Browsing by Author "Volmink, Jimmy"
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- ItemAdvancing global health through cardiovascular research, mentorship, and capacity building : in memoriam, professor Bongani Mayosi (1967–2018)(BMC (part of Springer Nature), 2018-10-03) Nachega, Jean B.; Ntsekhe, Mpiko; Volmink, Jimmy; Thabane, LehanaENGLISH ABSTRACT: No abstract available
- ItemAfrican HIV/AIDS trials are more likely to report adequate allocation concealment and random generation than North American trials(Public Library of Science (PLOS), 2008-10) Siegfried, Nandi; Clarke, Michael; Volmink, Jimmy; Van der Merwe, LizeBackground: Adherence to good methodological quality is necessary to minimise bias in randomised conrolled trials (RCTs). Specific trial characteristics are associated with better trial quality, but no studies to date are specific to HIV/AIDS or African trials. We postulated that location may negatively impact on trial quality in regions where resources are scarce. Methods: 1) To compare the methodological quality of all HIV/AIDS RCTs conducted in Africa with a random sample of similar trials conducted in North America; 2) To assess whether location is predictive of trial quality. We searched MEDLINE, EMBASE, CENTRAL and LILACS. Eligible trials were 1) randomized, 2) evaluations of preventive or treatment interventions for HIV/AIDS, 3) reported before 2004, and 4) conducted wholly or partly (if multi-centred) in Africa or North America. We assessed adequacy of random generation, allocation concealment and masking of assessors. Using univariate and multivariate logistic regression analyses we evaluated the association between location (Africa versus North America) and these domains. Findings: The African search yielded 12,815 records, from which 80 trials were identified. The North American search yielded 13,158 records from which 785 trials were identified and a random sample of 114 selected for analysis. African trials were three times more likely than North American trials to report adequate allocation concealment (OR = 3.24; 95%CI: 1.59 to 6.59; p<0.01) and twice as likely to report adequate generation of the sequence (OR = 2.36; 95%CI: 1.20 to 4.67; p = 0.01), after adjusting for other confounding factors. Additional significant factors positively associated with quality were an a priori sample size power calculation, restricted randomization and inclusion of a flow diagram detailing attrition. We did not detect an association between location and outcome assessor masking. Conclusions: The higher quality of reporting of methodology in African trials is noteworthy. Most African trials are externally funded, and it is possible that stricter agency requirements when leading trials in other countries and greater experience and training of principal investigators of an international stature, may account for this difference. © 2008 Siegfried et al.
- ItemBeta-blockers and the treatment of hypertension : it is time to move on(Clinics Cardiv Publishing, 2007-12) Wiysonge, Charles Shey; Volmink, Jimmy; Opie, Lionel H.Existing solid scientific evidence with hard outcome data should be the basis for treatment guidelines, and where such evidence is lacking, we must invest in research. A case in point is the initiation of antihypertensive treatment with a beta-blocker. Beta-blockers are pharmacological agents that block the action of endogenous catecholamines on beta-adrenergic receptors, part of the sympathetic nervous system which mediates the ‘fight or flight’ response.
