Birthweight and blood pressure among children in Harare, Zimbabwe

AIM: To determine whether poor uterine growth may be associated with increased blood pressure and subsequent hypertension in adulthood. METHODS: A retrospective cohort study of 756 schoolchildren (mean age 6.5 years) was carried out in six low income areas in Harare city, Zimbabwe. Indices of intrauterine growth and blood pressure were assessed. RESULTS: Adjusted for current weight, the children's systolic blood pressure was inversely related to their birthweight; for each decreasing kg of birthweight, systolic blood pressure rose by 1.73 mm Hg (95% CI; 0.181 to 3.28). After adjustment for current weight, systolic blood pressure was also inversely associated with occipito-frontal circumference, but not with birth length or gestational age. Diastolic blood pressure was not associated with any of the intrauterine indices. CONCLUSION: Fetal size may be inversely related to systolic blood pressure in childhood in an African population.     

Influence of psychoactive substance use on the reliability of psychiatric diagnosis.

The interrater reliability of diagnoses, made on the basis of a structured interview for psychiatric patients with and without psychoactive substance use disorders (PSUDs), was examined. 47 pairs of ratings by 9 different clinical interviewers were used. Results supported 3 major findings: (1) The interrater reliability for non-PSUD psychiatric diagnoses is quite high when an S has no diagnosable PSUD; it is lower, though still substantial when a PSUD is present; (2) interviewers are not aware of this and are just as certain of the accuracy of their diagnoses when a PSUD is present as when one is not; and (3) interrater reliability is moderate to substantial as to the judgment of whether, when a non-PSUD diagnosis is present, it is caused by the use of psychoactive substances. The implications of these findings for the appropriate selection of treatments for dually diagnosed patients are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cardiac disease distribution among patients referred for echocardiography in Harare, Zimbabwe

OBJECTIVE: To determine the distribution of cardiac diseases seen in a tertiary referral hospital. DESIGN: Cross sectional survey. SETTING: Harare Central Hospital, Harare, Zimbabwe. SUBJECTS: 1,507 patients referred for echocardiographic evaluation. MAIN OUTCOME MEASURE: Cardiac diagnosis. RESULTS: 1,153 (76.5%) echocardiographic studies were abnormal, while 354 were normal. Rheumatic heart disease was the predominant diagnosis (25.1%) with 208 (74.3%) of cases being females. The main valvular lesion in females was mitral stenosis (48.1%), while in males it was mitral regurgitation (61.1%). Other diagnoses were: pericardial disease 250 (22.4%), dilated cardiomyopathy 245 (22.0%), hypertensive heart disease 148 (13.3%) and others (17.4%). There were 65 cases of peripartum cardiomyopathy among the cases of dilated cardiomyopathy and 34 cases of acute myocarditis among "others". CONCLUSION: A detailed clinical, radiological and echocardiographic assessment at the time of echocardiography enabled a credible diagnosis to be assigned to the majority of patients. Echocardiography is appropriate technology in this setting given the range of "echo-friendly" cardiac lesions found.     

HIV infection and HIV-1 clades among pregnant women in Harare, Zimbabwe

Official figures indicate that at least 1 million of Zimbabwe's 11 million population are infected with HIV, while the most recent survey results indicate that about 24% of apparently healthy women in the country are HIV seropositive. 60 (29.1%) of 206 pregnant women attending Edith Opperman and Budiriro clinics in Harare who were screened for infection with HIV were found to be HIV-1 seropositive. 66.6% of the HIV-1-infected women were infected with subtype C, 48.3% with subtype A, and 33.3% with subtype B. 45% of the infected were infected with subtypes A and C, 10% with A and D, 30% with B and C, and 6.6% with subtypes A, B, C, and D. 2 samples (3.3%) were nonreactive. The high prevalence rate of HIV-1 infection in this study population points to the urgent need to implement more aggressive approaches to controlling HIV/AIDS among women in Zimbabwe.     

Dietary risk factors for pre-eclampsia among women attending Harare Maternity Hospital, Zimbabwe

