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Biomedical subjects

G Joubert

Publications and source records attributed to G Joubert.

At least 73 records · Page 4Linked to original sources
PubMed1994

Prevalence of vaginitis, syphilis and HIV infection in women in the Orange Free State.

OBJECTIVE: To determine the prevalence of vaginitis, syphilis and HIV infection in women in the Orange Free State. METHOD: By cluster sampling, 120 rural (farm) and 120 urban (local authority) clusters, each containing 4 women, were selected. Women aged 18-49 years who were included in the study had a cervical smear taken for cytological evaluation and blood specimens drawn for syphilis and HIV testing; they were questioned on their knowledge of AIDS. RESULTS: Trichomonas vaginalis vaginitis was present in 27.4% of the rural women and 29.6% of the urban women, Gardnerella vaginalis in 7.2% and 8.4% and Candida spp. in 2.6% and 6.7% respectively. Syphilis serology was positive in 12% of rural and 16% of urban women. HIV was present in 0.4% of rural and 1.5% of urban women. Ninety per cent of urban women and 74% of rural women knew AIDS was a sexually transmitted disease. CONCLUSIONS: The prevalences of trichomonas vaginitis and syphilis were unusually high, while HIV positivity was similar to that in other reports in South Africa.

Adolescent↗
PubMed1994

Evaluation of the long-term results of mitral valve repair in 254 young patients with rheumatic mitral regurgitation.

BACKGROUND: Surgical valve repair for mitral regurgitation has significant advantages over valve replacement, but the durability of the technique varies according to the cause of mitral valve disease. In this study, we examined the long-term performance of this procedure in a young rheumatic population and also attempted to identify factors predicting a poor outcome. METHODS AND RESULTS: Between January 1981 and 1989, 308 patients underwent primary mitral valve repair for rheumatic mitral regurgitation at our institution. Forty-nine patients who failed to report after surgery and another 5 with discordant data were excluded from the analysis. Mitral regurgitation was pure in 182 patients (72%) and associated with mild commissural fusion in 72 patients (28%). Patient ages ranged from 6 to 52 years (mean, 18 +/- 9 years). A total of 243 patients (96%) were in New York Heart Association class III or IV before surgery, and 66 (26%) had atrial fibrillation. Mean follow-up period was 60 +/- 35 months (range, 1 to 132 months). Rheumatic activity was present clinically in 30% and macroscopically during surgery in 32%. Surgical techniques included insertion of a Carpentier ring (99%), chordal shortening (88%), leaflet resection (14%), chordal transposition (7%), and commissurotomy (28%). Operative mortality was 2.6%, late mortality was 15%, and the reoperation rate was 27%. At 5 years, 96.8% of the patients were free from thromboembolism, 97.7% were free from endocarditis, 74.9% were free from reoperation, 66% were free from valve failure, and 66.2% were free from major events. Multivariate analysis identified active rheumatic carditis as a significant predictor of reoperation, valve failure, and future events, while sinus rhythm and shorter bypass time at initial surgery were the only predictors of long-term survival. Patients with pure mitral regurgitation, sinus rhythm, and no active carditis at initial operation had the best overall 5-year results. Among the 148 survivors without reoperation, 142 (96%) were in New York Heart Association class I and II, and 107 (72%) were in sinus rhythm. Doppler echocardiographic studies showed absence of mitral regurgitation in 34 patients (23%), severe regurgitation in 23 (16%), and severe mitral stenosis in 6 (4%). CONCLUSIONS: Mitral valve repair in this young rheumatic population is associated with a high long-term morbidity. Presence of active rheumatic carditis has a significantly adverse effect on the success of mitral valve repair.

Actuarial Analysis↗
PubMed1993

Study of risk factors leading to coronary heart disease in urban Zulus.

Coronary heart disease (CHD) is still relatively uncommon in the black population of South Africa. We embarked on a study to determine the prevalence of risk factors leading to CHD in the black population of Durban. The study sample was selected from patients attending a dental clinic at a hospital. A total of 458 Zulus (age range 16-69 years) were studied. The prevalence of CHD was 2.4%. The prevalence percentage of selected risk factors were: hypertension (SBP > or = 140 mmHg and/or a DBP > or = 90 mmHg) was 28%, males 31.9%, females 25.4%; protective levels of high density lipoprotein cholesterol/total cholesterol (HDLC/TC) (> or = 20%) were 81.3%; diabetes, males 4.9%, females 2.9%; smoking > or = ten cigarettes per day, males 28.1%, females 3.4%; obesity, males 3.7%, females 22.6%. We have found the Minnesota Coding System for ECG changes of CHD and Rose questionnaire to be unreliable for eliciting CHD in Blacks. Hypercholesterolaemia is less common and this may explain the low incidence of CHD in Blacks. Epidemics of CHD as seen in the Indian, 'mixed' and white South Africans can still be prevented in the black population but preventive measures must be instituted rapidly.

