Age estimation from sternal ends of ribs by phase analysis in South African Blacks

The sternal ends of ribs are used in age determination of unknown adult remains. Standards for American populations have been described and tested. The method described by Işcan et al. is reviewed and compared with other age markers of the human skeleton. Three hundred and thirty-nine (265 male, 74 female) sternal ends of right fourth ribs, belonging to black individuals deceased in the Gauteng Province of South Africa, were collected during 1994, 1995, and 1996. Three South African investigators applied the existing method and found the repeatability among them acceptable, although the method was less accurate to predict age in this population. New phases with adjusted criteria and age ranges were developed specifically for the South African black population. A tendency toward delayed maturation was found, as well as a diversion of the appearance of female ribs perimenopausally. Future studies involving more individuals in the older age ranges, and females of all ages, could broaden the representativeness of these phases.

Change in common carotid artery diameter, distensibility and compliance in subjects with a recent history of impaired glucose tolerance: a 3-year follow-up study

OBJECTIVE

To assess the development of common carotid artery properties (diameter, distensibility and compliance) in a cohort of 140 subjects (mean age 65.8 years, SD 7.5 years) originally diagnosed as impaired glucose tolerant in a population-based study, and to explore determinants of changes observed.

DESIGN

An observational, longitudinal study over a 3-year-period.

METHODS

Vessel wall movement detector system based on ultrasonography, linear generalized estimating equations.

RESULTS

Carotid artery diameter rose from 6.87-7.02 mm (+ 2.2%, P<0.001). Distensibility decreased from 11.8 to 10.9 x 10-3 kPa-1 (-8.3%, P=0.009). Compliance decreased from 0.44-043 mm2 kPa-1 (P=0.17). Changes in blood pressure level were negatively associated with changes in distensibility and compliance. Baseline fasting glucose levels were positively associated with changes in diameter, while fasting insulin levels were negatively associated with changes in distensibility and compliance in men, but not in women.

CONCLUSIONS

In subjects with a recent history of impaired glucose tolerance, we observed an increase in carotid artery diameter and a decrease in distensibility. Change in blood pressure level and baseline fasting glucose and HbA1c levels were positively related to the increase in diameter. In men, but not in women, baseline fasting insulin levels were associated with an acceleration of these changes.

Osteometric variation in the humerus: sexual dimorphism in South Africans

There has been a surge of research on forensic anthropology in South Africa. Differences between the populations of this country and others are demonstrated in many studies. Yet, many forensic osteometric techniques based on other populations are still in use. The purpose of the present study is to develop an osteometric sex determination technique using the humerus. The sample is composed of skeletons of 104 whites and 88 blacks from the Dart and Pretoria collections. Six humeral dimensions were initially analyzed using stepwise discriminant function statistics. Humeral head diameter, deltoid tuberosity circumference and epicondylar breadth were individually calculated in order to make the technique usable for fragmented remains. The results indicated that the head and epicondylar diameters are the best in whites to differentiate sexes from each other, while head diameter and maximum length are best in blacks. Accuracy of correct classification was as high as 96% in whites and 95% in blacks. Crossvalidation provided the same accuracy as the original classification. These accuracy percentages are as high as those expected from the femur and tibia. Posterior probability, which measures the percent affiliation of the sample with its original sex group, was also mostly 80% or better. South African collections are ideal for osteometric analysis, because they are still growing in numbers with cross-sectional representatives from the country.

Sex steroids, insulin, and arterial stiffness in women and Men

Arterial stiffness may be influenced by sex steroids and insulin; the association with fasting insulin level may be stronger in women than in men. Therefore, we analyzed the effects of sex steroid administration on (1) arterial stiffness and (2) the relationship between fasting insulin level and arterial stiffness. Twelve male-to-female transsexuals were treated with ethinyl estradiol and cyproterone acetate, and 18 female-to-male transsexuals were treated with testosterone esters, with assessments made at baseline and after 4 and 12 months. Changes in distensibility and compliance coefficients (DC and CC, respectively) of the common carotid artery, femoral artery (FA), and brachial artery (BA) were analyzed in relation to changes in fasting plasma levels of glucose, insulin, HDL-cholesterol, and triglycerides. After 4 months of estrogens and antiandrogens in men, significant reductions in the CC and DC of the FA (P=0.006 and P=0.04, respectively) and BA (P=0.04 and P=0.04, respectively) were observed. In women, testosterone, on average, did not affect DC or CC, but the changes in fasting insulin level were strongly negatively associated with changes in the CC and DC, especially in the FA and BA. These associations were significantly less strong in genetic men and were independent of age, mean arterial pressure, and glucose and lipid levels. This experimental study shows (1) that short-term administration of estrogens and antiandrogens increases FA and BA stiffness in men and (2) that the fasting insulin level is a stronger determinant of arterial stiffness in women than in men.

