking and quitting rates at the beginning and end of this demonstration project. METHODS: A tobacco intervention program was developed at low cost in collaboration with the community, and involved a wide range of activities targeting people of all ages, especially those at risk for cardiovascular disease. Community members were trained to deliver smoking cessation programs and specific advice to smokers. Cross-sectional surveys were conducted in 1989 in a random sample of 1238 people, aged 15 years and older, prior to the 5-year demonstration project, and again in 1996 among 974 people at the end of the project. Demographic data and smoking and quitting patterns were collected by interviewer-administered questionnaires. Trained field workers used standardized procedures for recording blood pressure, height, and weight. RESULTS: The community participated with enthusiasm in the activities surrounding smoking cessation and the annual World No Smoking Day. The smoking rate decreased significantly between the two surveys (OR 1996/1989 = 0.82; 95% CI of 0.69-0.99), and the quitting rate increased significantly during the 5-year intervention period compared to the 5 years prior to the baseline survey (OR 1996/1989 = 0.74; 95% CI of 0.57-0.98). Men who participated in the program but continued to use tobacco in 1996 smoked more cigarettes than those who smoked in 1989. People who quit during the intervention period tended to be older, hypertensive, and obese; they consumed no alcohol, and noticed the health warnings posted in the community if they were older and had 10 or more years of education. CONCLUSIONS: A low-cost community-based tobacco control program was successfully implemented in the Mamre community. The program was received enthusiastically, built tobacco cessation skills, and significantly reduced the community's smoking rate compared to that before the demonstration project.

Modifiable risk factors for Type 2 diabetes mellitus in a peri-urban community in South Africa.

AIMS: To investigate the prevalence of Type 2 diabetes mellitus (DM) and its risk factors in a working class peri-urban community in South Africa. METHODS: A cross-sectional descriptive study was conducted in 1996, where all persons aged 15 years and older, who were resident in randomly selected houses in Mamre, 55 km from the centre of Cape Town, were sampled. Subjects underwent a 75-g oral glucose tolerance test. Socio-demographic and anthropometric data were obtained and physical activity was assessed using a 7-day activity recall questionnaire. The 1985 WHO criteria were used to define diabetes. RESULTS: The response rate was 64.5% (n = 974). The participants comprised 56% women, 44% men, mean age 37.6 (range 15-86) years. The crude prevalence of Type 2 DM was 7.1% and impaired glucose tolerance (IGT) 8.0%. The age-adjusted prevalence of Type 2 DM was 10.8% (95% confidence interval (CI) 8.2-13.5%) and IGT 10.2% (95% CI 7.7-12.8%). Regression analysis indicated that age (risk ratio (RR) 7.40, 95% CI 3.45-15.86), waist circumference (RR 4.53, 95% CI 2.04-10.05), low total energy expenditure (RR 1.75, 95% CI 1.07-2.56) and family history of diabetes (RR 2.31, 95% CI 1.42-3.77) were independent risk factors for Type 2 DM, while sex, obesity and regular alcohol consumption were not. CONCLUSIONS: This previously unstudied community has an intermediate prevalence on the international scale of Type 2 DM, which is linked to potentially modifiable risk factors.

Anthropometric profile of a black population of the Cape Peninsula in South Africa.

This study describes the anthropometry of an urban black population living in the Cape Peninsula, South Africa. A random sample of 986 selected adults aged 15-64 years and 163 children aged three to six years, included data on heights, weights, and mid-upper arm circumferences and calculation of the body mass index (BMI). The mean height of men was 168.3 cm and that of women 158.3 cm. Mean weight, BMI and mid-upper arm circumference for men were 66.2 kg, 23.4 and 28.1 cm and for women 69.8 kg, 27.8 and 30.6 cm respectively. The prevalence of underweight in men (BMI < 20) was 19% and in women (BMI < 19) 3.7%; 22% of the men were overweight (BMI > or = 25) and 7.9% obese (BMI > or = 30), while 36.4% of women were overweight (BMI > or = 24) and 34.4% obese (BMI > or = 30). More than half of the women above the age of 35 years were obese. Anthropometry of the three to six year old children was calculated for stunting, wasting and underweight, expressed in terms of the National Centre for Health Statistics standards, and revealed co-existing evidence of growth retardation and wasting with emergent obesity. These findings suggest that a part of this community, who may have been nutritionally deprived during childhood, has moved from undernutrition to extreme overnutrition without having achieved optimal nutritional status. Complexities that need to be considered when planning strategies to address malnutrition in the black South African population are identified.

