PubMed Health⌕ Search

Biomedical subjects

P Rheeder

Publications and source records attributed to P Rheeder.

At least 19 recordsLinked to original sources
PubMed2006

The effect of abdominal obesity on insulin sensitivity and serum lipid and cytokine concentrations in African women.

OBJECTIVES: Studies have shown clear associations of abdominal obesity with lipid and glucose metabolism and cytokine levels in a number of different population groups. However, no such studies have been performed in an African population in which visceral adipose tissue levels have been shown to be lower than in European subjects. DESIGN AND PATIENTS: Cross-sectional analysis in 124 African women. MEASUREMENTS: Fasting serum samples were taken from all subjects and anthropometric measurements obtained. Blood levels of glucose, insulin, total cholesterol, high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol, triglyceride, interleukin (IL)-6, IL-8 and IL-18 were measured. Subjects were separated into normal and abnormal glucose tolerant groups and into tertiles according to waist circumference (WC). Insulin resistance was assessed using the homeostasis model assessment (HOMA). RESULTS: Abnormal glucose-tolerant subjects had higher WC, glucose and HOMA levels than the normal glucose-tolerant group. Increased WC was associated with higher triglyceride, insulin and HOMA levels and lower HDL levels. Multiple regression analyses showed that WC associated positively with HOMA and serum triglyceride levels and negatively with HDL levels. IL18 was a positive but weak determinant of the HOMA level and BMI correlated positively with serum IL-6 concentrations. CONCLUSIONS: Although previous studies have shown that African subjects have a lower visceral adipose depot size than European subjects, abdominal obesity is still associated with insulin resistance and dyslipidaemia. The association between abdominal obesity and metabolic dysfunction within this population is not dependent upon IL-6, IL-8 or IL-18.

Abdominal Fat↗
PubMed2006

Unsuspected glucose abnormalities in patients with coronary artery disease.

OBJECTIVES: To compare the ability of fasting glucose, glycosylated haemoglobin ( HbA(1c)), the American Diabetic Association (ADA) score and measures of the metabolic syndrome (waist circumference, high-density lipoprotein (HDL), and triglycerides) in predicting an initial diagnosis of diabetes mellitus or abnormal glucose tolerance based on the World Health Organization (WHO) criteria. DESIGN: A cross-sectional, diagnostic study was undertaken of 120 patients admitted to the cardiology wards of Pretoria Academic Hospital for elective coronary angiographic studies. MAIN OUTCOME MEASURES: All subjects underwent a modified glucose tolerance test whereby fasting and 2-hour post glucose (75 g) plasma glucose levels were measured. Using the revised WHO criteria, the overall incidence of diabetes was found to be 11.7% (95% confidence interval (CI): 6.5 - 19) and the overall incidence of abnormal glucose tolerance was 46% (CI: 37 - 55). RESULTS: In univariate analysis for the diagnosis of diabetes, HbA(1c) (p < 0.05) yielded the largest area (0.76) under the receiver operating characteristic (ROC) curve, with a sensitivity of 21%, specificity of 99%, positive predictive value (PPV) of 75% and negative predictive value (NPV) of 91%. For the prediction of abnormal glucose tolerance, applying multivariate analysis using a logistic regression model, the combination of age, ethnic group, serum HDL, serum triglycerides and HbA(1c) yielded an area under the ROC curve of 0.79, sensitivity of 66%, specificity of 80%, PPV of 76% and a NPV of 71%. CONCLUSION: Most subjects with diabetes mellitus (9 of 14) would not have been detected if a 2-hour oral glucose tolerance test had not been done. Addition of either HbA(1c) or lipid parameters to the model of age and ethnic group were similar in predicting abnormal glucose tolerance.

Age Factors↗
PubMed2005

The relationship between insulin sensitivity and serum adiponectin levels in three population groups.

