BackgroundChronic lifestyle diseases share similar modifiable risk factors, including hypertension, tobacco smoking, diabetes, obesity, hyperlipidaemia and physical inactivity. Metabolic syndrome refers to the cluster of risk factors that increases the risk for developing type 2 diabetes mellitus (DM) and cardiovascular disease.ObjectivesThe study aimed to assess health status and identify distinct risk-factor profiles for both chronic lifestyle diseases and metabolic syndrome in rural and urban communities in central South Africa.MethodsThe investigation formed part of the Assuring Health for All in the Free State (AHA-FS) study. During interviews by trained researchers, household socio-demographic and health information, diet, risk factors (i.e. history of hypertension and/or diabetes) and habits (e.g. smoking and inadequate physical activity levels) were determined. Adult participants underwent anthropometric evaluation, medical examination and blood sampling.ResultsThe risk-factor profile for chronic lifestyle diseases revealed that self-reported hypertension and physical inactivity were ranked the highest risk factor for the rural and urban groups respectively. The cumulative risk-factor profile showed that 40.1% of the rural and 34.4% of the urban study population had three or more risk factors for chronic lifestyle diseases. Furthermore, 52.2% of rural and 39.7% of urban participants had three or more risk factors for metabolic syndrome.ConclusionThis study confirmed that the worldwide increase in the prevalence of chronic lifestyle diseases can be attributed to a more sedentary lifestyle, especially illustrated in the urban study population, and increasing obesity. The rural study population had a higher prevalence of risk factors for metabolic syndrome.

Background: Health professional students frequently use alcohol and narcotics. The potential impact on academic performance and professional behaviour is concerning.Aim: This study aimed to determine self-reported use of alcohol, illicit substances (e.g. cannabis, lysergic acid diethylamide [LSD], magic mushroom, cocaine, crack, ecstasy, methamphetamine and heroin), prescription medication and smoking habits, correlating academic performance.Setting: Faculty of Health Sciences, University of the Free State.Methods: An observational, descriptive, cross-sectional study design was used. Information was obtained using a self-administered questionnaire, capturing demographics, self-reported academic performance, drinking and smoking habits, and substance use. Coded responses were analysed using the Remark Office OMR 8 Software System. Descriptive statistics were calculated for categorical variables.Results: Completed questionnaires comprised 171 students. A total of 78.4% of second year and 82.8% of third year students reported using alcohol. Twenty-two per cent of second year and 24.1% of third year students reported cannabis use. In the second year group, three (2.7%) students reported using magic mushroom, two (1.8%) reported cocaine, two (1.8%) reported ecstasy and one (0.9%) reported using methamphetamine. Only third year students reported using LSD or ‘crack’. Cigarette smoking was common – 31.5% and 35.1% in both groups, respectively. Smokeless tobacco devices were used by 8.5% of second year and 7.1% of third year students. Almost 40% of both groups reported that they had smoked a water pipe. Academic performance achieved was mostly 60% – 69% (38.9%) among second year students and 70% – 79% (46.6%) among third year students.Conclusion: Self-reported use of alcohol and drugs and smoking among medical students is alarming. Additional student support, early identification and referral for management and/or rehabilitation should be a priority at tertiary institutions responsible for training future healthcare professionals.

Recent higher education changes toward outcomes-based education emphasize competent learners, but a widely accepted definition of competence is still lacking. Although the importance of anatomy in health professions education is recognized, there is still uncertainty about what anatomical competence entails and how to assess it. This study aimed to provide a framework for assessing anatomical competence, using an anatomy competence score, for the anatomy course in the undergraduate medical learning program at the University of the Free State in South Africa. All assessments within the dissection program of two student groups (July 2012 to June 2014) were explored to determine the representation of the three competence domains: knowledge, skill and application in context. Student performance in the final objective structured practical examination (OSPE) was investigated for the three domains and the different body regions. Knowledge had ±50% representation in assessments and the different body regions (in final OSPE) for both groups, and skill and application represented ±25% each in both groups. The best average student performance was in the skill domain (64% and 67% for the respective groups). All domains showed good reliabilities (> 0.75) and student performance correlated well between the domains (P < 0.001). This study suggests a representation ratio of 2:1:1 between knowledge, skill and application (i.e., 50% knowledge and 25% skill and application respectively), for anatomical competence assessment. However, this ratio depends on the assessment type, the stage of the anatomy course and the institutional context. Nonetheless, it provides a guideline for ensuring that assessments address all competence domains. Anat Sci Educ 9: 319-329. © 2015 American Association of Anatomists.

