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Globally, fiscal measures are deemed effective in combating the obesity epidemic at population level. A health promotional levy (HPL) on sugar sweetened beverages (SSBs) was implemented in April 2018 in South Africa to reduce sugar consumption.This cross-sectional, descriptive study investigated consumers' understanding and opinion of the HPL, and impact on consumption of SSBs. Data was collected outside 15 grocery stores, within four health sub-districts of the City of Cape Town. An interviewer-administered questionnaire was completed with literate, adult consumers (Participants (46.0%) were aware of the HPL but regarded it insufficient to change purchasing behaviour (55.4%). The lower income group (56.4%) was most affected by the increased price of SSBs. Those who agreed (46.8%) that the levy would help to reduce the prevalence of obesity was significantly more likely to notice a price increase in SSBs (54.5%) (Participants were receptive for legislative measures to combat the prevalence of obesity but lacked clarity of the goal and implementation of the HPL. A multipronged approach is crucial to lower sugar intake sustainably and an environment which offers healthy alternatives to SSBs. A higher HPL combined with transparency of how revenue is utilised could enhance the impact of the sugar tax strategy.

To investigate pregnant women from the Safe Passage Study for the individual and combined effects of smoking and drinking during pregnancy on the prevalence of clinical placental abruption.The aim of the original Safe Passage Study was to investigate the association of alcohol use during pregnancy with stillbirths and sudden infant deaths. Recruitment for this longitudinal study occurred between August 2007 and October 2016. Information on smoking and drinking was collected prospectively at up to 4 occasions during pregnancy where a modified timeline follow-back method was used to assess the exposure to alcohol. Placentas were examined histologically in a subset of pregnant women. For this study we examined the effects of smoking and drinking on fetal growth and the prevalence rate of placental abruption. High smoking constituted of 10 or more cigarettes per day and high drinking of four or more binge drinking episodes or 32 and more standard drinks during pregnancy. Placental abruption was diagnosed in two ways, by the clinical picture or the macroscopic and microscopic examination of the placenta.When compared to the non-drinking/non-smoking group, the high drinking/high smoking group were significantly older, had a higher gravidity, had a lower household income and booked later for prenatal care; fewer of them were employed and had toilet and running water facilities in their houses. Clinical placental abruption was diagnosed in 49 (0.87 %) of 5806 pregnancies. Histological examination was done in 1319 placentas; macroscopic and microscopic diagnosis of placental abruption was made in 8.2 % and 11.9 % of placentas respectively. These 49 cases were then correlated with seven smoking/drinking patterns during pregnancy. When compared to rates for no smoking/no drinking (0.11 %) and low smoking/no drinking (0.55 %), the prevalence rate of placental abruption was significantly higher (p .005) in the low smoking/low drinking group (1.25 %). There was also a significant relationship between low maternal employment and methamphetamine use with placental abruption.As many conditions and habits are associated with placental abruption, it is impossible to single out one specific cause but concomitant drinking and smoking seem to increase the risk of placental abruption.

Background. Although women are informed about the dangers of drinking and smoking during pregnancy when they book for antenatal care, it is uncertain whether this advice is accepted, or whether attempts are made to apply it in subsequent pregnancies. Objectives. To assess how pregnant women respond to the advice to refrain from smoking and drinking during pregnancy in subsequent pregnancies. Methods. Research staff were trained to obtain accurate prospective information on smoking and drinking during pregnancy in a prospective study, using well-standardised methods. Care was taken to inform participants about the dangers of smoking and drinking during pregnancy. They were also given pamphlets on these dangers in their own language and a list of telephone numbers where they could find help to quit should they need it. This information was repeated at subsequent study visits (ranging from 1 to 3, depending on the gestational age at which they enrolled). Gestational age was determined by early ultrasound. Z -scores of birthweight for gestational age were determined according to the INTERGROWTH-21st study. Pregnancy outcomes of women who enrolled twice ( n =888) or three times ( n =77) in the Safe Passage Study were compared with those of women in the first enrolment ( n =889). Results. The proportion of drinkers did not change significantly ( p =0.058) from the first to the second and third enrolments (63.8%, 59.0% and 54.6%, respectively). A similar trend was found for smokers (73.3%, 72.2% and 68.4%, respectively). Cannabis use was reported by 15.1%, 9.7% and 12.0% ( p

Background The extent to which smoking and drinking in a local community is associated with nutrition and Z-scores of infants from spontaneous preterm deliveries, is uncertain. Aim To investigate associations of different levels of maternal smoking and drinking in spontaneous preterm birth with infant birthweight Z-scores. Methods Information, including gestational age (determined by earliest ultrasound), maternal arm circumference (measured at enrolment), smoking-drinking data (obtained up to 4 occasions), birthweight data (obtained from medical records) and birthweight Z-scores (calculated from INTERGROWTH- 21st study), collected over a period of nine years was used to compare 407 spontaneous preterm births with 3 493 spontaneous term births Analyses of variance, correlations and multiple regression were performed in STATISTICA. Results Women with spontaneous preterm birth, had significantly lower gravidity and smaller arm circumference when compared to women with spontaneous birth at term. Women with spontaneous preterm birth drank more and heavier during pregnancy, and more smoked. Gestational age at birth was significantly longer in heavy-smokers-heavy-drinkers compared to heavy-smokers-no-drinkers (7.1 days) and in no-smokers-heavy-drinkers when compared to no-smokers-no-drinkers (11.2 days). Birthweight was significantly lower in low-smokers-heavy-drinkers when compared to low-smokers-no-drinkers (240g) and in heavy-smokers-low-drinkers when compared to no-smokers-low-drinkers (273g). Birthweight Z-scores were significantly lower in low-smokers-heavy-drinkers when compared to low-smokers-low-drinkers and low-smokers-no-drinkers; and, also significantly lower in heavy-smokers-low-drinkers when compared to low-smokers-low-drinkers and no-smokers-low-drinkers. Conclusion Alcohol aggravates the detrimental effect of smoking on birthweight and birthweight Z-scores but seems to counteract the negative association of smoking with gestational age.

