Biomedical subjects

I Stander

Publications and source records attributed to I Stander.

At least 19 recordsLinked to original sources

PubMed2003

Bone mineral density and lifetime physical activity in South African women.

We investigated the relation between lifetime physical activity and bone mineral density (BMD) in South African women using data collected in a case-control study of breast cancer in relation to BMD. Subjects (n = 144) were of black African or mixed ancestral origin, and <60 years of age (mean age 42.6 +/- 8.9 years). Cases had newly diagnosed breast cancer (n = 62) and controls were referred for conditions unrelated to BMD or breast cancer (n = 82). Physical activity data consisting of household, occupational and leisure-time activity, and activity for transport, were collected via questionnaire at 4 life stages (epochs), viz. 14-21, 22-34, 35-50, and 50+ years of age. Total energy (MET hrs) and peak strain scores were calculated. Lumbar spine and total proximal femur BMD were measured using dual-energy x-ray absorptiometry. BMD measures were similar between groups, therefore data were combined. BMD measures were unrelated to total lifetime physical activity. However, the major determinants of total proximal femur BMD included age, transport activity including walking and bicycling between the ages of 14 and 21 years, and current weight (adjusted r2 = 0.33, P < 0.0001). The major determinants of lumbar spine BMD included age, household energy expenditure between the ages of 14 and 21 years, and current weight (adjusted r2 = 0.23, P < 0.0001). Total peak bone strain score for activities between 14-21 years of age was also significantly correlated with lumbar spine BMD ( r = 0.18, P < 0.05). Intraclass correlation coefficients to assess tracking of activity through epochs 1, 2, and 3 were high for total energy expenditure (0.96; 95%CI: 0.94-0.97), household (0.98; 95%CI: 0.97-0.99) and occupational activity (0.78; 95%CI: 0.71-0.84) and activity for transport (0.92; 95%CI: 0.89-0.94). These data suggest that walking or activities resulting in impact loading at a young age are associated with higher BMD in later years. In addition, our findings suggest tracking of physical activity over time.

Absorptiometry, Photon↗

PubMed2003

Limited Pap screening associated with reduced risk of cervical cancer in South Africa.

BACKGROUND: We investigated the effect of Pap smear screening on the incidence of invasive cancer of the cervix in the Western Cape, South Africa where screening is limited. METHODS: Data were derived from a case-control study of the association of hormonal contraceptives and invasive cervical cancer. Incident cases (n = 524) of invasive cervical cancer who presented at two tertiary hospitals and controls (n = 1540) series matched for age, race, and place of residence were interviewed. Information on a wide range of variables was collected including whether the women had previously had a Pap smear taken and the number and timing of smears. Odds ratios (OR) and 95% CI were calculated using multiple logistic regression. RESULTS: The OR of cervical cancer was reduced among women who had ever had a smear (OR = 0.3, 95% CI: 0.3-0.4). The OR declined with increasing number of smears to 0.2 for >/=>3 smears (trend P = 0.0003). Among women who had a smear <5 years previously the OR was 0.3, but even if the smear was taken >/=15 years previously the women remained at reduced risk (OR = 0.5). CONCLUSION: The data suggest that even limited Pap smear screening reduces the risk of cervical cancer. Should a screening programme be successfully implemented, the incidence of cervical cancer might be reduced by as much as 70%.

Adult↗

PubMed2001

The accuracy of self-reported weight by overweight and obese women in an outpatient setting.

