Timing, rates, and causes of death in a large South African tuberculosis programme.

Background: Tuberculosis (TB) mortality remains high across sub-Saharan Africa despite integration of TB and HIV/ART programmes. To inform programme design and service delivery, we estimated mortality by time from starting TB treatment.

Methods: Routinely collected data on TB treatment, vital status, and the timing and causes of death, were linked to cardio-respiratory autopsy data, from 1995-2008, from a cohort of male platinum miners in South Africa.

Quantifying errors in the estimation of tuberculosis mortality in a population of South African miners.

Background: All-cause mortality, based on national tuberculosis programme (NTP) register deaths, may under- or overestimate tuberculosis (TB) specific mortality in the population.

Objective: To assess the factors influencing this measurement in a single large population with high TB prevalence and mortality.

Methods: Routinely collected data on TB cases and treatment outcomes were linked to population data from a cohort of South African miners from 1995 to 2008.

The impact of HIV, an antiretroviral programme and tuberculosis on mortality in South African platinum miners, 1992-2010.

Background: HIV and tuberculosis (TB) are the most common causes of death in South Africa. Antiretroviral therapy (ART) programmes should have had an impact on mortality rates. This study describes the impact of HIV, a Wellness (HIV/ART) programme and TB on population-wide trends in mortality and causes of death among South African platinum miners, from before the HIV epidemic into the ART era.

Unnatural deaths in South African platinum miners, 1992-2008.

Background: The mortality rate from unnatural deaths for South Africa is nearly double the world average. Reliable data are limited by inaccurate and incomplete ascertainment of specific causes of unnatural death. This study describes trends in causes of unnatural death between 1992 and 2008 in a cohort of South African miners.

Missed opportunities in TB diagnosis: a TB process-based performance review tool to evaluate and improve clinical care.

Background: Traditional tuberculosis (TB) treatment outcome measures, such as cure rate, do not provide insight into the underlying reasons for missing clinical targets. We evaluated a TB Process-Based Performance Review (TB-PBPR) tool, developed to identify "missed opportunities" for timely and accurate diagnosis of TB. The tool enables performance assessment at the level of process and quality of care.

Association of isoniazid preventive therapy with lower early mortality in individuals on antiretroviral therapy in a workplace programme.

Objective: To describe the association between isoniazid preventive therapy (IPT) and mortality among individuals starting antiretroviral therapy (ART) in a workplace programme in South Africa where tuberculosis (TB) incidence is very high.

Methods: ART-naive individuals starting ART from January 2004 to December 2007 were followed for up to 12 months. Deaths were ascertained from clinic and human resource data.

Assessment of reliability of lung function screening programs or longitudinal studies.

The aim was to determine reliability of lung function measurements performed according to recommendations of the American Thoracic Society (ATS) at a screening program in a large South African gold mine and to determine the usefulness of the reliability coefficient G for monitoring the reliability of lung function measurements in a mass screening program. The reliability coefficient G estimates the amount of random error of measurement, relative to the total variation in a measurement. The coefficient G was calculated as a correlation coefficient between two consecutive lung function tests performed within 6 mo, over a period of 43 mo on 3,378 miners.

Interaction of HLA phenotype and exposure intensity in sensitization to complex platinum salts.

The development of sensitization to inhaled allergens is determined by the interaction of multiple genetic and environmental influences. Occupational sensitization to low-molecular-weight chemicals allows a specific immunological response to an inhaled hapten to be studied in a well-defined population with characterized exposure. We investigated the workforce of a large platinum refinery exposed to ammonium hexachloroplatinate (ACP) to test the hypothesis that the development of IgE-associated sensitization to ACP was influenced by human leukocyte-associated antigen (HLA) phenotype, especially in those with lower ACP exposure.

Allergy to complex salts of platinum in refinery workers: prospective evaluations of IgE and Phadiatop status.

Background: Experience has shown some variation in the associations between IgE, atopy, and sensitization to platinum salts. Clarification of these associations, and the value of the parameters in predicting and diagnosing sensitization of workers at risk, required prospective investigation.

Objectives: Evaluation of total IgE and Phadiatop(R) status to establish baseline values, and changes during employment, predictive or associated with subsequent platinum salt sensitization.

Health effects of passive smoking in adolescent children.

Objective And Design: To study the effects of passive smoking on health in adolescent schoolchildren by questionnaire, spirometry and laboratory investigations.

Setting: Two schools in the Vanderbijlpark area.

Participants: Seven hundred and twenty-six high-school children of average age 16 years.

Platinum salt sensitivity in refinery workers: incidence and effects of smoking and exposure.

Objective: To measure the incidence of platinum salt sensitivity (PSS) in refinery workers and examine the influence of cigarette smoking and exposure to platinum salts on sensitisation.

