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Biomedical subjects

J Katzenellenbogen

Publications and source records attributed to J Katzenellenbogen.

At least 19 recordsLinked to original sources
PubMed2001

Hospital utilisation expectancies in New Zealand, 1980-98.

The need to synthesise mortality and morbidity information to achieve a more global and relevant measure of population health status is well recognised, with health expectancy indices being the most common approach used to date. Using New Zealand hospital discharge and mortality data over the 1980-98 period, we introduce readers to a newly developed health index, the Hospital Utilisation Expectancy (HUE). We describe how HUE changes with age and over time. New Zealand national and regional trends are described. The methodological strengths of the measure and its applications in the health sector are discussed.

Adolescent↗
PubMed2000

Risk of breast cancer in relation to the use of injectable progestogen contraceptives and combined estrogen/progestogen contraceptives.

Recent studies have suggested that progestogen-only contraceptives and combined estrogen/progestogen oral contraceptives (COCs) may increase the risk of breast cancer among women less than 35 years of age or among recent users. The authors conducted a case-control study, in which cases of breast cancer (n = 484) [corrected] and controls (n = 1,625) hospitalized for conditions unrelated to contraceptive use were interviewed from 1994 to 1997 in hospitals in greater Cape Town, South Africa. The women were aged 20-54 years, resided in a defined area around Cape Town, and were Black or of mixed racial descent. The relative risk for exposure to injectable progestogen contraceptives (IPCs), mostly depot medroxyprogesterone acetate, was 0.9 (95% confidence interval (CI) 0.7, 1.2). There were no consistent associations within categories of age or recency or duration of use. For exposure to COCs, the overall relative risk was 1.2 (95% CI 1.0, 1.5). Among women below age 35 years, the relative risk was 1.7 (95% CI 1.0, 3.0), and it was unrelated to the duration or recency of use. The findings suggest that IPCs do not increase the risk of breast cancer, and that COCs may increase the risk among women below age 35 years, although bias cannot be excluded.

Adult↗
PubMed1999

Blood pressure and social support observations from Mamre, South Africa, during social and political transition.

OBJECTIVE: Social support, by moderating cardiovascular reactivity, has been demonstrated to attenuate the effects of stress on blood pressure in American communities. This is the first report to examine the relationship between social support and blood pressure in a South African context, during a period of infrastructure modernisation and political change. METHODS: A total of 1240 residents (542 men, 698 women) of mixed ethnic origin, older than 14 years and stratified by age and sex, participated in a survey to determine risk factors for hypertension and cardiovascular diseases. Social support was assessed by a questionnaire developed in consultation with the community. It was defined by interactions that may threaten family harmony (score 1) and by networking between relatives, friends, colleagues and neighbours (score 2). RESULTS: Mean blood pressure of the sample was 130/79 mm Hg (s.d. 25/14 mm Hg). Hypertension prevalence was 26.9%. Only 36% of women compared to 57.3% of men (P < 0.0001) were employed. More women (29%) than men (22%) reported threats to family harmony, but social support networks were similarly perceived by both sexes. Systolic and diastolic blood pressure correlated weakly with score 1 (r = 0.096, P < 0.0007) but no association was observed with score 2. Score 1 was not associated with blood pressure by multiple regression analysis, that included confounding by age, sex, BMI, alcohol consumption and smoking status. CONCLUSIONS: Neither threats to family harmony nor networking between relatives, friends or neighbours, significantly influences blood pressure in this community. Measures of social support thought to moderate blood pressure may have limited cross-cultural application. Attitudinal changes during socio-political transition may impact on the generalisability of instruments for measurement.

Adolescent↗
PubMed1997

A case control study of breast cancer risk and exposure to injectable progestogen contraceptives. Methods and patterns of use among controls.

