The page number in the footer is not for bibliographic referencingwww.tandfonline.com/ojfp 40 RESEARCH ARTICLE ABSTRACTS South African Family Practice is co-published by Medpharm Publications, NISC (Pty) Ltd and Taylor & Francis, and Informa business S Afr Fam Pract ISSN 2078-6190 EISSN 2078-6204 © 2016 The Author(s) RESEARCH South African Family Practice 2016; 58(4):136–141 http://dx.doi.org/10.1080/20786190.2016.1151641 Open Access article distributed under the terms of the Creative Commons License [CC BY-NC 3.0] http://creativecommons.org/licenses/by-nc/3.0 Investigation of the coexistence of CKD and non-communicable chronic diseases in a PBM company in South Africa WP Meuwesena, JM du Plessisa*, JR Burgera, MS Lubbea and M Cockerana a Medicine Usage in South Africa (MUSA), North-West University, Potchefstroom, South Africa *Corresponding author, email: jesslee.duplessis@nwu.ac.za Background: Chronic kidney disease (CKD) is a public health problem, with increasing global prevalence. Several factors could influence the prognosis of CKD, including comorbid chronic conditions. This study investigated the coexistence of CKD and non- communicable chronic diseases in the private health sector of South Africa. Methods: Retrospective medicine claims data from a pharmaceutical benefit management (PBM) company was used to perform this descriptive, quantitative study. The study population consisted of all patients identified with an ICD-10 code for CKD (N18) during the study period of January 1, 2009 to December 31, 2013. Results: CKD patients represented 0.10% to 0.14% of the total patients on the database from 2009 to 2013. The mean age of the CKD patients over the study period varied between 58 and 61 years. Prevalence was higher in males (male-to-female ratio 1:0.8) and in patients aged 35–64 years (p = 0.014; Cramer’s V = 0.039). The occurrence of chronic conditions in the CKD population was prevalent, with hypertension occurring in more than half the CKD patients. Conclusion: Several chronic conditions, especially those regarding atherosclerotic risk factors, frequently co-occurred with CKD. Lifestyle management and frequent screening tests of these patients are of the utmost importance to improve the outcome of CKD. Keywords: chronic kidney disease, comorbid chronic conditions, risk factors, South Africa Introduction Chronic kidney disease (CKD) is a global public health problem, with an estimated prevalence of 8%–16% worldwide.1 Prevalence rates of CKD seem to be high in both developing and developed countries,2−3 with an estimated prevalence of 14.3%4 in South Africa. Early diagnosis of and intervention in CKD can reduce the risk of cardiovascular events, kidney failure and deaths that are associated with CKD.5 Global CKD mortality rates increased to the 18th biggest cause of death in 2010,6 after being ranked in 27th position in 1990. In South Africa, deaths caused by CKD increased by 67% from 1999 to 2006.7 Chronic kidney disease is a silent killer, complicating the diagnosis of the disease. Less than 10% of people with CKD are aware that they have the condition.8 It has few symptoms9 and is nearly always asymptomatic during the early stages of the disease.10 In addition, several clinical conditions such as diabetes mellitus, hypertension and cardiovascular disease (CVD) are risk factors, and patients with these conditions should be closely monitored when CKD is suspected so that the deterioration in renal function can be identified early.9−11 Other risk factors that might increase the risk of CKD include gender, smoking, obesity, age, genetics, metabolic disturbances and chronic use of NSAIDs.5,12 There is a lack of data regarding the prevalence of CKD in the private health sector of South Africa, especially data surrounding the occurrence of comorbid conditions. Chronic kidney disease is one of the conditions on the prescribed minimum benefit (PMB) chronic disease list (CDL) in the private health sector of South Africa. The PMB CDL is a feature of the Medical Schemes Act (Act 131 of 1998) and consists of 26 common conditions that require treatment for more than 12 months and are considered to be life-threatening.13 If provided for by way of a therapeutic algorithm for the condition, all costs relating to the diagnosis, medication, doctors’ consultations and tests must therefore be covered by medical schemes.14,15 The chronic conditions co- occurring with CKD that form part of the PMB CDL conditions include diabetes mellitus, hypertension, dyslipidaemia, and cardiac failure among others. This study investigated the existence of CKD along with non- communicable chronic diseases in a PBM company in South Africa, in order to create awareness and improve the clinical outcome and prognosis the disease. By increasing our knowledge and understanding regarding the epidemiology of CKD in terms of risk factors and comorbid chronic diseases, we might be able to assess the level of its underdiagnosis8,16 and estimate the potential impact of early screening. Method Study design A descriptive, quantitative study was performed using retrospective medicine claims data obtained from a national pharmaceutical benefit management company (PBM). The PBM currently manages the medicine benefits of 1.7 million beneficiaries on behalf of 40 medical schemes. All of South Africa’s pharmacies and 98% of all dispensing doctors are on this service provider database. The database represented 9% to 13% of the total medical schemes industry in South Africa during the study period.17 Data from January 1, 2009 to December 31, 2013 were used. The database contained information on 1  033  057 (2009), 968  158 (2010), 864  977 (2011), 815  810 (2012) and 809  857 (2013) patients over the five-year study period. Data fields that were South African Family Practice is co-published by Medpharm Publications, NISC (Pty) Ltd and Taylor & Francis, and Informa business S Afr Fam Pract ISSN 2078-6190 EISSN 