Adult↗
PubMed1992

Dermatoses--an occupational hazard in the canning industry.

Despite the recognition that occupational dermatitis is extremely common, few data exist on the prevalence of skin disorders in South African industry. A cross-sectional prevalence study among 686 female workers in a canning factory in the western Cape showed high rates of dermatoses--in particular, chronic paronychia, intertrigo and dermatitis of the hands. A statistically significant association was found between exposure to 'wet work' in the industry and the prevalence of chronic paronychia and intertrigo. Age was also found to be associated with these dermatoses, irrespective of duration of service. The prevalence of dermatitis of the hands was increased among high-exposure workers, but not significantly. Dermatoses are an important occupational hazard in the canning industry, and there is a need for improved preventive measures.

Adolescent↗
PubMed1992

Compensatability and contact dermatitis in the canning industry.

If reports from the Workmen's Compensation Commissioner are compared with international figures, dermatitis in South African industry appears to be underestimated. Compensation for occupational dermatitis in South Africa relies on the presence of a positive patch test. A prevalence study at a canning factory in the western Cape showed high rates of dermatoses. No association could be shown between dermatitis, intertrigo or chronic paronychia and patch-test positivity. It is argued that patch-test positivity is purely coincidental to the dermatoses and that patch testing has little role to play where the majority of occupational dermatoses are irritant in nature. Reform of the system of compensation for occupational skin disorders is urgently needed and should be integrated in workplace-based preventive and curative programmes.

Dermatitis, Contact↗
PubMed1992

Dermatoses in the canning industry--the roles of glove use and non-occupational exposures.

Primary prevention is the mainstay of management of occupational dermatoses. Despite the high rates of dermatoses found in a study of 686 female workers in a canning factory in March 1990, use of protective gloves was extremely low, even though there was evidence that they prevented acute paronychia and intertrigo. Reasons associated with low glove use were unavailability, discomfort and workers' failure to perceive a protective role for gloves. Difficulties with replacement of damaged gloves were an important cause of unavailability. Domestic and other non-occupational exposure at the workplace appeared to be unimportant in the development of dermatoses. Important preventive interventions are possible in the industry to reduce the rates of dermatoses among the workforce.

Adolescent↗
PubMed1992

Morbidity among bathers exposed to polluted seawater. A prospective epidemiological study.

As the first phase of a major programme to develop epidemiologically derived recreational water quality criteria for South Africa, a preliminary epidemiological-microbiological study was conducted in Cape Town during February and March 1990. Serial trials were carried out at a clean and at a relatively polluted beach over weekends. Participants were recruited at the beach, at which time information on swimming status and sociodemography was obtained. This provided for a beach-going but non-swimming control group. Symptoms which developed subsequent to the beach visit were obtained by follow-up telephone interviews conducted 3-4 days later. Water samples collected on trial days both before and during maximum swimming activity, were analysed for enterococci, faecal coliforms, staphylococci, coliphages and F-male-specific bacteriophages. Significant differences in the indicator levels at the beaches were observed. An excess in gastro-intestinal, respiratory and skin symptoms were found among swimmers relative to non-swimmers at the polluted beach. Although not statistically significant, the results are suggestive of a relationship between swimming-associated illness and water quality. The study demonstrated the feasibility of the methodology and the results of the overall programme will form the basis for the development of epidemiologically derived recreational water quality criteria for South African beaches.

Bathing Beaches↗
PubMed1992

Mortality from external causes in South African adolescents, 1984-1986.