Objectives: Obesity prevalence is increasing worldwide. In South Africa, older and urbanised African women have significantly higher rates of obesity. Limited information is available on the relationship between anthropometric parameters, adipokines and metabolic health status of African women. This study investigated the relationship between obesity, adipokines and the components of metabolic syndrome in urban African women. Methods: This study included 135 urban African women that were 26-63 years of age, identified with metabolic syndrome in the urban leg of the Assuring Health for All in the Free State (AHA-FS) study. To establish anthropometric status, the following measures were taken: body weight, height and waist circumference. Blood was drawn to determine leptin, adiponectin levels and metabolic status. Results: Adiponectin levels in obese women were significantly decreased compared to normal weight women. Leptin levels and leptin:adiponectin ratios (L:A) were increased in the obese group compared to the overweight and normal weight groups. Leptin and L:A showed strong positive correlations with body mass index and waist circumference. Adiponectin levels decreased as the number of components of metabolic syndrome increased. The L:A ratio was significantly lower in women with elevated triglycerides and significantly higher in women with elevated blood glucose levels. Adiponectin levels were significantly lower in women with elevated blood glucose. Conclusion: This study confirms the inverse relationship between adiponectin and leptin with increased body adiposity. Results indicate that waist circumference, fasting blood glucose and triglyceride levels are the metabolic syndrome components most closely associated with altered adiponectin and leptin levels and L:A in urban African women with metabolic syndrome.Normal weight kg/m 2 ) (n = 17)* Age 50.0 [47.0-52.0] Adiponectin (μg/mL) 14.4 [9.3-19.1] Leptin (ng/mL) 9.1 [5.7-14.1] L:A ratio # 0.7 [0.5-1.3] Overweight (BMI 25-29.9 kg/m 2 ) (n = 35) Age 45.0 [37.0-54.0] Adiponectin (μg/mL) 9.2 [5.0-13.2] Leptin (ng/mL) 22.0 [12.3-31.7] L:A ratio 2.2 [1.4-5.4] Obese (BMI ≥ 30 kg/m 2 ) (n = 83) Age 48.0 [41.0-56.0] Adiponectin (μg/mL) 6.4 [4.1-10.2] Leptin (ng/mL) 44.1 [31.8-75.7] L:A ratio 7.9 [3.6-11.9]

Background: A worldwide increase in the prevalence of diabetes mellitus (DM) has been reported and an even further increase is expected as a result of lifestyle changes. The objectives of this study were to determine the prevalence of DM in the rural southern Free State and to investigate the contribution of risk factors such as age, physical activity, body mass index (BMI), waist-to-hip ratio and waist circumference to the development of impaired fasting glucose (IFG) or DM.Methods: Fasting venous plasma glucose (FVPG) levels were obtained from a total of 552 participants from Springfontein (n = 195), Trompsburg (n = 162) and Philippolis (n = 180). Participants were between 25 and 64 years of age, with 28.1% male (mean age 47.3 years) and 71.9% female (mean age 46 years). Anthropometric status was determined using standardised techniques. Levels of physical activity were determined using a 24-hour recall of physical activity as well as frequency of performing certain activities. Relative risks (RR) as well as 95% confidence intervals (95% CI) were used to distinguish significant risk factors for having IFG or DM.Results: In the study population the prevalence of DM was 7.6% (5.2% in men and 8.6% in women) and that of IFG was 6.3% (4.5% in men and 7.1% in women). The majority of nondiabetic (34%), IFG (55%) and DM (61%) participants were between the ages of 51 and 60 years. Age was found to be a statistically significant risk factor for having IFG or DM in participants older than 40 years of age (RR 2.3; 95% CI [1.22; 4.34]). Crude measurements (not age-and gender-adjusted) of waist circumference (RR 3.23; 95% CI [1.82; 5.74]), BMI (RR 2.32; 95% CI [1.43; 3.78]) and waist-to-hip ratio (RR 2.51; 95% CI [1.55; 4.07]) were statistically significant risk factors for having IFG or DM. Physical inactivity in men ≥ 40 years was also a statistically significant risk factor (RR 3.23; 95% CI [1.15;9.05]) for having IFG or DM.Conclusions: In this study, 37.5% of diabetics were newly discovered. A high waist circumference, BMI and waist-to-hip-ratio were associated with an increased risk for developing IFG or DM, with a high waist circumference being the most significant general risk factor. Physically inactive men (≥ 40 years) were also at a higher risk of having IFG or DM. Follow-up FVPG and glucose tolerance tests should be performed on participants in the IFG group. A need for intervention regarding the identification and treatment of DM in these rural areas has been identified.