OBJECTIVE: To describe the patterns of use of injectable progestogen contraceptives (IPCs) among coloured and black women in the Western Cape. These data are part of an ongoing study in the Western Cape, the main aim of which is to explore the relationship between IPCs and breast cancer. DESIGN: A population-based case-control study of breast cancer risk in relation to the use of IPCs among coloured and black women. SETTING: The Western Cape, including the Cape metropole and surrounding rural areas. STUDY SUBJECTS: All coloured and black women with newly diagnosed breast cancer, resident in the study area and below age 55 years, who present at either of the two tertiary care hospitals in the Western Cape are recruited. Controls are a sample of hospitalised patients representative of the populations from which the patients are drawn. Cases are frequency-matched to controls according to cross-tabulation of age, ethnic group and residential area in a ratio of approximately 1:3. MEASUREMENTS: Questionnaires are administered by trained nurse interviewers, information is elicited on a wide range of variables, including sociodemographic variables, medical history, family history of breast disease, lifetime history of all methods of contraception and use of non-contraceptive female steroids, reproductive variables, cigarette smoking, alcohol consumption and other potentially confounding variables. RESULTS: Between January and December 1994, 122 incident cases and 389 controls were enrolled. Ever-use of IPCs among the controls was 72% (N = 280) and use for 5 years or more was 30% (N = 117). Use of IPCs in the distant past was common, with 61% (N = 232) of all controls having initiated use 10 or more years previously. Current use was also high (19%). Other contraceptive methods were used far less commonly. CONCLUSION: Coloured and black women in South Africa have been using and continue to use IPCs for more commonly and for longer periods than women anywhere else in the world. It is therefore especially important to evaluate the risk of breast cancer and other health effects of IPCs. The rates of use identified in this study ensure that there will be adequate statistical power to evaluate long-term use, use in the distant past and current use of IPCs.

Adult↗
PubMed1997

The epidemiology of incomplete abortion in South Africa. National Incomplete Abortion Reference Group.

OBJECTIVE: To describe the epidemiology of incomplete abortion (spontaneous miscarriage and illegally induced) in South Africa. DESIGN: Multicentre, prospective, descriptive study. SETTING: Fifty-six public hospitals in nine provinces (a stratified, random sample of all hospitals treating gynaecological emergencies). PATIENTS: All women of gestation under 22 weeks who presented with incomplete abortion during the 2-week study period. MAIN OUTCOME MEASURES: Incidence of, morbidity associated with and mortality from incomplete abortion. MAIN RESULTS: An estimated 44686 (95% CI 35633-53709) women per year were admitted to South Africa's public hospitals with incomplete abortion. An estimated 425 (95% CI 78-735) women die in public hospitals from complications of abortion. Fifteen per cent (95% CI 13-18) of patients have severe morbidity while a further 19% (95% CI 16-22) have moderate morbidity, as assessed by categories designed for the study which largely reflect infection. There were marked inter-provincial differences and inter-age group differences in trimester of presentation and proportion of patients with appreciable morbidity. CONCLUSIONS: Incomplete abortions and, in particular, unsafe abortions are an important cause of mortality and morbidity in South Africa. The methods used in this study underestimate the true incidence for reasons that are discussed. A high priority should be given to the prevention of unsafe abortion.

Abortion, Incomplete↗
PubMed1997

An analysis of the cost of incomplete abortion to the public health sector in South Africa--1994.

OBJECTIVE: To analyse the medical costs incurred in treating women for incomplete abortion. This study was performed in conjunction with a nationwide survey of women who presented to public hospitals with incomplete abortion in 1994. DESIGN: Cost analysis with two modified Delphi panels used to develop models of resource use reflecting three severity categories of symptoms and three hospital treatment settings. SETTING: Public hospitals in South Africa. PARTICIPANTS: A panel of 15 senior level obstetrician/ gynaecologists and a second panel of 11 patient care managers representing district, regional and tertiary level hospitals in 7 provinces. MAIN RESULTS: A conservative estimate of the total cost of treating women is R18.7 million +/- R3.5 million for 1994. An estimated R9.74 million +/- R1.3 million of this was spent treating women with 'unsafe' incomplete abortions. CONCLUSIONS: The management of incomplete abortion requires significant public sector expenditure. The long-term indirect costs to women, their families and communities are discussed and treatment costs estimated so that unmet needs for medical care resulting from unsafe abortions can be addressed.