OBJECTIVE: To investigate the accuracy of self-reported weight of overweight and obese women and characterisation of under-, correct- and over-reporters based on a number of related variables. DESIGN: Weight was self-reported before entering the study. At baseline, actual weight was recorded, and demographic, health, nutritional, psychological and physical activity questionnaires were completed. SETTING: A hospital outpatient department. SUBJECTS: Participants were 131 women aged 18-64 years with a body mass index attending a Comprehensive Weight Management Programme. OUTCOME MEASURES: The accuracy of self-reported weight was investigated for the total group, and the subjects were then categorised into three groups according to accuracy of self-reported weight (under-, correct- and over-reporters). The relationship between these accuracy groups and demographic, health, nutritional, and psychological variables and physical activity was examined, to characterise the under-, correct- and over-reporters. RESULTS: Although not statistically significantly different, the total group of women tended to underestimate their weight by 0.8 (+/-3.6) kg. Categorisation according to the accuracy groups revealed that 29% underestimated their weight by 2 kg or more, 19% overestimated their weight by 2 kg or more, and only 52% correctly estimated their weight within 2 kg. Some trends and statistically significant differences between the accuracy groups concerning certain variables, e.g. height, age, income, education, contraceptive pill usage, smoking and food choices were evident. CONCLUSIONS: Self-reported weight of a group of overweight/obese individuals may be a valid and reliable indicator of actual weight, but self-reported weight of an overweight/obese individual can not be interpreted similarly. Further research is necessary to ensure reliable characterisation of under-, over- and correct reporters.

Adolescent↗

PubMed2001

Perceptions of fluorosis in northern Cape communities.

The objective of the study was to determine the perception of fluorosis in communities living in the Northern Cape Province of South Africa where there is a considerable range in fluoride levels of drinking water. The fluoride levels of the drinking water were categorised as suboptimal (0.40-0.60 ppmF), optimal (0.99-1.10 ppmF) or supra-optimal (1.70-2.70 ppmF). The teeth of 694 children aged 6, 12 and 15 years were examined. Dental fluorosis occurred among children of all ages in all areas studied. As anticipated there appears to be a direct relationship between fluoride levels in the drinking water and levels of dental fluorosis, and the severity of the condition increased with an increase in levels of fluoride in the water supplies. Children in low fluoride areas showed some form of mild fluorosis (37% very mild and 17% mild). However, 19% of this group experienced moderate or severe forms of fluorosis. In areas with optimal levels of fluoride 30% of children showed a questionable form of fluorosis and 21% mild fluorosis. Moderate or severe forms of fluorosis were recorded in 31% of children in the optimal fluoride area. The Community Fluorosis Index (CFI) scores for the sub-optimal and optimal areas were of medium public health significance and for the supra-optimal area of very high public health significance. Of concern is the high percentage of children (45%) in the supra-optimal area with severe forms of fluorosis. The awareness and concern for stains on teeth were mostly expressed by children with moderate or severe fluorosis. This study suggests that the proposed fluoride concentration (not more than 0.7 ppmF) prescribed in the Regulations on Fluoridating the Water Supplies for South Africa would minimise the risk of dental fluorosis.

Adolescent↗

PubMed2001

The dental health of 12-year-old children whose diets include canned fruit from local factories: an added risk for caries?

OBJECTIVE: To determine the dental health of 12-year-old children from households that are supplied with sweetened canned fruit from local factories. METHODS: The DMFS and DMFT indices were determined for 12-year-old pupils from 6 schools, 3 of which are situated in communities with fruit canning factories. Subjects were questioned about the workplace of household members and supplies of sweetened canned fruit from factories. To compare indices we used a two-way analysis of variance, for multiple comparisons the Bonferroni Test and for proportions the Chi-Squared Test. Fluoride content of the drinking water was measured for each school. RESULTS: The fluoride content for all schools was less than 0.1 ppm. In only 2 schools were the majority of pupils from households that were supplied regularly with canned fruit from factories. An analysis of the DMFT data of the children in all the schools showed that there were significantly fewer children with a DMFT = 0 and significantly more with a DMFT = 4+ in the 2 schools. The mean DMFS and DMFT of children in households supplied with canned fruit were significantly higher than those children without the supply. CONCLUSION: The supply of sweetened canned fruit to households may be an added risk to dental health for the children in that household.

Analysis of Variance↗

PubMed2000

[What do dental students at the University of Stellenbosch know of the education and functions of oral hygienists?].