Reduced plasma adiponectin levels are associated with insulin resistance. Black South Africans, like African Americans, are more insulin-resistant than BMI-matched white subjects, as are Asian Indians. We investigated whether this interethnic variation in insulin resistance is due to differences in plasma adiponectin levels. Blood and anthropometric measurements were taken from black, white and Asian-Indian subjects. Serum adiponectin, lipids, glucose and insulin were measured; insulin sensitivity was calculated using HOMA. Black (HOMA = 2.62 +/- 0.99) and Asian-Indian subjects (HOMA = 3.41 +/- 2.85) were more insulin-resistant than BMI-matched white (HOMA = 1.76 +/- 0.63) subjects (p = 0.0001). Furthermore, the white subjects had higher adiponectin levels (8.11 +/- 4.39 microg/ml) compared to black (5.71 +/- 2.50 microg/ml) and Asian Indian (5.86 +/- 2.50 microg/ml) subjects (p = 0.003). When all ethnic groups were combined, multiple regression analysis demonstrated that serum adiponectin levels corrected for BMI and ethnicity did not correlate with HOMA, but did explain 10.0 % of the variance in HDL-cholesterol levels. Within each ethnic group, adiponectin only correlated inversely with HOMA in white subjects. Adiponectin may play a role in determining serum HDL-cholesterol levels, but ethnic variation in insulin sensitivity is not dependent on serum levels of this adipokine. The relationship between adiponectin and insulin resistance varies across ethnic groups.

Adiponectin↗
PubMed2005

The South African stroke risk in general practice study.

BACKGROUND: Incidence of stroke is increasing in sub-Saharan Africa and stroke prevention is an essential component of successful stroke management. General practitioners (GPs) are well placed to manage stroke risk factors. To design appropriate strategies for risk factor reduction we need to know the risk factor prevalence in each of the population groups attending GPs. The aim of this study was to establish the prevalence of stroke risk factors in the South African general practice population. METHOD: We conducted a multicentre, observational study of patients attending general practice in South Africa. Two hundred general practices were randomly selected from lists provided by pharmaceutical representatives. Each GP approached 50 consecutive patients aged 30 years and older. Patients completed an information sheet and the GP documented the patient's risk factors. The resulting sample is relevant if not necessarily representative in a statistical sense. RESULTS: A total of 9 731 questionnaires were returned out of a possible 10,000. The mean age of particpants was 50.7 years. Seventy-six per cent had 1 or more risk factors and 40% had 2 or more risk factors. Hypertension was the commonest risk factor in all population groups (55%) but was highest in black patients (59%). Dyslipidaemia was commonest in whites (37%) and least common in blacks (5%). Diabetes was commonest in Asians (24%) but least common in whites (8%). Risk factors other than smoking increased with age. CONCLUSION: This study provides unique data on the prevalence of stroke risk factors in a South African general practice population. Risk factors are common in all population groups, but differ in distribution among the groups. There is considerable opportunity to reduce the burden of stroke in South Africa through GP screening for and treatment of risk factors.

Adult↗
PubMed2004

Effect of exercise versus relaxation on haemoglobin A1C in Black females with type 2 diabetes mellitus.

BACKGROUND: Evidence suggests that populations in Africa develop Type 2 diabetes mellitus (DM) at an increasing rate as they reject their traditional lifestyles. Diabetes is the tenth most common cause for total life years lost in females in South Africa. Physical activity is under-used in the management of type 2 DM in South Africa. AIM: To investigate the efficacy of an exercise intervention programme compared to relaxation exercises to decrease HbA1c over a period of 12 weeks, in type 2 DM female subjects. DESIGN: Single blind, double-intervention randomized trial. METHODS: Clinical measurements were done before and after the 12-week exercise and relaxation interventions. The interventions consisted of education and aerobic exercise for the exercise group, and education and relaxation for the second group. RESULTS: Adjusted baseline HbA1c change from baseline in the exercise group after 12 weeks was -0.39% (95%CI -0.80 to 0.02) and in the relaxation group -0.97% (95%CI -1.38 to 0.55) (p = 0.052). The results for the BMI were -0.07% kg/m2 (95%CI -0.2 to 0.14) in the exercise group versus -0.23 kg/m2 (95%CI -0.44 to 0.02) in the relaxation group (p = 0.28). The difference from baseline in distances covered following the 6 min walk test was statistically significantly greater (p < 0.01) in the exercise group: 46.76 m (95%CI 36.20-57.32) vs the relaxation group 22.7 m (95%CI 12.07-33.33). DISCUSSION: The exercise intervention failed to reduce the HbA1c to a greater extent than in the relaxation control group. Both groups improved significantly from baseline, probably due to the study effect.