Detection and measurement of hypercholesterolaemia in South Africans attending general practitioners in private practice--the cholesterol monitor.

BACKGROUND: This paper reports data on the detection and management of hypercholesterolaemia in patients attending general practitioners in private practice in South Africa. METHODS: The frequency of cholesterol testing and the level at which active therapeutic intervention occurred at medical practices were monitored over a 2-year period. A sample of 200 medical practitioners was selected from private practices in major cities. Data on patients seen by the selected doctors during a 5-day monitoring period were recorded on a standardised form. RESULTS: 12,842 patients were seen by the 200 private practice GPs. More men (18.7%) than women (10.4%) had coronary heart disease (CHD), and their mean total cholesterol (TC) levels were 5.9 mmol/l and 6.0 mmol/l, respectively. Only 3.1% of the patients were reported to have familial hypercholesterolaemia (FH) and 12.8% were reported to have a family history of CHD. Reported smoking rates were exceptionally high (77.5% of women and 64.4% of men). The most commonly prescribed group of lipid-lowering agents was HMG-CoA reductase inhibitors. CONCLUSIONS: Inadequate management of hypercholesterolaemia leaves many patients with a high risk of CHD mortality in South Africa. Appropriately investigated patients with hypercholesterolaemia should receive treatment to reduce cardiovascular disease using more effective TC control programmes than are currently used in South Africa.

Twelve-year results of the Coronary Risk Factor Study (CORIS).

BACKGROUND: After 4 years a coronary heart disease risk factor intervention programme produced equally large and significantly reduced risk profiles in two intervention towns compared with a control town. Intervention effects through community participation were assessed after cessation of the active intervention programme. The impact of secular trends was assessed in the control town and in two previously unstudied towns. METHODS: Cross-sectional surveys were done in a random sample of 1620 participants aged 15-64 years in the three original towns 12 years after the initial quasi-experimental study. Two years later 327 subjects, aged 35-44 years, were studied in the original control town and in two non-intervention towns. Risk factor knowledge, smoking and medical histories were determined by questionnaire. Blood pressure, anthropometry and blood lipids were recorded. Data were compared across towns, and with previous surveys. RESULTS: At 12 years the low intensity intervention town maintained a significantly better risk factor profile than the control town, while the high intensity intervention town now matched the control town. No differences in risk factor profiles were found between the control town and the two new towns. Deaths from coronary heart disease and strokes showed a downward trend in the study area. CONCLUSIONS: Outcome suggests large ongoing secular trends during the study could have overtaken the intervention effects in the high intensity town, but not in the low intensity intervention town, which showed an advantage over the control town. These results support the effectiveness of media-based, long term health promotion strategies to reduce cardiovascular disease risk profiles.

Smoking in urban pregnant women in South Africa.

