No description available.

To examine pancreatic volume (PV) changes among patients with different duration of type 2 diabetes and whether pancreatic atrophy was associated with loss of insulin secretory capacity. Methods. This cross-sectional study (203 patients with type 2 diabetes, 93 controls without diabetes) was conducted from January 2016 to December 2017. Patients with type 2 diabetes were divided into 3 groups: recently diagnosed (duration≤2 years), midterm (duration 3-9 years), and long term (duration≥10 years). All the patients were scanned with upper abdominal computerized tomography; PV was then calculated by an experienced technician. Absolute insulin deficiency was defined as fasting C-peptide<0.9 ng/mL. Results. Compared with PV (cm3) in the controls, the mean PV was similar in patients with recently diagnosed type 2 diabetes (68.8 versus 71.0, P=0.56) but significantly reduced in patients with midterm (68.8 versus 60.8, P<0.05) and long-term (68.8 versus 53.1, P<0.001) type 2 diabetes. A similar trend was observed for the PV index (PV adjusted for body surface area and body mass index). Furthermore, rates of pancreatic atrophy and absolute insulin deficiency increased with duration of diabetes. Multiple logistic regression analysis indicated that pancreatic atrophy was associated with higher likelihood of absolute insulin deficiency (odds ratio=4.47, 95%confidence interval=1.45-13.8). Conclusions. PV was reduced in those with midterm and long-term type 2 diabetes compared to individuals without type 2 diabetes. Overall, pancreatic atrophy was associated with the loss of insulin secretory capacity in patients with type 2 diabetes.

No description available.

No description available.

Background: Could heterosexual HIV transmission be a driver of HIV infections that occur in men who have sex with men (MSM)? Noting the disproportionately high HIV prevalence among MSM across a variety of settings, this subpopulation is often considered as sources of new infections, overlooking the possibility of HIV transmission from the heterosexual – general – population to MSM. Objective: To assess the relative contribution of heterosexual transmission of HIV for onwards transmission of HIV from one man to another. Method: An agent based model of heterosexual transmission of HIV in South Africa was extended to simulate the HIV epidemic among MSM from 1990 to 2012. The model included gay men (who only have sex with men), bisexual men (who have partners of both sexes) in addition to men who have sex with women. HIV prevalence and sexual behaviour data collected among MSM in South Africa served as calibration data. Results: The model estimated that 28.7% (IQR: 27.4-28.9%) of MSM were HIV positive in 2010. By simulating a counterfactual HIV epidemic in South Africa, where HIV only spreads via male-male sex, we observe a decline in HIV incidence occurring in MSM by 56% over the period of 1990-2010, relative to the historical reality of HIV spreading via heterosexual and male-male sex. Analogously, HIV prevalence among MSM in 2010 under the counterfactual scenario reached only 10.0% (IQR 2.8- 17.4%), substantially less than HIV prevalence estimates from samples of MSM in South Africa. Conclusion: Roughly half of the HIV infections among MSM in South Africa can be attributed to the high levels of HIV prevalence in the general population. Scale up of interventions to target high risk behaviours with male partners should dispel possible misconceptions of bisexually active or heterosexual MSM as lower risk partners, relative to those MSM in gay communities.

Background: Violence is one of the leading causes of morbidity and mortality in South Africa's Western Cape province. Recent efforts, both globally and locally, have focused on using emergency room surveillance systems to collect data on violent injuries and to use these data to inform comprehensive, sustainable interventions such as urban upgrading. Drawing on insights from criminology, these urban upgrading interventions have sought to use environmental design to ameliorate socio-ecological factors related to violence. Objective: To use injury surveillance data in order to describe the pattern of violent injuries presenting to health facilities in the communities of Khayelitsha and Nyanga and to assess the effect of the Violence Prevention through Urban Upgrading programme (VPUU) on risk of violent non-fatal injury in these two areas. Methods: We conducted a case-control study using data from a series of semi-annual rapid assessments to compare violent and non-violent injuries in adults presenting to five heath facilities in Khayelitsha and Nyanga between September 2013 and October 2015. Multivariable logistic regression was used to assess the risk of violent injury with respect to demographic and behavioural characteristics and exposure to the VPUU intervention. Results: Multivariable analysis of 1,753 complete cases revealed that living in a VPUU intervention area was protective against presentation for violent injury when controlling for other risk factors (OR=0.75, p=0.022). Age, gender, race, and alcohol consumption were also found to be significantly associated with presentation for violent injury. There was a statistically significant interaction effect between alcohol and gender; the association between alcohol consumption and violent injury was stronger in women than in men. Conclusion: This study highlights the demographic and behavioural factors associated with violent injury and provides preliminary evidence of the reduction of violent injury risk in VPUU intervention areas.