Abortion, Incomplete↗
PubMed1997

Methodological issues in the South African incomplete abortion study.

In 1994, a national hospital-based study was undertaken of cases of incomplete abortion presenting to public hospitals in South Africa. Data were collected for all women admitted to a random sample of hospitals with incomplete abortion during a two-week period. The WHO protocol for such studies was used as a basis for developing the methods to describe the epidemiology of incomplete abortion and hospital management of cases. Attempts were made to estimate the proportion of cases that might have been induced. This report focuses on methodological issues arising from the study that have implications for future research. The findings demonstrate that only a small proportion of the women acknowledged having had an induced abortion and that only a few of those who did showed evidence of interference with pregnancy. Clinical opinion of sepsis and the likelihood of induction were found to be highly unreliable. These findings considerably reduce the usefulness of the WHO-protocol method of estimating the likely origin of incomplete abortions. Results presented in terms of three partially overlapping descriptive categories are judged to better reflect the limitations of the data collected.

Abortion, Incomplete↗
PubMed1996

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

Hypertension prevalence, treatment status and factors relating to high blood pressure were determined in an urban black community of the Cape Peninsula, South Africa. A study population of 986 subjects aged 15-64 years was randomly selected. Blood pressure, height, weight and serum cholesterol levels were measured, while demographic information, personal and family history relating to hypertension and attendance of health services were determined by questionnaire. Overall 9.2% of males and 12.9% of females were hypertensive according to WHO criteria. Blood pressures between 160/95 and 140/90 mmHg were found in 10% of males and 10.5% of females. The treatment status of hypertensives showed that 24.3% had a blood pressure below 160/95 mmHg, and 16% below 140/90 mmHg. Hypertensives used more alcohol and were more overweight than normotensives. Multiple logistic regression revealed that hypertension was independently related to age, being overweight and more urbanised. The degree of urbanisation also predicted to what extent hypertension prevalence increases with age. This black population had low hypertension rates compared with other similar groups in South Africa. These data suggest that as rural blacks increasingly undergo urbanisation, hypertension prevalence increases. Necessary diagnostic and treatment regimens and hypertension services are not yet in place in the South African health services, and need to be established.

Adolescent↗
PubMed1996

Public sector primary care of diabetics--a record review of quality of care in Cape Town.

AIM: To evaluate the quality of health care received by diabetics. DESIGN: External audit by means of retrospective record review. SITE: Ambulatory outpatient diabetes clinics at community health centres in black areas of Cape Town. METHOD: A stratified random sample (520) of all patients who attended any of five health centres during 1991 was reviewed by a clinician who had been trained to do structured record reviews. RESULTS: The response rate was 73.1%. Of all patients reviewed 91% had non-insulin-dependent diabetes mellitus and the remainder insulin-dependent diabetes mellitus; 65% were female and 35.8% were employed. Only 35% attended optimally. Fingerprick blood glucose values were recorded at 98.4% of visits, blood pressure was recorded at 74.1% of all visits and for 97.4% of patients; urine dipstick test results were recorded at 84.6% of visits and for over 99% of patients in 1991, and weight was recorded at 68.8% of visits. In contrast, fundoscopy was recorded for 6% of patients and examination of the feet was performed in 4.7% of patients. Fewer than half (48.9%) of visits resulted in any change in management. Polypharmacy is frequent, with an average of 2.3 non-hypoglycaemic drugs prescribed per visit. CONCLUSION: Attendance and examination for treatable complications are inadequate. Care is routinised and reactive and there is polypharmacy. RECOMMENDATIONS: Simple but appropriate protocols and matching in-service education are likely to improve the care of and health outcome for diabetics at these sites.

Adult↗
PubMed1995

Methodological issues in a disablement prevalence study: Mitchells Plain, South Africa.