OBJECTIVE: To identify specific foods that predispose Zimbabwean women to a higher or lower risk of pre-eclampsia and/or eclampsia. DESIGN: A case control study was implemented. Participants were asked by questionnaire to recall the specific amounts of meats, poultry, fruits, fish, vegetables and dairy products they had consumed in the month prior to giving birth. SETTING: Harare Maternity Hospital, Harare, Zimbabwe between June of 1995 and April of 1996. SUBJECTS: 180 women clinically diagnosed with pre-eclampsia (144) or eclampsia (36), and 194 normotensive women without these conditions. MAIN OUTCOME MEASURES: Pre-eclampsia/eclampsia. RESULTS: There were few associations between consumption of specific food items and the occurrence of pre-eclampsia/eclampsia. Meat and fruit were the only foods found to be significantly associated with pre-eclampsia. Women who consumed 12 or more servings of meat per month were more likely to have pre-eclampsia/eclampsia when compared to women eating 11 servings of meat or less per month. While intake of bananas and mangos was unrelated to risk, women who consumed other fruits (i.e. apples, oranges, grapes, peaches, apricots, paw paw, and plums), were 1.7 (95% CI = 1.0 to 3.1) times more likely to develop pre-eclampsia/eclampsia as women who ate none of these fruits. However, women who consumed relatively large quantities of these fruits were not at a particularly high risk. Increased consumption of kapenta was modestly associated with a decrease in disease risk, but this finding was well within the limits of chance and no association was present with intake of other types of fish. CONCLUSIONS: Our findings suggest that variation in consumption of specific foods do not have a strong effect on the incidence of pre-eclampsia in this population. However, further research involving the use of a more comprehensive dietary measure, biochemical measurements of nutrients, pre-pregnancy assessment and ascertainment of dietary intake prior to the development of pre-eclampsia are needed.     

Pulmonary tuberculosis in Harare, Zimbabwe: analysis by spoligotyping

BACKGROUND: Over the last 10 years there has been a fourfold increase in cases of tuberculosis in Harare, Zimbabwe. The use of molecular epidemiology to understand tuberculosis transmission in this epidemic has been hampered by the availability of suitable culture facilities. A study was therefore undertaken to explore the potential of spoligotyping, a polymerase chain reaction based technique that does not require tuberculosis culture. METHODS: Adults attending a chest clinic with clinical or radiological pulmonary tuberculosis and one smear positive sputum were enrolled over one month. Demographic, socioeconomic, and clinical data were gathered using a standardised questionnaire. Molecular fingerprinting of genomic DNA recovered from sputum was performed by spoligotyping. RESULTS: Sixty one subjects (median age 28 years (range 18-73); 61% men) were recruited and 57 provided adequate sputum samples. Recent rural-urban migration or immigration was not common; 40% of subjects lived in crowded living conditions. DNA suitable for spoligotyping was recovered from 28 patients and 20 different genotypes of Mycobacterium tuberculosis were identified. Fifteen patients were infected with an M tuberculosis strain shared by one or more individuals. Patients infected with a shared spoligotype were not closely linked geographically within Harare, but were more likely to live in overcrowded conditions (69% versus 23%; odds ratio 6.85 (95% CI 1.2 to 47), p = 0.026). Analysis of the patients' original rural family homes revealed two geographically related spoligotype clusters. CONCLUSIONS: Spoligotyping may yield valuable molecular typing information in populations where tuberculosis culture is not available. This novel technique requires further development and evaluation in larger epidemiological studies.     

Gender differences in psychiatric comorbidity among adolescents with substance use disorders.

The authors examined gender differences in rates of comorbid psychiatric disorders among adolescents with 1 or more psychoactive substance use disorders. Baseline diagnostic data were obtained from 135 adolescents, ages 12 to 19, and their parents-guardians, who participated in a study to develop and efficacy test Integrated Family and Cognitive-Behavioral Therapy. Rates of attention-deficit/hyperactivity disorder and conduct disorder were higher among drug-abusing male adolescents compared with drug-abusing female adolescents. However, high rates of disruptive behavior disorders also characterized drug-abusing female adolescents. Similarly, drug-abusing female adolescents exhibited a higher rate of major depression compared with drug-abusing male adolescents. However, rates of dysthymia, double depression (i.e., major depression and dysthymia), and bipolar disorder were equivalent between genders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Impact of HIV counselling and testing on HIV seroconversion and reported STD incidence among male factory workers in Harare, Zimbabwe

OBJECTIVES: To assess the impact of HIV counselling and testing on HIV seroconversion and incidence of reported sexually transmitted diseases (STDs) among male factory workers in Harare, Zimbabwe. DESIGN: Prospective, observational study among men recruited to participate in a future workplace based AIDS prevention intervention. METHODS: Participants provided STD histories and blood for HIV antibody testing at enrolment and six month intervals during visits to factories. Participants received HIV test results, post test counselling, and free STD services at the project clinic. RESULTS: Between March 1993 and June 1995, 2,414 men were enrolled with 85% follow up. Overall HIV sero-incidence was 2.60 per 100 person-years; the incidence of reported STDs was 10.19 per 100 person-years. Men who obtained their HIV test results had significantly higher HIV sero-incidence and incidence of reported STDs compared to men who did not obtain their results (IRRs: 1.87, 3.47, respectively). Among men who obtained their HIV test results, a non-significant 40% decrease in HIV sero-incidence was observed after obtaining test results compared to before obtaining results (p = 0.18). The incidence of reported STDs, however, increased by 30% after obtaining HIV test results (p = 0.10). CONCLUSIONS: Decreased HIV sero-incidence in the face of increased reported STD incidence suggests that timely treatment of STDs may decrease the risk of acquiring HIV even in the absence of behaviour change. In populations with high rates of HIV and STDs, the greatest benefit of HIV counselling and testing may be achieved by simultaneously offering STD screening and treatment services.     