Familial hyperhomocysteinaemia and endothelium-dependent vasodilatation and arterial distensibility of large arteries

OBJECTIVES

Mild hyperhomocysteinaemia, fasting as well as after a methionine load, occurs in families and is associated with premature atherosclerosis. We hypothesised that endothelial dysfunction plays a role in the relation between hyperhomocysteinaemia and clinical vascular disease.

METHODS

In this study flow-mediated, endothelium-dependent vasodilatation of the brachial artery and, as a marker of biophysical changes of the vessel wall such as increased smooth muscle cell tone or collagen formation, arterial distensibility of the common carotid artery were investigated in 123 healthy first-degree relatives of patients with mild hyperhomocysteinaemia and coronary, cerebral or peripheral artery disease.

RESULTS

In multiple linear regression analyses, the increase in the homocysteine concentration after a standard methionine load was a significant determinant of an impaired flow-mediated vasodilatation of the brachial artery (measured on a separate day). The only other predictors were the baseline vessel diameter and age. Fasting homocysteine level was not associated with flow-mediated vasodilatation in the brachial artery. There was no relationship between homocysteine levels and nitroglycerine-induced, endothelium-independent vasodilatation of the brachial artery. Arterial distensibility of the carotid artery was also not related to homocysteine levels.

CONCLUSIONS

In healthy first-degree relatives of patients with mild hyperhomocysteinaemia, the increase in homocysteine level after a methionine load is an independent predictor of endothelial dysfunction. The results also suggest that fasting and post-methionine homocysteine levels may reflect distinct disturbances in methionine metabolism, which may be linked to vascular dysfunction through distinct mechanisms.

The use of a rating instrument to teach and assess communication skills of health-care workers in a clinic in the Western Cape

Research in health communication shows communication to be an important aspect of successful health-care. Moreover, training courses which provide feedback have been shown to improve health professionals' ability to conduct successful interviews. This article describes a rating instrument which was developed in order to facilitate teaching and assessing the communication aspects of health-care interviews. The instrument was found to be useful in a training programme offered to nursing staff of a TB Clinic in Mitchells Plain, Western Cape. The instrument appears as Table 1. In the Table categories of communication behaviours, each indicating an important aspect of the interaction, are given as the six headings. These are: establishing rapport and respect listening receptively confirming the patient sharing control informing effectively and checking perceptions. Within each category the more detailed specific behaviours are listed, allowing for close analysis of a care-giver's interviewing skill. The article briefly discusses the importance in effective communication between the care-giver and patient of each category of behaviours given in the instrument, supported by evidence from research. Lastly the article describes a "case study" on how the instrument has been successfully used in a training programme.

Craniometric determination of population affinity in South Africans

A vital aspect of skeletal analysis is the determination of population affinity of an unknown individual. The aim of this paper is to develop discriminant function formulae to determine race from craniometric dimensions of South African blacks and whites. Skeletons used in this study came from the Universities of the Witwatersrand and Pretoria. The sample is composed of 53 white males and 53 white females and 45 black males and 45 black females. Using 13 standard cranial and 4 mandibular dimensions, average accuracies of 98% were obtained from the crania, which were much more discriminatory than the mandibles (74% males, 87% females). When a "leave-one-out classification" technique was applied to the sample to measure accuracy of multivariate classification, this accuracy was about the same as obtained from the multivariate function. A posterior probability of 0.80 or more was found in as much as 96% of the sample. Stepwise discriminant function formulae for incomplete remains (vault and face) were also derived. Prediction accuracy was considerably lower when North American based formulae were tested on the South Africans, indicating significant craniometric differences between these populations.

