Longitudinal cohort studies in sub-Saharan Africa are urgently needed to understand cardiovascular disease development. We, therefore, explored health behaviours and conventional risk factors of ...African individuals with optimal blood pressure (BP) (≤ 120/80 mm Hg), and their 5-year prediction for the development of hypertension.
The Prospective Urban Rural Epidemiology study in the North West Province, South Africa, started in 2005 and included African volunteers (n = 1994; aged > 30 years) from a sample of 6000 randomly selected households in rural and urban areas.
At baseline, 48% of the participants were hypertensive (≥ 140/90 mmHg). Those with optimal BP (n = 478) were followed at a success rate of 70% for 5 years (213 normotensive, 68 hypertensive, 57 deceased). Africans that became hypertensive smoked more than the normotensive individuals (68.2% vs 49.8%), and they also had a greater waist circumference ratio of geometric means of 0.94 cm (95% CI: 0.86-0.99) and greater amount of γ-glutamyltransferase 0.74 U/l (95% CI: 0.62-0.88) at baseline. The 5-year change in BP was independently explained by baseline γ-glutamyltransferase R(2) = 0.23, β = 0.13 U/l (95% CI: 0.01-0.19). Alcohol intake also predicted central systolic BP and carotid cross-sectional wall area (CSWA) at follow-up. Waist circumference was another predictor of BP changes β = 0.18 cm (95% CI: 0.05-0.24) and CSWA. HIV infection was inversely associated with increased BP.
During the 5 years, 24% of Africans with optimal BP developed hypertension. The surge in hypertension in Africa is largely explained by modifiable risk factors. Public health strategies should focus aggressively on lifestyle to prevent a catastrophic burden on the national health system.
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•9 novel PE-degrading bacteria were isolated from Cerrado soil.•PE-degrading bacteria are from Comamonas, Delftia and Stenotrophomonas genera.•Strains are capable of degrading PE of ...191.000 without additives or pre-treatments.•Nitrogen metabolism is involved in the chemical modification of PE.
Discarded PE-based products pose a social and environmental threat because of their recalcitrance to degradation, a consequence of the unique set of PE’s physicochemical properties. In this study we isolated nine novel PE-degrading bacteria from plastic debris found in soil of the savanna-like Brazilian Cerrado. These bacterial strains from the genera Comamonas, Delftia, and Stenotrophomonas showed metabolic activity and cellular viability after a 90-day incubation with PE as the sole carbon source. ATR/FTIR indicated that biodegraded PE undergone oxidation, vinylene formation, chain scission, among other chemical changes. Considerable nanoroughness shifts and vast damages to the micrometric surface were confirmed by AFM and SEM. Further, phase imaging revealed a 46.7% decrease in the viscous area of biodegraded PE whereas Raman spectroscopy confirmed a loss in its crystalline content, suggesting the assimilation of smaller fragments. Intriguingly, biodegraded PE chemical fingerprint suggests that these strains use novel biochemical strategies in the biodegradation process. Our results indicate that these microbes are capable of degrading unpretreated PE of very high molecular weight (191,000gmol−1) and survive for long periods under this condition, suggesting not only practical applications in waste management and environmental decontamination, but also future directions to understand the unraveled metabolism of synthetic polymers.
Knowledge about the effects of the neuropeptide oxytocin (OXT) on human sexual behaviors and partner interactions remains limited. Based on our previous studies, we hypothesize that OXT should be ...able to positively influence parameters of sexual function and couple interactions.
Employing a naturalistic setting involving 29 healthy heterosexual couples (n=58 participants), we analyzed the acute effects of intranasally administered OXT (24IU) on sexual drive, arousal, orgasm and refractory aspects of sexual behavior together with partner interactions. Data were assessed by psychometric instruments (Acute Sexual Experiences Scale, Arizona Sexual Experience Scale) as well as biomarkers, such as cortisol, α-amylase and heart rate.
