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BackgroundMethodResultsConclusionDiabetes mellitus (DM) has reached epidemic proportions in South Africa. Targets for adequate glycaemic control are rarely being met. DM self-management is a cornerstone of effective DM care and people with DM should be adherent to various self-care behaviours. This study aims to describe the behavioural factors contributing to DM management control and how they relate to glycaemic control.A cross-sectional survey used the Diabetes Self-Management Questionnaire (DSMQ) to assess knowledge and self-management behaviours of physical activity, glucose management, dietary control, and health care use amongst patients attending a diabetic clinic at a tertiary hospital in Johannesburg. Regression analysis models were used to determine the relationship between the independent variables of DM knowledge and self-care behaviours and the outcome variable glycaemic control.A total of 214 participants were enrolled; the majority were African (55.6%) and Coloured (30.4%). Only 14% of patients achieved a target HbA1c of less than 7%. Participants scored the highest average scores on the DSMQ for the healthcare use subscale, followed by glucose management, then physical activity. The lowest mean score was noted for the dietary subscale. The dietary control subscale of the DSMQ was most significantly associated with HbA1c (OR 0.79 [CI 0.64–0.96], p-value 0.020). Overall compliance with diabetes self-management behaviours is associated with improved glycaemic control, whereby patients who scored higher on the DSMQ were less likely to have poor glycaemic control (OR: 0.51 [CI 0.28–0.94], p-value 0.030).The barriers to effective DM control are vast and complex. This study shows that effective self-management overall is associated with better glycaemic control. Dietary control is most significantly associated with HbA1c. Most people living with DM find it challenging to adhere to a nutritious and diverse DM diet. There is room for further research and intervention regarding medical nutrition therapy that will be culturally and financially appropriate for the South African population. [ABSTRACT FROM AUTHOR]

Background: The risk of complications from type 2 diabetes mellitus (T2DM) is high. Achieving targets reduces the morbidity and mortality. This study aims to assess whether patients at the Helen Joseph Hospital's Diabetic Clinic are meeting the 2012 SEMDSA targets for diabetes. Methods: A retrospective clinical audit was carried out. The files of 321 patients with T2DM were reviewed. Glycated haemoglobin (HbA1c), blood pressure, abdominal circumference and lipograms were assessed. Results: The study population comprised majority black (n = 143; 44.6%) and coloured (n = 109; 34%) patients and was predominantly female (n = 200; 62.3%). The mean age was 59.4 years (SD 9.9 years). In total, 89.1% (n = 286) had hypertension, and 82.2% (n = 264) dyslipidaemia. The metabolic syndrome criteria were fulfilled by 266 (91.2%) patients. The majority did not exercise (n = 174; 56.3%). A small number smoked (n = 39; 12.5%) and used alcohol (n = 33; 10.6%). Mean HbA1c was 9.5% (SD 2.4; range 3.9–16.9%). Only 49 (15.3%) achieved the target HbA1c. Target blood pressure was achieved by 72 patients (25%). LDL target was achieved by 71 (22.6%) and abdominal circumference by 32 (11%) patients. Conclusions: Despite adequate protocols and access to tertiary medical care, a very small percentage of patients are achieving proposed targets. The reasons for this are likely multi-fold and further analysis is required to assess these. [ABSTRACT FROM AUTHOR]

The study examined the extent, demographics and risks for child pedestrian, burns and drowning mortality in Johannesburg. Information on the demographics, scene and temporal circumstances for childhood injury deaths from 2000 to 2010 was gleaned from the National Injury Mortality Surveillance System. Descriptive statistical methods were used. The study recorded 756 pedestrian (8.7/100,000), 439 drowning (5.1/100,000), and 399 burn injury deaths (4.6/100,000) among children aged 0-14 years. Male children were the main victims, with male-to-female ratios of 2.3 for drowning, 1.7 for pedestrian and 1.2 for burn mortality. The pattern of child mortality differed across age groups with older children recording higher rates for pedestrian deaths and younger children higher rates for the non-traffic deaths. Pedestrian and burn mortality especially affected black children, while drowning affected both black and white children. The time, day and month of greatest injury mortality varied by injury cause, with e.g. pedestrian mortality common in afternoons and evenings, weekends, and dispersed across the year although increasing towards year end. The study highlighted the salience of differentiating risks for childhood injuries by discrete external cause for purposes of informing prevention responses.