Sexual dimorphism in the crania and mandibles of South African whites

Numerous studies have clearly demonstrated that skeletal characteristics vary by population. To date, there are no metric cranial criteria for South African whites. Therefore, the purpose of this study is to establish population specific standards for sex determination from the skull. A total of 12 standard cranial and five mandibular measurements were taken from 44 male and 47 female skeletons of known sex and race from the Pretoria and Dart collections. These were subjected to SPSS discriminant function analysis. Bizygomatic breadth was the most dimorphic dimension. Five functions were developed from the complete cranium, vault, face, mandible and bizygomatic breadth. Dimensions from the complete cranium provided the best accuracy. In the mandible, bigonial breadth was the most dimorphic of the measurements taken. Average accuracies ranged from 80% (bizygomatic breadth alone) to 86% (cranium). These accuracies are similar to those obtained by researchers on other groups (e.g., 84% in Japanese crania and about 86% in American whites and blacks). Diagnostic accuracy, however, is lower than that obtained from the South African femur and tibia.

Correlation among total lymphocyte count, absolute CD4+ count, and CD4+ percentage in a group of HIV-1-infected South African patients

Depletion of CD4+ T cells is one of the hallmarks of progression of HIV-1 infection. However, measurement of the CD4+ T-cell count is expensive and often unavailable in less developed areas. Previous studies have suggested that the total lymphocyte count (TLC) can be used to predict a low absolute CD4+ T-cell count. To determine the relationship between TLC and CD4+ T-cell count in HIV-1-infected South African patients, 2777 HIV-1-seropositive patients visiting the Immunology clinic at the Pelonomi Hospital in Bloemfontein, South Africa from April 1991 to April 1997 were included in the study. In total, 3237 observations were used to determine sensitivity, specificity, and likelihood ratios, with 95% confidence intervals, of various cutpoints of the TLC to predict an absolute CD4+ T-cell count of <200 cells/mm3, CD4+ percentage <20%, and CD4+ percentage <15%. Spearman rank correlations were calculated between TLC and CD4+ T cells, CD4+ percentage and CD8+ T cells, as well as between CD4+ and CD8+ T cells. Results demonstrated that a TLC of 2 x 10(9)/L or less had a sensitivity of 90.3% to detect patients with a CD4+ T-cell count of <200 cells/mm3, but a specificity of only 53.7%. When the TLC cutoff value was lowered, specificity increased but sensitivity decreased. For the observations as a group, a correlation (r = 0.704) between CD4+ T-cell count and TLC was demonstrated, but if the patients were divided into three groups according to their CD4+ T-cell count, this correlation weakened considerably. Therefore, although TLC shows a correlation with CD4+ T-cell count, it is not a good predictor of the CD4+ T-cell count in this population and should preferably not be used in the clinical care of HIV/AIDS patients.

Endothelium-dependent vasodilatation is impaired in peritoneal dialysis patients

BACKGROUND

Peritoneal dialysis (PD) patients have a high risk of cardiovascular mortality, which is not completely explained by conventional risk factors. Other factors related to chronic renal failure and/or dialysis treatment might lead to endothelial dysfunction, which is associated with an adverse cardiovascular outcome. One such factor is hyperhomocysteinaemia, which has a high prevalence in PD patients.

METHODS

A vessel wall movement detector system was used to investigate endothelium-dependent, flow-mediated, and endothelium-independent, glyceryl trinitrate-induced, vasodilatation of the brachial artery in 29 PD patients and 29 control subjects.

RESULTS

Endothelium-dependent vasodilatation was markedly reduced in the PD group: 5.7 +/- 1.0% vs 10.4 +/- 1.3% in the control group (P = 0.004). Endothelium-independent vasodilatation was not impaired. Plasma total homocysteine was elevated in the PD patients (45.2 +/- 6.2 micromol/l), but was not related to endothelium-dependent vasodilatation.

CONCLUSION

Chronic peritoneal dialysis patients have impaired endothelium-dependent vasodilatation, which may reflect an increased susceptibility for the development of atherosclerosis and thrombosis.

Sex determination from the femur and tibia in South African whites

With the current high incidence of violent crimes in South Africa, it has become very important to be able to determine the sex of individuals from their skeletal remains. The aim of this study is to provide standards usable for this purpose, to be used on the contemporary South African white population. Very little skeletal data is available for this group. Osteometric information was obtained from 56 male and 50 female individuals from cadaver collections. Six femoral and seven tibial measurements were taken, and subjected to SPSS discriminant function analysis. The distal breadths from both the femur and tibia provided the best discrimination. Formulae were developed for a number of combinations of measurements, which can be used to determine the sex on fragmentary remains. Average accuracies ranged from 86% to 91%, with female accuracies slightly higher than those of the males. The results of this study compares well with others, e.g., those from American whites.