Adult↗
PubMed2004

Assessing peripheral arteries in South African black women with type 2 diabetes mellitus.

OBJECTIVES: To determine the value of ankle and toe blood pressure indices and pedal pulse palpation in the assessment of peripheral arterial disease in subjects with type 2 diabetes mellitus (DM). DESIGN: Cross-sectional study. SUBJECTS: A convenience sample of 85 female subjects with type 2 DM underwent a series of peripheral vascular assessments at the diabetes clinic of a community hospital. OUTCOME MEASURES: Palpation of the pedal pulses, Doppler-derived ankle brachial systolic blood pressure indices, photo plethysmographic-derived toe brachial systolic blood pressure indices and antero-posterior radiographs of both feet. RESULTS: Mean values were 1.15 (standard deviation (SD): 0.17) and 0.76 (SD: 0.17) for ankle brachial index (ABI) and toe brachial index (TBI) respectively. The differences between the two indices increased from 0.36 (95% confidence interval (CI): 0.32-0.41) to 0.58 (95% CI: 0.46-0.70) depending on whether ABI was less or greater than 1.3. The correlation coefficient for left versus right foot was 0.62 and 0.71 for ABI and TBI respectively. The relationship between ABI and TBI is non-linear with a cut point close to 1.3. Both ABI and TBI were significantly lower in subjects who had both pedal pulses absent on palpation. CONCLUSIONS: The relationship between ABI and TBI is linear below an ABI of 1.3. but with a wide 95% prediction interval. If both pedal pulses are absent the ABI is significantly diminished compared with when both pulses are present, even though not necessarily below 0.9.

Aged↗
PubMed2004

Physician education programme improves quality of diabetes care.

BACKGROUND: Diabetes mellitus is a common chronic disease needing long-term glycaemic control to prevent complications. Guidelines are available for achievement of optimal glycaemic control, but these are seldom properly instituted. OBJECTIVES: To determine if a physician education programme and a structured consultation schedule would improve the quality of diabetes patient care in a diabetes clinic. SETTING: Two tertiary care diabetes clinics at Kalafong Hospital, Pretoria. STUDY DESIGN: Quasi-experimental controlled before-and-after study. METHODS: A baseline audit of the quality of care in two comparable diabetes clinics was performed. Three hundred patients were randomly selected for audit of their hospital records: 141 from the intervention and 159 from the control clinics. Thereafter a physician training programme and a structured consultation schedule were introduced to the intervention clinic and maintained for a 1-year period. The control clinic continued with care as usual. Process and outcome measures were determined at a post-intervention audit and compared between the two groups. Consultation time was measured for both the intervention and control groups and data were compared. RESULTS: At baseline the intervention and control groups did not differ significantly with regard to process and outcome measures. After intervention the intervention group had significantly higher process measure scores than the control group (p < 0.01). HbA1c did not significantly differ between the two groups (p = 0.60). The average number of clinic visits reduced over time for the intervention group compared with the control group (p < 0.01), but the average consultation times were significantly longer (p < 0.01). CONCLUSION: The introduction of a physician education programme and a structured consultation schedule improved the quality of care delivered at a tertiary care diabetes clinic.