Intranasal OXT administration did not alter “classical” parameters of sexual function, such as sexual drive, arousal or penile erection and lubrication. However, analysis of variance and a hierarchical linear model (HLM) revealed specific effects related to the orgasmic/post-orgasmic interval as well as parameters of partner interactions. According to HLM analysis, OXT increased the intensity of orgasm, contentment after sexual intercourse and the effect of study participation. According to ANOVA analysis, these effects were more pronounced in men. Men additionally indicated higher levels of sexual satiety after sexual intercourse with OXT administration. Women felt more relaxed and subgroups indicated better abilities to share sexual desires or to empathize with their partners. The effect sizes were small to moderate. Biomarkers indicated moderate psychophysiological activation but were not affected by OXT, gender or method of contraception.
Using a naturalistic setting, intranasal OXT administration in couples exerted differential effects on parameters of sexual function and partner interactions. These results warrant further investigations, including subjects with sexual and relationship problems.
•OXT differentially affects sexual experience in healthy couples.•Classical parameters of sexual function such as sexual drive, arousal or penile erection and lubrication were not altered.•However, HLM analysis revealed effects related to the orgasmic and post-orgasmic interval as well as partner interaction.
Since the advent of democracy, the South African government has been putting charters, policies, strategies and plans in place in an effort to strengthen public health system performance and enhance ...service delivery. However, public health programme performance and outcomes remained poor while the burden of disease increased. This was also the case in the Free State Province, where major public health system challenges occurred around 2012. Assessment was necessary in order to inform health system strengthening.
The study entailed a multi-method situation appraisal utilising information collated in 44 reports generated in 2013 through presentations by unit managers, subdistrict assessments by district clinical specialist teams, and group discussions with district managers, clinic supervisors, primary health care managers and chief executive and clinical officers of hospitals. These data were validated through community and provincial health indabas including non-governmental organisations, councils and academics, as well as unannounced facility visits involving discussions with a wide range of functionaries and patients. The reports were reviewed using the World Health Organization health system building blocks as a priori themes with subsequent identification of emerging subthemes. Data from the different methods employed were triangulated in a causal loop diagram showing the complex interactions between the components of an (in) effective health system.
The major subthemes or challenges that emerged under each a priori theme included: firstly, under the 'service delivery' a priori theme, 'fragmentation of health services' (42 reports); secondly, under the 'health workforce' a priori theme, 'staff shortages' (39 reports); thirdly, under the 'health financing' a priori theme, 'financial/cash-flow problems' (39 reports); fourthly, under the 'leadership and governance' a priori theme, 'risk to patient care' (38 reports); fifthly, under the 'medical products/technologies' a priori theme, 'dysfunctional communication technology' (27 reports); and, sixthly, under the 'information' a priori theme, 'poor information management' (26 reports).
The major overall public health system challenges reported by stakeholders involved fragmentation of services, staff shortages and financial/cash-flow problems. In order to effect health systems strengthening there was particularly a need to improve integration and address human and financial deficiencies in this setting.
Celotno besedilo
Dostopno za:
CEKLJ, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Meta-analyses suggest a sustained alleviation of depressive symptoms through glabellar botulinum toxin (BTX) injections. This can be explained by the disruption of facial feedback loops, which may ...moderate and reinforce the experience of negative emotions. Borderline personality disorder (BPD) is characterized by excessive negative emotions. Here, a seed-based resting-state functional connectivity (rsFC) analysis following BTX (
N
= 24) or acupuncture (ACU,
N
= 21) treatment in BPD is presented on areas related to the motor system and emotion processing. RsFC in BPD using a seed-based approach was analyzed. MRI data were measured before and 4 weeks after treatment. Based on previous research, the rsFC focus was on limbic and motor areas as well as the salience and default mode network. Clinically, after 4 weeks both groups showed a reduction of borderline symptoms. However, the anterior cingulate cortex (ACC) and the face area in the primary motor cortex (M1) displayed aberrant rsFC after BTX compared to ACU treatment. The M1 showed higher rsFC to the ACC after BTX treatment compared to ACU treatment. In addition, the ACC displayed an increased connectivity to the M1 as well as a decrease to the right cerebellum. This study shows first evidence for BTX-specific effects in the motor face region and the ACC. The observed effects of BTX on rsFC to areas are related to motor behavior. Since symptom improvement did not differ between the two groups, a BTX-specific effect seems plausible rather than a general therapeutic effect.