Twelve-year results of the Coronary Risk Factor Study (CORIS)

BACKGROUND

After 4 years a coronary heart disease risk factor intervention programme produced equally large and significantly reduced risk profiles in two intervention towns compared with a control town. Intervention effects through community participation were assessed after cessation of the active intervention programme. The impact of secular trends was assessed in the control town and in two previously unstudied towns.

METHODS

Cross-sectional surveys were done in a random sample of 1620 participants aged 15-64 years in the three original towns 12 years after the initial quasi-experimental study. Two years later 327 subjects, aged 35-44 years, were studied in the original control town and in two non-intervention towns. Risk factor knowledge, smoking and medical histories were determined by questionnaire. Blood pressure, anthropometry and blood lipids were recorded. Data were compared across towns, and with previous surveys.

RESULTS

At 12 years the low intensity intervention town maintained a significantly better risk factor profile than the control town, while the high intensity intervention town now matched the control town. No differences in risk factor profiles were found between the control town and the two new towns. Deaths from coronary heart disease and strokes showed a downward trend in the study area.

CONCLUSIONS

Outcome suggests large ongoing secular trends during the study could have overtaken the intervention effects in the high intensity town, but not in the low intensity intervention town, which showed an advantage over the control town. These results support the effectiveness of media-based, long term health promotion strategies to reduce cardiovascular disease risk profiles.

Communication with TB patients; a neglected dimension of effective treatment?

Previous research has shown that patients who are satisfied with their interactions with a health provider tend to adhere to treatment. This study sets out to investigate the quality of the communication in the interactions between clinic nurses at a Western Cape clinic and newly notified tuberculosis patients. Routine interviews between clinic nurses and tuberculosis patients were video-recorded, transcribed and analysed, using a qualitative instrument devised by the researchers. The interactions were evaluated as being essentially nurse-centred; there was an unequal distribution of control, poor receptivity to the patient and little confirmation of the patient. The nursing staff received a period of training in communication skills. After this training their interviews with patients revealed a significant shift towards a more patient-centred approach, resulting in mutual satisfaction of nurse and patient. Training in communication skills should be introduced at TB clinics, in order to improve patients' adherence to therapy.

Estimation of the prevalence of familial hypercholesterolaemia in a rural Afrikaner community by direct screening for three Afrikaner founder low density lipoprotein receptor gene mutations

We have determined the prevalence of familial hypercholesterolaemia (FH) in a rural Afrikaner community by means of direct DNA screening for three founder-related Afrikaner low density lipoprotein (LDL) receptor gene mutations. A random sample of 1612 persons, aged 15-64 years, was selected as a subsample of 4583 subjects from an Afrikaner community living in the south-western Cape, South Africa. Participants who had a total serum cholesterol (TC) in the high TC category as defined in the consensus recommendations by the Southern African Heart Foundation, were screened for three founder-related LDL receptor gene mutations, causing FH in 90% of Afrikaners. Of the subsample, 201 participants (12.5%) had TC levels above the 80th percentile. In this group the combined prevalence of the three common Afrikaner LDL receptor gene defects (D206E, FH Afrikaner-1; V408M, FH Afrikaner-2; D154N, FH Afrikaner-3) was calculated as 1: 83. When taking into account the reported background prevalence of other FH gene defects of 1:500 in this community, their overall prevalence of FH was estimated to be 1:72. The significant differences found between the FH patients and other high risk patients with raised cholesterol levels were higher TC and LDL cholesterol levels and lower high density lipoprotein cholesterol levels in FH patients. The treatment status of the molecularly identified FH patients and other hypercholesterolaemic persons suggests that this condition is inadequately diagnosed and poorly managed in this study population. An extrapolation to the entire South African population suggests that there are about 112000 FH patients in the country who are under-diagnosed as a group and therefore not receiving the care that would help to reduce the burden of FH-associated ischaemic heart disease in South Africa.

Skeletal growth of children from the Iron Age site at K2 (South Africa)

Cross-sectional growth data were obtained from the skeletal remains of children from the Iron Age site of K2 near the Limpopo River. Standard measurements of the diaphyseal lengths of the long bones from both limbs were recorded and compared to published skeletal data. For this purpose, data on Eskimo and Aleut skeletons, Libben skeletons, and skeletons from Indian Knoll and Altenerding were used. An attempt to study growth allometrically was made. K2 children were growing as well as children from these other groups. Comparison of data for K2 children with those on living South African "Cape Coloured" rural children, studied during the late 1980s, shows the similarity of growth of both groups.