- Item‘Building on shaky ground’—challenges to and solutions for primary care guideline implementation in four provinces in South Africa : a qualitative study(BMJ Publishing, 2020-05) Kredo, Tamara; Cooper, Sara; Abrams, Amber Louise; Muller, Jocelyn; Schmidt, Bey-Marrié; Volmink, Jimmy; Atkins, SallaObjectives Clinical guidelines support evidence-informed quality patient care. Our study explored perspectives of South African subnational health managers regarding barriers to and enablers for implementation for all available primary care guidelines. Design: We used qualitative research methods, including semistructured, individual interviews and an interpretative perspective. Thematic content analysis was used to develop data categories and themes. Setting: We conducted research in four of nine South African provinces with diverse geographic, economic and health system arrangements (Eastern Cape, Western Cape, KwaZulu-Natal, Limpopo). South Africa is a middle-income country with high levels of inequality. The settings represented public sector rural and peri-urban health facilities. Participants: Twenty-two participants with provincial and district health management roles, that comprised implementation and/or training on primary care guidelines, were included. Results: Participants recommended urgent consideration of health system challenges, particularly financial constraints, impacting on access to the guidelines themselves and to medical equipment and supplies necessary to adhere to guidelines. They suggested that overcoming service delivery gaps requires strengthening of leadership, clarification of roles and enhanced accountability. Participants suggested that inadequate numbers of skilled clinical staff hampered guideline use and, ultimately, patient care. Quality assurance of training programmes for clinicians—particularly nurses—interdisciplinary training, and strengthening post-training mentorship were recommended. Furthermore, fit-for-purpose guideline implementation necessitates considering the unique settings of facilities, including local culture and geography. This requires guideline development to include guideline end users. Conclusions: Guidelines are one of the policy tools to achieve evidence-informed, cost-effective and universal healthcare. But, if not effectively implemented, they have no impact. Subnational health managers in poorly resourced settings suggested that shortcomings in the health system, along with poor consultation with end users, affect implementation. Short-term improvements are possible through increasing access to and training on guidelines. However, health system strengthening and recognition of socio-cultural–geographic diversity are prerequisites for context-appropriate evidence-informed practice.
- ItemThe burden of hypertension in sub-Saharan Africa : a four-country cross sectional study(BioMed Central, 2015) Guwatudde, David; Nankya-Mutyoba, Joan; Kalyesubula, Robert; Laurence, Carien; Adebamowo, Clement; Ajayi, IkeOluwapo; Bajunirwe, Francis; Njelekela, Marina; Chiwanga, Faraja S.; Reid, Todd; Volmink, Jimmy; Adami, Hans-Olov; Holmes, Michelle D.; Dalal, ShonaENGLISH SUMMARY : Background: Hypertension, the leading single cause of morbidity and mortality worldwide, is a growing publichealth problem in sub-Saharan Africa (SSA). Few studies have estimated and compared the burden of hypertension across different SSA populations. We conducted a cross-sectional analysis of blood pressure data collected through a cohort study in four SSA countries, to estimate the prevalence of pre-hypertension, the prevalence of hypertension,and to identify the factors associated with hypertension. Methods: Participants were from five different population groups defined by occupation and degree of urbanization, including rural and peri-urban residents in Uganda, school teachers in South Africa and Tanzania, and nurses in Nigeria. We used a standardized questionnaire to collect data on demographic and behavioral characteristics, injuries, and history of diagnoses of chronic diseases and mental health. We also made physical measurements (weight, height and blood pressure), as well as biochemical measurements; which followed standardized protocols across the country sites. Modified Poison regression modelling was used to estimate prevalence ratios (PR) as measures of association between potential risk factors and hypertension. Results: The overall age-standardized prevalence of hypertension among the 1216 participants was 25.9 %. Prevalence was highest among nurses with an age-standardized prevalence (ASP) of 25.8 %, followed by school teachers (ASP = 23.2 %), peri-urban residents (ASP = 20.5 %) and lowest among rural residents (ASP = 8.7 %). Only 50.0 % of participants with hypertension were aware of their raised blood pressure. The overall age-standardized prevalence of pre-hypertension was 21.0 %. Factors found to be associated with hypertension were: population group, older age, higher body mass index, higher fasting plasma glucose level, lower level of education, and tobacco use. Conclusions: The prevalence of hypertension and pre-hypertension are high, and differ by population group defined by occupation and degree of urbanization. Only half of the populations with hypertension are aware of their hypertension, indicating a high burden of undiagnosed and un-controlled high blood pressure in these populations.