Background: Obesity and other noncommunicable disease (NCD) risk factors are increasing in low- and middle-income countries. There are few data on the association between increased added sugar intake ...and NCD risk in these countries.Objective: We assessed the relation between added sugar intake and NCD risk factors in an African cohort study. Added sugars were defined as all monosaccharides and disaccharides added to foods and beverages during processing, cooking, and at the table.Design: We conducted a 5-y follow-up of a cohort of 2010 urban and rural men and women aged 30–70 y of age at recruitment in 2005 from the North West Province in South Africa.Results: Added sugar intake, particularly in rural areas, has increased rapidly in the past 5 y. In rural areas, the proportion of adults who consumed sucrose-sweetened beverages approximately doubled (for men, from 25% to 56%; for women, from 33% to 63%) in the past 5 y. After adjustment, subjects who consumed more added sugars (≥10% energy from added sugars) compared with those who consumed less added sugars had a higher waist circumference mean difference (95% CI): 1.07 cm (0.35, 1.79 cm) and body mass index (in kg/m2) 0.43 (0.12, 0.74) and lower HDL cholesterol −0.08 mmol/L (−0.14, 0.002 mmol/L).Conclusions: This cohort showed dramatic increases in added sugars and sucrose-sweetened beverage consumption in both urban and rural areas. Increased consumption was associated with increased NCD risk factors. In addition, the study showed that the nutrition transition has reached a remote rural area in South Africa. Urgent action is needed to address these trends.
Obesity is a multifactor disease associated with cardiovascular disorders such as hypertension. Recently, gut microbiota was linked to obesity pathogenesisand shown to influence the host metabolism. ...Moreover, several factors such as host-genotype and life-style have been shown to modulate gut microbiota composition. Exercise is a well-known agent used for the treatment of numerous pathologies, such as obesity and hypertension; it has recently been demonstrated to shape gut microbiota consortia. Since exercise-altered microbiota could possibly improve the treatment of diseases related to dysfunctional microbiota, this study aimed to examine the effect of controlled exercise training on gut microbial composition in Obese rats (n = 3), non-obese Wistar rats (n = 3) and Spontaneously Hypertensive rats (n = 3). Pyrosequencing of 16S rRNA genes from fecal samples collected before and after exercise training was used for this purpose.
Exercise altered the composition and diversity of gut bacteria at genus level in all rat lineages. Allobaculum (Hypertensive rats), Pseudomonas and Lactobacillus (Obese rats) were shown to be enriched after exercise, while Streptococcus (Wistar rats), Aggregatibacter and Sutturella (Hypertensive rats) were more enhanced before exercise. A significant correlation was seen in the Clostridiaceae and Bacteroidaceae families and Oscillospira and Ruminococcus genera with blood lactate accumulation. Moreover, Wistar and Hypertensive rats were shown to share a similar microbiota composition, as opposed to Obese rats. Finally, Streptococcus alactolyticus, Bifidobacterium animalis, Ruminococcus gnavus, Aggregatibacter pneumotropica and Bifidobacterium pseudolongum were enriched in Obese rats.