The external causes of death in South African adolescents are described. Nationally registered mortality data for 1984-1986 were used to calculate proportional mortality. Mortality rates were also calculated, except in the case of black deaths, since these deaths are known to be under-registered and the estimated population figures are known to be inaccurate. Of the 16,348 adolescent deaths registered in 1984-1986, external causes accounted for 56.8% and symptoms, signs and ill-defined conditions for 10.0%. A greater proportion of girls died from symptoms, signs and ill-defined conditions whereas a greater proportion of boys died from external causes. A larger proportion of black adolescent deaths were categorised as symptoms, signs and ill-defined conditions. The risk of death by external cause for coloureds aged 15-19 years was 1.7 that of whites, while in the 10-14 year age group it was the same as that of whites. In the 15-19-year age group assault was the most common external cause of death in blacks and coloureds, compared with road accidents for whites. The highest number of deaths by external cause per day occurred over the Christmas period. The analysis indicated that mortality rates in South African adolescents are high and that many deaths may be the result of risk-taking behaviour. With the increasing urbanisation of blacks, the impact of external causes of death can be expected to increase further.

Accidents↗
PubMed1992

Risk factors and coronary heart disease in Durban blacks--the missing links.

Coronary heart disease (CHD) is still relatively uncommon in the black population of South Africa. We embarked on a study to determine the prevalence of risk factors leading to CHD in the black population of Durban. The study sample was selected from patients attending a dental clinic at a hospital. A total of 458 patients (age range 16-69 years) was studied. The prevalence of CHD was 2.4%. The percentage prevalences of selected risk factors were: hypertension (blood pressure > or = 140 mmHg systolic and/or > or = 90 mmHg diastolic) 28% (31.9% for males, 25.4% for females); protective levels of high-density lipoprotein/total cholesterol > or = 20%, 81.3%; diabetes mellitus 4.9% for males, 2.9% for females; smoking > or = 10 cigarettes per day 28.1% for males, 3.4% for females; obesity 3.7% for males 22.6% for females. We found the Minnesota Coding System for electrocardiographic changes of CHD and the Rose questionnaire to be unreliable for eliciting CHD in blacks. Hypercholesterolaemia is less common, and this may explain the low incidence of CHD in blacks. Epidemics of CHD as seen in Indian, coloured and white South Africans can still be prevented in the black population, but preventive measures must be instituted rapidly.

Adolescent↗
PubMed1991

A comparison of cross-sectional and longitudinal survey methods in measuring patient compliance with tuberculosis treatment.

A group of 179 tuberculosis patients, notified within a specific time period in an area served by a community-based TB clinic in Cape Town, was defined. Cross-sectional and longitudinal measurements of compliance were taken to test the validity of the two research methods in compliance surveillance. The cross-sectional method was found to mask significantly the true extent of non-compliance with tuberculosis treatment (19.5% v. a true 40.3%). The sampling and measurement biases inherent in the cross-sectional design were illustrated. The first bias was introduced because the cross-sectional survey captured only treatment survivors. By the date of the cross-sectional survey 45 patients were no longer on the clinic treatment list, between 4 and 13 (2.2 - 7.3% of the original group) having been lost as a result of poor compliance. The second and most extensive bias was introduced because the cross-sectional survey measured the compliance of all patients on a particular day irrespective of the time since notification. Thus for the cross-sectional group the compliant proportion was 80.5% at the time of the cross-sectional survey but fell to 65.4% by the end of treatment (as measured in the longitudinal survey). The absolute significance of the association between compliance and various demographic and treatment variables did not change with survey method. However, in two instances the association approached significance in only one of the two surveys. The study implies that serious clinical repercussions are possible if management decisions are based on the results of inappropriately designed studies. The place of the longitudinal and cross-sectional research methods in compliance surveillance is discussed.

Adult↗
PubMed1990

Knowledge, attitudes and beliefs about AIDS in township school students in Cape Town.

Students (N = 377) from four Cape Town township high schools were surveyed to obtain information on their knowledge of and attitudes towards the acquired immunodeficiency syndrome (AIDS), and on their sexual behaviour. The study was undertaken to provide information for planning an AIDS education intervention. Three-quarters of students reported that they had had sexual intercourse. Most students had heard of AIDS, and the majority of these knew that it was infectious. More than half of the students were confused or lacked knowledge about the modes of transmission. Two-thirds of the students believed AIDS could be prevented, but knowledge of prevention strategies was superficial. Of the sexually active students only 11.4% had ever used a condom, and of all students 39.6% stated that they would use a condom in the future. Two-thirds of the students were not aware that there is no cure for AIDS. Students did not acknowledge that AIDS could affect them directly, and attributed the problem to prostitutes and 'promiscuous' people in 36.4% of responses, and to 'white' people in 23.8% of responses. Students expressed intolerance, fear and rejection of people with AIDS, and only 6.4% would accept an affected person into their class. Almost all the students wanted AIDS education at school, and most of these requested that the school nurse facilitate this education. It is concluded that appropriate AIDS prevention education is urgently required for both high school and junior school students.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Risk factors for coronary heart disease in the Indians of Durban.