Objective: We aimed to describe patterns of substance use among patients admitted to an emergency psychiatric unit for non-fatal suicidal behaviour (NFSB) or another psychiatric reason and establis...

Background: Vitamin D deficiency is fast emerging as a global pandemic. In South Africa few studies have been conducted to determine the vitamin D status of the healthy population.Methods: This prospective study with an analytical component investigated vitamin D status of healthy undergraduate students at two time points (winter and summer) at Stellenbosch University. Serum 25(OH)D was determined, anthropometric measurements taken and dietary vitamin D intake estimated (food-frequency questionnaire). Skin tone was determined (Fitzpatrick skin type classification), and a skin reflectometry device used to measure dermal melanin content.Results: Results of 242 students indicated a mean serum 25(OH)D of 63.80 ± 41.35 ng/ml and a high prevalence of vitamin D sufficiency (88%). Significantly more females experienced suboptimal vitamin D levels than males (18 vs. 5%; p 0.01). Participants with lighter skin tones had higher levels of 25(OH)D than those with darker skin tones (chi-square = 24.02; p = 0.02). The majority (60.74%) had a normal BMI, although there was no significant relationship between BMI and serum 25 (OH)D (Spearman’s r=–0.11; p = 0.09). Total mean dietary vitamin D intake was 7.99 ± 13.81 mcg, with 87.2% having inadequate intake ( 15 mcg). The relationship between total vitamin D intake and serum 25(OH)D was found to be significant in winter (p 0.001) and summer (p = 0.01). Serum vitamin D levels were significantly higher in the winter phase (p 0.001).Conclusions: A low prevalence of vitamin D deficiency was found amongst healthy young adults, despite low dietary vitamin D intakes. Significant relationships were found between serum 25(OH)D and gender, skin tone and vitamin D intake. Further studies need to be conducted, especially in high-risk groups, before results are applied to the greater South African public.

In low-income countries, prospective data on combined effects of in utero teratogen exposure are lacking and necessitates new research. The aim of the present study was to explore the effect of in utero teratogen exposure on the size of the kidneys and pancreas 5 years after birth in a low-income paediatric population. Data was collected from 500 mother–child pairs from a low-income setting. Anthropometric measurements included body weight, (BW) body height, mid-upper arm and waist circumference (WC). Clinical measurements included blood pressure (BP), mean arterial pressure and heart rate. Ultrasound measurements included pancreas, and kidney measurements at age 5 years. The main outcome of interest was the effect of maternal smoking and alcohol consumption on ultrasound measurements of organ size at age 5 years. Left and right kidney length measurements were significantly lower in smoking exposed children compared to controls (p = 0.04 and p = 0.03). Pancreas body measurements were significantly lower in smoking exposed children (p = 0.04). Multiple regression analyses were used to examine the associations between the independent variables (IDVs), maternal age, body mass index (BMI), mid-upper arm circumference (MUAC) and BW of the child, on the dependent variables (DVs) kidney lengths and kidney volumes. Also, the association between in utero exposure to alcohol and nicotine and pancreas size. WC was strongest (r = 0.28; p < 0.01) associated with pancreas head [F (4, 454) = 13.44; R2 = 0.11; p < 0.01] and tail (r = 0.30; p < 0.01) measurements at age 5 years, with in utero exposure, sex of the child and BMI as covariates. Kidney length and pancreas body measurements are affected by in utero exposure to nicotine at age 5 years and might contribute to cardiometabolic risk in later life. Also, findings from this study report on ultrasound reference values for kidney and pancreas measurements of children at age 5 years from a low-income setting.

Objective To examine the effects of socioeconomic and demographic conditions on the prevalence of preterm birth in a local community. Methods Pregnant women (aged ≥16 years) willing to provide informed consent in one of the two languages of the community were recruited in South Africa between August 2007 and January 2015. Specifically designed case report forms collected information and measurements prospectively. Results After reviewing the medical records of 5806 women, it was possible to identify those who had spontaneous preterm birth (SPTB), induced preterm birth (IPTB), or spontaneous term birth (STB). Women with IPTB (vs SPTB) were more obese and had higher education levels and household incomes; more had telephones and running water at home. They enrolled earlier and more developed hypertension and pre-eclampsia. Women with SPTB (vs STB) were less obese, shorter, had smaller arm circumferences and higher gravidities and Edinburgh Depression Scores, lower education, fewer telephones, and less running water at home. More women with SPTB used methamphetamine, cigarettes, and were heavier smokers. Conclusion SPTB and IPTB should not be conflated. Programs to reduce the high prevalence of SPTB should include improving education, lifestyle, and socioeconomic conditions. Addressing hypertension should help reduce preterm inductions.

Objectives: This study aimed to evaluate nutrition care and nursing professional knowledge received by adults on highly active antiretroviral therapy attending primary health care (PHC) facilitiesD...