- ItemThe Cameroon Mobile Phone SMS (CAMPS) trial : a protocol for a randomized controlled trial of mobile phone text messaging versus usual care for improving adherence to highly active anti-retroviral therapy(BioMed Central, 2011-01) Mbuagbaw, Lawrence; Thabane, Lahana; Ongolo-Zogo, Pierre; Lester, Richard T.; Mills, Edward; Volmink, Jimmy; Yondo, David; Essi, Marie Jose; Bonono-Momnougui, Renee-Cecile; Mba, Robert; Ndongo, Jean Serge; Nkoa, Francois C.; Ondoa, Henri AtanganaBackground: This trial aims at testing the efficacy of weekly reminder and motivational text messages, compared to usual care in improving adherence to Highly Active Antiretroviral Treatment in patients attending a clinic in Yaoundé, Cameroon. Methods and Design: This is a single-centered randomized controlled single-blinded trial. A central computer generated randomization list will be generated using random block sizes. Allocation will be determined by sequentially numbered sealed opaque envelopes. 198 participants will either receive the mobile phone text message or usual care. Our hypothesis is that weekly motivational text messages can improve adherence to Highly Active Antiretroviral Treatment and other clinical outcomes in the control group by acting as a reminder, a cue to action and opening communication channels. Data will be collected at baseline, three months and six months. A blinded program secretary will send out text messages and record delivery. Our primary outcomes are adherence measured by the visual analogue scale, self report, and pharmacy refill data. Our secondary outcomes are clinical: weight, body mass index, opportunistic infections, all cause mortality and retention; biological: Cluster Designation 4 count and viral load; and quality of life. Analysis will be by intention-to-treat. Covariates and subgroups will be taken into account. Discussion: This trial investigates the potential of SMS motivational reminders to improve adherence to Highly Active Antiretroviral Treatment in Cameroon. The intervention targets non-adherence due to forgetfulness and other forms of non-adherence. Trial Registration: Pan-African Clinical Trials Registry PACTR201011000261458 http://clinicaltrials.gov/ NCT01247181
- ItemCompliance of clinical trial registries with the World Health Organization minimum data set : a survey(BioMed Central, 2009-07) Moja, Lorenzo P.; Moschetti, Ivan; Nurbhai, Munira; Compagnoni, Anna; Liberati, Alessandro; Grimshaw, Jeremy M.; Chan, An-Wen; Dickersin, Kay; Krleza-Jeric, Karmela; Moher, David; Sim, Ida; Volmink, JimmyBackground: Since September 2005 the International Committee of Medical Journal Editors has required that trials be registered in accordance with the World Health Organization (WHO) minimum dataset, in order to be considered for publication. The objective is to evaluate registries' and individual trial records' compliance with the 2006 version of the WHO minimum data set. Methods: A retrospective evaluation of 21 online clinical trial registries (international, national, specialty, pharmaceutical industry and local) from April 2005 to February 2007 and a cross-sectional evaluation of a stratified random sample of 610 trial records from the 21 registries. Results: Among 11 registries that provided guidelines for registration, the median compliance with the WHO criteria were 14 out of 20 items (range 6 to 20). In the period April 2005–February 2007, six registries increased their compliance by six data items, on average. None of the local registry websites published guidelines on the trial data items required for registration. Slightly more than half (330/610; 54.1%, 95% CI 50.1% – 58.1%) of trial records completed the contact details criteria while 29.7% (181/610, 95% CI 26.1% – 33.5%) completed the key clinical and methodological data fields. Conclusion: While the launch of the WHO minimum data set seemed to positively influence registries with better standardisation of approaches, individual registry entries are largely incomplete. Initiatives to ensure quality assurance of registries and trial data should be encouraged. Peer reviewers and editors should scrutinise clinical trial registration records to ensure consistency with WHO's core content requirements when considering trial-related publications.
