Browsing by Author "Steyn, K."

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    Doctors' attitudes and practices regarding smoking cessation during pregnancy
    (Health and Medical Publishing Group (HMPG), 2005-05) Everett, K.; Odendaal, H. J.; Steyn, K.
    Objective. To investigate the current smoking cessation practices and attitudes of doctors working in the public antenatal services, as well as their perceived barriers to addressing the issue in the context of routine care. Study design. The study was qualitative, consisting of 14 semi-structured, one-to-one interviews with doctors purposefully sampled from 5 public sector hospitals in Cape Town, South Africa. Results. The doctors in this study regarded HIV, poor nutrition, alcohol abuse and psychosocial stress as equal or higher risks to pregnant women than smoking. They tended to underestimate the magnitude of the risk of smoking during pregnancy. Doctors were unaware of the guidelines offering clinicians brief, structured approaches to smoking cessation counselling and were generally pessimistic that they could influence the smoking behaviour of pregnant women, especially poor, disadvantaged women who face multiple barriers to achieving health-enhancing behaviour. However, most doctors were concerned about improving their communication with pregnant women about smoking and open to adopting new approaches or tools that could assist them. Perceived barriers to providing smoking cessation interventions included a lack of counselling skills and educational resources, other pressing priorities, too little time, and the levels of stress currently experienced by doctors and midwives working in public sector hospitals as a result of dramatic staff and budget cuts. Conclusion. The study suggests that doctors working in the public sector antenatal services are not routinely addressing the issue of smoking during pregnancy or using effective methods to assist women to give up smoking. Doctors need convincing that smoking cessation interventions can be effective. The promotion and provision of evidence-based guidelines such as the Clinical Practice Guideline for Treating Tobacco Use and Dependence (Fiore, 2000), with minimal training, is a possible strategy for integrating smoking cessation interventions into routine antenatal care in South Africa.
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    Evidence insufficient to confirm the value of population screening for diabetes and hypertension in low- and-middle-income settings
    (Health & Medical Publishing Group, 2015) Durao, S.; Ajumobi, O.; Kredo, T.; Naude, C.; Levitt, N. S.; Steyn, K.; Bradshaw, D.; Young, T.
    To assess the evidence from systematic reviews on the effect on morbidity and mortality of blanket screening for hypertension or diabetes mellitus compared with targeted, opportunistic or no screening, we searched for relevant systematic reviews and conducted duplicate study selection, data extraction and quality appraisal. Results were summarised narratively. We included two completed reviews of moderate quality and one ongoing Cochrane review. In one completed review, general health checks had no effect on total morbidity or mortality or on healthcare services compared with no health checks. In the other, intensive hypertension screening methods were ineffective in increasing screening uptake or detecting new cases compared with less intensive methods. Both reviews included studies in high-income settings. There is insufficient evidence from currently available systematic reviews to confirm a beneficial effect of blanket screening for hypertension and/or diabetes compared with other types of screening methods in low- and middle-income settings. Scarce resources are being mobilised to implement mass screening intervention for diabetes and hypertension without adequate evidence of its effects. A systematic review is needed to assess clinical effectiveness, cost-effectiveness and overall impact on the health system of screening strategies, especially in low- and middle-income settings such as exist in South Africa. Robust evaluation of these outcomes would then be necessary to inform secondary prevention strategies.
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    Linkage disequilibrium between a marker on the low-density lipoprotein receptor and high cholesterol levels
    (Health & Medical Publishing Group, 1986-07) Brink, P. A.; Steyn, L. T.; Bester, A. J.; Steyn, K.
    We describe the presence of a linkage disequilibrium between high cholesterol levels in Afrikaner individuals and the common allele of the Pvu II restriction fragment polymorphism on the low-density lipoprotein (LDL) receptor gene. The frequencies of the common and the rare allele in a sample of the Afrikaner population were 0,654 and 0,346 (65 individuals) and 0,794 and 0,206 in the hypercholesterolaemic population (34 patients) (P < 0,05). This finding supports other evidence for a founder origin of the high frequency of familial hypercholesterolaemia among Afrikaners.