Preliminary report on the paleodemography of the K2 and Mapungubwe populations (South Africa)

Paleodemographic studies have seldom been attempted in sub-Saharan Africa. The Mapungubwe complex of sites in northern Transvaal (A.D. 970-1200) has yielded enough skeletal material to warrant such an investigation. The skeletal collection consists of 109 individuals (97 from K2 and 12 from Mapungubwe itself). Because the sites are extensive and their complete excavation impractical, only reconstruction of the population dynamics, not the population size, was possible. There were 81 child and juvenile skeletons (below 15 years of age) and 7 male, 5 female, 4 possible male, and 4 possible female adult skeletons. Eight adult skeletons were too fragmentary to warrant even tentative sex diagnoses. Either age-specific burial practices resulting in the surplus of child skeletons, unusual child mortality, or a state of substantial natural increase must be the explanation for this age distribution. The hypothesis of the natural increase can be partly tested by using an appropriate correction to the life table. The life table corrected for r = 2.5% has a newborn life expectancy of 18.93 +/- 1.79 years and a survivorship to 15 years of 41.66% +/- 3.91. The population pyramid derived from this life table compares well with data on some third world populations observed earlier this century. The fertility rate required to maintain the natural increase under such mortality conditions is high but comparable to that of some historical populations. High positive natural increase would indicate an economically successful population.

The intervention effects of a community-based hypertension control programme in two rural South African towns: the CORIS Study

The objective of the hypertension programme of the Coronary Risk Factor Study (CORIS) was to evaluate the effectiveness of the first 4 years of community-based intervention. The hypertension intervention model comprised a blood pressure station where the whole population was screened for hypertension, non-drug management was provided and hypertensives were monitored after referral to general practitioners for drug therapy. Two levels of intervention were maintained: in the high-intensity intervention town (N = 2,278) hypertensives were actively followed up, and in the low-intensity intervention town (N = 2,620) no active follow-up procedure existed. A third town acted as control (N = 2,290). In the cohort which was hypertensive at baseline, the net decreases in systolic blood pressure (mean +/- SE) after correction for changes in the control town were 0.5 +/- 2.2 mmHg (men) and 4.5 +/- 2.2 mmHg (women) in the low-intensity intervention town, and 5.6 +/- 2.3 mmHg (men) and 7.5 +/- 2.2 mmHg (women) in the high-intensity intervention town. The net decrease in diastolic blood pressure was 3.4 +/- 1.2 mmHg (men) and 4.4 +/- 1.1 mmHg (women) in the low-intensity intervention town, and 6.1 +/- 1.2 mmHg (men) and 5.9 +/- 1.1 mmHg (women) in the high-intensity intervention town. These reductions were statistically significant with one exception. The changes in the total population in the 3 communities after 4 years of intervention were similar to those found in the hypertensive cohort.(ABSTRACT TRUNCATED AT 250 WORDS)

Community-based intervention: the Coronary Risk Factor Study (CORIS)

The Coronary Risk Factor Study (CORIS) examined the feasibility and effectiveness of a multifactorial community intervention programme to reduce coronary heart disease (CHD) risk factor levels. Three Afrikaner communities were surveyed before and after a 4-year intervention in two of the communities, the third serving as a control (C). Intervention was primarily by small mass media (low-intensity intervention, LII) or by small mass media plus interpersonal intervention to high-risk individuals (high-intensity intervention, HII). After allowing for change in C, significant net reductions in blood pressure, smoking, and risk score were obtained in LII and HII alike. Though the total cholesterol (TC) fell by 10-12%, there was no net reduction in favour of the intervention communities. However, LII and HII resulted in significant increases in high-density lipoprotein cholesterol (HDL-C) levels and HDL-C/TC ratios in comparison to C. Overall, the LII community fared almost as well as the HII community, and high-risk individuals did not show a greater change in risk factors than others. We conclude that community-based intervention works, and that in these particular communities a media-based health education programme was more cost-effective than one which adds a greater degree of interpersonal intervention.