- ItemConducting a meta-ethnography of qualitative literature : lessons learnt(BioMed Central, 2008-04) Atkins, Salla; Lewin, Simon; Smith, Helen; Engel, Mark; Fretheim, Atle; Volmink, JimmyBackground: Qualitative synthesis has become more commonplace in recent years. Meta-ethnography is one of several methods for synthesising qualitative research and is being used increasingly within health care research. However, many aspects of the steps in the process remain ill-defined. Discussion: We utilized the seven stages of the synthesis process to synthesise qualitative research on adherence to tuberculosis treatment. In this paper we discuss the methodological and practical challenges faced; of particular note are the methods used in our synthesis, the additional steps that we found useful in clarifying the process, and the key methodological challenges encountered in implementing the meta-ethnographic approach. The challenges included shaping an appropriate question for the synthesis; identifying relevant studies; assessing the quality of the studies; and synthesising findings across a very large number of primary studies from different contexts and research traditions. We offer suggestions that may assist in undertaking meta-ethnographies in the future. Summary: Meta-ethnography is a useful method for synthesising qualitative research and for developing models that interpret findings across multiple studies. Despite its growing use in health research, further research is needed to address the wide range of methodological and epistemological questions raised by the approach.
- ItemConfronting the illusion of certainty : what has clinical epidemiology contributed?(Stellenbosch : University of Stellenbosch, 2006) Volmink, Jimmy
- ItemEconomic support to improve tuberculosis treatment outcomes in South Africa : a pragmatic cluster-randomized controlled trial(BioMed Central, 2013-05) Lutge, Elizabeth; Lewin, Simon; Volmink, Jimmy; Friedman, Irwin; Lombard, CarlAbstract Poverty undermines adherence to tuberculosis treatment. Economic support may both encourage and enable patients to complete treatment. In South Africa, which carries a high burden of tuberculosis, such support may improve the currently poor outcomes of patients on tuberculosis treatment. The aim of this study was to test the feasibility and effectiveness of delivering economic support to patients with pulmonary tuberculosis in a high-burden province of South Africa. Methods This was a pragmatic, unblinded, two-arm cluster-randomized controlled trial, where 20 public sector clinics acted as clusters. Patients with pulmonary tuberculosis in intervention clinics (n = 2,107) were offered a monthly voucher of ZAR120.00 (approximately US$15) until the completion of their treatment. Vouchers were redeemed at local shops for foodstuffs. Patients in control clinics (n = 1,984) received usual tuberculosis care. Results Intention to treat analysis showed a small but non-significant improvement in treatment success rates in intervention clinics (intervention 76.2%; control 70.7%; risk difference 5.6% (95% confidence interval: -1.2%, 12.3%), P = 0.107). Low fidelity to the intervention meant that 36.2% of eligible patients did not receive a voucher at all, 32.3% received a voucher for between one and three months and 31.5% received a voucher for four to eight months of treatment. There was a strong dose–response relationship between frequency of receipt of the voucher and treatment success (P <0.001). Conclusions Our pragmatic trial has shown that, in the real world setting of public sector clinics in South Africa, economic support to patients with tuberculosis does not significantly improve outcomes on treatment. However, the low fidelity to the delivery of our voucher meant that a third of eligible patients did not receive it. Among patients in intervention clinics who received the voucher at least once, treatment success rates were significantly improved. Further operational research is needed to explore how best to ensure the consistent and appropriate delivery of such support to those eligible to receive it. Trial registration Current Controlled Trials ISRCTN50689131
- ItemEconomic support to improve tuberculosis treatment outcomes in South Africa : a qualitative process evaluation of a cluster randomized controlled trial(BioMed Central, 2014-06) Lutge, Elizabeth; Lewin, Simon; Volmink, JimmyBackground Poverty undermines the adherence of patients to tuberculosis treatment. A pragmatic cluster randomized controlled trial was conducted to investigate the extent to which economic support in the form of a voucher would improve patients’ adherence to treatment, and their treatment outcomes. Although the trial showed a modest improvement in the treatment success rates of the intervention group, this was not statistically significant, due in part to the low fidelity to the trial intervention. A qualitative process evaluation, conducted in the final few months of the trial, explained some of the factors that contributed to this low fidelity. Methods In-depth interviews were conducted with patients who received vouchers, nurses in intervention clinics, personnel in shops who administered the vouchers, and managers of the TB Control Programme. These interviews were analyzed thematically. Results The low fidelity to the trial intervention can be explained by two main factors. The first was nurses’ tendency to ‘ration’ the vouchers, only giving them to the most needy of eligible patients and leaving out those eligible patients whom they felt were financially more comfortable. The second was logistical issues related to the administration of the voucher as vouchers were not always available for patients on their appointed clinic dates, necessitating further visits to the clinics which they were not always able to make. Conclusions This process evaluation identifies some of the most important factors that contributed to the results of this pragmatic trial. It highlights the value of process evaluations as tools to explain the results of randomized trials and emphasizes the importance of implementers as ‘street level bureaucrats’ who may profoundly affect the way an intervention is administered. Trial registration Current Controlled Trials ISRCTN50689131, registered 21 April 2009.The trial protocol is available at the following web address: http://www.hst.org.za/publications/study-protocol-economic-incentives-improving-clinical-outcomes-patients-tb-south-africa.
