Infant mortality in South Africa.
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Biomedical subjects
Publications and source records attributed to J C Davies.
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The effects of exercise training on riboflavin requirements and of riboflavin intake on endurance were examined in 14 women, 50-67 y of age, who participated in a 10-wk, two-period crossover exercise study at two riboflavin intakes, 0.15 micrograms/kJ (0.6 micrograms/kcal) and 0.22 micrograms/kJ (0.9 micrograms/kcal). Subjects exercised 20-25 min/d, 6 d/wk, for 4-wk periods on a cycle ergometer at 75-85% of their maximal heart rate. Riboflavin status was assessed by measuring the erythrocyte glutathione reductase activity coefficient (EGRAC) and urinary riboflavin excretion. Physical performance was evaluated by using a walking treadmill test to determine maximal oxygen capacity (VO2max) and anaerobic threshold by gas exchange (ATGE). Exercise significantly affected riboflavin status as EGRAC increased (P less than 0.001) and riboflavin excretion decreased (P less than 0.01) in both groups. VO2max increased significantly with exercise (P less than 0.01). However, changes in VO2max (L/min) and ATGE with exercise training were not different in the two groups. Riboflavin requirements of older women increased with exercise training, but increased riboflavin intake did not enhance improvements in endurance.
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A study was undertaken to determine if there were detectable effects on the respiratory health status of children resident in the eastern Transvaal highveld as a consequence of their exposure to community air pollution, comparing them with children in areas ostensibly less polluted. A prevalence study was conducted in white schoolchildren from 11 schools in the eastern Transvaal highveld (1,031 children) and from 11 schools in non-polluted towns in the Transvaal (978 children). A questionnaire was completed by each child's mother, and height and weight were measured and spirometry recorded on a vitalograph. Cough, wheeze, asthma and chest illnesses were more frequently reported from polluted areas compared with non-polluted areas, taking into account parental smoking and home cooking fuel (odds ratios 1.34, 1.20, 1.15 and 1.88, respectively). After correcting for age, children in the polluted area were 0.83 cm shorter (P = 0.035). However, there were no significant differences in forced vital capacity and forced expiratory volume in 1 second after standardising for height, age, parental smoking and home cooking fuel. We conclude that, in children, exposure to pollution in the eastern Transvaal highveld may cause respiratory symptoms and chest illness and may affect height but does not measurably affect lung function, as assessed by spirometry.
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It is frequently stated that the most common primary lung cancer cell type in asbestos-exposed persons is adenocarcinoma. Recently a contrary opinion has been expressed. This study compares the cell types recorded among deceased South African miners whose lungs were examined at the National Centre for Occupational Health. It supports the opinion that adenocarcinoma is not associated with asbestos exposure. From the large database available, there is no evidence of a consistent association between any particular cell type and specific mining exposure.
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In this, the first of a three-part series of articles in which we propose steps towards a comprehensive strategy for the control of HIV infection, we consider briefly the world-wide experience with the HIV epidemic. Our objective is to highlight the problems and controversial issues which are pertinent to strategies for the control of HIV infection. We focus on problems of case-definition, differences between 'African' and 'Western' AIDS and the implications for South Africa, and problems with sensitivity and specificity of tests used at present, particularly in the context of false positivity in a community with a low prevalence of HIV infection. We consider some of the ethical issues, including the need for adequate counselling, the need for informed consent before testing, and the centrality of confidentiality, particularly in the context of possible victimisation and neglect of HIV-positive individuals. Differences between 'notification' and 'reporting' are emphasised. Recommendations are made regarding these problems.
In this, the second of a three-part series of articles in which we propose steps towards a comprehensive strategy for the control of HIV infection, we consider controversies relating to screening for HIV, the indications for and desirability of mandatory testing of certain groups at risk, and the place of voluntary testing in the control of HIV transmission and infection. Key recommendations are that mandatory testing of donors of blood and other vital tissues, patients on haemodialysis and haemodialysis unit staff is justified, and that children put up for adoption may require testing. We make further recommendations regarding HIV testing as a prerequisite for life insurance and recommend that voluntary testing be offered, supported by adequate pre- and post-test counselling. We consider that all health care workers should accept as their moral obligation the care and management of HIV-infected individuals, and that they should be adequately educated and skilled in such work. These recommendations were reached largely by consensus, although there were occasions when individual authors condoned recommendations with which they did not personally agree.
In this, the third of a three-part series of articles in which we emphasise the urgent need for and propose steps towards a comprehensive strategy for the control of HIV infection, we highlight the fundamental importance of an education campaign and the three critical essentials for a successful campaign. The first concerns the responsibility of the State in administering the programme, in providing adequate funds on an on-going basis and in delegating responsibility for the day-to-day activities to the appropriate local authorities and non-governmental organisations. The second relates to the need to establish a multidisciplinary AIDS group representative of groups at risk and of relevant scientific expertise to ensure that appropriate policies are developed and that changes to policy are made in response to changing circumstances, based on sound epidemiological, managerial and educational principles. These must take particular account of circumstances peculiar to South Africa, such as the migrant labour system, which may promote both promiscuity and homosexuality. Thirdly, the need to ensure open, appropriate communication with the groups at risk and the public at large in the development, implementation and evaluation of the education campaign is emphasised. In this context we plead for more psychosocial research. These recommendations were reached largely by consensus, although there were occasions when individual authors condoned recommendations with which they did not personally agree.
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A pilot survey of the distribution and content of occupational health services in South African manufacturing industries was carried out in the Germiston area of the Witwatersrand using the records of the Workmens' Compensation Commissioner as a sampling frame. All establishments with 50 or more workers and a stratified random sample of smaller ones (495 in all) were contacted. The overall response rate was 56% and was positively related to work force size, the larger establishments showing higher response rates. The offering of health services, defined minimally as at least a part-time nurse or doctor employed on the premises, was reported in 11% of work places employing 52% of the work force and was also positively related to work force size. Seventeen percent of establishments had ever monitored environmental conditions, and all classes of industry in the study area fell short of government recommendations. The advantages of the study approach used here, based on a countrywide sampling frame and a mail questionnaire, include 1) the relatively modest cost; 2) the creation of an information framework to which can be added additional information obtained from other sources e.g., factory visits; and 3) the use of a database for sampling that is countrywide, regularly updated, and versatile, with the potential for extending the observations with a similar (geographic) or different focus, for instance, by industrial class or work force size.
A computerized system for recording the results of structured, numerically coded autopsy reports on various types of mine workers has been in operation at the National Centre for Occupational Health in Johannesburg since 1975. Historical developments, particularly those associated with compensation for occupational disease, have resulted in very high autopsy rates, especially among whites. Since its inception, the pathology automation (PATHAUT) system has accumulated the results of more than 33,000 autopsies. The data set is described in the hope of stimulating interest in the possible uses of the data and encouraging collaborative research. Some characteristics of the database with potential research implications are discussed. These include differing age and work patterns for blacks and whites and geographic factors with potential influence on whether a body or only the cardiorespiratory organs are sent for examination.
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