RESUMO
Background. Cardiovascular diseases (CVDs) are a challenge to populations and health systems worldwide. It is projected that by 2020 about a third of all deaths globally will be caused by CVDs; and that they will become the single leading cause of death by 2030. Empirical evidence suggests that there is socioeconomic patterning in the distribution and prevalence of risk factors for CVD; but the exact nature of this relationship in South Africa remains unclear. Objective. To examine the association between socioeconomic status (SES) and risk factors for CVD in a cohort of adult South Africans living in rural and urban communities.Method. This was a cross-sectional analytical study of baseline data on a population-based cohort of 1 976 SA men and women aged 35 - 70 years who were part of the Cape Town arm of the Prospective Urban and Rural Epidemiology (PURE) Study.Results. We found a complex association between SES and CVD risk factors; its pattern differing between urban and rural participants. Marital status showed the most consistent association with CVD risk in both groups: widowed participants living in urban communities were more likely to be hypertensive as well as diabetic; while single participants in both locations were more likely to use alcohol and tobacco products. Level of education was the only SES variable that had no significant association with any CVD risk factor in either study group. All measured SES variables were significantly different between urban and rural participants (p0.05); with diabetes; obesity and alcohol use significantly more prevalent in urban than in rural participants (p0.05) while hypertension and tobacco use were not (p?0.05). Conclusions. In this cohort of South Africans; there were significant associations between SES and CVD risk; with marked differences in these associations between rural and urban locations. These findings highlight the need to consider SES and area of residence when designing interventions for CVD prevention and control
Assuntos
Doenças Cardiovasculares , Estudos Transversais , Classe Social , Saúde da População UrbanaRESUMO
Background: To obtain an adequate cervical (Papanicolaou) smear; the transformation zone; including the squamo-columnar junction; should be sampled as carcinoma develops preferentially in this transformation zone. The Ayre spatula has been widely used but is not very effective. Other sampling devices have been developed to improve efficiency; including the cytobrush. The purpose of this study was to compare the adequacy of cervical smears taken with the Ayre spatula as opposed to the cytobrush. MethodsThis was a retrospective analytical study. One sampler; an experienced general practitioner; took the smears in the period 1990 to 2004. Initially; the Ayre spatula was used to consecutively sample the cervix and thereafter; a cytobrush alone was used. Two groups were thus formed for comparison. The presence of endocervical cells was accepted as an indicator of an adequate smear. A Cusco speculum was used to visualize the cervix. The sample was smeared onto a slide and fixated with an alcohol aerosol spray. ResultsA total of 4561 smears were taken and 247 had no endocervical cells. A further 34 smears were classified as unsatisfactory due to the presence of degeneration (19); insufficient squamous cells (7); inflammatory exudate (4); excess blood (3) and/or a thick slide (1).The cytobrush group was similar demographically to the Ayre spatula group: 1981 (99) and 2490 (98) respectively were non pregnant; 67 (3) and 110 (4) were nulliparous; 1008 (50) and 1370 (54) were para 1 - 5; and 931 (46) and 1075 (42) were para 6 or more; 0 (0) and 2 (0.1) were aged between 10 - 19 years; 1496 (75) and 2012 (78) between 20 - 49; and 510 (25) and 541 (21) were aged 50 years or more. Of 2006 smears taken with a cytobrush; 1955 (97.5) contained endocervical cells compared with 2325 (91) of 2555 smears taken with an Ayre spatula. The difference was significant with an Odds Ratio of 4.56 (95Confidence Interval 3.42-6.42). ConclusionThe cytobrush is significantly more efficacious than the Ayre spatula in obtaining adequate cervical smears. Use of the cytobrush will ensure less repeat smears with a consequent reduction in workload for samplers and laboratories. Although very few smears lacked sufficient squamous cells (an indicator of adequate ectocervical sampling); current best practice is that the cytobrush be used together with a wooden spatula to ensure adequate sampling of both the endocervical and ectocervical components of the transformation zone
Assuntos
Carcinoma , Avaliação de Programas e Projetos de Saúde , Esfregaço VaginalRESUMO
Background: The study aimed to i) investigate the smoking habits of students attending tertiary institutions of learning in the Eastern Cape Province (ECP) and ii) determine the knowledge of the students about the health hazards of smoking and their attitude towards current government anti-smoking legislation.Methods: This was a questionnaire-based study involving all seven tertiary institutions of learning in the ECP; viz. the Universities of Transkei; Fort Hare; Port Elizabeth and Rhodes University; and the Border; Eastern Cape and Port Elizabeth technikons. A total of 1 728 students were interviewed out of a student population of 30;080. Stratified random sampling was used to select the students. Two-way tables were used to test the independence of the variables and chi-square tests were applied. A 'p' value of below 5 was used as a test of significance. Results : A total of 1 480 students completed the questionnaires (86). The racial classification of the respondents was 79 Black; 13 White; 7 Coloured and 2 Indian. Twenty-six per cent of the students were smokers; of which 37 were male and 15 were female. Forty-five per cent of the Coloured students smoked; while the figures for Whites and Blacks were 26 and 25 respectively. Seventy per cent of the students smoked less than 10 cigarettes a day. Fifty-two per cent of the smokers said they wanted to stop smoking. Sixty-one per cent had been influenced to start smoking by their friends and only 13 were influenced by advertisements. Ninety-four percent agreed that smoking was dangerous to the smoker's health; while 73 responded that there was a relationship between mothers who smoke and low birth weight. Thirteen per cent thought the legislation was too tough; while 30 said it was good as it was. On measures to reduce smoking; 86 favoured restricting smoking in public places.Conclusion: This study has demonstrated that smoking is prevalent in tertiary institutions of learning in the Eastern Cape Province. The demographic profile of the smokers reflects the national picture. The knowledge of the harmful effects of smoking is generally good