- ItemErrors in the completion of the death notification form(Health and Medical Publishing Group (HMPG), 2007-11) Burger, Elsie Helena; Van der Merwe, Lize; Volmink, JimmyObjectives. To determine the frequency of errors in the cause of death sequence and to assess the completeness of information recorded on death notification forms (DNFs). Design. A population-based descriptive study. Setting. All residents of two residential areas in the Cape Town metropole who died during the period 1 June 2003 to 31 May 2004. Methods. We examined DNFs for pre-specified major and minor errors, assessed potential predictors of major errors using multivariate analysis, and assessed the DNFs for completeness in terms of particulars of the deceased, the informant and the health professional certifying death. Results. 844 DNFs were evaluated. Errors were found in 91.7% (95% CI 89.7 - 93.4%) of DNFs, and 43.4% (95% CI 40.1 - 46.7%) had at least one major error, most commonly an illogical cause of death sequence. Factors that seemed to affect the frequency of major errors were the number of lines of the cause of death sequence that had been completed, the age, gender and area of residence of the deceased, and the type of facility where the DNF had been completed. Varying levels of completeness were found for different items of information with some questions such as the education, occupation, usual business and smoking history of deceased being largely ignored by health professionals. Conclusion. An unacceptably high proportion of DNFs in the greater Cape Town area contain errors sufficiently serious to affect the accuracy of cause of death coding. This has far-reaching implications for the reliability of mortality data in South Africa. Educational, managerial and administrative interventions are urgently needed to improve the standard of DNF completion.
- ItemEvidence-based African first aid guidelines and training materials(Public Library of Science (PLOS), 2011-07) Van de Velde, Stijn; De Buck, Emmy; Vandekerckhove, Philippe; Volmink, JimmyThis Health in Action report describes the African First Aid Materials project (AFAM, http://www.afam.redcross.be/). This project developed evidence-based guidelines on how basic first responders should be trained to manage emergency situations in an African context. The project also includes the development of training materials to support the implementation. The objective of this manuscript is to inform educators and health care professionals about these guidelines and training materials and to promote their use when developing first aid training programmes for sub-Saharan Africa.
- ItemFeasibility of a large cohort study in sub-Saharan Africa assessed through a four-country study(Co-Action Publishing, 2015-05-25) Dalal, Shona; Holmes, Michelle D.; Laurence, Carien; Bajunirwe, Francis; Guwatudde, David; Njelekela, Marina; Adebamowo, Clement; Nankya-Mutyoba, Joan; Chiwanga, Faraja S.; Volmink, Jimmy; Ajayi, Ikeoluwapo; Kalyesubula, Robert; Reid, Todd G.; Dockery, Douglas; Hemenway, David; Adami, Hans-OlovBackground: Large prospective epidemiologic studies are vital in determining disease etiology and forming national health policy. Yet, such studies do not exist in sub-Saharan Africa (SSA) notwithstanding the growing burden of chronic diseases. Objective: We explored the feasibility of establishing a large-scale multicountry prospective study at five sites in four sub-Saharan countries. Design: Based on country-specific considerations of feasibility, Nigeria enrolled health care professionals, South Africa and Tanzania enrolled teachers, and Uganda enrolled village residents at one rural and one periurban site each. All sites used a 6-month follow-up period but different approaches for data collection, namely standardized questionnaires filled out by participants or face-to-face interviews. Results: We enrolled 1415 participants from five sites (range 200489) with a median age of 41 years. Approximately half had access to clean-burning cooking fuel and 70% to piped drinking water, yet 92% had access to a mobile phone. The prevalence of chronic diseases was 49% among 45- to 54-year-olds and was dominated by hypertension (21.7% overall) ranging from 4.5 to 31.2% across sites and a serious injury in the past 12 months (12.4% overall). About 80% of participants indicated willingness to provide blood samples. At 6-month follow-up, 68% completed a questionnaire (45 to 96% across sites) with evidence that mobile phones were particularly useful. Conclusions: Our pilot study indicates that a large-scale prospective study in SSA is feasible, and the burden of chronic disease in SSA may already be substantial necessitating urgent etiologic research and primary prevention.