Prevalence and implications of perinatal substance use in Missouri

A study was conducted to determine the prevalence of perinatal substance use in Missouri. The population sample studied was selected according to a multi-stage probability-proportional-to-size sampling. The weighted prevalence for perinatal exposure to alcohol, tobacco or illicit substances was 31.9%, 10.8% for illicit substances, 21.9% for tobacco use, and 7.9% for self-reported alcohol use. In 1993, an estimated 23,925 perinatal exposures to licit and illicit substances occurred.     

Long-term patterns of service use and cost among patients with both psychiatric and substance abuse disorders

OBJECTIVES: This is a longitudinal study designed to determine: (1) if patients dually diagnosed with psychiatric and substance abuse disorders incur higher health care costs than other psychiatric patients and (2) if higher costs can be attributed to particular subgroups of the dually diagnosed or types of care. METHODS: Two cohorts of veterans treated in Veterans Affairs mental health programs at the start of fiscal year 1991 were followed for 6 years: one cohort of inpatients (n = 9,813) and the other of outpatients (n = 58,001). Data were analyzed on utilization of all types of Veterans Affairs health care. Repeated measures analysis of variance was used to examine cost differentials between dually diagnosed patients and other patients. RESULTS: Dually diagnosed outpatients incurred consistently higher health care costs than other psychiatric outpatients, attributable to higher rates of inpatient psychiatric and substance abuse care; however, this difference decreased with time. Costs were substantially higher in the inpatient cohort overall, but there were no differences in cost between dually diagnosed and other patients. CONCLUSIONS: In an atmosphere of cost cutting and moves toward outpatient care, the dually diagnosed may lose access to needed mental health services. Possibilities of developing more intensive outpatient services for these patients should be explored.     

The Timeline Followback reports of psychoactive substance use by drug-abusing patients: Psychometric properties.

The Timeline Followback (TLFB; L. C. Sobell and M. B. Sobell, 1996) interview, which uses a calendar method developed to evaluate daily patterns and frequency of drinking behavior over a specified time period, has well-established reliability and validity for assessing alcohol consumption. Although several investigators have used the TLFB to evaluate drug-using behavior, few studies have examined the psychometric properties of the interview for this purpose. The authors conducted TLFB interviews with a sample of adult drug-abusing patients seeking treatment for substance abuse (n?=?113) at baseline, posttreatment, and quarterly thereafter for 12 months. It was found that the patients' reports about their drug consumption using this method generally had high (a) retest reliability, (b) convergent and discriminant validity with other measures, (c) agreement with collateral informants' reports of patients' substance use, and (d) agreement with results from patients' urine assays. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Community studies on adolescent substance use, abuse, or dependence and psychiatric comorbidity.

A literature review on community studies of adolescent substance use, abuse, or dependence (SU/A/D) and psychiatric comorbidity yielded 22 articles from 15 studies with information on rates, specificity, timing, and differential patterns of comorbidity by gender, race/ethnicity, and other factors. Results revealed that 60% of youths with SU/A/D had a comorbid diagnosis, and conduct disorder (CD) and oppositional defiant disorder (not attention-deficit/hyperactivity disorder) were most commonly associated with SU/A/D, followed by depression. Child psychopathology (particularly CD) was associated with early onset of substance use and abuse in later adolescence. The authors suggest that available data relevant to SU/A/D and psychiatric comorbidity can be used to better address such questions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Unplanned pregnancies in Harare, Zimbabwe: what is the contraceptive history and awareness of the mothers?