The common principal components (CPC) model provides a way to model the population covariance matrices of several groups by assuming a common eigenvector structure. When appropriate, this model can provide covariance matrix estimators of which the elements have smaller standard errors than when using either the pooled covariance matrix or the per group unbiased sample covariance matrix estimators. In this paper, a regularised CPC estimator under the assumption of a common (or partially common) eigenvector structure in the populations is proposed. After estimation of the common eigenvectors using the Flury-Gautschi (or other) algorithm, the off-diagonal elements of the nearly diagonalised covariance matrices are shrunk towards zero and multiplied with the orthogonal common eigenvector matrix to obtain the regularised CPC covariance matrix estimates. The optimal shrinkage intensity per group can be estimated using cross-validation. The efficiency of these estimators compared to the pooled and unbiased estim...

OBJECTIVE To assess whether fetal foot length at autopsy could reliably indicate gestation duration at stillbirth and the effects of maceration on this method. METHODS The present cross-sectional secondary analysis was part of the Safe Passage Study; all Safe Passage Study participants who experienced a stillbirth at Tygerberg Academic Hospital, Cape Town, South Africa, between August 1, 2007, and January 31, 2015, were eligible to participate. After providing written informed consent for autopsy, the duration of gestation calculated using early ultrasonography and fetal foot length were compared. RESULTS There were 69 fetal autopsies included in the present study; placental histology was available for 65. Generally, the gestation length calculated from the first ultrasonography scan correlated well with that calculated from the fetal foot length (Spearman correlation=0.85). However, significant differences were found in the gestation lengths calculated when the fetus was macerated (P

Low and high plasma glutamine levels are associated with increased mortality. This study aimed to measure glutamine levels in critically ill patients admitted to the intensive care unit (ICU) , correlate the glutamine values with clinical outcomes, and identify proxy indicators of abnormal glutamine levels. Patients were enrolled from three ICUs in South Africa, provided they met the inclusion criteria. Clinical and biochemical data were collected. Plasma glutamine was categorized as low (&lt, 420 &micro, mol/L), normal (420&ndash, 700 &micro, mol/L), or high (&gt, mol/L). Three hundred and thirty patients (median age 46.8 years, 56.4% male) were enrolled (median APACHE II score) 18.0 and SOFA) score 7.0). On admission, 58.5% had low (median 299.5 &micro, mol/L) and 14.2% high (median 898.9 &micro, mol/L) plasma glutamine levels. Patients with a diagnosis of polytrauma and sepsis on ICU admission presented with the lowest, and those with liver failure had the highest glutamine levels. Admission low plasma glutamine was associated with higher APACHE II scores (p = 0.003), SOFA scores (p = 0.003), C-reactive protein (CRP) values (p &lt, 0.001), serum urea (p = 0.008), and serum creatinine (p = 0.023) and lower serum albumin (p &lt, 0.001). Low plasma glutamine was also associated with requiring mechanical ventilation and receiving nutritional support. However, it was not significantly associated with length of stay or mortality. ROC curve analysis revealed a CRP threshold value of 87.9 mg/L to be indicative of low plasma glutamine levels (area under the curve (AUC) 0.7, p &lt, 0.001). Fifty-nine percent of ICU patients had low plasma glutamine on admission, with significant differences found between diagnostic groupings. Markers of infection and disease severity were significant indicators of low plasma glutamine.

BACKGROUND: Aorta and carotid intima-media thickness (IMT) is a measure of subclinical atherosclerosis and useful to assess cardiometabolic risk in the young. The in utero milieu may involve cardiometabolic programing and the development of cardiometabolic risk factors in children. Maternal smoking, alcohol consumption, and micronutrient deficiencies during pregnancy influence the development of the cardiovascular system through a process of DNA methylation. AIM: To explore an association between maternal smoking and alcohol consumption during pregnancy and intima media thickness in 5-year-old children for a low-income setting. METHODS: Data were collected from 500 mother–child pairs at antenatal clinic visit, at birth, and at age 5 years. Anthropometric measurements were collected at birth and again at age 5 years. As well as clinical and ultrasound measurements at age 5 years. Clinical measurements, at age 5 years, included blood pressure, mean arterial pressure, and heart rate. Ultrasound measurements of the aorta and carotid arteries IMT were performed at age 5 years. Main outcome of interest was effect of dual teratogen exposure on the ultrasound measures IMT as indication of cardiometabolic risk. RESULTS: cIMT was significantly higher in children exposed to both alcohol and nicotine during pregnancy compared to those not exposed (p = .008). In separate linear models, dual in utero exposure (beta = 0.12; p = .01) and male sex (beta = 0.14; p = .01) were associated with higher right cIMT values (F(6,445) = 5.20; R(2) = 0.07, p < .01); male sex (beta = 0.13; p = .01) and low birth weight (beta = 0.07; p = .01) with higher left cIMT value (F(4,491) = 4.49; R(2) = 0.04; p = .01); and males sex (beta = 0.11; p = .02) with higher aorta IMT (F(6,459) = 5.63; R(2) = 0.07; p< .01). Significant positive correlations between maternal measures of adiposity, maternal MUAC (r = 0.10; p = .03), and maternal BMI (r = 0.12; p< .01) and right cIMT measurements adjusted for the BMI of the child at age 5 years as covariate. Blood pressure measurements at age 5 years were not significantly associated with IMT but, instead, correlated significantly and positively with the BMI of the child at age 5 years (p< .01). CONCLUSION: Children exposed to both maternal smoking and alcohol consumption during pregnancy presented with cardiometabolic risk factors 5 years after birth. In addition, maternal adiposity, male sex, and low birth weight were associated with higher IMT at age 5 years.