Adult↗
PubMed2002

Development and testing of a 25-item patient satisfaction scale for black South African diabetic outpatients.

Although there is general agreement that patient satisfaction is an integral component of service quality, there is a paucity of South African research on reliable and valid satisfaction measures and the effects of health status on satisfaction. A 25-item patient satisfaction scale was developed and tested for evaluating the quality of health care for black diabetic outpatients. It was hypothesised that: (1) the underlying dimensions of patient satisfaction were interpersonal and organisational; and (2) patients in poor health would be less satisfied with the quality of their care than patients in good health. The questionnaire was administered to 263 black outpatients from Pretoria Academic Hospital and Kalafong Hospital. Factor analysis was conducted on the patient satisfaction scale and three factors, accounting for 71% of the variance, were extracted. The major items on Factor I were helpfulness, communication, support and consideration, representing the interpersonal dimension. Factors II and III were mainly concerned with service logistics and technical expertise, with the emphasis on waiting time, follow-up and thoroughness of examination. The three factors had excellent reliability coefficients, ranging between 0.82 (technical), 0.85 (logistics) and 0.98 (interpersonal). Multiple analyses of co-variance showed that patients in poor general health were significantly less satisfied with the logistical (p = 0.004) and technical (p = 0.007) quality of their care than patients in good health; patients in poor mental health were significantly less satisfied with the interpersonal quality of their care (p = 0.05) than patients in good mental health. These findings provided support for both hypotheses and suggested that patients in poor health attend to different aspects of their care than patients in good health. Of more importance to clinical practice, the results endorsed the need for a multidisciplinary health team comprising nurse/social worker (Factor I: support, communication), health service managers (Factor II: service logistics) and physician (Factor III: technical expertise) to enhance treatment outcome for diabetic patients. It is recommended that: (1) further research is conducted on this patient satisfaction scale with diverse populations in different settings to complement and validate the scale for generalised use in South Africa; (2) the scale is used to collect information on patient satisfaction before and after implementing an intervention to improve the quality of health care, and (3) measurement of health status is an essential adjunct to assessment of patient satisfaction.

Adolescent↗
PubMed2002

An educational intervention to improve the quality of care of diabetic patients.

OBJECTIVE: As few studies have addressed intervention for in-hospital care of diabetes mellitus (DM) patients, we set out to investigate whether an educational intervention targeting doctors could improve the quality of care for diabetic patients. DESIGN: An observational interventional study conducted at Pretoria Academic Hospital, a tertiary care hospital. SUBJECTS: Doctors working in the Department of Internal Medicine were the subjects of two interventional sessions on diabetic care, and all diabetic patients admitted to the wards in the above Department were evaluated. OUTCOME MEASURES: A Diabetes Attitude Scale (DAS-3) and a Diabetes Practice Scale (DPS) were completed by each doctor before and after the interventional educational sessions. Data from diabetic patients in the wards were collected for 5 weeks before and 5 weeks after the interventional training, and these two sets of data were compared to measure the effect of the interventional training. RESULTS: Subscales of the DAS-3 showed an improvement, with a statistically significant improvement in attitude regarding seriousness of DM (P = 0.03), and a trend towards improvement in attitude regarding need for special training and patient autonomy. Most of the items on the DPS improved significantly (P < 0.05). CONCLUSIONS: A short educational intervention resulted in an improvement in attitude, knowledge and clinical management of diabetic patients.

Adult↗
PubMed2002

The metabolic syndrome in black hypertensive women--waist circumference more strongly related than body mass index.