- ItemIncentives and enablers to improve adherence in tuberculosis(Cochrane, 2015-09-03) Wiysonge, Charles Shey Umaru; Lutge, Elizabeth E.; Knight, Stephen E.; Sinclair, David; Volmink, JimmyBackground: Patient adherence to medications, particularly for conditions requiring prolonged treatment such as tuberculosis (TB), is frequently less than ideal and can result in poor treatment outcomes. Material incentives to reward good behaviour and enablers to remove economic barriers to accessing care are sometimes given in the form of cash, vouchers, or food to improve adherence. Objectives: To evaluate the effects ofmaterial incentives and enablers in patients undergoing diagnostic testing, or receiving prophylactic or curative therapy, for TB.
- ItemInterventions for treating tuberculous pericarditis(John Wiley & Sons, Ltd. on behalf of The Cochrane Collaboration, 2017) Wiysonge, Charles S.; Ntsekhe, Mpiko; Thabane, Lehana; Volmink, Jimmy; Majombozi, Dumisani; Gumedze, Freedom; Pandie, Shaheen; Mayosi, Bongani M.Background: Tuberculous pericarditis – tuberculosis infection of the pericardial membrane (pericardium) covering the heart – is becoming more common. The infection can result in fluid around the heart or fibrosis of the pericardium, which can be fatal. Objectives: In people with tuberculous pericarditis, to evaluate the effects on death, life‐threatening conditions, and persistent disability of: 1. 6‐month antituberculous drug regimens compared with regimens of 9 months or more; 2. corticosteroids; 3. pericardial drainage; and 4. pericardiectomy. Search methods: We searched the Cochrane Infectious Diseases Group trials register (January 2005); the Cochrane Controlled Trials Register (Issue 4, 2004); MEDLINE (1966 to January 2005); EMBASE (1980 to January 2005); and checked the reference lists of existing reviews. We also contacted organizations and individuals working in the field. Selection criteria: Randomized and quasi‐randomized controlled trials of treatments for tuberculous pericarditis. Data collection and analysis: Two reviewers independently assessed trial quality and extracted data. Meta‐analysis using fixed effects models calculated summary statistics, provided there was no statistically significant heterogeneity, and expressed results as risk ratio. Study authors were contacted for additional information. Main results: Four trials met the inclusion criteria, with a total of 469 participants. Treatments tested were adjuvant steroids and surgical drainage. Two trials with a total of 383 participants tested adjuvant steroids in participants with suspected tuberculous pericarditis in the pre‐HIV era. Fewer participants died in the intervention group, but numbers were small (risk ratio [RR] 0.65; 95% confidence interval [CI] 0.36 to 1.16, n = 350). One small trial tested steroids in HIV positive participants with effusion showed a similar pattern (RR 0.50; 95% CI 0.19 to 1.28, n = 58). One trial examined open surgical drainage compared with conservative management, and showed surgery relieved cardiac tamponade. Authors' conclusions: Steroids could have important clinical benefits, but the trials published to date are too small to demonstrate an effect. This requires large placebo controlled trials. Subgroup analysis could explore whether effusion or fibrosis modify the effects. Therapeutic pericardiocentesis under local anaesthesia and pericardiectomy also require further evaluation.