The Mitchells Plain Disability Survey was undertaken primarily to expand a community-based rehabilitation programme in an underprivileged South African urban community. This descriptive survey used a proportional stratified random cluster sampling strategy (sample size 2424), with stratification by suburb and clusters consisting of 15 adjacent plots. A household screening questionnaire (based on the WHO disability questionnaire), identified people who reported health problems affecting their functional ability, while a second follow-up interview confirmed disablement status and obtained a medical, disablement and demographic profile of the disabled and ascertained their needs. This paper discusses different methodological issues related to the survey design and emphasizes the need for standardization of methods in the disablement field. Sampling issues include sample loss in a multi-staged data collection strategy as well as the non-independence of observations when sampling entire house- holds. The trade-off between studying disability across diagnostic, disablement and age categories, and wide confidence intervals for specific prevalence rates, is discussed. Because of the prohibitive costs validation of disablement status is often omitted in a low-budget project (as this one was), weakening the design of such studies. Even if the 'disabled' are correctly identified, the criteria for identifying respondents determine what type of disablement prevalence will be obtained, Different diagnoses reported on screening yielded different positive predictive values of disability--the most debilitating conditions yielding the highest proportion of disabled people. The quality of the data--evaluated through comparisons of initial and repeat screening interviews, and proxy and self-reporting--is described. There is a need for disability research to continue developing suitable methods for a wide range of purposes. One such is a 'good-enough' survey design which can be implemented rapidly, at relatively low cost, to yield useful results at local level.

Activities of Daily Living↗
PubMed1993

Mortality in a rural South African mission, 1837-1909: an historical cohort study using church records.

Three decadal birth cohorts (1837-1846), 1870-1879 and 1900-1909) each of approximately 500 individuals, were constructed retrospectively through the parish records of the Moravian Mission at Mamre in the Western Cape region of South Africa. Nominative data collection techniques were used to determine the infant mortality rates (IMR), quinquennial mortality rates (QMR) and life expectancies of the three cohorts. The quality of the data was investigated, specifically non-registration and attrition. Overall, male registration coverage was substantially better than that for females. Birth registration was best for the 1837-1846 cohort for males and females, with the 1900-1909 registration being next best. Infant death registration was most complete for males in these two cohorts, but was poor for females. Based on these data, the IMR for the cohorts born in 1837-1846, 1870-1879 and 1900-1909 (196, 182 and 128 per 1000 respectively for males and 160, 172 and 97 per 1000 respectively for females) appeared to be underestimates. There was some evidence of a downward trend for the IMR with time for males, but this was not statistically significant. For the three cohorts QMR did not differ statistically for males, but for females the third cohort was consistently lower than the other cohorts. The difference was small (well within the 95% confidence interval) but the third cohort ranked consistently below the other two. The life expectancies did not differ significantly between cohorts. The life expectancies at birth (range 34-40 years for males and 32-45 years for females) were probably overestimates due to biased IMR. The life expectancies at age 1 (range 41-44 for males and 37-49 for females) were considered to be more representative figures. Life expectancies at age 20 (37-45 years) were fairly stable over time except for females in the 1900-1909 cohort whose life expectancies were substantially higher than the figures for the earlier cohorts. All mortality indices investigated in this study consistently showed a lighter burden of mortality in historical Mamre compared to 'coloureds' in the Cape Colony at the turn of the century. This is probably the result of the better housing, environmental, social, economic and educational conditions on the missions relative to the rest of the Colony in the century after the emancipation of slaves.

Adult↗
PubMed1991

Risk factors for coronary heart disease in the black population of the Cape Peninsula. The BRISK study.