The purpose of this study was to determine the knowledge of dental students regarding the requirements for the course in oral hygiene at the University of Stellenbosch, the functions of oral hygienists and how they rate the necessity of the profession compared with other health care providers. Students in their second, third, fourth and fifth years of study were asked to complete a questionnaire. Although obvious gaps existed in the knowledge of a notable number of students, the majority of students in all the years showed good insight into the requirements for and contents of the course and functions of an oral hygienist. The number of second- and third-year students who gave the correct answers were consistently fewer than the senior students, indicating that when dental students come into contact with oral hygiene students in their clinical years their knowledge of the course and the profession improves. The void in the knowledge of dental students which most certainly needs correction is the limited concept some of them have about the training oral hygienists receive in periodontics (especially the preclinical students), orthodontics, medicines, legal aspects concerning dentistry, first aid and diagnostic radiology. Regarding the functions of oral hygienists, their importance was regarded by many students as comparable with that of occupational therapists, radiographers, nurses, dieticians and dental therapists, notably higher than that of dental assistants and slightly less important than that of physio-therapists.

Attitude↗

PubMed1999

Ambulance visits for severe hypoglycaemia in insulin-treated diabetes.

AIM: To determine, in insulin-treated diabetes the incidence and risk factors for severe hypoglycaemia requiring ambulance visits. METHODS: A cross-sectional, questionnaire survey was made of patients with type 1 diabetes, who received help for severe hypoglycaemia from Ambulance Association personnel, during the period 1/6/95 to 31/5/96. RESULTS: The ambulance service made 386 emergency visits to 247 persons with type 1 diabetes. Of these, 128 respondents (52%) completed a questionnaire detailing personal and diabetes history, usual diabetes care practices and hypoglycaemia management. Two or more visits for severe hypoglycaemia were made to 26.3% of patients, who reported a longer duration of diabetes than those who required only one visit (28 vs 20 years, p<0.03). Self-blood-glucose monitoring was performed by 98.4% of respondents and 66.4% self-adjusted insulin doses. Intensively treated patients (> or = 3 insulin injections daily) reported less awareness of hypoglycaemia than standard therapy patients (< or = 2 insulin injections daily) (p<0.05). Fifty-four per cent of respondents had glucagon available for emergency use, but those who lived alone and in general practitioner care only (27%) were less likely to have glucagon (p<0.05) compared to those with companions and in shared-care arrangements (62%). Hypoglycaemia management was influenced by the availability of glucagon. Oral glucose was used by 82% before injecting glucagon, whereas 40% of patients without glucagon called for the ambulance when severe symptoms were present even before initiating treatment with oral glucose. CONCLUSION: This survey determined the minimum frequency of severe hypoglycaemia requiring the ambulance at 1.6 episodes patient(-1) year(-1). Precipitating factors and a lack of coping skills and behaviours that might prevent severe hypoglycaemia and ambulance calls were identified.

Aged↗

PubMed1999

Treatment status and experiences of hypertension patients at a large health center in Cape Town.

OBJECTIVE: This study was undertaken at a community health center (CHC) in the Cape Peninsula in order to assess the treatment status, knowledge and experiences of hypertensive patients. In addition, a health indicator sheet for hypertension was evaluated and an attempt was made to identify predictors of blood pressure (BP) control at this clinic. METHODS: Two hundred two hypertensive patients were selected by interviewing the first available hypertensive patients. The patients' BP was measured electronically and by sphygmomanometer, and was compared to that recorded by the clinician on their clinic folders; heights and weights were also determined. RESULTS: Of the hypertensives, 41.6% had a BP above 160/95 mm Hg and only 42.1% had a BP below 140/90 mm Hg. Patients had little knowledge of either the consequences of hypertension or the actions needed to ensure that complications were prevented; 31% suggested home remedies for hypertension. The majority of the patients were satisfied with the service they received, but 47% complained about long waiting times, 37% felt that the doctor did not examine them adequately, and 15.5% reported that insufficient medication was provided when filling prescriptions. Urine and eye tests had been conducted infrequently during the previous two years. Thirty percent of the patients requested the return of the dedicated hypertension clubs. Conditional logistic regression models identified that patients who expressed the need to make proposals to the clinic staff about their care had better BP control than those who did not. CONCLUSIONS: The BP of hypertensive patients is not optimally controlled at this CHC and both non-drug and drug management of hypertension need to be improved. Steps should be taken to help hypertensive patients become more knowledgeable so that they may play more active and compliant roles in their hypertension care. Patients also suggested that dedicated hypertension clubs be reinstituted at the CHCs.