- ItemInvestigating the association between diabetes mellitus, depression and psychological distress in a cohort of South African teachers(Health & Medical Publishing Group, 2015-11) Domingo, Abdul Kader; Asmal, Laila; Seedat, Soraya; Esterhuizen, Tonya M.; Laurence, Carien; Volmink, JimmyBackground. Diabetes mellitus (DM) may increase the risk of depression as a result of a sense of threat of debilitating complications or because of associated lifestyle changes. Depression may increase the risk of type 2 diabetes as a result of poor health behaviours. Objective. To determine the association between diabetes mellitus, depression and psychological distress in a cohort of South African (SA) teachers. Methods. Teachers from 111 public schools in the Metro South District of the Cape Metropolitan area, SA, were invited to participate in this study. The Center for Epidemiologic Studies Depression Scale (CES-D) and the Kessler Psychological Distress Scale (K10) were used to assess depression and psychological distress, respectively. A professional nurse completed a physical examination and collected blood for measurement of glucose, cholesterol and serum creatinine. Results. Of the 388 teachers who completed the questionnaires, 67.5% were female and the average age was 46.2 years (standard deviation 8.7). Psychological distress was identified in 28.1% of the cohort and depression in 15.5%, and 7.7% were found to fulfil criteria for DM. A diagnosis of DM was associated with an increased risk of depression (adjusted odds ratio (AOR) 3.90; 95% confidence interval (CI) 1.33 - 11.37) and psychological distress (AOR 3.62; 95% CI 1.31 - 10.00). Conclusion. The high prevalence of obesity and DM in this cohort of SA teachers is of concern. A diagnosis of DM was strongly associated with an increased risk of depression and psychological distress.
- ItemLow carbohydrate versus isoenergetic balanced diets for reducing weight and cardiovascular risk : a systematic review and meta-analysis(Public Library of Science, 2014-07) Naude, Celeste E.; Schoonees, Anel; Senekal, Marjanne; Young, Taryn; Garner, Paul; Volmink, JimmyAbstract Background: Some popular weight loss diets restricting carbohydrates (CHO) claim to be more effective, and have additional health benefits in preventing cardiovascular disease compared to balanced weight loss diets. Methods and Findings: We compared the effects of low CHO and isoenergetic balanced weight loss diets in overweight and obese adults assessed in randomised controlled trials (minimum follow-up of 12 weeks), and summarised the effects on weight, as well as cardiovascular and diabetes risk. Dietary criteria were derived from existing macronutrient recommendations. We searched Medline, EMBASE and CENTRAL (19 March 2014). Analysis was stratified by outcomes at 3–6 months and 1–2 years, and participants with diabetes were analysed separately. We evaluated dietary adherence and used GRADE to assess the quality of evidence. We calculated mean differences (MD) and performed random-effects metaanalysis. Nineteen trials were included (n = 3209); 3 had adequate allocation concealment. In non-diabetic participants, our analysis showed little or no difference in mean weight loss in the two groups at 3–6 months (MD 0.74 kg, 95%CI 21.49 to 0.01 kg; I2 = 53%; n = 1745, 14 trials; moderate quality evidence) and 1–2 years (MD 0.48 kg, 95%CI 21.44 kg to 0.49 kg; I2 = 12%; n = 1025; 7 trials, moderate quality evidence). Furthermore, little or no difference was detected at 3–6 months and 1–2 years for blood pressure, LDL, HDL and total cholesterol, triglycerides and fasting blood glucose (.914 participants). In diabetic participants, findings showed a similar pattern. Conclusions: Trials show weight loss in the short-term irrespective of whether the diet is low CHO or balanced. There is probably little or no difference in weight loss and changes in cardiovascular risk factors up to two years of follow-up when overweight and obese adults, with or without type 2 diabetes, are randomised to low CHO diets and isoenergetic balanced weight loss diets.