Violence among youth is a major health and safety burden globally. There is a dearth in the development and evaluation of targeted interventions that addresses the multi-faceted nature of youth violence to ensure effectiveness and replicability. This study aims to systematically evaluate the fidelity of implementation of the Building Bridges Mentoring intervention that focuses on the prevention of youth violence in two low-income communities in South Africa. This study employed a mixed methods concurrent triangulation design. Qualitative data were analysed using deductive thematic analysis, and quantitative data using descriptive statistics and T -tests. The results indicate that for all the intervention components, implementation fidelity (i.e. adherence, exposure, quality of programme delivery, and participant responsiveness) was generally moderate to high, suggesting a 'good' implementation of the programme in the real world. Evaluating the fidelity of implementation is vital to obtain a comprehensive insight into whether an intervention was implemented according to its design, and to verify and validate the findings and outcomes, and accord credibility and integrity of the study.

Cushing's syndrome (CS) may present with different neurological and/or psychiatric symptoms including anxiety, depression, cognitive impairment and psychosis. Psychosis is a rare clinical manifestation, with literature limited to case reports. We report a case of a 52-year-old woman with psychosis secondary to CS who was mis-diagnosed as schizophrenia-like psychosis. This case highlights the importance of considering CS as a differential when ruling out medical causes in patients with either new or persistent mental health disturbances., Competing Interests: The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article., (© 2022. The Authors.)

Most cases of hypertension are because of essential hypertension, however 5% - 15% of cases can be a result of a secondary cause. In this article, we focus on the endocrine causes of secondary hypertension with a particular focus on pheochromocytomas (PCCs) and paragangliomas (PGLs). Around 15 endocrine disorders can initially present with hypertension. Amongst those PCCs and PGLs are rare but potentially life-threatening causes. An early diagnosis and timely referral can be life-saving. Herein, we present an approach for screening and diagnosis of these patients and focus on the importance of genetic testing.

Summary: Acromegaly is a rare, chronic progressive disorder with characteristic clinical features caused by persistent hypersecretion of growth hormone (GH), mostly from a pituitary adenoma (95%). Occasionally, ectopic production of GH or growth hormone-releasing hormone (GHRH) with resultant GH hypersecretion may lead to acromegaly. Sometimes localizing the source of GH hypersecretion may prove difficult. Rarely, acromegaly has been found in patients with an empty sella (ES) secondary to prior pituitary radiation and/or surgery. However, acromegaly in patients with primary empty sella (PES) is exceeding rarely and has only been described in a few cases. We describe a 47-year-old male who presented with overt features of acromegaly (macroglossia, prognathism, increased hand and feet size). Biochemically, both the serum GH (21.6 μg/L) and insulin-like growth factor 1 (635 μg/L) were elevated. In addition, there was a paradoxical elevation of GH following a 75 g oral glucose load. Pituitary MRI demonstrated an ES. In order to exclude an ectopic source of GH hypersecretion, further biochemical tests and imaging were done, which were unremarkable. Notably, increased uptake in the sella turcica on the 68Gallium DOTATATE PET/CT confirmed the ES as the likely source of GH secretion. As no overt lesion was noted, medical treatment (octreotide acetate) was initiated with a good clinical and biochemical response. At his 3 month follow-up, he reported an improvement in symptoms (fatigue and headache), however he still complained of low libido. Due to a persistently low testosterone level at follow-up, a long-acting testosterone was initiated. His GH level normalised, and IGF-1 has significantly reduced., Learning Points: The commonest cause of acromegaly is due to GH hypersecretion from pituitary adenomas (95%). Acromegaly has rarely been found in patients with ES. It is important to exclude a past history suggestive of pituitary apoplexy. Extra-pituitary source of GH such as ectopic production of GHRH with resultant GH hypersecretion needs to be excluded. In such cases, since there is no resectable mass, medical therapy is the primary treatment option.