Aged↗

PubMed1998

South African oral hygienists: their profile and perception of their profession and career.

The aim of the study was to determine a profile of the oral hygienists in South Africa, their views on the profession, work-place, and the practice of their career, which aspects of the work they enjoy and which are not enjoyable, their opinions on expanding duties for hygienists and which duties should be included, and their perceptions about the status and importance of oral hygienists vis-à-vis other health providers. A questionnaire was sent to every third registered oral hygienist and 47 per cent responded. The majority who responded were in the age group 20 to 39 years, had been in practice for less than 15 years, were married, qualified at the Universities of Pretoria and Stellenbosch, and were employed in traditional practice. The larger proportion worked individually and practised from six to eight hours per day. They were happy with the training they received, believed their job was worthwhile, were satisfied with their careers and enjoyed a cordial relationship with dentists. Motivating, educating, assisting patients and communicating with people were the most enjoyable aspects of practice while procedures associated with the treatment of gingivitis and periodontitis and the poor response of patients to treatment were the least enjoyable. The majority preferred expanded duties for hygienists which should include elementary dentistry, local anaesthesia, minor extractions and emergency treatment and they also desired greater independence. Seventy-eight per cent felt that the public does not know what oral hygiene is. The status and importance of the profession were rated comparable to that of physiotherapists, qualified nurses, radiographers and dental therapists but significantly higher than dental assistants.

Adult↗

PubMed1997

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.

Adult↗

PubMed1996

Dimensional differences in the craniofacial morphologies of groups with deep and shallow mandibular antegonial notching.

Certain craniofacial characteristics were identified on the lateral cephalograms of 40 untreated subjects with shallow mandibular antegonial notches and 40 subjects with deep notches. Subjects with shallow notches demonstrated more on the morphological characteristics usually associated with horizontal mandibular growth patterns than did subjects with deep notches, and their mandibles were positioned more protrusively. In general, the mandibles of the shallow notch subjects proved to be longer than mandibles of the deep notch subjects. On average, mandibles with deep notches showed greater gonial angles, deeper posterior ramus notch depths, and larger occlusal plane inclinations. The total anterior facial height of shallow notch subjects was much smaller than that of the deep notch subjects. The maxillae in deep notch subjects were more retrusive in relation to the cranial base when compared with the shallow notch subjects. A discriminant analysis was used to determine which combinations of variables were most consistently related to either deep or shallow mandibular antegonial notches. Eighty percent (80%) of the cases were classified correctly as deep or shallow notch cases by means of this discriminant function.

Adolescent↗

PubMed1996

An evaluation of the effect of oral ketamine and standard oral premedication in the sedation of paediatric dental patients.

We compared the effectiveness of ketamine with standard oral premedication (SOP) in 60 children, 2-7 years of age, sedated orally for dental treatment under local anaesthesia. Children were assigned randomly to receive either 12.5 mg/kg ketamine or 0.5 ml/kg of SOP orally 60 min before the dental procedure. Pulse rate, systolic, diastolic and mean arterial pressures, respiratory rates and blood oxygen saturation were recorded prior to drug administration, 60 min thereafter and immediately before the dental procedure. Anxiety levels were measured at the same time intervals. The level of sedation was measured 60 min after drug administration. No significant differences were found in the anxiety levels between the groups 60 min after oral administration. The level of sedation in both groups before surgery was excellent. Operator evaluation for overall effectiveness of treatment showed that sedation was very good in 60 per cent of children in the ketamine group compared with 20 per cent in the SOP group. More children in the ketamine group were better sedated (p < 0.05). Both premedicants produce good sedation and anxiolysis 60 min after premedication and immediately before the surgical procedure.