OBJECTIVE: To evaluate the association between birthweight and maternal heart rate (MHR) or heart rate variability (HRV) under resting conditions at 20–24 gestational weeks and 34 weeks or later (34+ weeks). METHODS: Data were retrospectively reviewed from the Safe Passage Study, a prospective longitudinal cohort study of alcohol use in pregnancy and birth outcomes in Cape Town, South Africa, between August 2007 and January 2015. Using custom-designed software, MHR and indicators of HRV were obtained from the recorded maternal electrocardiograms and compared with birthweight and z-scores of birthweight adjusted for gestation and gender. RESULTS: Data from 5655 women were included. MHR increased from 84.6 bpm at 20–24 weeks to 88.3 bpm at 34+ weeks. Increasing MHR from 70–80 to 80–90 and 90–100 bpm at 20–24–weeks was associated with increasing birthweight from 2940 to 2998 and 3032 g, respectively (P

Objective To examine the association of prenatal alcohol exposure (PAE) on cognitive abilities and behaviour profiles of 4-year-old children. Design Prospective cohort study. Setting Cape Town, South Africa. Population A cohort of 500 children. Methods Children from the Safe Passage Study, which prospectively collected PAE, were included. Cognition and behavioural profiles were assessed. Children with and without PAE were compared. Mean scores were compared, with P ≤ 0.05 considered significant. Results were adjusted for confounding factors. Main outcome measures The Kaufman Assessment Battery for children measured intellectual and mental ability; the NEPSY-II instrument assessed neurocognitive performance. The caregiver completed the Preschool Child Behaviour checklist to rate the child's problem behaviours and competencies. Results Two hundred children had no PAE, 117 children had mild to moderate PAE (with no binge episodes), 113 children had heavy PAE (with one or two binge episodes), and 70 children had very heavy PAE (with three or more binge episodes). Women who binge drank had significantly higher rates of smoking, marijuana use, and methamphetamine use. Low to moderate PAE had no effect on cognitive ability and behaviour. Very heavy PAE was associated with problems performing simultaneous as well as sequential functions, lower scores in the language and sensorimotor domain, and more attention and pervasive developmental problems. Conclusions Low to moderate PAE was not associated with cognitive processing or developmental problems. Women who had many binge drinking episodes during pregnancy were the most at risk for cognitive processing, neurocognitive, and behaviour problems in their children at 4 years of age. Tweetable abstract Low to moderate prenatal alcohol use was not associated with cognitive or behavioural problems in 4-year-olds.

For two or more populations of which the covariance matrices have a common set of eigenvectors, but different sets of eigenvalues, the common principal components (CPC) model is appropriate. Pepler et al. (2015) proposed a regularised CPC covariance matrix estimator and showed that this estimator outperforms the unbiased and pooled estimators in situations where the CPC model is applicable. This paper extends their work to the context of discriminant analysis for two groups, by plugging the regularised CPC estimator into the ordinary quadratic discriminant function. Monte Carlo simulation results show that CPC discriminant analysis offers significant improvements in misclassification error rates in certain situations, and at worst performs similar to ordinary quadratic and linear discriminant analysis. Based on these results, CPC discriminant analysis is recommended for situations where the sample size is small compared to the number of variables, in particular for cases where there is uncertainty about the population covariance matrix structures.

Background: Emphasis is currently placed on the importance of employee and student wellness initiatives. The aim was to assess staff and student health status at the Faculty of Medicine and Health Sciences (FMHS), Stellenbosch University (SU), and to conduct a wellness needs assessment.Methods: Online, self-administered questionnaires were used to collect data concerning staff and students. Additionally, students’ anthropometric and biochemical parameters were assessed. Summary statistics, correlation coefficients and appropriate analysis of variance were used for data analyses.Results: Data were obtained from staff (survey: n = 300) and students (screening: n = 536; survey: n = 330). Some 58% (n = 174) of staff had a self-reported BMI of ≥ 25 kg/m2 whilst mean screening values for all variables fell within normal reference ranges for students. In all, 78% (n = 232) of staff reported to exercise < 150 min/week and 28% (n = 91) of students were sedentary for > 8 h/day; 63% (n = 188) of staff expressed the need to make better food choices, 17% (n = 55) of students were aware of the need to change but experienced reluctance, and both staff and students felt dietary assistance would be beneficial (43% vs. 46%). In addition, 79% of staff (n = 208) and 42% of students (n = 138) reported being under constant pressure.Conclusion: Much can be done to improve the health and well-being of both staff and students at the FMHS, SU. Wellness is a multifactorial concept; as such, health-promotional strategies for classrooms and workplaces should consider all factors in order to provide a holistic approach and potentially identify those who are at risk of a sub-optimal wellness status.Keywords: health sciences, health screening, online survey, staff and student wellness

Objective To examine the effects of cigarette, marihuana and methamphetamine smoking and consumption of alcohol during pregnancy on maternal serum alpha-fetoprotein (MSAFP) levels at 20-24 weeks. Study design In the Safe Passage Study (SPS) more than 12,000 pregnant women were prospectively followed up during pregnancy and until the infant was one year old to examine the effects of exposure to alcohol during pregnancy on stillbirth and sudden infant death syndrome. The present study is a cross-sectional secondary analysis of MSAFP analyses done at 20-24 weeks gestation in 1,679 SPS participants, recruited at the Bishop Lavis Community Health Centre, Cape Town, South Arica. Results Low or moderate alcohol consumption with or without smoking, nor methamphetamine or marihuana use affected mean MSAFP levels. High MSAFP levels were associated with high alcohol consumption, young age, low body mass index (BMI) (