Trends in cranial capacity and cranial index in Subsaharan Africa during the Holocene

Craniometric data have been collected from published and unpublished reports of numerous authors on 961 male and 439 female crania from various sites in Subsaharan Africa spanning the last 100 ka. All data available in the literature, irrespective of their "racial" affinities, were used to cover the prehistoric and early historic times (up to 400 a BP). Samples covering the last 400 years do not include European colonists and consist of skeletons exavated at archeological sites, collected by early European travelers and derived from anatomical collections. Cranial capacity, depending on the mode of its calculation, has decreased by 95-165 cm³ among males and by 74-106 cm³ among females between the Late Stone Age (30-2 ka BP) and modern times (last 200 years). Values of the cranial index did not show any trend over time and their averages remained in the dolichocephalic category. The decrease in cranial capacity in Subsaharan Africa is similar to that previously found in Europe, West Asia, and North Africa, but, unlike the latter, it is not accompanied by brachycephalization. © 1993 Wiley-Liss, Inc.

Multiple intracavitary cardiac masses; an uncommon presentation of African Burkitt's lymphoma

A 29-yr-old patient is described, who presented with rapid general deterioration and right heart failure. Two-dimensional echocardiography revealed massive intracardiac tumor involving the right atrium, the right ventricle and the left atrium. At histology the diagnosis of Burkitt's lymphoma was made. This report presents what we believe to be the first case of a patient with primary cardiac manifestations and multiple intracardiac masses in this disease.

Sinbelewenis van die dwelmmiddelafhanklike pasiënt

This study turns to determine how the drug dependant patient subjectively experiences his purpose in life, as well as establishing guide-lines for activating an experience of a life with a purpose during the rehabilitation programme of the drug dependant patient.

[Perception of life's meaning by drug-dependent patients]

This study aims to determine how the drug dependent patient subjectively experiences his purpose in life, as well as establishing guide-lines for activating an experience of a life with a purpose during the rehabilitation programme of the drug dependent patient. A qualitative model of research using an explorative and descriptive contextual study was used. By using a non-probable convenience selection method, 15 voluntary drug dependent patients were defined as units of analysis in order to determine the extent of their subjective experience of their purpose in life, using a semi-structured interview with the help of the "Purpose in life Test". The units of analysis complied with the criteria for drug dependency and were studied within the given context, i.e. the short term unit inside the hospital environment. Data obtained, after completing the instrument of measurement, was processed using the point allocation system of the attitude scale in the first section, a coding and frequency analysis of important words in the second section, and the phenomenological method of Giorgi in the third section. The results indicated that 14 out of the 15 units of analysis experienced their purpose in life as weak. From these results a programme for the activating of purpose in life experience was proposed and implemented on a single drug dependent patient who was selected as a case study. The data obtained during the presentation of the programme consist of summaries made by the therapist during the course of each session, and independent evaluations of the therapist and the patient.

The aqueductus vestibuli--a morphological study

The morphology of the aqueductus vestibuli enjoys considerable attention as it may possibly play a role in the cause of Ménière's disease. In this study, silicone rubber casts of human temporal bones were used, and the aqueductus vestibuli was then measured by means of a reflection microscope. By this method the morphometry of the aqueductus vestibuli was determined accurately.

Change in knowledge in a coronary heart disease risk factor intervention study in three communities

We investigated health and diet knowledge as it relates to coronary heart disease (CHD) in three rural areas which participated in a community-oriented CHD risk factor intervention study. Knowledge of risk factors (risk knowledge) was fairly satisfactory at baseline, but diet knowledge was poor. Males, the young, and individuals with a lower level of education had less knowledge. Intervention consisted of a 3-year small mass media programme in one community (low-intensity intervention, LII), additional interpersonal intervention to high-risk individuals in the second (high-intensity intervention, HII), and no intervention in the control community (C). In the cohorts, with the baseline survey and the follow-up study 4 years apart, knowledge improved by 8.1% points in males (7.5% in females) in the HII community and by 7.1% (6.5%) in the LII community, compared to 5.5% (4.8%) in the C community (P less than 0.01). Diet knowledge improved more than risk knowledge, and individuals with lower initial scores benefitted most. Female scored highest. Educational level made a modest positive contribution to knowledge gain, after adjusting for differences in baseline knowledge. High-risk individuals did not have better knowledge at baseline, nor did they gain more from the intervention. We conclude that community intervention over a 4 year period, based on community diagnosis and tailored to the community's needs, can improve health knowledge.