These data indicate that non-obese and hypertensive rats harbor a different gut microbiota from obese rats and that exercise training alters gut microbiota from an obese and hypertensive genotype background.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
The rising prevalence of obesity and excessive adiposity are global public health concerns. Understanding determinants of changes in adiposity over time is critical for informing effective ...evidence-based prevention or treatment. However, limited information is available to achieve this objective. Cultural, demographic, environmental, and behavioral factors including socio-economic status (SES) likely account for obesity development. To this end, we related these variables to anthropometric measures in 1058 black adult Tswana-speaking South Africans who were HIV negative in a prospective study over five years. Body mass index (BMI) and waist circumference increased in both sexes, whereas triceps skinfold thickness remained the same. Over the five years, women moved to higher BMI categories and more were diagnosed with central obesity. Age correlated negatively, whereas SES, physical activity, energy, and fat intake correlated positively with adiposity markers in women. In men, SES, marital status, physical activity, and being urban predicted increases in adiposity. For women, SES and urbanicity increased, whereas menopause and smoking decreased adiposity. Among men, smokers had less change in BMI than those that never smoked over five years. Our findings suggest that interventions, focusing on the urban living, the married and those with the highest SES-the high-risk groups identified herein-are of primary importance to contain morbidity and premature mortality due to obesity in black South Africans.
Analgesic trials frequently fail to demonstrate efficacy of drugs known to be efficacious. Poor pain reporting accuracy is a possible source for this low essay-sensitivity. We report the effects of ...Accurate-Pain-Reporting-Training (APRT) on the placebo response in a trial of Pregabalin for painful-diabetic-neuropathy. The study was a two-stage randomized, double-blind trial: In Stage-1 (Training) subjects were randomized to APRT or No-Training. The APRT participants received feedback on the accuracy of their pain reports in response to mechanical stimuli, measured by R-square score. In Stage-2 (Evaluation) all subjects entered a placebo-controlled, cross-over trial. Primary (24-h average pain intensity) and secondary (current, 24-h worst, and 24-h walking pain intensity) outcome measures were reported. Fifty-one participants completed the study. APRT patients (n = 28) demonstrated significant (p = 0.036) increases in R-square scores. The APRT group demonstrated significantly (p = 0.018) lower placebo response (0.29 ± 1.21 vs. 1.48 ± 2.21, mean difference ± SD = -1.19±1.73). No relationships were found between the R-square scores and changes in pain intensity in the treatment arm. In summary, our training successfully increased pain reporting accuracy and resulted in a diminished placebo response. Theoretical and practical implications are discussed.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Objectives
To review the scientific literature pertaining to the use of hand‐carried and hand‐held ultrasound devices in low‐ and middle‐income countries (LMIC), with a focus on clinical ...applications, geographical areas of use, the impact on patient management and technical features of the devices used.
Methods
The electronic databases PubMed and Google Scholar were searched. No language or date restrictions were applied. Case reports and original research describing the use of hand‐carried ultrasound devices in LMIC were included if agreed upon as relevant by two‐reviewer consensus based on our predefined research questions.
Results
A total of 644 articles were found and screened, and 36 manuscripts were included for final review. Twenty‐seven studies were original research articles, and nine were case reports. Several reports describe the successful diagnosis and management of difficult, often life‐threatening conditions, using hand‐carried and hand‐held ultrasound. These portable ultrasound devices have also been studied for cardiac screening exams, as well as a rapid triage tool in rural areas and after natural disaster. Most applications focus on obstetrical and abdominal complaints. Portable ultrasound may have an impact on clinical management in up to 70% of all cases. However, no randomised controlled trials have evaluated the impact of ultrasound‐guided diagnosis and treatment in resource‐constrained settings. The exclusion of articles published in journals not listed in the large databases may have biased our results. Our findings are limited by the lack of higher quality evidence (e.g. controlled trials).
Conclusions
Hand‐carried and hand‐held ultrasound is successfully being used to triage, diagnose and treat patients with a variety of complaints in LMIC. However, the quality of the current evidence is low. There is an urgent need to perform larger clinical trials assessing the impact of hand‐carried ultrasound in LMIC.
Objectifs
Passer en revue la littérature scientifique portant sur l'utilisation d'appareils d’échographie portatifs dans les pays à faible revenu et à revenu intermédiaire (PFR‐PRI) en mettant l'accent sur les applications cliniques, les zones géographiques d'utilisation, l'impact sur la prise en charge des patients et les caractéristiques techniques des appareils utilisés.