OBJECTIVES: The study aimed to estimate the proportion of unplanned pregnancies among mothers delivering at the referral Harare Hospital and to describe their levels of contraceptive use and awareness in relation to the planning of pregnancy. DESIGN: Systematic sample of mothers who had just delivered identified through maternity delivery, records. The study was analysed as a case-referent study where cases where mothers who had unintended pregnancies and those with intended or planned pregnancies served as referents. SETTING: Postnatal wards of Harare Maternity Hospital. SUBJECTS: 923 mothers following delivery. MAIN OUTCOME MEASURES: Socio-demographic characteristics, pregnancy planning, contraceptive history and contraceptive knowledge. RESULTS: Of the 923 deliveries studied, 377 (41%) were unintended (cases), of which 9% were unwanted. Mothers aged 19 years or below (Odds ratio [OR] = 2.4; 95% confidence interval [CI] = 1.6 to 3.7) and those aged 35 years or above (OR = 3.2, 95% CI = 1.8 to 5.5) were significantly more likely to report the index pregnancy as having been unintended. Nulliparous (OR = 2.4) and parity five or more (OR = 8.2) mothers were at significantly increased risk of unintended pregnancy. Mothers presenting with unintended pregnancies were also significantly more likely to be single (OR = 7.8), divorced/separated or widowed (OR = 6.0). Contraceptive ever use was 53% and 58% in cases and referents, respectively. The combined oral contraceptive pill was the most commonly known and used method of contraception. Contraceptive failure was reported by 23% of mothers with unplanned pregnancies. Previous use of the progesterone only pill (OR = 2.2), the condom (OR = 2.3) or the IUCD (OR = 6.3) were significantly associated with the likelihood of reporting with unplanned pregnancy. Mothers in both groups were concerned about contraceptive method failure, irregular menstruation and perceived subsequent infertility with contraception. Failure to discuss family planning with the male partner (OR = 2.3) or partner refusing use of contraception (OR = 2.8) constituted risk factors for unplanned pregnancy. CONCLUSION: Results point to the need for wider contraceptive counselling and provisions which encourage and involve the male partner. Programmes for reproductive health services and education should target women in identified high risk circumstances.     

3H-spiperone binding to peripheral mononuclear cells in psychiatric in-patients

1. There is an ongoing controversy, if increased binding of 3H-spiperone to lymphocytes might discriminate between schizophrenia and other psychiatric diseases or even be a genetic vulnerability marker for schizophrenia, or predict the response to neuroleptic treatment. 2. Some critical methodological details which might contribute to this controversy are described. 3. 3H-spiperone binding was evaluated in 31 patients with schizophrenia, 7 patients with schizoaffective disorder, bipolar type, 6 patients with a manic episode and 6 patients with a depressive episode of bipolar major affective disorder (DSM-III-R criteria), and in 19 healthy subjects. 4. There were no significant differences in characteristic binding parameters (KD, Bmax) between all groups of psychiatric in-patients and in comparison to healthy subjects. Moreover, there was no relation of binding parameters to any of the subtypes of schizopherenia or to the course of illness according to DSM-III-R-criteria. 5. Neuroleptic treatment or clinical response to treatment had no consistent effect on binding parameters intra-individually. 6. In summary, 3H-spiperone binding to lymphocytes failed to differentiate between the diagnostic subgroups (DSM-III-R) and between treatment responders and non-responders in our sample of patients.     

Correlates of stages of change for substance abuse among psychiatric outpatients.

Brief algorithms are used to determine stage of change; however, psychometric support in substance users other than smokers is minimal. The authors examined the reliability and validity of a self-report algorithm in a sample of 84 persons with both psychiatric and substance use disorders. A 1-week retest resulted in 75% of persons being reassigned to the same stage. Compared with precontemplators, participants in the preparation stage reported higher problem recognition, steps taken toward change, cons of using, and benefits of quitting. The pros of using did not differ across stages. The action stage was marked by less frequent substance use and lower perceived costs of quitting. These results support the reliability and validity of staging algorithms in patients with comorbid disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stress, family environment, and multiple substance use among seventh graders.

Evaluated the Guttman-scaled nicotine, alcohol, cannabis (marihuana), and multiple substance use in relation to measures of major life stressors, daily hassles, family cohesion, conflict and expressiveness, coping, and anxiety among 425 7th graders. Instruments included the State-Trait Anxiety Inventory. Major life stressors, family cohesion, and the subjective distress of daily hassles contributed significantly in stepwise regression analyses for nicotine, cannabis, and multiple substance use. For alcohol use, major life stressors and family conflict were significant. In the case of cannabis and multiple substance use, a moderating interaction of family cohesion and life stress was obtained. Identified as multiple substance users reported high rates of occurrence of a number of life stressors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prevalence of DSM-IV substance abuse and dependence disorders among prison inmates

The study examined the 30-day and lifetime prevalence of DSM-IV alcohol and drug disorders among state prison inmates. A sample of 400 inmates consecutively admitted to a state prison reception center were assessed for alcohol and drug disorders using the Structured Clinical Interview for DSM-IV (SCID-IV). Test-retest reliabilities were calculated for the SCID-IV. Lifetime substance abuse or dependence disorders were detected among 74% of inmates, including over half who were dependent on alcohol or drugs. For the 30 days prior to incarceration, over half of the sample were diagnosed as having substance abuse or dependence disorders, including 46% who were dependent on alcohol or drugs. Black inmates were significantly less likely to be diagnosed as alcohol dependent than whites or Hispanics. The high rates of substance use disorders are consistent with previous findings from other studies conducted in correctional settings and reflect the need to expand treatment capacity in prisons.