Aims This study aimed to explore the neuro-cognitive deficits of alcohol-induced psychotic disorder as compared to the cognitive deficits of uncomplicated alcohol dependence. Methods Participants were recruited from the acute psychiatric admission wards of the Department of Psychiatry, University of Stellenbosch and Stikland and Tygerberg Academic Hospitals in the Western-Cape, South Africa. Participants who met DSM IV TR criteria (American Psychiatric Association. Diagnostic and statistical manual of mental disorders. American Psychiatric Association, Washington, DC, 2000) for Alcohol Dependence and for alcohol-induced psychotic disorder, respectively, were included. Participants who met criteria for another current DSM IV TR Axis I disorder were excluded. A structured interview was done prior to neuropsychological assessment to ascertain current mental state and to obtain relevant demographic detail and history. Neuropsychological assessments were performed and supervised by clinical psychologists at either Tygerberg or Stikland Hospital. Results The groups were matched demographically with similar period of abstinence prior to assessment. The alcohol-induced psychotic disorder group experienced first psychotic symptoms at age 35. The results reflected statistically significant differences on tasks measuring immediate memory; recall upon delay; exaggeration of memory difficulty and abstract thinking. Conclusion This study concurs with earlier literature that some cognitive deficits are greater in alcohol-induced psychotic disorder compared to uncomplicated alcohol dependence.

Two new nonparametric common principal component model selection procedures based on bootstrap distributions of the vector correlations of all combinations of the eigenvectors from two groups are proposed. The performance of these methods is compared in a simulation study to the two parametric methods previously suggested by Flury in 1988, as well as modified versions of two nonparametric methods proposed by Klingenberg in 1996 and then by Klingenberg and McIntyre in 1998. The proposed bootstrap vector correlation distribution (BVD) method is shown to outperform all of the existing methods in most of the simulated situations considered.

The objective of this study was to examine the variation in and intercorrelation among wood properties determining the suitability of 16- to 20-year-old South African-grown Pinus patula trees for structural timber. A total of 1 112 sawn boards from 340 logs, 170 trees and 17 different compartments were examined. Sawlogs were taken from two height levels from each tree. The mean modulus of elasticity measured on edge (MOEedge) was far below, and the mean twist higher than the limits set for structural grade softwood timber in South Africa. All the desirable properties for structural timber improved with distance from the pith with the exception of the fifth percentile value for modulus of rupture (MOR), which was higher at the pith than for the boards processed adjacent to the pith. Boards processed from the lower part of the stem were superior in most of the important properties compared to the properties higher up in the stem. The correlation between the dynamic modulus of elasticity (MOEdyn) and MOR of ...

Background. Venous thromboembolism (VTE) is a common complication during and after hospitalisation, and is regarded as the most common cause of preventable death in hospitalised patients worldwide. Despite its importance, there are few data on VTE risk and adherence to prophylaxis prescription guidelines in surgical patients from the South African (SA) public sector, especially from low-resource environments such as Eastern Cape Province.Objectives. To evaluate the risk and prescription of VTE prophylaxis to surgical patients at a tertiary government hospital in the Eastern Cape.Methods. A cross-sectional clinical audit of general surgical inpatients was performed on two dates during July and August 2017. Patients’ VTE risk was calculated by using the Caprini risk assessment model (RAM) and thromboprophylaxis prescription evaluated accordingly.Results. A total of 179 patients were included in the study, of whom 56% were male and 44% female. The average age was 45 (range 18 - 83) years. Of the total number of participants, 33% were elective cases and 67% were emergency admissions. With application of RAM, 77% of patients were at risk of VTE (Caprini score ≥2), with 81% of elective and 74% of emergency patients being at risk. The most prevalent risk factors for VTE were major surgery (34%), age 41 - 60 years (30%), age 61 - 74 years (20%) and sepsis during the previous month (27%). A contraindication to chemoprophylaxis was recorded in 30% of patients, with the most prevalent being renal dysfunction (40%), peptic ulcer disease (34%), active bleeding (17%), liver dysfunction (17%), coagulopathy (6%) and recent cerebral haemorrhage (6%). With regard to VTE risk profile and contraindications to chemoprophylaxis, the correct thromboprophylactic treatment was prescribed to 26% of at-risk patients, with 21% of elective and 27% of emergency admission patients receiving the correct therapy.Conclusions. Despite a high proportion of patients being at risk of VTE, the rate of adequate thromboprophylaxis prescription for surgical inpatients at Frere Hospital, East London, SA is very low. Increased availability of mechanical prophylaxis, as well as interventions to improve the rate of adequate prophylaxis prescription, needs to be evaluated for feasibility and effect in this hospital and other SA public hospitals.

