Smoking patterns in the coloured population of the Cape Peninsula (CRISIC study)

A cross-sectional study of tobacco-smoking habits in a random sample of 976 coloured subjects aged 15-64 years revealed that smoking was common, 57% of men and 41% of women being current smokers and 10.4% of men and 9.6% of women having stopped smoking. Heavy smoking prevailed, indicating by mean daily consumption of 14.2 and 13.1 cigarettes among male and female smokers respectively; only 33.5% of male and 39.6% of female smokers used less than 10 cigarettes per day. Coloured smokers smoked more heavily during the weekend. Both men and women smoked mostly filter cigarettes. Forty-four per cent of male and 49.5% of female smokers stated that they had attempted to stop smoking, mainly for health reasons. More than one-third of the participants had a positive attitude to combating smoking, particularly those with an educational level higher than Standard 7. Former smokers and heavy smokers had a significantly higher prevalence of ischaemic heart disease than the other participants. Smoking was associated with a low body mass index, low high-density lipoprotein cholesterol levels, low socio-economic standing, high alcohol consumption and type A coronary-prone behaviour in men. In 1982 the economically active coloured population of the Cape Peninsula spent an estimated R36.2 million on cigarettes.     

Provision of immunisation--the Gazankulu experience

Following the outbreak of poliomyelitis in Gazankulu in 1982, the immunisation services in Gazankulu were thoroughly examined. As a result of this, a comprehensive immunisation policy for Gazankulu was accepted in November 1986. The broad aim of the policy is to provide effective immunisation to all Gazankulu residents against tuberculosis, diphtheria, pertussis, tetanus, poliomyelitis and measles. A specific objective is that by the end of 1987, 85% of under-5s should have been vaccinated against these six diseases and by the end of 1990 this percentage should be 97%. The detailed strategies to reach these objectives are highlighted. Within the framework of the objectives, the policy allows different areas to formulate individual strategies. Programme monitoring and community involvement are two crucial aspects of the policy and these are discussed in detail. The early successes and difficulities in implementing this policy are discussed.     

Just old age? A study of prostatism in general practice

This study examines the proposal made by urologists that prostatism should be treated at an earlier stage by surgical intervention. A review of the notes of all male patients over the age of 60 years in a general practice showed that 43% of patients with prostatism had developed either acute or chronic retention prior to surgery. A prospective enquiry was therefore performed which revealed that 6% of the study population had undisclosed marked prostatism and a further 14% had mild prostatism. It was concluded that opportunistic screening should be considered as a method for achieving the earlier and more elective treatment of prostatism.     

Health actions and disease patterns related to coronary heart disease in the coloured population of the Cape Peninsula

The health-related behaviour of the Cape Peninsula coloured population, which has been shown to have an adverse coronary heart disease (CHD) risk factor profile, is reported. Private medical services were used most often by participants: 54.1% and 51.6% of males and females respectively had made use of these services during the preceding year. Only 17.9% and 21.8% of males and females respectively had attended day hospitals during the year. Blood pressures were measured in 43.8% and 57.1% of male and female participants respectively during the year preceding the study. The results indicated the need for the measurement of blood pressure to determine the true prevalence of hypertension, since patient reporting of the condition was inaccurate. Attempts to give up smoking had been made by 44.4% of male and 47.1% of female smokers. About 75% of the participants were found to have hypercholesterolaemia, yet their knowledge of the prudent diet was poor and few reported appropriate dietary modifications to protect against CHD. Frequent reporting of hypercholesterolaemia, hypertension and constipation by the study population highlights the need for dietary education. Mortality rates (MRs) for CHD and cerebrovascular disease (CVD) for the coloured and the white populations were compared. In all age groups white males had higher MRs for CHD than coloured males, while coloured females older than 34 years had higher rates than their white counterparts. The coloured population had MRs for CVD that were higher than those of whites.     