A germline mutation is identified in almost 40% of pheochromocytoma/paraganglioma (PPGL) syndromes. Genetic testing and counseling are essential for the management of index cases as well as presymptomatic identification and preemptive management of affected family members. Mutations in the genes encoding the mitochondrial enzyme succinate dehydrogenase (SDH) are well described in patients with hereditary PPGL. Among patients of African ancestry, the prevalence, phenotype, germline mutation spectrum, and penetrance of SDH mutations is poorly characterized. We describe a multifocal paraganglioma in a young African male with an underlying missense succinate dehydrogenase subunit B ( SDHB ) mutation and a history of 3 first-degree relatives who died at young ages from suspected cardiovascular causes. The same SDHB mutation, Class V variant c.724C>A p.(Arg242Ser), was detected in one of his asymptomatic siblings. As there are limited data describing hereditary PPGL syndromes in Africa, this report of an SDHB -associated PPGL is a notable contribution to the literature in this growing field. Due to the noteworthy clinical implications of PPGL mutations, this work highlights the existing need for broader genetic screening among African patients with PPGL despite the limited healthcare resources available in this region., (© The Author(s) 2021. Published by Oxford University Press on behalf of the Endocrine Society.)

The present study investigated the relationship between neighbourhood characteristics and childhood pedestrian fatalities (2001-2010) in Johannesburg, South Africa. This cross-sectional study used negative binomial regression models. Results indicate that: areas with high concentrated disadvantage have elevated childhood pedestrian deaths, especially for those aged 5 to 9 years. Areas marked by residential mobility are associated with high pedestrian deaths among children 0 to 4 years. Black childhood pedestrian deaths are higher in areas marked by a high concentration of female-headed households. The analyses highlight the value of further exploring the effects of neighbourhood characteristics and suggest points of entry for interventions to reduce or prevent childhood pedestrian traffic mortality.

Dynamic violence and injury prevention interventions located within community settings raise evaluation challenges by virtue of their complex structure, focus, and aims. They try to address many risk factors simultaneously, are often overlapped in their implementation, and their implementation may be phased over time. This article proposes a statistical and analytic framework for evaluating the effectiveness of multilevel, multisystem, multi-component, community-driven, dynamic interventions. The proposed framework builds on meta regression methodology and recently proposed approaches for pooling results from multi-component intervention studies. The methodology is applied to the evaluation of the effectiveness of South African community-centered injury prevention and safety promotion interventions. The proposed framework allows for complex interventions to be disaggregated into their constituent parts in order to extract their specific effects. The potential utility of the framework is successfully illustrated using contact crime data from select police stations in Johannesburg. The proposed framework and statistical guidelines proved to be useful to study the effectiveness of complex, dynamic, community-based interventions as a whole and of their components. The framework may help researchers and policy makers to adopt and study a specific methodology for evaluating the effectiveness of complex intervention programs.

Background: The development, implementation and evaluation of community interventions are important for reducing child violence and injuries in low- to middle-income contexts, with successful implementation critical to effective intervention outcomes. The assessment of implementation processes is required to identify the factors that influence effective implementation. This article draws on a child safety, peace and health initiative to examine key factors that enabled or hindered its implementation, in a context characterised by limited resources., Methods: A case study approach was employed. The research team was made up of six researchers and intervention coordinators, who led the development and implementation of the Ukuphepha Child Study in South Africa, and who are also the authors of this article. The study used author observations, reflections and discussions of the factors perceived to influence the implementation of the intervention. The authors engaged in an in-depth and iterative dialogic process aimed at abstracting the experiences of the intervention, with a recursive cycle of reflection and dialogue. Data were analysed utilising inductive content analysis, and categorised using classification frameworks for understanding implementation., Results: The study highlights key factors that enabled or hindered implementation. These included the community context and concomitant community engagement processes; intervention compatibility and adaptability issues; community service provider perceptions of intervention relevance and expectations; and the intervention support system, characterised by training and mentorship support., Conclusions: This evaluation illustrated the complexity of intervention implementation. The study approach sought to support intervention fidelity by fostering and maintaining community endorsement and support, a prerequisite for the unfolding implementation of the intervention.