Administration, Oral↗

PubMed1994

Alkali-soluble and insoluble fluoride in erupted and unerupted human enamel from a high fluoride area with a low fluorosis score.

The amounts of fluoroapatite and 'CaF2-like' fluoride (F) were determined in enamel of unerupted and erupted teeth that had been exposed in vivo to 1.8-2.6 parts/10(6) F in the drinking water and to brushing with F dentifrice at least once a day, and occasionally to a F mouth-rinse (0.022% F). Enamel was sampled by acid-etching and the F levels were measured with an adapted F ion-selective electrode. More F was built into the deeper enamel in the high-F area than in a similar low-F area. Unerupted enamel did not etch significantly (p > 0.05) deeper than erupted enamel. No significant differences (p > 0.05) were found in the F concentrations amongst the following: alkali-washed erupted, unwashed erupted, alkali-washed unerupted and unwashed unerupted at the outer most enamel (approx. 6 microns). However the erupted enamel (alkali-washed or not) showed higher F levels than unerupted enamel (alkali-washed or not) between approx. 6 microns and greater than 100 microns. The increase of F for this high-F area was about 100% in the deeper enamel while for a low-F area it was approx. 78% in the most outer enamel with no increase after a depth of about 20 microns. In contrast to a similar low-F area (water F < 0.10 parts/10(6)), no significant 'CaF2-like' F could be detected in erupted or unerupted enamel for the high-F area.

Dental Enamel↗

PubMed1994

Profile enhancement and cephalometric landmark identification.

The reproducibility of two soft tissue landmarks (SN, V) and two anterior bony landmarks (A, ANS) was determined by three observers for three cephalometric techniques. The three techniques were aimed at soft tissue profile enhancement either by standard exposure control (technique 1), a hand-held metal shield covering the profile (technique 2), or a brass wedge in the collimator (technique 3). For each technique, the sample was restricted to 20 subjects with a skeletal convexity greater than +4 mm. The four landmarks were identified three times with 7-day intervals between readings. The figure-of-merit (or mean radius) method was used to assess the probability of "hitting" a target (landmark) area. The mean radius from the sample mean point of impact (MPI) ranged from 0.585 mm to 1.758 mm. For a specific landmark, the difference was never greater than 0.5 mm when grouped by observer and technique. No technique excelled in overall consistency for the identification of anterior bony and soft tissue landmarks. Techniques 1 and 3 produced the most consistent identification of points ANS and SN, but with no significant difference between the two techniques. Interacting factors prevented any recommendation regarding a preferential technique for the identification of points A and V. There is statistically no reason to recommend the use of a handheld, metal profile shield for more consistent landmark identification.

Analysis of Variance↗

PubMed1993

The areca nut chewing habit and oral squamous cell carcinoma in South African Indians. A retrospective study.

A retrospective study (1983-1989) of oral squamous carcinomas and concomitant oral habits was undertaken in South African Indians from Natal. Information came from hospital records and interviews with patients, families and friends. There were 143 oral squamous carcinomas; these occurred in a ratio of 1:1,6 for men and women respectively. Squamous carcinomas of the cheek (buccal mucosa, alveolar sulcus and gingiva) occurred most frequently, especially in women (57/89--64%), while in men tongue cancer predominated (22/54--41%). Ninety-three per cent of women (83/87) and 17% of men (9/54) habitually chewed the areca nut. Thirty-nine of 57 women (68%) with cheek cancer and 21/25 (84%) with tongue cancer only chewed the nut (no tobacco, snuff or smoking). Analyses confirmed an association between nut chewing and cheek cancer. The odds ratio (OR) for oral cancer in women 25 years and older who only chewed the nut was 43,9 and the attributable risk (AR) 0,89 (89%). With tobacco the OR increases to 47,42 and the AR to 0,91 (91%). The data showed that the areca nut habit with or without tobacco use is important in the development of oral squamous carcinoma. Elimination of this habit can reduce the risk in these women substantially (89-91%) if all other factors remain the same.