Includes bibliographical references (leaves 59-66). / Sexual risk behaviour is the underlying driving force of HIV transmission. The discovery and introduction of antiretroviral therapy (ART) has led to significant changes in the treatment and management of HIV, the benefits of which manifest as reduced viral load and consequently attenuated morbidity and mortality in HIV-infected individuals. As the benefits of ART are realized, prevention research is increasingly focusing on the sexual risk behaviour of subpopulations of HIV-infected individuals with known positive serostatus, who are at high risk of transmitting HIV. This study examines the levels of sexual risk behaviour of HIV-infected individuals seeking care across different service settings in Cape Town, South Africa. Furthermore, it seeks to understand the risk factors associated with sexual activity that could lead to secondary transmission.

Includes abstract. / Includes bibliographical references (leaves 69-72). / The objectives of the study is to estimate baseline characteristics, survival, and factors associated with mortality and losses to follow-up in patients on antiretroviral therapy (ART), and compare the periods before (early) and after (late) 3 months on treatment.

Includes bibliographical references (leaves 96-98). / This thesis examines the associations between self-reported hypertension diagnosis and Diagnostic and Statistical Manual of Mental Disorders 4th edition (DSM-IV) defined a) anxiety disorders b) depressive disorders and c) comorbid anxiety-depression, both lifetime and 12-month, adjusting for potential confounding variables.

Background: The management of hypertension according to the patient' s absolute risk of cardiovascular disease. rather than their blood pressure in isolation from other risk factors, is now widely advocated because it targets treatment at those with most to gain. In South Africa blood pressure is traditionally managed according to the patient's level of blood pressure. Main Objective: To identify the proportion of traditionally treated hypertensive patients who may benefit from cessation or intensification of treatment as judged by a risk-based approach to their management. Design: A cross sectional descriptive survey of patients and their medical records with assessment of absolute risk of cardiovascular disease using Framingham risk equations. Setting: Eight Clothing Industry Health Benefit Fund clinics in Cape Town, South Africa. Participants: 382 women and men, predominantly coloured, attending for the treatment of hypertension Main outcome measure: The proportions of patients in whom the predicted risk of a cardiovascular event within 5 years is less than 10% and those in whom the risk within five years is greater than 20%. Results: 65% of participants (CI 60 - 70%) were at less than 10% risk of a cardiovascular event in the next 5 years and 19% (Cl 15-23%) were at more than 20% risk of a cardiovascular event despite current treatment. 5% (CI 3.2-7.9%) were at greater than 20% risk of a cardiovascular event in the next 5 years having no previous history of a cardiovascular event. 14% (CI 10-17%) were at greater than 20% risk of a cardiovascular event in the next 5 years because of a previous history of a cardiovascular event. 1.3% (CI 0.4-3%) were at less than 10% risk of a cardiovascular event within the next 5 years, despite having a systolic blood pressure over 170mmHg. Conclusion: Assessment of the cardiovascular risk of patients treated for hypertension identifies those patients at most and least risk. Resources could therefore be targeted at those with the most to gain from treatment and the unwanted side effects of antihypertensive medication avoided in those at low risk. Almost two thirds of patients currently being treated for hypertension were at less than 10% risk of developing a cardiovascular event within the next 5 years. A trial of medication reduction or cessation in this group is justified and the resources could be redirected at those 5% whose risk remains very high despite current levels of treatment.