BACKGROUND. Gunshot injuries from interpersonal violence are a major cause of mortality. In South Africa (SA), the Firearms Control Act of 2000 sought to address firearm violence by removing illegally owned firearms from circulation, stricter regulation of legally owned firearms, and stricter licensing requirements. Over the last few years, varied implementation of the Act and police corruption have increased firearm availability. OBJECTIVES. To investigate whether changes in firearm availability in SA were associated with changes in firearm homicide rates. METHODS. This was a retrospective time trend study (1994 - 2013) using postmortem data. Time trends of firearm and non-firearm homicide rates were analysed with generalised linear models. Distinct time periods for temporal trends were assigned based on a priori assumptions regarding changes in the availability of firearms. RESULTS. Firearm and non-firearm homicide rates adjusted for age, sex and race exhibited different temporal trends. Non-firearm homicide rates either decreased or remained stable over the entire period. Firearm homicide increased at 13% annually from 1994 through 2000, and decreased by 15% from 2003 through 2006, corresponding with changes in firearm availability in 2001, 2003, 2007 and 2011. A 21% annual increase in firearm homicide after 2010 coincided with police fast-tracking new firearm licence applications. Cape Town's coloured population experienced a significantly greater increase than other population groups following additional exposure to illegal firearms from 2007. CONCLUSIONS. The strong association between firearm availability and homicide, and the reversal of a decreasing firearm homicide trend during a period of lax enforcement, provide further support for the association between reduced firearm homicide and stricter regulation.

BACKGROUND: The Western Cape Province had the highest homicide rates in South Africa during the early 2000s. South African Police Service (SAPS) data suggested a significant decline in homicide rates in the Western Cape since 2007. It ranked second highest to the Eastern Cape Province until 2013 and ranked highest again at 52.1/100 000 in 2015. A recent national injury mortality survey offers an alternative data source to assess whether the decline in homicide rates in the Western Cape was real. METHODS: A retrospective record review of autopsies was conducted from 45 state mortuaries in eight provinces for 2009. In addition, mortality data for the Western Cape were sourced from the Provincial Injury Mortality Surveillance System. Age-standardised mortality rates and crude homicide rates per 100 000 population were calculated to compare with the SAPS crude rates. RESULTS: Our study found that the Western Cape had a provincial age-standardised homicide rate of 40.1/100 000 in 2009 and ranked fourth highest among the nine provinces. The crude homicide rate of 43/100 000 for the Western Cape was similar to the SAPS provincial homicide rate of 42.4/100 000. The Northern Cape Province was the only notable exception to our provincial homicide rate ranking comparison with the SAPS for 2009. CONCLUSIONS: The Western Cape is fortunate to have alternative data sources to monitor trends in homicides over time. The latest release of the 2014/2015 SAPS crime statistics should be assessed in a similar manner, with a more recent data source, to validate accuracy of the provincial rates on a regular basis.

BACKGROUND: Current driver mortality estimates do not consider the great differences in exposure across the population, giving a false impression that driver deaths are lowest in the youngest age group. Interventions to reduce risk among the younger age group include graduated driver licensing (GDL) - a three-phase licensing system for novice drivers consisting of a learner's permit, a provisional license, and a full license. OBJECTIVES: We calculated driver fatality rates per 10 000 registered drivers in each age group and assessed the need for stricter licensing conditions for novice and younger drivers. METHODS: Age-specific driver mortality rates were calculated using Western Cape Province 2008 mortuary data. The total number of licensed drivers in each age group served as the denominator. Incidence rate ratios were calculated using the age group of 65 - 79 years as the reference. Chi-square test of trend on incidence rate ratios for the age groups was done. Statistical significance was set as p<0.05. RESULTS: There were 339 driver deaths; mean age was 39.4±13.8 years, and males accounted for 80% of the deaths. Age-specific driver mortality rates were highest in the youngest age group (15 -19 years). There was a significant progressive decrease (except for the age group 45 - 49 years) in the risk of death from road traffic injuries with increasing age compared with the age group >65 years (chi² for trend p<0.0001). CONCLUSION: This study showed a relationship between driver's mortality risk and younger age, and underscores the need for introduction of a GDL programme in South Africa.