Adolescent↗

PubMed1992

Simvastatin in non-insulin-dependent diabetic patients with hypercholesterolaemia.

The objective of this study was to evaluate the lipid-lowering effect of simvastatin in non-insulin-dependent diabetes mellitus (NIDDM) patients with hypercholesterolaemia while possible clinical and biochemical adverse effects were monitored for. Forty-three NIDDM patients with hypercholesterolaemia (total cholesterol > 6.5 mmol/l) used simvastatin after a detailed clinical laboratory evaluation as well as a 4-week wash-out period and a 4-week placebo baseline period. Simvastatin treatment was initiated with a 10 mg dose for 6 weeks; this was increased to 20 mg and 40 mg at 12 and 18 weeks of follow-up respectively if the total cholesterol level had not decreased to below 5.17 mmol/l. Patients were placed on a lipid-lowering diet and continued to take any regular non-lipid-lowering medication throughout the trial; side-effects were monitored at 6-week intervals until patients had taken simvastatin for 24 weeks. The mean total cholesterol level was reduced by 22.2% at the first follow-up visit, and by 24.2%, 23.3%, and 28.5% at the second, third and fourth follow-up visits respectively compared with base-line levels. A dose of 10 mg simvastatin brought about a reduction in total cholesterol similar to those found with higher doses. The mean triglyceride level was reduced by 20.9% with 20 mg simvastatin. The high-density lipoprotein cholesterol level was not altered significantly and neither was the control of diabetes.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1991

A 6-month trial of simvastatin (HMG-CoA reductase inhibitor) in the treatment of hypercholesterolaemia.

The aim of this study was to evaluate the long-term efficacy and tolerability of the 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitor simvastatin, over a 24-week period. Patients (108) with primary hypercholesterolaemia were clinically, haematologically and biochemically evaluated and established on a cholesterol-lowering diet. After a wash-out period free from other lipid-lowering drugs and a baseline period on placebo of 1 month each, 10 mg simvastatin was introduced at night. The dose was increased to 20 mg and 40 mg at 6 and 12 weeks' follow-up respectively if the total cholesterol (TC) level was still above 5.17 mmol/l. Follow-up took place every 6 weeks and included lipid, haematological, biochemical and clinical evaluation. A full ophthalmological evaluation was conducted at baseline and at 24 weeks' follow-up. Overall the TC level was reduced below the baseline level by 34.3% at week 18 of follow-up and 32.5% at week 24. Patients with higher initial TC levels showed greater TC lowering in response to simvastatin than did those with lower initial TC levels. A group of 45 patients was followed up for an additional 12 weeks after the end of the trial and maintained TC reductions similar to those at the end of the trial. Fourteen patients experienced adverse effects which were thought to be drug-related. One patient was withdrawn from the trial after developing conjunctivitis that proved to be related to the use of simvastatin.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1991

Toothbrushing with the root of Euclea natalensis.

The custom of cleaning teeth and the gums with a chewed root of the tree Euclea natalensis, in the belief that it benefits oral health, is practised in South Africa by married women of an African Zanzibari community. The root of E. natalensis contains naphthoquinones which are bactericidal and, as they are also pigments, the mouths of the root users are stained bright orange. Samples of fresh root were tested against Streptococcus mutans and organisms in saliva and from deep periodontal pockets. Aerobic as well as anaerobic bacterial growth was suppressed in all instances. In addition we compared the plaque index (Silness et Löe), the periodontal index (CPITN), the DMFT and the state of the oral mucosa of root users and non-users. No significant differences were recorded in any of the variables. Although the beneficial effects claimed for this custom may have scientific validity, it is concluded that the daily practice is too limited to have a demonstrable beneficial effect.

Adult↗