OBJECTIVE: To examine the association between measures of obesity and features of the metabolic syndrome in treated black female hypertensive subjects. DESIGN: Cross-sectional study. SETTING: An urban primary health care centre in Mamelodi, Pretoria. SUBJECTS: Women with hypertension and without known diabetes mellitus or secondary causes of hypertension. In total 124 women participated, with a mean age of 56.9 years (standard deviation (SD) 11.0) and mean body mass index (BMI) of 34.1 kg/m2 (SD 8.1). MAIN OUTCOME MEASURES: Blood pressure, glucose, insulin and lipid levels. RESULTS: Waist circumference and waist-hip ratio were more strongly associated with insulin, uric acid, glucose and triglycerides than was BMI. Statistically significant associations were found between waist circumference and low high-density lipoprotein HDL cholesterol (standardised regression coefficient -0.006, standard error of the mean (SEM) 0.002), log triglycerides (0.007, SEM 0.003), uric acid (0.002, SEM 0.001) and log insulin (0.012, SEM 0.003). BMI was only significantly associated with uric acid (0.002, SEM 0.002) and log insulin (0.009, SEM 0.004). CONCLUSION: In a group of black hypertensive women measures of central obesity were more strongly associated with components of the metabolic syndrome than BMI.

Black People↗
PubMed2002

Monofilament assessment of neuropathy in a community diabetes clinic.

OBJECTIVE: To compare the detection of diabetic neuropathy using monofilament, cotton wool, pinprick, vibration sense and symptom evaluation. SETTING: The diabetes clinic of a community hospital. METHODS: Two examiners evaluated 89 women with diabetes mellitus (DM) using a 10 g monofilament, cotton wool, pinprick and a 128 Hz tuning fork after completion of a University of Texas subjective peripheral neuropathy verbal questionnaire. RESULTS: Vibration sense was abnormal in either foot in 8% of subjects. Neuropathy as defined by monofilament, cotton wool and pinprick was present in 26%, 3% and 6% of patients respectively. The respective kappa values (kappa) for the comparison between monofilament neuropathy and cotton wool neuropathy, pinprick neuropathy and symptom-defined neuropathy were 0.18, 0.21 and 0.06. The kappa-value comparing monofilament and tuning fork-defined neuropathy was 0.24. There was fair agreement between 10 versus 3 sites (kappa = 0.60). CONCLUSION: More abnormalities were detected using the monofilament compared with cotton wool or pinprick. There was poor concordance between symptoms and clinically detected neuropathy. The ideal number of sites that need to be evaluated is still contentious.

Cross-Sectional Studies↗
PubMed2001

Ethnic differences in C-peptide levels and anti-GAD antibodies in South African patients with diabetic ketoacidosis.

To determine differences between Black and White South Africans with diabetic ketoacidosis (DKA) and between Black patients on insulin vs. those on oral agents presenting with DKA, post stabilization fasting C-peptide levels and anti-glutamic acid decarboxylase (GAD) antibodies were measured together with serum glucose, acid base and urine ketones on admission. Of 60 patients with diabetic ketoacidosis (DKA) (76 admissions), the 43 Black patients had a higher BMI (23.1 vs. 20.0 kg/m(2), p=0.05) than did the 17 White patients, were more often newly diagnosed (37% vs. 1%, p=0.03), and a greater proportion of Black patients had fasting C-peptide levels >0.3 nmol/l (28% (10/36) vs. 0%, p=0.03). Of these 10 Black patients, eight were anti-GAD-negative. Thirteen Black patients (33%) were anti-GAD-positive vs. 10 (67%) White patients (p=0.03). There was no statistically significant difference in anti-GAD positivity between Black patients on oral agents or those on insulin. Most patients (5/7) admitted on oral agents had negative C-peptide levels after stabilization. Our results suggest that in patients presenting with DKA, a quarter of Black South Africans have C-peptide levels regarded as being indicative of type 2 DM and are less frequently anti-GAD-antibody-positive than are White South Africans.

Adult↗
PubMed2001

The effect of type 2 diabetes mellitus on health-related quality of life (HRQOL).