Design: A prospective cohort study with examination of workers at quarterly intervals for 18 months, and again at 24 months.

Setting: A South African primary platinum refinery.

Exercise, regardless of induced bronchoconstriction or inspired air conditions, does not alter airway reactivity.

The effects of exercise on asthmatic airway caliber are well recognized. Only a few studies, however, evaluated the effects of prior exercise on asthmatic airway reactivity. Eight asthmatic children (ages 10 to 16 years; mean, 12) performed histamine inhalation tests on three occasions assigned in random order: (1) control; (2) 40 to 60 min after exercise (6 min ergometer cycling) done while breathing cold dry (CD) air (temperature = -13 degrees C, relative humidity = 0 percent); and (3) 40 to 60 min after exercise done while breathing warm humid (WH) air (temperature = 33 degrees C, relative humidity = 100 percent).

Thalassemia: lung function with reference to iron studies and reactive oxidant status.

Pulmonary function tests were performed in 15 thalassemic patients (age 5 years 8 months to 18 years 6 months), receiving both regular transfusions and desferrioxamine, to determine the presence and nature of any abnormalities in lung function. Reactive oxidant production from neutrophils was measured simultaneously to ascertain if a causal relationship existed between free radical production and tissue damage in the lungs. Mean total lung capacity, mean residual volume, and mean forced vital capacity were significantly reduced, indicating a restrictive pattern of lung function abnormality.

Exercise-related cardiac arrest in cardiac rehabilitation. The Johannesburg experience.

Prescribed physical activity plays a major role in the rehabilitation of patients with coronary artery disease, and as with any other form of treatment its benefits must be weighed against its possible risks. This study attempted to establish the safety of cardiac rehabilitation as a medical intervention at the Johannesburg Cardiac Rehabilitation Centre from its inception in September 1982 to July 1988, and analyses the medical status of patients who suffered a cardiac arrest (CA) in order to determine possible factors predictive of sudden death. Between September 1982 and July 1988, 1,574 patients were admitted to the unit; 480,000 man-hours of exercises were accumulated with 4 episodes of CA, giving an incidence of CA of 1/120,000 patient-hours.

The Johannesburg cardiac rehabilitation programme.

Cardiac rehabilitation has become a generally accepted mode of treatment for patients suffering from coronary artery disease. The Johannesburg cardiac rehabilitation programme was started in 1982 and has rapidly grown to become one of the largest programmes in southern Africa. This paper describes the 387 patients admitted to the unit between June 1986 and July 1988 and evaluates the effects of a combined exercise training and lifestyle modification programme.

Growth hormone response to exercise in asthmatic and normal children.

Maximal growth hormone (GH) increments following exercise were compared in asthmatic (n = 14) and normal (n = 8) children. Exercise, which consisted of 6 min ergometer cycling while breathing cold dry (CD) air, induced asthma in all asthmatic patients but not in normal subjects. Baseline plasma GH levels were similar in both groups.

Elastase binding capacity of alpha 2-macroglobulin in plasma of patients with asthma or chronic obstructive pulmonary disease, without alpha 1-protease inhibitor deficiency.

The amidolytic activity of alpha 2-macroglobulin complexed with porcine pancreatic elastase (EC 3.4.21.

Respiratory heat loss in exercise-induced asthma. Measurement and clinical application.

The theoretical considerations of conditioning inspired air and the application of the respiratory heat loss (RHL) formula are discussed. An on-line method for measuring RHL is described together with the apparatus for generating frigid dry and warm humid air. Exercise-induced asthma (EIA) was studied using these methods.

Reflex heart rate control in asthma. Evidence of parasympathetic overactivity.

The bronchial hyperreactivity characteristic of asthma may be related to enhanced parasympathetic nervous activity. We postulated that an abnormality in the autonomic control of airway caliber might be reflected by a parallel change in the reflex control of heart rate. We examined the heart-rate variations induced by deep breathing (respiratory sinus arrhythmia), the Valsalva maneuver, and standing up from the recumbent position in asthmatic subjects and nonasthmatic control subjects.

A comparative assessment of carbuterol, fenoterol and hexoprenaline in allergic asthma.

Carbuterol tablets (2,0 mg) were compared with the tablets of fenoterol (2,5 mg) and hexoprenaline (1 mg). The three drugs were shown to be equally effective for a period of 4 hours, but carbuterol and fenoterol exerted a statistically significant bronchodilating action for 7 and 8 hours respectively, while the action of hexoprenaline lasted for 4 hours in the majority of patients. The aerosols of carbuterol (200 mg) and fenoterol (400 mg) appeared to be similar in inhibiting exercise-induced asthma, whereas hexoprenaline (200 mg) did not appear to be as effective.