AIM: To estimate the exposure to active and passive smoking of pregnant women in South Africa and to determine their knowledge and behaviour with regard to smoking during pregnancy. METHODS: A questionnaire was completed by pregnant women attending antenatal services in four South African cities. Questions were asked about smoking status, beliefs on the health effects of tobacco smoke during pregnancy, exposure to passive smoking and behavioural changes with regard to smoking during pregnancy. Women from different ethnic groups and social classes participated. RESULTS: The study population was 394 pregnant women. Of these 42% were black, 29% coloured and 10% Indian women, who used public antenatal services, and 19% were pregnant women (ethnicity unspecified) who attended private obstetric practices. Of the coloured women, 47% smoked; for the black and Indian women and those who attended a private practice, the smoking rates were 4%, 3% and 28%, respectively. Approximately 90% of the pregnant women knew it was unhealthy to smoke during pregnancy. Most women who smoked stopped or reduced tobacco use during their pregnancy. Of the pregnant women, 70% lived with at least one smoker in the house. CONCLUSIONS: Few black and Indian pregnant women in South Africa smoke, while coloured pregnant women smoke heavily. Quitting programmes should be targeted at them when they attend antenatal services. Pregnant women and their families should be alerted to the impact of environmental tobacco smoke, since so many are passive smokers during pregnancy.

Estimation of the prevalence of familial hypercholesterolaemia in a rural Afrikaner community by direct screening for three Afrikaner founder low density lipoprotein receptor gene mutations.

We have determined the prevalence of familial hypercholesterolaemia (FH) in a rural Afrikaner community by means of direct DNA screening for three founder-related Afrikaner low density lipoprotein (LDL) receptor gene mutations. A random sample of 1612 persons, aged 15-64 years, was selected as a subsample of 4583 subjects from an Afrikaner community living in the south-western Cape, South Africa. Participants who had a total serum cholesterol (TC) in the high TC category as defined in the consensus recommendations by the Southern African Heart Foundation, were screened for three founder-related LDL receptor gene mutations, causing FH in 90% of Afrikaners. Of the subsample, 201 participants (12.5%) had TC levels above the 80th percentile. In this group the combined prevalence of the three common Afrikaner LDL receptor gene defects (D206E, FH Afrikaner-1; V408M, FH Afrikaner-2; D154N, FH Afrikaner-3) was calculated as 1: 83. When taking into account the reported background prevalence of other FH gene defects of 1:500 in this community, their overall prevalence of FH was estimated to be 1:72. The significant differences found between the FH patients and other high risk patients with raised cholesterol levels were higher TC and LDL cholesterol levels and lower high density lipoprotein cholesterol levels in FH patients. The treatment status of the molecularly identified FH patients and other hypercholesterolaemic persons suggests that this condition is inadequately diagnosed and poorly managed in this study population. An extrapolation to the entire South African population suggests that there are about 112000 FH patients in the country who are under-diagnosed as a group and therefore not receiving the care that would help to reduce the burden of FH-associated ischaemic heart disease in South Africa.

Apolipoprotein B levels and related factors in a rural white South African community--the CORIS study. Coronary Risk Factor Study.

OBJECTIVE: In a survey of the Coronary Risk Factor Study (CORIS), apolipoprotein B (apoB) levels were determined to ascertain their impact on coronary heart disease (CHD) risk. Other CHD risk factors associated with apoB were also identified. DESIGN: Cross-sectional analytical study, which included CHD risk factor and dietary questionnaires, electrocardiography, anthropometric and blood pressure measurements, and a blood sample for a lipid profile. SETTING AND PARTICIPANTS: The three districts of Riversdale, Robertson and Swellendam in the south-western Cape; a 25% random sample of 1,528 white respondents aged 15-68 years. RESULTS: Men tended to have higher mean apoB levels than women. Classification of CHD risk by apoB levels and total cholesterol (TC) levels did not correspond, as only 61% of men and 58.5% of women were classified in the same risk categories. Respondents in the highest apoB risk category reported a medical history of hypercholesterolaemia and hypertension more frequently than those in lower categories. There was a significant increase from the low to the high apoB risk category of TC, low-density lipoprotein (LDL) cholesterol, triglyceride levels, body mass index and percentage body fat. Using stepwise multiple regression, 84.9% of the variation in apoB of men and 85.8% in apoB of women were accounted for by significantly associated variables. CONCLUSION: Although apoB may be a better predictor of CHD than TC or LDL cholesterol concentrations, its easy approximation with the formula (TC-HDLC)/2 + 20, high cost, measurement variability and an approach in management similar to that for raised TC discourage its routine use in the screening of patients for CHD.