Hypertension in a rural South African white population and the effect of antihypertensive treatment on the risk of coronary heart disease

The association between hypertension and coronary risk factors and the effect of antihypertensive treatment on coronary risk were investigated in rural South African whites aged 15-64 years. Almost 25% of men (range 1.9-46.6%) and almost 27% of women (2.1-56.2%) were hypertensive or being treated for hypertension; the prevalence increased with age, particularly among women. Only 25.8% of male and 43.4% of female hypertensives were being treated, and of these only 38% had controlled blood pressure. Hypertension was associated with a high serum total cholesterol level, a low high-density lipoprotein cholesterol level, a high body mass index, a high uric acid level, a high prevalence of coronary heart disease and, in men, high alcohol consumption. Treated hypertensives had a greater risk of coronary heart disease than untreated hypertensives. Men on beta-blockers had significantly lower high-density lipoprotein cholesterol levels than men not on treatment, while uric acid levels in both men and women on diuretics were higher than those of untreated hypertensives. Hypertension in the study population appears to be inadequately treated, and antihypertensive medication may impact adversely on metabolic risk factors. The goal of antihypertensive therapy should be a net reduction of coronary heart disease risk.     

L-arginine reverses the antinatriuretic effect of cyclosporin in renal transplant patients

BACKGROUND: Cyclosporin has been shown to facilitate renal vasoconstriction and to have an antinatriuretic effect. The existence of an interference of cyclosporin with the vasodilating properties of endothelium mediated by nitric oxide production could mediate these effects. On the other hand, the infusion of the nitric oxide precursor L-arginine has been shown to induce renal vasodilatation and to facilitate natriuresis in normal volunteers. We have investigated the renal effects of the administration of an infusion of L-arginine in renal transplant patients chronically treated with cyclosporin. To facilitate the analysis of the data the effects of the administration of a similar dose of cyclosporin on renal function during the infusion of a vehicle were also investigated during the administration of a vehicle of L-arginine. DESIGN: Ten male renal transplant patients, chronically treated with cyclosporin and with a stable renal function were studied during 2 consecutive days after the administration of the usual morning dose of cyclosporin. The first day they received an intravenous infusion of vehicle and the second the infusion of graded doses of L-arginine (50, 100, 150 mg/kg/h) during 3 consecutive h. RESULTS: The first day, after cyclosporin administration a significant fall (P < 0.01) was observed in natriuresis and kaliuresis in the absence of changes in renal plasma flow and glomerular filtration rate. After the administration of L-arginine significant (P < 0.01) increases of renal plasma flow, glomerular filtration rate, and natriuresis were seen. The increase in blood levels of cyclosporin after its administration did not differ between days 1 and 2. CONCLUSION: These results indicate that L-arginine facilitates renal vasodilatation and natriuresis in renal transplant patients. Furthermore, the observed increase in sodium excretion could indicate that L-arginine counteracts the antinatriuretic effect of cyclosporin.      

The relationship between dietary factors and serum cholesterol values in the coloured population of the Cape Peninsula

A cross-sectional study of 976 coloured subjects aged 15-64 years identified a population consuming a typical Western diet. Nutrient intake, determined by the 24-hour dietary recall method, reflected a diet high in fat (37% of total energy intake) and animal protein and a polyunsaturated/saturated fatty acid ratio of 0.85. Only 32.2% of men and 27.5% of women consumed a prudent diet (Keys score less than or equal to 28). The influence of this Western diet on serum total cholesterol (TC) levels was seen to be marked when participants with a high risk of developing coronary heart disease (CHD) were compared with those with a TC level putting them at low risk; the former consumed significantly more saturated fat and had a higher mean Keys score. Multiple linear regression analysis on TC levels of men identified six variables that explained 26.9% of the variation of TC. These were body mass index, age, the inverse of the polyunsaturated fat intake, saturated fat intake, polyunsaturated/saturated fat ratio and cholesterol intake. For women only three variables (age, the inverse of the polyunsaturated/saturated fat ratio, and body mass index) explained 30.2% of the variation of TC. Promotion of the prudent diet to lower TC levels of the coloured population of the Cape Peninsula is an increasingly urgent priority.     

Simple method for production of internal control DNA for Mycobacterium tuberculosis polymerase chain reaction assays.

A simple method for the production of internal control DNA for two well-established Mycobacterium tuberculosis polymerase chain reaction assays is described. The internal controls were produced from Mycobacterium kansasii DNA with the same primers but at a lower annealing temperature than that used in the standard assays. In both assays, therefore, the internal control DNA has the same primer-binding sequences at the target DNA. One-microgram quantities of internal control DNA which was not contaminated with target DNA could easily be produced by this method. The inclusion of the internal control in the reaction mixture did not affect the efficiency of amplification of the target DNA. The method is simple and rapid and should be adaptable to most M. tuberculosis polymerase chain reaction assays.