2078-6204 © 2016 The Author(s) RESEARCH South African Family Practice 2016; 58(4):131–135 http://dx.doi.org/10.1080/20786190.2015.1120932 Open Access article distributed under the terms of the Creative Commons License [CC BY-NC 3.0] http://creativecommons.org/licenses/by-nc/3.0 Active myofascial trigger points in head and neck muscles of patients with chronic tension-type headache in two primary health care units in Tshwane K Josepha*, SA Hitchcocka, HP Meyera, MM Geyserb and PJ Beckerc a Department of Family Medicine, Kalafong Hospital and University of Pretoria, Pretoria, South Africa b Department of Family Medicine and Emergency Medicine, Kalafong Hospital and University of Pretoria, Pretoria, South Africa c Faculty of Health Sciences, University of Pretoria and Biostatistics Unit, MRC (Pretoria), Pretoria, South Africa *Corresponding author, email: raju@webmail.co.za Background: The management of patients presenting with chronic tension-type headache (CTTH) can be challenging for primary health care practitioners. As with most chronic pain disorders, a multimodal management approach is frequently required. It has been postulated that myofascial pain syndrome (MPS) and its hallmark myofascial trigger points (MTrPs) found in specific muscle tissues may play a role in the chronic pain experienced by patients with CTTH. Little is known about the prevalence of MTrPs in patients with CTTH, in primary health care settings on the African continent. This study therefore aimed to investigate the prevalence of active MTrP’s in specific head and neck muscles/muscle groups in patients with CTTH. Methods: A prospective, cross-sectional and descriptive study was done in two primary health care facilities situated in Tshwane, South Africa. The sample included 97 adult patients with CTTH. Five head and neck muscles/muscle groups were examined bilaterally for active MTrPs. Outcome measures were the prevalence and distribution of active MTrPs in these patients. Results: Active MTrPs were found in 95.9% of the patients, the majority (74.2%) having four or more active MTrPs. The temporalis muscles and suboccipital muscle group exhibited the highest number of active MTrPs (prevalence 87.6% and 80.4% respectively). Conclusion: Our study suggests a strong association between MPS and CTTH in patients, presenting in the primary health care setting. This indicates the importance of a musculoskeletal assessment of neck and pericranial muscles in patients with CTTH. This can assist in determining the most appropriate treatment strategy in these patients. Keywords: chronic pain disorders, chronic tension type headache (CTTH), myofascial pain syndrome (MPS), myofascial trigger points (MTrPs), primary headache Introduction In clinical practice, the generalist doctor is frequently required to manage a patient with a chronic primary headache disorder. Management of chronic tension-type headache (CTTH), with a one-year period prevalence of 0.9–2.2% in European and American studies,1,2 can in particular be challenging. It is generally accepted that chronic pain disorders, such as CTTH, require a multi-modal management approach. A better understanding of the potential myofascial pain components in patients with CTTH will assist primary care physicians in the assessment and management of this common disorder. The association between tension-type headache and myofascial pain syndrome (MPS) has been studied for many years. Researchers have observed an increased tenderness with palpation of peri- cranial myofascial tissue in patients with tension-type headache.3 It has also been suggested that pain from muscles in the head, neck and shoulders may be referred to the head and then be experienced as headache.4,5 MPS is a common musculoskeletal pain disorder, the main clinical features being regional pain and muscle tenderness, associated with the presence of myofascial trigger points (MTrPs) and referred pain with palpation.5 This condition is a well- documented and accepted clinical entity that is frequently associated with headache disorders.5 MPS originates from MTrPs within muscles and surrounding tissue, such as ligaments and tendons.6 A MTrP is the clinical finding in patients with MPS and has been described by Simons et al.5 as a well-defined hyperirritable and painful area in a taut band of skeletal muscle. Active MTrPs are associated with a spontaneous pain complaint and digital compression of the trigger point elicits a pattern of non-dermatomal pain referral, which mostly coincides with the patient’s pain symptoms. Latent MTrPs do not produce spontaneous pain and lack the referral pattern seen in active MTrPs.5,7,8 Simons et al. published a comprehensive manual of the patterns of referred pain from different MTrPs throughout the body.5 Active MTrPs may develop after an injury to muscle fibres, which may be a single traumatic event or repetitive micro-trauma to muscles, which then is followed by local muscle contraction.9 Sustained muscle contraction and shortening of sarcomeres lead to local ischaemia and release of several pro-inflammatory chemical mediators that may sensitise peripheral nociceptors. Microdialysis studies done in active MTrP areas have shown elevated levels of many chemical mediators such as tumour necrosis factor α (TNF α), interleukin Iβ (IL-Iβ), calcitonin-gene- related polypeptide (CGRP), substance P, bradykinin, serotonin and norepinephrine.10 These mediators in turn may sensitise neurons at the level of the dorsal horn in the spinal cord with resultant central sensitisation (if the peripheral sensitisation is sustained), and the formation of active MTrPs.5,9,11 The following clinical criteria have been proposed for the diagnosis of MPS.5 S Afr Fam Pract 2016; DOI:10.1080/20786190.2015.1120932 S Afr Fam Pract 2016; DOI:10.1080/20786190.2016.1151641 Abstract (Full text available online at www.tandfonline.com/ojfp) Abstract (Full text available online at www.tandfonline.com/ojfp)