Design and baseline characteristics of a hypertension intervention program in a South African village.

The Mamre Hypertension Project was initiated in response to studies indicating that hypertension and cardiovascular disease were prevalent in a rural community of Mamre, located in the Western Cape, South Africa. A survey was done to collect baseline information on the prevalence of hypertension and other cardiovascular disease risk factors. The age-adjusted prevalence of hypertension in people aged 15 years or more was 13.9% in men and 16.3% in women. Of the hypertensive subjects, 27% were not aware of their hypertension, a further 14.4% were not on treatment, and only 16.8% had their blood pressure (BP) controlled at under 140/90 mm Hg. There was a high prevalence of smoking, heavy alcohol use (in men), obesity (in women) and physical inactivity. The survey results will be used to assess the impact of the intervention programme using a before and after design, and are being used to direct interventions. The intervention programme comprises a BP station catering primarily for people with hypertension, and a health education and promotion programme directed at the general community. The BP station screens for hypertension, monitors BP and compliance with medication in hypertensives, and encourages risk factor modification. Health promotion activities include a smoking cessation group and a weight reduction and exercise group. These are run by community volunteers with support from outside consultants. The effects of the programme will be assessed after 4-5 years.

Cyanobacterial (blue-green algae) poisoning of livestock in the western Cape Province of South Africa.

Three outbreaks of cyanobacterial (blue-green algae) poisoning involving cattle and sheep are described. In 2 of these acute mortality was followed by photodermatitis in some of the surviving animals. In all 3 outbreaks the hepatotoxicity of the water collected from the dams where the animals had been drinking was confirmed following the intraperitoneal administration to mice. Nodularia spumigena was the dominant cyanobacterium in the first 2 outbreaks, and Microcystis aeruginosa in the third. The presence of the heptapeptide toxin microcystin-LR in the third outbreak was demonstrated by high pressure liquid chromatography.

Smoking in the black community of the Cape Peninsula, South Africa.

The purpose of this study was to determine tobacco-use and related factors in the black population of the Cape Peninsula. About 52% of the men, but only 8% of the women used tobacco regularly. Men and women who smoked cigarettes, smoked 9.6 and 4.3 cigarettes on average per day, respectively. Although many men smoked, 80% perceived smoking to be harmful to health as did 92% of the women. For women, smoking was inversely related to their level of education, while for men it was directly related to being employed. Smoking was also related to the use of alcohol in both genders. Women below 45 years who had spent less than a third of their lives in the city had lower smoking rates than those who had spent more than a third of their lives in the city. Smoking is one of the most important public health issues facing the black community of the Cape Peninsula.

Hypertension in the coloured population of the Cape Peninsula.

In a random sample of 976 coloured people 17.2% of men and 18.4% of women were hypertensive (greater than or equal to 160/95 mmHg or receiving medication). In the same population 35.6% of men and 24.7% of women suffered from total hypertension (greater than or equal to 140/90 mmHg). Men between 25 and 44 years had a markedly higher prevalence of hypertension than women of the same age. Above this age the situation was reversed. Correcting for under- and over-cuffing increased the mean pressures in men and decreased them in older women. Only 42.2% of hypertensive men and 69.9% of women were aware of their condition. Only 41.3% were on medication for it and a mere 16% had blood pressures below 160/95 mmHg. Hypertensives had significantly lower intakes of potassium, calcium, magnesium and saturated fat than normotensive subjects. Young hypertensives consumed more salt than older hypertensives. Both systolic and diastolic blood pressures were positively associated with alcohol consumption, smoking (in men), total serum cholesterol, low-density lipoprotein cholesterol, non-fasting triglyceride and uric acid levels. Hypertensive subjects were less educated and showed more type A coronary-prone behaviour than normotensives. A comparison of the prevalence of hypertension in the four South African ethnic groups is given.