A cross-sectional study of risk factors for ischaemic heart disease (IHD) in a random sample of 986 black people aged 15-64 years living in the Cape Peninsula revealed a population at lower risk for IHD than other South Africans. Blood pressures of 140/95 mmHg or above were found in 14.4% of males and 13.7% of females. Fifty-two per cent of males and 8.4% of females smoked, while 16.5% of males and 25.8% of females had a total cholesterol (TC) level imparting risk for developing IHD. In this population the TC level is not a good surrogate measure for low-density lipoprotein cholesterol because of the high level of high-density lipoprotein cholesterol (HDLC) found in this population. A protective HDLC/TC ratio of 20% was found in 96% of males and 96.1% of females. When considering the three major reversible IHD risk factors at a high level of risk, 30.8% of males and 12.5% of females had at least one such a risk factor. The population was frequently exposed to the media, with 80% listening to the radio every day and 55% watching television at least once a week. This suggests that a healthy lifestyle could be promoted successfully by means of these media. In addition, schools should promote a healthy lifestyle and the prevention of chronic degenerative diseases should be incorporated into the evolving primary health care services in South Africa.

Adolescent↗
PubMed1991

Measurement of estrogen receptors in normal and neoplastic lymph node tissue from dogs.

Estrogen receptors were measured in normal canine lymph nodes and neoplastic tissue from dogs with lymphoma, using a commercially available [3H]estradiol dextran-coated charcoal assay. Using the same assay, estrogen receptors were detected in the positive-control tissues--dog uterus, rat uterus, and lyophilized bovine uterus. Specific binding of [3H]estradiol was not detected in rat skeletal muscle or in any of the canine lymphoid tissues, indicating that the specimens did not contain estrogen receptors.

Animals↗
PubMed1990

Village health-workers and GOBI-FFF. An evaluation of a rural programme.

Growth monitoring, oral rehydration, breast-feeding and immunisation--female education, family spacing and food supplementation (GOBI-FFF) are a selective package of World Health Organisation primary health care strategies recommended by UNICEF. Changes over a 1-year period in the implementation of the components of GOBI-FFF were investigated in a rural village in Ciskei to detect any changes associated with a newly modified village health-worker (VHW) programme. A baseline survey was conducted before the introduction of a modified VHW programme and a second survey took place a year later. The principles of GOBI-FFF were already familiar to and have since been increasingly practised by the community and health personnel. Breast-feeding is widespread, most carers know how to make oral rehydration solution and most children have a 'Road to Health' card and are being weighed regularly. However, malnutrition remains a major problem and the food supplementation programme is operating poorly. The high coverage of the community by the village health-workers and the clinic suggest that these two channels should be used more intensively to strengthen the GOBI-FFF programme in the area.

Breast Feeding↗
PubMed1988

Mamre Community Health Project--rationale and methods.

The overall aim of the Mamre Community Health Project is to improve the health status of the people of Mamre and to develop an approach to health promotion which may be applicable to other similar areas. Integral to this is the establishment of a surveillance system to monitor changes longitudinally with particular reference to the effects of interventive programmes and the rural-urban transition that the community is experiencing. A multidisciplinary approach that also involves both postgraduate and undergraduate students will be utilised. This article outlines the methodology employed in the first phase of the project, which was concerned with the collection of the baseline data to determine priorities, plan interventions and establish a suitable surveillance system. Approximately 1,000 households were visited and 5,000 residents interviewed by 10 trained interviewers who were selected from the community. Sampling was not used. Methodological issues addressed include the methods used to gain the co-operation and participation of the community, development of an appropriate questionnaire, selection and training of interviewers, supervision of field-work, coding of data and steps taken to ensure the reliability and validity of information collected. Thorough planning with meticulous attention to detail ensured that the Mamre Community Health Project was completed on target with fairly smooth implementation of the data collection phase. Future research will focus on refining epidemiological methods, especially aspects of study design, case definition and exposure status.

Data Collection↗
PubMed1988

Mortality in Mamre, 1981-1987.

Mortality statistics for Mamre were extracted from the Regional Services Council records for 1981-1987. The standardised mortality ratios were 0,70 for males and 0,55 for females. The age-specific mortality rates, including the infant mortality rate (23.6/1,000 live births), were lower than the national rates for coloureds. Non-natural causes of death were well above the national level. The high proportion of non-natural deaths is reflected in potential years of life lost (PYLL) for this cause--58% among males and 43% among females. Diseases of the circulatory system accounted for 19% and 17% of PYLL, and carcinomas for 7% and 14%.

Black or African American↗