Moisture content (MC) gradient at the time of preservation plays a pivotal role in determining the success of the preservation process. The South African pole drying industry relies on auger drill sampling to determine whether the MC of dried poles is acceptable for preservative treatment. The objectives of this study were to determine: (i) the reliability and (ii) potential sources of errors of the auger drill MC sampling method on kiln dried E. grandis poles. Destructive oven-dry MC determination on sample blocks of 12.5 mm thickness and 25 mm width as the benchmark method and auger drill samples in increments of 25 mm were used to determine the MC gradient at the theoretical ground line (TGL) of poles. Results showed that the MC of 25 mm deep increment auger drill samples did not differ from those measured using the block method. However, there were differences between MC values measured using the auger drill and block methods when samples of 50 mm or 75 mm in length were considered. Differences in MC values measured after drying also occurred in parts of the poles where moisture was still high, i.e., above fibre saturation point. It was concluded that SANS 5983 (South African Bureau of Standards. Standard method for preparation of test specimens for moisture content determination in timber and timber products, 2008), which specifies taking single radial auger drill samples of depth 70±5 mm at mid length, is a reliable method for measuring MC in a kiln dried E. grandis pole. It is recommended that MC is determined in auger increments of 25 mm at the most critical zone of a pole, such as the TGL rather than mid length.

Non-destructive testing for drying defects in Eucalyptus grandis utility poles would be highly advantageous. These defects can negatively affect creosote preservative treatment and in-service performance. The objective of this study was to assess correlations between drying defects such as surface checking, honeycombing, collapse, their parameters and moisture content (MC) gradient in poles, to possibly find a simple and quick but reliable method to assess internal and external drying defects. Defects and moisture content gradients were measured in 39 kiln-dried E. grandis poles. After measuring surface check length, width and depth using a measuring tape, a ruler and a depth gauge, destructive sampling at the theoretical ground line (TGL) was done to measure the MC gradient between the shell and core of poles. Digital image analysis of cross-sections of discs cut at TGL was used to measure honeycomb check width, length and area, as well as counting individual closed surface checks. Collapse was assessed using qualitative methods. Results showed that honeycombing and collapse were positively, and surface checking and MC gradient were negatively correlated. Surface check width, length and depth were also correlated. Honeycomb count, check width, length and area were strongly correlated. It was concluded that measuring any of these surface check and/or honeycomb parameters may give meaningful deductions about the extent of surface checking and honeycombing respectively.

In specific cases, kiln drying prior to preservative treatment is the prescribed method of utility pole seasoning in South Africa. The slow drying nature of Eucalyptus grandis poles makes rapid kiln drying potentially detrimental due to development of defects such as excessive surface checking, honeycomb and collapse. To control these defects while maintaining the fastest drying rate possible, the effect of drying schedule on the drying quality of E. grandis poles was investigated. Full length pole drying was simulated in thirty 2.1 m long butt sections of poles of which the top ends were end sealed. Three industrially used schedules that differed in dry and wet bulb temperature and duration of drying (T db, T wb and time) were chosen: 80°C/59°C/8 days, 80°C/69°C/10 days and 70°C/59°C/12 days. Surface check length of each pole was measured after drying. Cross-sections cut at the theoretical ground line (TGL), 1.5 m from the butt end, were used to measure the moisture content (MC) gradient between the shell and core of poles. Digital image analysis of cross-sections of discs cut at TGL was used to measure the area of honeycomb and disc cross-section. Collapse was assessed qualitatively. With all three schedules, MC's in the pole cores at the end of drying were still very high. Some poles were above 25% in the outer 25 mm of the treatable zone. The 70°C/59°C/12 days schedule generated the highest surface check total length. A reduction in the wet bulb depression of the 80°C dry bulb schedules from 21 to 11°C, accompanied by a simultaneous increase in drying time, did not reduce honeycomb or collapse. With a wet bulb depression of 11°C, a slight reduction in honeycombing was observed when T db was reduced from 80 to 70°C. From this preliminary study it can be concluded that at 80°C T db, poles should be dried longer than 8 days and that T db's lower than 80°C should be considered to minimise potentially serious drying defects.

Eucalyptus grandis wood is susceptible to serious drying defects and all possible measures before and during kiln drying of poles need to be taken to minimize the defects. In order to identify factors that may affect drying quality of poles, the objective of this study was to assess relationships between surface check total length and depth, MC gradient, honeycomb percentage of pole cross section area, extent of collapse, sapwood depth, heartwood percentage of pole cross-sectional area, green MC and pole diameter. The defects were measured on 3 loads of 10 kiln-dried E. grandis poles, using a different drying schedule for each load. After measuring surface check length using a measuring tape and check depth using feeler gauges and a ruler, poles were cross cut at the theoretical ground line (TGL) 1.5 m from the butt end, to measure the MC gradient between the shell and core of poles. Digital image analysis of cross sections of discs cut at TGL was used to measure sapwood depth, and the areas of honeycomb, heartwood and disc cross section. Collapse was assessed using qualitative methods. Results showed that surface check total length was positively correlated with sapwood depth, and the average depth of surface checks was greater than the average sapwood depth. MC gradient between the shell and core was positively correlated with green MC while the transformed honeycomb percentage and collapse class were both positively correlated with heartwood percentage. It was concluded that pole drying defects are related to sapwood depth, green MC and heartwood percentage, and if pre-sorting of poles by these characteristics is done and appropriate kiln schedules are used, drying defects can be minimised.

An approximate degrees of freedom test is suggested for hypotheses of the kindH0:C′Φ1M=C′Φ2Min two independent multivariate linear models:Yi=Xi iΦi+εi,i=1, 2, under the assumption of error matrix variate normality and heteroscedasticity. It is shown for specific vector choices of the matricesCandMthat the test reduces to approximate degrees of freedom solutions obtained by Nel (1989), Nel and van der Merwe (1986) and Welch (1947) for simpler models.