Anthropogenic climate change and anticipated adverse effects on human health as outlined by the Intergovernmental Panel on Climate Change (IPCC) are taken as givens. A conceptual model for thinking about the spectrum of climate-related health risks ranging from distal and infrastructural to proximal and behavioural and their relation to the burden of disease pattern typical of sub-Saharan Africa is provided. The model provides a tool for identifying modifiable risk factors with a view to future research, specifically into the performance of interventions to reduce the impact of climate change.

Projections show that the effects of climate change in Africa will not be uniform over the region. The region is extremely vulnerable to climate change because of poverty, a high pre-existing disease burden, fragmented health services and water and food insecurity. Despite the consensus that locally relevant information is necessary to inform policy and practice related to climate change, very few studies assessing the association between climate change and health in southern Africa have been conducted. More comprehensive information is therefore urgently needed for the southern African region to estimate the health risks from projected future changes in climate.

INTRODUÇÃO: A resposta fisiológica aguda ao exercício aeróbio progressivo demanda funcionamento adequado dos sistemas pulmonares, cardiovasculares e músculo-esquelético. Infelizmente, todos estes sistemas estão negativamente afetados em pacientes com insuficiência cardíaca (IC), resultando numa redução significativa da capacidade aeróbia comparada com indivíduos aparentemente saudáveis. O teste de exercício cardiopulmonar (TCP) representa uma técnica não-invasiva de avaliação que fornece compreensão valiosa sobre a saúde e funcionamento dos sistemas fisiológicos que ditam a capacidade aeróbia de um indivíduo. Os valores de várias variáveis-chave obtidas através do TCP, como consumo pico de oxigênio e eficiência ventilatória são encontrados frequentemente como anormais em pacientes com IC. Além da capacidade das variáveis do TCP refletir de maneira aguda os graus variáveis da fisiopatologia, também possuem forte significância prognóstica, aumentando ainda mais o seu valor clínico. A participação num programa de exercícios aeróbios crônicos, anteriormente era contra-indicada em pacientes com IC. Agora é uma intervenção aceitável de estilo de vida. Após um período de treinamento com exercícios aeróbios, durante várias semanas/meses, tem sido evidenciada uma melhora em vários fenômenos fisiopatológicos que contribuem às anormalidades constatadas frequentemente durante TCP na população com IC. CONCLUSÕES: As adaptações fisiológicas induzidas por exercícios aeróbios resultam em uma melhora significativa de capacidade aeróbia e de qualidade de vida. Além disso, há evidências sugerindo que treinamento com exercícios aeróbios melhora a morbidade e a mortalidade em pacientes com IC. Este artigo fornece uma revisão da literatura que destaca a significância clínica dos testes de exercícios aeróbios e treinamento nesta população cardíaca única.

INTRODUCTION: The appropriate physiological response to an acute bout of progressive aerobic exercise requires proper functioning of the pulmonary, cardiovascular and skeletal muscle systems. Unfortunately, these systems are all negatively impacted in patients with heart failure (HF), resulting in significantly diminished aerobic capacity compared with apparently healthy individuals. Cardiopulmonary exercise testing (CPX) is a noninvasive assessment technique that provides valuable insight into the health and functioning of the physiological systems that dictate an individual’s aerobic capacity. The values of several key variables obtained from CPX, such as peak oxygen consumption and ventilatory efficiency, are often found to be abnormal in patients with HF. In addition to the ability of CPX variables to acutely reflect varying degrees of pathophysiology, they also possess strong prognostic significance, further bolstering their clinical value. Once thought to be contraindicated in patients with HF, participation in a chronic aerobic exercise program is now an accepted lifestyle intervention. Following several weeks/months of aerobic exercise training, an abundance of evidence now demonstrates an improvement in several pathophysiological phenomena contributing to the abnormalities frequently observed during CPX in the HF population. These exercise-induced adaptations to physiological function result in a significant improvement in aerobic capacity and quality of life. CONCLUSIONS: Furthermore, there is initial evidence to suggest that aerobic exercise training improves morbidity and mortality in patients with HF. This paper provides a review of the literature highlighting the clinical significance of aerobic exercise testing and training in this unique cardiac population.