The snacking habits of white preschool children

Three-day estimated dietary records were kept for 194 white 3- and 4-year-old children to determine and evaluate the extent, nature and quality of their snacking. All but 1 child ate between meals, with morning and afternoon snacking being favoured in terms of frequency and quantity. Soft drinks were consumed most frequently, followed by fresh fruits and fruit juices, sweets and chocolates, milk and sugar. Between-meal eating contributed more than one-third of the average day's energy and approximately one-quarter of most vitamins and minerals to the children's diets. Foods eaten between meals were, however, significantly less nutrient-dense than mealtime foods. Non-basic foods supplied more energy to the diet than any of the five basic food groups, but minimal quantities of micronutrients. Sugar consumption, mostly in the form of sugary foods and drinks, was high, but was not consumed exclusively between meals. Such children should be encouraged to make more use of basic commodities, particularly when snacking.

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.

The combating of tuberculosis: health perceptions, intentions and vaccination of children

This study was part of a comprehensive research project undertaken at the request of the SANTA Health Education Committee to evaluate the tuberculosis guidance programme. The aim of the research was to examine factors influencing black people's health perceptions and intentions concerning the combating of tuberculosis as well as vaccination of their children. Data were collected by means of a questionnaire based on the Health Belief Model. The research was conducted in selected areas of the OFS, the Transvaal and Natal (N = 1,198). It was found that factors indicating a greater degree of development of the individual (e.g. literacy) were positively associated with positive health perceptions such as that medical treatment can cure TB completely. Some positive associations were also found between perceptions/modifying factors and intentions/vaccination. Indications were also found of an inability on the part of health personnel to influence the public positively.

An evaluation of two guidance programmes to promote breast-feeding

During the past ten years a comprehensive research project has been undertaken to develop a guidance programme in three adjacent communities in the South-Western Cape with the aim of lowering the high incidence of coronary heart disease. The purpose of this substudy was to determine whether the guidance provided in the different communities had any influence on the knowledge of and attitudes towards the nutrition of pregnant women, babies and infants as well as breast-feeding practices of the women who gave birth during the period 1980 to 1986. In the first community guidance was provided by means of small mass media and interpersonal communication whereas only the small mass media were employed in the second. The third served as the control community. The findings suggest that the combined interpersonal and mass media programme was more successful than the mass media programme alone.

Media use and preference related to coronary heart disease of the coloured population of the Cape Peninsula. The CRISIC study

As a part of a comprehensive coronary risk factor study among the coloured population of the Cape Peninsula (the CRISIC study), the media use and preference of the population were examined with a view to suggesting appropriate media for conveying health messages. A stratified sample (N = 976) was randomly drawn from the coloured population in the age group 15 to 64 years in the Cape Peninsula. Data were collected by means of a pre-tested questionnaire. Analysis of the data showed that information on the prevention of heart disease was obtained in greater measure from the mass media than from interpersonal communication. As far as media preference is concerned, television was considered the most effective medium factor conveying information to the community, followed by instruction given to school children. Greater use of health educators to convey health messages, as well as a multi-media approach, is suggested for a successful intervention programme.

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.

The relationship between alcohol consumption and coronary risk factors in the CORIS Study

The cross-sectional relationship between reported alcohol consumption and coronary risk factors was investigated in the three-community Coronary Risk Factor Study (CORIS) population, consisting of 7,188 participants. Among drinkers of both sexes, the lowest level of systolic and diastolic blood pressure, serum cholesterol, tobacco use, body mass index, total daily energy expenditure, uric acid and Bortner score were found at the lower end of the alcohol consumption range. Non-drinkers had higher mean values for most of these risk factors than light drinkers. An increase in alcohol consumption was associated with a progressive increase in almost all the risk factors. Although men used more alcohol than women, at comparable alcohol consumption levels women generally had lower levels of risk factors than men.

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.

Relationship between coronary-prone (type A) behaviour and other coronary risk factors in the coloured population of the Cape Peninsula

In this investigation, conducted among 976 adult coloureds living in the Cape Peninsula, emphasis was placed on the relationship between type A (coronary-prone) behaviour and a number of other coronary risk factors (hypertension, hypercholesterolaemia, overweight and cigarette smoking), as well as certain demographic variables (age, occupational group and level of education). There was a fairly even distribution between high and low type A behaviour scores for both sexes in the groups aged 15 - 54 years, whereas there were proportionally fewer high than low scores in people between 55 and 64 years old. Housewives generally had lower scores than working women and other women who were not economically active. Both male and female respondents with high type A scores recorded on average higher systolic blood pressure readings. Type A men also smoked more than others. It appears that type A behaviour is mainly independent of other coronary risk factors.