Coronary heart disease (CHD) is a major problem in migrant Indians throughout the world. In South Africa it has reached 'epidemic' proportions. A field survey was conducted among Indians in the metropolitan area of Durban to determine the prevalence and known risk factors for CHD. In a study of 778 subjects aged 15-69 years (408 men), 15.3% (sex and age adjusted 13.4%) had a history of CHD. The important risk factors in men were hypercholesterolaemia, hypertriglyceridaemia, diabetes, and smoking, and in women diabetes, hypercholesterolaemia, and hypertriglyceridaemia. The minor risk factors were hyperuricaemia, sedentary occupation, obesity in women and a positive family history of CHD. A study of the major risk factors leading to CHD showed that 52% (sex and age adjusted 45.5%) had at least one major risk factor at the higher (level A) and 68% (sex and age adjusted 61.9%) at the lower (level B) risk levels. Diabetes mellitus was strongly associated with a positive history of CHD. In 47.6% (sex and age adjusted 48.2%) of the total group resting ECG abnormalities were found that could be coded. Because of the severe nature of CHD in the migrant Indian, an immediate and intensive programme of primary prevention of CHD risk factors should be instituted.

Adolescent↗
PubMed1990

Trends in childhood injury mortality in three South African population groups, 1968-1985.

Trends in major causes of injury mortality and the proportion of total deaths attributable to injuries from 1968 to 1985 for white, coloured and Asian children less than 15 years in the RSA were examined. There were 937 injury deaths in 1968 and 853 in 1985 but no clear trends in overall mortality rates were observed. There were, however, marked fluctuations in injury mortality rates from year to year with peaks in 1975 and 1981/1982. The impact of injury as a cause of death has increased relative to a decrease in other diseases, notably gastro-enteritis and malnutrition in children less than 5 years. Patterns varied considerably between age, sex and population groups. Overall, road and burn death rates decreased while drowning and assault rates increased. Reasons for observed trends are discussed and the need for the collection of reliable national data for the total population is highlighted.

Accidents, Traffic↗
PubMed1990

Injury-related mortality in South African children, 1981-1985.

Data on all registered deaths in children less than 15 years in the RSA (excluding Transkei, Bophuthatswana, Venda and Ciskei) were analysed for 1981-1985. Variations in age, sex and population group pattern for different causes of injury were evaluated. Injury accounted for 8% of deaths in children less than 15 years and was the leading cause of death between the ages of 5 years and 14 years (accounting for 43% of deaths). Motor vehicle accidents were the most important cause of injury deaths in all age groups except less than 1 year, when accidental choking and suffocation resulted in more deaths. Drowning accounted for 19% of injury deaths and burns for 11%. In 14% of injury deaths it was not determined if the injury was accidental or purposefully inflicted. In all age and population groups deaths among boys outnumbered girls. The impact and pattern of injury varied considerably between age and population groups and reasons for these findings are discussed.

Accidents, Traffic↗
PubMed1990

The relationship between dietary factors and serum cholesterol values in the coloured population of the Cape Peninsula.

A cross-sectional study of 976 coloured subjects aged 15-64 years identified a population consuming a typical Western diet. Nutrient intake, determined by the 24-hour dietary recall method, reflected a diet high in fat (37% of total energy intake) and animal protein and a polyunsaturated/saturated fatty acid ratio of 0.85. Only 32.2% of men and 27.5% of women consumed a prudent diet (Keys score less than or equal to 28). The influence of this Western diet on serum total cholesterol (TC) levels was seen to be marked when participants with a high risk of developing coronary heart disease (CHD) were compared with those with a TC level putting them at low risk; the former consumed significantly more saturated fat and had a higher mean Keys score. Multiple linear regression analysis on TC levels of men identified six variables that explained 26.9% of the variation of TC. These were body mass index, age, the inverse of the polyunsaturated fat intake, saturated fat intake, polyunsaturated/saturated fat ratio and cholesterol intake. For women only three variables (age, the inverse of the polyunsaturated/saturated fat ratio, and body mass index) explained 30.2% of the variation of TC. Promotion of the prudent diet to lower TC levels of the coloured population of the Cape Peninsula is an increasingly urgent priority.

Adolescent↗