Introduction: Diabetes mellitus is one of the most common clinical conditions seen by family physicians in their daily practice. They are constantly confronted with the burden of caring for poorly controlled and poorly adherent patients presenting with preventable debilitating, disabling and mutilating complications. Lifestyle modifications in combination with medications have been proven to contribute to the prevention and delay of complications. Aims: The study aimed to investigate the knowledge and practice of lifestyle modifications and also to determine challenges faced by patients in their practice of lifestyle changes in the management of type 2 diabetes mellitus in the Middelburg subdistrict of Mpumalanga. Study design: An observational, descriptive and cross-sectional study was done. Data were collected from 150 patients with type 2 diabetes mellitus (T2DM) using a self-administered questionnaire. Results:The results showed that DM was more prevalent among females and the age group 50-59 years was mostly affected. Nearly 50% of the respondents were obese and about 35% of them overweight. Lifestyle modification was understood as healthy dietary habits. Only 35% of the respondents participated in exercises. Brisk walking (59%) was the preferred form of exercise among these participants. A statistically significant finding was that 79.63% of participants who did not adhere to exercise recommendations had poor glycaemic control. Only 40.48% of participants who adhered to exercise recommendations had good glycaemic control. Obesity (47.52%) and overweight (32.67%) were associated with poor glycaemic control. Conclusion and recommendation:The majority of the participants thought that lifestyle modification was healthy eating; only a third of them regularly exercised. The author recommends a multidisciplinary and multilevel approach involving different stakeholders-among others, patients and community, health professionals/providers and government services-in assisting diabetic patients with lifestyle modification.

BackgroundViolence has been with us since time immemorial. In South Africa, violence plays a detrimental role in our daily lives, affecting almost everybody, directly or indirectly. The country experiences high levels of violence, with incidents of violence being reported in the newspapers and on radio and television on a daily basis. In the author's personal experience as a casualty officer at Witbank General Hospital, a considerable number of patients with assault-related injuries were seen every day. The objectives of this study were to assess the demographic and social factors associated with assault incidents, as well as to establish the type of injuries suffered by the victims of assault. MethodsThe method used was a descriptive, cross-sectional survey, undertaken at the casualty department of the Witbank General Hospital in Mpumalanga Province from 29 October 1999 to 1 May 2000. All patients who attended for injuries due to alleged assault (interpersonal violence) and met the inclusion criteria were included in the study. A total of 547 patients were selected as subjects of the study. ResultsThe majority of the victims were male (71.8%; N = 389), 69% (N = 377) were single and 91% (N = 498) were of African descent. The age group of the majority (86.9%; N = 475) ranged between 17 and 45 years. All the respondents had injuries to more than one part of the body. Among the assaulted patients, 86.6% (N = 474) had more than one type of injury. The majority of the victims of assault (81.4%; N = 445) were not admitted for in-hospital treatment. ConclusionsThe study revealed that a typical victim of assault treated at Witbank Hospital was an African male between the ages of 17 and 45 years. He had been attacked during the night or over the weekend. He had also probably been drinking. He would have suffered minor injuries, mainly to the head and neck.

Background In contrast with the setting of acute myocardial infarction, there are limited data regarding the impact of diabetes mellitus on clinical outcomes in contemporary cohorts of patients with chronic coronary syndromes. We aimed to investigate the prevalence and prognostic impact of diabetes according to geographical regions and ethnicity. Methods and results CLARIFY is an observational registry of patients with chronic coronary syndromes, enrolled across 45 countries in Europe, Asia, America, Middle East, Australia, and Africa in 2009–2010, and followed up yearly for 5 years. Chronic coronary syndromes were defined by ≥1 of the following criteria: prior myocardial infarction, evidence of coronary stenosis >50%, proven symptomatic myocardial ischaemia, or prior revascularization procedure. Among 32 694 patients, 9502 (29%) had diabetes, with a regional prevalence ranging from below 20% in Northern Europe to ∼60% in the Gulf countries. In a multivariable-adjusted Cox proportional hazards model, diabetes was associated with increased risks for the primary outcome (cardiovascular death, myocardial infarction, or stroke) with an adjusted hazard ratio of 1.28 (95% confidence interval 1.18, 1.39) and for all secondary outcomes (all-cause and cardiovascular mortality, myocardial infarction, stroke, heart failure, and coronary revascularization). Differences on outcomes according to geography and ethnicity were modest. Conclusion In patients with chronic coronary syndromes, diabetes is independently associated with mortality and cardiovascular events, including heart failure, which is not accounted by demographics, prior medical history, left ventricular ejection fraction, or use of secondary prevention medication. This is observed across multiple geographic regions and ethnicities, despite marked disparities in the prevalence of diabetes. ClinicalTrials identifier ISRCTN43070564

Background: The aim of this study was to establish the type of clinical work done by the doctors in the emergency room at a district hospital in an underserved area. The findings of the study would assist the management in planning for training, recruitment and allocation of medical and nursing personnel.

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