BACKGROUND: The workforce of 'physician-scientists' is ageing and decreasing in numbers. The responsibility to combat this trend rests on future generations of healthcare professionals and it is therefore valuable to evaluate medical students' attitudes towards research. OBJECTIVE: To establish the attitudes of University of Cape Town (UCT) medical students towards research and to investigate the factors influencing these attitudes. METHODS: An anonymous, cross-sectional, self-administered questionnaire was administered to medical students from years 1 to 6 studying medicine at UCT in 2011. Questions were primarily closed-ended and consisted of Likert scales. RESULTS: Out of a population of 1 195 medical students, 733 were sampled (63%); 65% were female, 53% were preclinical students (years 1 - 3) and 47% were in their clinical years (year 4 - 6). Overall, 61% of students had a positive attitude towards research and 74% felt that participation in research was important to their medical school education; 22% had been involved in voluntarily extracurricular research, 4% had presented at a scientific meeting and 3% had published in peer-reviewed journals. A number of perceived barriers to student research were identified including a lack of adequate training, time and research opportunities. CONCLUSION: Students believed that research was important and had a positive attitude towards it. However, few had been involved in voluntary research and produced work worthy of presentation and/or publication. Addressing identified barriers and improving students' attitudes may begin to reverse the trend in declining numbers of physician-scientists.

With advancing technology it has become possible to accurately record and assess fetal heart rate (FHR) patterns from gestations as early as 20 weeks. The aim of our study was to describe early patterns of FHR, as recorded by transabdominal fetal electrocardiogram according to the Dawes-Redman criteria. Accordingly, short-term variability, basal heart rate, accelerations and decelerations were quantified at 20-24 weeks gestation among women with uncomplicated pregnancies.This study was conducted in a subset of participants enrolled in a large prospective pregnancy cohort study. Our final data set consisted of 281 recordings of women with good perinatal outcomes who had undergone fetal electrocardiographic assessment as part of the Safe Passage Study.The success rate of the recordings was 95.4%. The mean frequency of small and large accelerations was 0.5 and 0.1 per 10 min, respectively and that of small and large decelerations 0.3 and 0.008 per 10 min, respectively. The mean and basal heart rates were both equal to 148.0 bpm at a median gestation of 161 days. The mean short term variation was 6.2 (SD 1.4) ms and mean minute range 35.1 (SD 7.1) ms.The 20-24-week fetus demonstrates FHR patterns with more accelerations and decelerations, as well as higher baseline variability than was anticipated. Information from this study provides an important foundation for further, more detailed, studies of early FHR patterns.

Suppose that X is a p-variate random vector, measured in two populations, with mean vector μ j and covariance matrix ψ j in population j,j = 1, 2. In this article we study normal theory estimation of the parameters under the following constraints. It is assumed that (a) the covariance matrices have p identical eigenvectors, (b) in the coordinate system given by the common eigenvectors, only q < p of the means are different between groups, and (c) only the q eigenvalues associated with the same q common eigenvectors are different between groups. There are two main areas of application of these models: (a) in morphometric studies, particularly if size differences between groups are to be removed from the analysis, and (b) in testing for equality of mean vectors and covariance matrices, especially in situations where the number of variables p is large. For applications of type (b), we suggest a randomization test and compare its performance to the T 2 test and to the likelihood ratio test for equali...

Alcohol-induced psychotic disorder (AIPD) also known as alcohol hallucinosis is a rare complication of alcohol abuse. The pathogenesis and treatment of AIPD are still unclear. Few prospective treatment studies are available but case reports generally suggest that anti-psychotic treatment is effective. Brain imaging changes in relation to treatment response have also not been studied except for case reports. The aim of this study was to investigate the effect of anti-psychotic treatment on psychopathology and regional cerebral blood flow (rCBF) in patients with AIPD before and after 6 weeks of treatment. Nineteen patients with AIPD were assessed by the Positive and Negative Syndrome Scale (PANSS) and single photon emission computed tomography (SPECT) before and after 6-weeks of open-label treatment with a fixed dose of haloperidol (5 mg/day). Highly significant improvements were noted on the positive, general and total scores of the PANSS. Post-treatment increased rCBF to the left caudate and left frontal lobe was noted. Changes in frontal, temporal, parietal, occipital, thalamic and cerebellar rCBF showed significant negative correlations with the degree of symptom improvement, suggesting dysfunction of these areas in AIPD. Psychopathological and rCBF findings suggest reversible generalised cerebral dysfunction in AIPD.

Rural to urban migration to major cities in South Africa continues to lead to the proliferation of informal settlements. There is little recent published data on the epidemiology of adult burns in the Western Cape, South Africa. A retrospective review of patients on the Burn Unit database was undertaken, looking at patients admitted to the Burn Unit between January 2003 and December 2008. This study discusses the characteristics and outcome of patients who were treated at the Tygerburg Burn unit. A total of 1908 patients were admitted to the burn unit during the 6 year period under review. Most fatal injuries occurred in the 20-40 year age group. Injuries due to shack fires and fuel stoves comprised 21% (399) of all admissions. Mortality due to these injuries comprised 28% (137) of total mortality. Gas stoves accounted for 24% with kerosene stoves accounting for 71% of injuries. The burn death rate in this study (25%) was found to have increased dramatically from the last audit done from 1986 to 1995 in which a burn death rate of 7.5% was observed. Reasons for this are explored. It is likely that those with HIV/AIDS have poorer outcomes. Shack fires and injuries due to fuel stoves are a common reason for admission to the burn unit and mostly involve young male individuals. Other research from the Southern African region does not mention shack fires as a separate entity making it difficult to obtain an accurate idea of the scale of the problem. Their injuries are severe with a high mortality. The use of kerosene stoves are a major contributing factor. Recommendations include enforceable legislation to promote safer stove design, research into safer bio fuels and materials for building shacks as well promoting fire safety among schoolchildren in the community. Further research is needed to determine the impact of HIV/AIDS on the outcome of acute burns within the Southern African region.