Coronary risk factors in the coloured population of the Cape Peninsula

A cross-sectional study of risk factors for coronary heart disease (CHD) in a random sample of 976 coloured people revealed a population greatly at risk of CHD. The major reversible risk factors--hypercholesterolaemia, hypertension and smoking--were very common, with 56% of the men and 40% of the women smoking, 18% of both men and women being hypertensive and 17% of both sexes being hypercholesterolaemic. At high cut-off points 62,8% of the men and 59,4% of the women had at least one major reversible risk factor. At lower but real levels of risk, over 80% of the population was affected. Other risk factors such as inactivity, overweight, hyperuricaemia, hypertriglyceridaemia and a positive family history of CHD were all common in this population group. A 'protective' high-density lipoprotein cholesterol level of greater than or equal to 20% of the total serum cholesterol level was found in 74,5% of the men and 81,1% of the women. A comparison with available data on other South African population risk profiles shows marked differences. The need for preventive strategies in the coloured population is clear.

Toxic aspergilli from pistachio nuts

Pistachio nut samples taken during various stages of development from orchards in Iran, showed that contamination with fungi occurred mainly during the later stages of nut development. Members of the genera Aspergillus and Penicillium occurred most frequently. Of the Aspergilli, the species A. niger, A. flavus and A. fischeri var. spinosus occurred most frequently, followed by A. terreus, A. tamarii and A. nidulans. Twenty-two isolates comprising 13 species were tested for toxicity to ducklings. Isolates of known toxic fungi included A. flavus, A. niger, A. parasiticus, A. ochraceus, A. versicolor, A. nidulans and A. terreus. The toxicity of A. fischeri var. spinosus is reported. Chemical analysis showed that all isolates of A. flavus and A. parasiticus produced aflatoxin B1, the isolates of A. versicolor and A. nidulans produced sterigmatocystin while the toxic isolate of A. ochraceus did not produce ochratoxins.

Isolation and purification of moniliformin

A bulk purification procedure is described for moniliformin, a mycotoxin produced by Fusarium moniliforme. The method involves methanol extraction of suitably molded maize, aqueous extraction of the methanol-free residue, ion exchange chromatography with a NaCl concentration gradient, desalination, and crystallization. A pKa value of 1.70 as well as molar absorptivities of 19100 (lambda (H2O) max 229 nm), 5600 (lambda (H2O) max 260 nm), and 4700 (lambda (MeOH) max 260 nm) L/mole/cm are reported for moniliformin.

New species of Aspergillus producing sterigmatocystin

A number of species belonging to the genus Aspergillus were evaluated for their toxicity to ducklings and the ability to produce sterigmatocystin. Three new species capable of producing sterigmatocystin were found, namely, Aspergillus aurantio-brunneus, Aspergillus quadrilineatus, and Aspergillus ustus. All three were toxic to ducklings. The production of sterigmatocystin by Aspergillus rugulosus was confirmed, and the toxicity of Aspergillus stellatus and Aspergillus multicolor is described.

Production of sterigmatocystin by Aspergillus versicolor and Bipolaris sorokiniana on semisynthetic liquid and solid media

Higher yields of sterigmatocystin were obtained with Aspergillus versicolor than with Bipolaris sorokiniana both in liquid and on solid media. The optimum temperature for sterigmatocystin production by A. versicolor was 27 to 29 degrees C and 23 degrees C for B. sorokiniana. In liquid shake cultures, production of sterigmatocystin by B. sorokiniana was negligible, whereas maximal production by A. versicolor was 210 mg/liter. On solid substrates, the highest yields (8 g/kg) were obtained with A. versicolor on still cultures of whole corn supplemented with Soytone.

Production of sterigmatocystin

A procedure for the isolation of pure sterigmatocystin is described. It involves cultivation of an appropriate fungus on sterile maize, and extraction and column chromatographic purification of the crude extract. With this method sterigmatocystin may be obtained at a fraction of its commercial cost. Aspergillus versicolor seemed to be the best producer (5-12 g/kg) in 250 ml Erlenmeyer flasks. The yield dropped markedly with increasing flask size.