Improving the quality of life of all South Africans has become a major concern to health care practitioners, organisations and politicians. However, the paucity of local information on health-related quality of life (HRQOL) does not allow us to address this public health challenge. In order to rectify this deficiency and complement international research, we undertook a study with 281 Type 2 Black diabetic patients and 437 controls, with no self-reported chronic conditions, to ascertain HRQOL. We used the SF-20 to measure functioning, general health, well-being and bodily pain (HRQOL). It was hypothesised that diabetes mellitus significantly affects functioning, general health and well-being. Multiple analyses of covariance controlled for age, schooling, marital status, employment status and commodity ownership (a socio-economic measure). Patients were significantly more likely to report poorer role functioning, poorer general health and more pain than controls, providing partial support for the hypothesis. Reliability (internal consistency) coefficients on the four multi-item SF-20 sub-scales ranged between 0.79 (well-being), 0.81 (general health), 0.83 (physical functioning) and 0.94 (role functioning) for patients: for controls these coefficients ranged between 0.70 (well-being), 0.78 (general health), 0.80 (physical functioning) and 0.90 (role functioning). Inter-correlations among the sub-scales were significant for patients and controls (p = 0.01). It was concluded that the SF-20 is a reliable instrument for measuring HRQOL in both patient and control samples, and diabetes mellitus has more impact on general health and level of pain than on well-being.

Adolescent↗
PubMed1999

The pharmacy screening project--an evaluation of pharmacy-based screening programmes.

OBJECTIVES: The purpose of this study was to establish the proportion of pharmacies providing screening tests in the areas of Pretoria, Potchefstroom and Klerksdorp, the types of tests used and their cost to patients, the criteria employed to select high-prevalence groups, the attitudes of pharmacists towards screening, and their knowledge of test characteristics. SETTING: In Pretoria, 155 pharmacies were randomly selected and all 43 pharmacies in Potchefstroom and Klerksdorp were included. METHODS: The pharmacies included in the study sample were first contacted by telephone to identify those providing screening tests. Pharmacies that provided screening tests and agreed to participate in this study were then visited and a questionnaire was administered. RESULTS: 57% of the pharmacies provided at least one type of screening test. Blood pressure measurement, serum cholesterol, capillary glucose and pregnancy testing were the most common screening tests available. With the exception of blood pressure measurement, the screening tests were conducted less than 5 times per week. All respondents referred clients with abnormal results to general practitioners but only 35% of pharmacies kept records of the patients tested and the test results. The knowledge of pharmacists concerning the important features of screening tests, such as false-positive and false-negative rates, was poor. No quality control procedures for the screening tests were employed. CONCLUSIONS: Providing pharmacists with specific training in the application and interpretation of screening procedures, and implementing quality control measures will reduce the number of false referrals or non-referrals, and will improve the quality of the service. If pharmacies are to play a meaningful role in screening for disease, coverage of the population will need to be increased substantially.

Adult↗
PubMed1998

Ambulatory blood pressure monitoring--comparison with office blood pressure in patients on antihypertensive therapy in private practice.

INTRODUCTION: Available data on the use of 24-hour ambulatory blood pressure recordings in private practice are limited. For this purpose we studied 39 consecutive hypertensive patients on treatment in a private practice. METHOD: Office blood pressure, 24-hour ambulatory blood pressure, daytime ambulatory blood pressure and M-mode echocardiography were undertaken in 39 consecutive hypertensive patients (21 men, 18 women) on treatment. RESULTS: Mean 24-hour ambulatory blood pressure and mean daytime ambulatory blood pressure were lower than office blood pressure, similar to findings seen in academic settings. A blood pressure load of more than 50% was seen in 12 out of 39 patients (31%). Left ventricular hypertrophy, assessed by means of Framingham criteria, was seen in 33% of patients. A white-coat effect was seen in 15.4% of patients. CONCLUSIONS: A large proportion (33%) of patients on treatment for hypertension had left ventricular hypertrophy, despite normal electrocardiograms. Ambulatory blood pressure measurements identified a blood pressure load of more than 50% in 31% of patients on treatment for hypertension.

Analysis of Variance↗