Alcohol-induced psychotic disorder (AIPD) is a rare complication of excessive alcohol use for which limited comparative studies are available. The aim of this study was to prospectively investigate demographic and psychopathological characteristics in patients with AIPD, schizophrenia, and uncomplicated alcohol dependence. We postulated that AIPD is a discrete clinical entity that can be differentiated from schizophrenia and uncomplicated alcohol dependence by means of standardized clinical assessments.Twenty-eight patients with AIPD, 21 with schizophrenia and 20 with uncomplicated alcohol dependence were assessed using psychiatric rating scales, including the positive and Negative Syndrome Scale.Patients with AIPD had a significantly lower educational level, later onset of psychosis, higher levels of depressive and anxiety symptoms, fewer negative and disorganized symptoms, better insight and judgment, and less functional impairment compared with patients with schizophrenia.The study provides further supportive evidence that AIPD can be clinically distinguished from schizophrenia.

There is increasing evidence that obsessive-compulsive disorder (OCD) is a heterogeneous disorder. Different clinical subtypes may be characterized by differing pathophysiological mechanisms and treatment outcomes.A cluster analysis was performed on 45 items of the Yale-Brown Obsessive-Compulsive Symptoms Checklist (YBOCS-CL) for 261 patients with OCD. Cluster solutions emerging at different linkage distance levels, and the associations of identified clusters with demographic, clinical and relevant genetic variables, were investigated.A 6-cluster solution emerged at a linkage distance level of 1.5, and a 3-cluster solution emerged at a linkage distance level of 2.1. The 3 clusters in the latter solution were labeled I) Contamination / washing, II) Hoarding / symmetry / ordering, and III) Obsessional / checking. Increased Cluster III scores were associated with earlier age of OCD onset and the Met/Met (L/L) genotype of the COMT Val158Met polymorphism.The data here are consistent with previous work delineating the different symptom subtypes of OCD, also with previous work suggesting that the Met/Met (L/L) genotype of the COMT Val158Met polymorphism may be associated with anxiety symptoms, as well as with previous work suggesting that dopaminergic genes may be particularly important in early-onset OCD.

Lipoid proteinosis is a rare hereditary disease which often results in bilateral calcifications in the medial temporal region. Thirty-four adults living with lipoid proteinosis (>10% of the world population) were extensively assessed with standardized neuropsychiatric and neuropsychological measures. Of these, 27 patients representing a homogenous group living in the Northern Cape were matched with 47 controls. Subjects with lipoid proteinosis had a high incidence of neuropsychiatric disorders and performed poorly on facial recognition of positive and negative emotions and on many neuropsychological measures. These findings are consistent with involvement of the medial temporal areas in cognitive and emotive processing.

Background : Primates reared in captivity may display stereotypic behaviors. These behaviors are arguably reminiscent of human obsessive–compulsive or posttraumatic symptoms, which respond to selective serotonin reuptake inhibitors (SSRIs). Captive primates with marked stereotypic behaviors were entered into a randomized controlled study of the SSRI, fluoxetine. Methods : A sample of 10 vervet monkeys with behaviors such as marked saluting, somersaulting, weaving, or head tossing was selected. Subjects were randomized to receive fluoxetine 1 mg/kg for 6 weeks ( n =5) or no treatment ( n =5). A rater blind to the medication status of subjects noted the frequency of the stereotypic behaviors. Results : Repeated-measures analysis of variance (RM-ANOVA) demonstrated a significant Group×Time difference with significantly fewer stereotypic symptoms in the fluoxetine group by endpoint. At this time, three of the five fluoxetine-treated subjects (but none of the no-treatment subjects) were responders on the Clinical Global Impressions (CGI) change item (CGI ≤2). Conclusions : Stereotypic behaviors in captive vervets gradually and partially decrease in response to administration of an SSRI, paralleling research on human anxiety symptoms. Further research on animal stereotypies may be useful in providing appropriate veterinary care, and in exploring the underlying neurobiology of certain psychiatric disorders.

A new solution to the multivariate Behrens-Fisher problem due to Nel and Van der Merwe (1986), is used to find new so¬lutions to the profile analysis problem for two groups of p-variate commensurable responses from multinormal distribution with unequal covariance matrices.

Some new algebra on pattern and transition matrices is used to determine the degrees of freedom and the parameter matrix, if the distribution of a linear sum of Wishart matrices is approximated by a single Wishart distribution. This approximation is then used to find a solution to the multivariate Behrens-Fisher problem similar to the Welch (1947) solution in the univariate case.

The concept of a matric-t variate is extended to cases where the positive (definite) part of the variate, which is usually Wishart distributed independently of the normal part, is a linear sum of positive (definite) variates with positive coefficients. These distributions and their quadratic forms are of importance i.a, for the exact solution to the multi¬variate Behrens-Fisher problem. A few useful identities con¬cerning the invariant polynomials with matrix arguments are derived