Méthodes
Recherche effectuée dans les bases de données électroniques PubMed et Google Scholar. Aucune restriction linguistique ou de période n'a été appliquée. Les rapports de cas et les recherches originales décrivant l'utilisation d'appareils d’échographie portatifs dans les PFR‐PRI ont été inclus, si trouvés pertinents par le consensus de deux reviewers, basé sur nos questions de recherche prédéfinies.
Résultats
644 articles ont été trouvés et analysés, 36 manuscrits ont été inclus pour analyse finale. 27 études faisaient l'objet d'articles de recherche originale et 9 étaient des rapports de cas. Plusieurs rapports décrivent le diagnostic et la prise en charge avec succès de conditions difficiles, souvent mortelles, en utilisant des appareils d’échographie portatifs. Ces dispositifs d’échographie portatifs ont également été étudiés pour les examens de dépistage cardiaques, ainsi que comme outil de triage rapide dans les zones rurales et à la suite de catastrophes naturelles. La plupart des applications se concentrent sur les plaintes obstétricales et abdominales. L’échographie portative peut avoir un impact sur la prise en charge clinique dans 70% de tous les cas. Cependant, aucun essai contrôlé randomisé n'a évalué l'impact sur le diagnostic et le traitement guidé par l’échographie dans les milieux à ressources limitées. L'exclusion des articles publiés dans des revues ne figurant pas dans les grandes bases de données peut avoir biaisé nos résultats. Nos résultats sont limités par le manque de donnée de meilleure qualité (par ex., les essais contrôlés).
Conclusions
L’échographie portative et réalisée à la main est utilisée avec succès au triage, au diagnostic et pour le traitement des patients avec diverses plaintes dans PFR‐PRI. Cependant, la qualité des données actuelles est faible. Il est urgent de procéder à des essais cliniques de grande envergure évaluant l'impact de l’échographie réalisée à la main dans les PFR‐PRI.
Objetivos
Revisar la literatura científica existente sobre el uso de aparatos portátiles de ultrasonido en países con ingresos bajos y medios (PIBM), con especial atención en las aplicaciones clínicas, las áreas geográficas de uso, el impacto sobre el manejo del paciente y las características técnicas de los aparatos utilizados.
Métodos
Se realizó una búsqueda en las bases de datos electrónicas PubMed y Google Scholar. No se aplicaron restricciones de idioma o fecha. Se incluyeron los informes de casos y artículos originales que describían el uso de aparatos de ultrasonido portátiles en PIBM, si dos revisores estaban de acuerdo sobre su relevancia basándose en las preguntas predefinidas de búsqueda.
Resultados
Se encontraron y revisaron 644 artículos, y se incluyeron 36 manuscritos en la revisión final. 27 estudios eran artículos de investigaciones originales y 9 eran informes de casos. Varios informes describan el diagnóstico exitoso y el manejo de condiciones difíciles, a menudo letales, utilizando equipos portátiles de ultrasonido. Estos equipos también han sido estudiados en pruebas de riesgo cardiaco, al igual que como herramientas de triaje rápido en áreas rurales y después de un desastre natural. La mayoría de las aplicaciones se centran en problemas obstétricos y abdominales. El ultrasonido portátil podría tener un impacto sobre el manejo clínico en hasta un 70% de todos los casos. Sin embargo, ningún ensayo aleatorizado y controlado ha evaluado el impacto del diagnóstico y el tratamiento guiado por ultrasonido en lugares con recursos limitados. Excluir aquellos artículos publicados en revistas que no figuran en las grandes bases de datos podría haber sesgado nuestros resultados. Nuestros hallazgos están limitados por la falta de evidencia de mayor calidad (ej. ensayos controlados).
Conclusiones
El uso de equipos de ultrasonido portátiles es exitoso para realizar el triaje, diagnóstico y tratamiento de pacientes con una variedad de problemas en PIBM. Sin embargo, la calidad de la evidencia actualmente disponible es baja. Existe una necesidad urgente de realizar ensayos clínicos grandes para evaluar el impacto de equipos de ultrasonido portátiles en PIBM.
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