- ItemNational stakeholders’ perceptions of the processes that inform the development of national clinical practice guidelines for primary healthcare in South Africa(BioMed Central, 2018-07-31) Kredo, Tamara; Cooper, Sara; Abrams, Amber; Daniels, Karen; Volmink, Jimmy; Atkins, SallaBackground: There is increased international focus on improving the rigour of clinical practice guideline (CPG) development practices. However, few empirical studies on CPG development have been conducted in low- and middle-income countries. This paper explores national stakeholders’ perceptions of processes informing CPG development for primary healthcare in South Africa, focusing on both their aspirations and views of what is actually occurring. Methods: A qualitative study design was employed including individual interviews with 37 South African primary care CPG development role-players. Participants represented various disciplines, sectors and provinces. The data were analysed through thematic analysis and an interpretivist conceptual framework. Results: Strongly reflecting current international standards, participants identified six ‘aspirational’ processes that they thought should inform South African CPG development, as follows: (1) evidence; (2) stakeholder consultation; (3) transparency; (4) management of interests; (5) communication/co-ordination between CPG development groups; and (6) fit-for-context. While perceptions of a transition towards more robust processes was common, CPG development was seen to face ongoing challenges with regards to all six aspirational processes. Many challenges were attributed to inadequate financial and human resources, which were perceived to hinder capacity to undertake the necessary methodological work, respond to stakeholders’ feedback, and document and share decision-making processes. Challenges were also linked to a complex web of politics, power and interests. The CPG development arena was described as saturated with personal and financial interests, groups competing for authority over specific territories and unequal power dynamics which favour those with the time, resources and authority to make contributions. These were all perceived to affect efforts for transparency, collaboration and inclusivity in CPG development. Conclusion: While there is strong commitment amongst national stakeholders to advance CPG development processes, a mix of values, politics, power and capacity constraints pose significant challenges. Contrasting perspectives regarding managing interests and how best to adapt to within-country contexts requires further exploration. Dedicated resources for CPG development, standardised systems for managing conflicting interests, and the development of a political environment that fosters collaboration and more equitable inclusion within and between CPG development groups are needed. These initiatives may enhance CPG quality and acceptability, with associated positive impact on patient care.
- ItemNext generation clinical guidance for primary care in South Africa – credible, consistent and pragmatic(Public Library of Science, 2018-03-30) Machingaidze, Shingai; Grimmer, Karen; Louw, Quinette; Kredo, Tamara; Young, Taryn; Volmink, JimmyBackground: Agreed international development standards underpin high quality de novo clinical practice guidelines (CPGs). There is however, no international consensus on how high quality CPGs should ‘look’; or on whether high quality CPGs from one country can be viably implemented elsewhere. Writing de novo CPGs is generally resource-intensive and expensive, making this challenging in resource-poor environments. This paper proposes an alternative, efficient method of producing high quality CPGs in such circumstances, using existing CPGs layered by local knowledge, contexts and products. Methods: We undertook a mixed methods case study in South African (SA) primary healthcare (PHC), building on findings from four independent studies. These comprised an overview of international CPG activities; a rapid literature review on international CPG development practices; critical appraisal of 16 purposively-sampled SA PHC CPGs; and additional interrogation of these CPGs regarding how, why and for whom, they had been produced, and how they ‘looked’. Results: Despite a common aim to improve SA PHC healthcare practices, the included CPGs had different, unclear and inconsistent production processes, terminology and evidence presentation styles. None aligned with international quality standards. However many included innovative succinct guidance for end-users (which we classified as evidence-based summary recommendations, patient management tools or protocols). We developed a three-tiered model, a checklist and a glossary of common terms, for more efficient future production of better quality, contextually-relevant, locally-implementable SA PHC CPGs. Tier 1 involves transparent synthesis of existing high quality CPG recommendations; Tier 2 reflects local expertise to layer Tier 1 evidence with local contexts; and Tier 3 comprises tailored locally-relevant end-user guidance. Conclusion: Our model could be relevant for any resource-poor environment. It should reduce effort and costs in finding and synthesising available research evidence, whilst efficiently focusing scant resources on contextually-relevant evidence-based guidance, and implementation.