African Adults Research Articles

Abstract 4127417: Trends in Atherosclerotic Cardiovascular Disease Related Mortality Among Older Adults in the United States From 1999-2021

Background: Atherosclerotic cardiovascular disease (ACVD) is the leading cause of mortality in the U.S, and increasing age is one of the greatest risk factors for the development and prognosis of ACVD. However, ACVD-related mortality trends in older adults have not yet been established. Aims: This study aims to highlight the annual trends and demographic differences in ACVD-related mortality among older adults in the U.S. from 1999 to 2021. Methods: The CDC WONDER multiple-cause of death database was examined from 1999 to 2021 for ACVD-related mortality in adults >65 years of age. Age-adjusted mortality rates (AAMRs) per 100,000 persons was calculated. Trends and annual percent changes (APCs) were calculated, and subsequently stratified by overall, sex, race/ethnicity, urbanization status, and census region. Results: Between 1999 and 2021, 9,307,495 ACVD-related deaths occurred among older adults in the U.S. AAMRs decreased from 1370.7 in 1999 to 803.5 in 2014 (APC, -3.64 [-3.89 to -3.46]), after which it gradually decreased to 741.3 in 2019 (APC, -1.24 [-2.54 to 0.19]), and then increased to 841.5 in 2021 (APC, 7.00 [3.92 to 9.18]). Men had consistently higher AAMRs than women from 1999 (AAMR men: 1754.1 vs women: 1122.2) to 2021 (AAMR men: 1169.6 vs women: 599.6). Non-Hispanic (NH) Black or African American older adults had the highest AAMR in 2020 (886.1), followed by NH White (849.4), NH American Indian/Alaska Native (752.5), Hispanics or Latino (718.3) and NH Asian or Pacific Islanders (494.4). AAMR also varied substantially by region (overall AAMR until 2020: Midwest 875.1; South 872.2; Northeast 801.0; West 789.2), and rural areas had higher ACVD-related mortality (993.5) than urban regions (954.7). Figure 1. Conclusion: Following a progressive decrease until 2019, ACVD-related mortality in U.S. older adults demonstrated a sharp increase in mortality in 2020 and 2021. The highest AAMRs were observed among Black or African American adults and men, and among patients living in the Midwestern and non-metropolitan areas. A targeted approach, with tailored strategies is required to counter the recent surge in ACVD-related mortality in older adults in the U.S.

Abstract 4128457: Trends in Hypertension-Related Mortality Among Younger Adults in the United States From 1999-2021

Background: The U.S. population has seen a dramatic increase in the burden of hypertension (HTN) among younger adults. However, HTN-related mortality trends among younger adults have not been investigated. Aim: We examined the trends and demographic differences in HTN-related mortality among younger adults in the U.S. Methods: Data from the CDC WONDER database was examined from 1999 to 2021 for HTN-related mortality in adults between 15 to 45 years of age. The International Statistical Classification of Diseases and Related Health Problems-10th Revision (ICD-10) codes employed were as follows: I10-I15 (hypertensive diseases). Age-adjusted mortality rates (AAMRs) per 100,000 persons and annual percent changes (APCs) with 95% confidence intervals (CIs) were calculated and stratified by year, sex, race/ethnicity, urbanization status and census region. Results: Between 1999 and 2021, 201,860 HTN-related mortalities occurred among younger adults in the U.S. The AAMR increased from 2.8 in 1999 to 5.0 in 2001 (APC, 35.3 [20.6 to 44.5]), after which it steadily increased to 9.4 in 2019 (APC 3.1, [2.7 to 3.5]), and sharply increased to 13.9 in 2021 (APC 22.3; 95% CI 15.1 to 26.4). Men had consistently higher AAMRs than women from 1999 (AAMR men: 3.6 vs women: 1.9) to 2021 (AAMR men: 18.9 vs women: 8.8). Non-Hispanic (NH) Black or African American young adults had the highest AAMR in 2020 (30.2), followed by NH American Indian/Alaska Natives (29.6), NH White (9.9), Hispanics or Latino (9.3) and NH Asian or Pacific Islanders (5.0). AAMR also varied substantially by region (overall AAMR: South 9.3; Midwest 6.4; West 5.8; Northeast 5.4), and rural areas had higher HTN-related mortality (8.5) than their urban counterparts (7.0). Figure 1. Conclusion: Following a steady increase until 2019, HTN-related mortality increased among young adults between 2020 and 2021. The highest AAMRs were observed among men and Black or African American young adults, and people residing in the Southern and non-metropolitan areas. This emphasizes the necessity of tailored interventions to mitigate the burden and reduce the current disparities in HTN-related mortality among young adults in the U.S.

Abstract 4141453: The Pandemic influenced the Self-care of African Immigrants with Diabetes and Hypertension

Background: Self-Care is essential for chronic illness management. Self-Care comprises three domains: Self-Care maintenance (daily behaviors to maintain health [e.g., medication adherence]), Self-Care monitoring (surveillance for changes), and (3) Self-Care management (prompt response to symptoms). The COVID-19 pandemic challenged self-care in some populations, but little is known about how it influenced the self-care of African immigrants living in the US with chronic illnesses such as hypertension and diabetes. Methods: Using a qualitative descriptive design, we enrolled a purposeful sample of 24 sub-Saharan African immigrant adults with self-reported symptomatic hypertension or diabetes. Participants who spoke English were enrolled between March 2020 and September 2021. Individual audio-taped interviews were transcribed and analyzed. Inductive and deductive thematic analysis was guided by the Theory of Self-Care of Chronic Illness. Results: Participants were mean=59 years (range 40-72). Most were Nigerian (n=16), male (n=16), married (n=17), living with family (n=21), highly educated (n=21), and reporting enough income to meet their needs (n=21). Five major themes were identified: (1) Being especially careful in following COVID-19 precautions (e.g., use of facemasks). (2) A focus on self-care maintenance (e.g., healthy diet, staying active while at home). Fear of COVID-19 increased medication adherence. Participants were diligent in taking medications as prescribed due to fear of COVID-19. (3) Close monitoring for symptoms. (4) Trouble reaching providers to discuss symptoms. (5) Access to resources. Participants reported loss of health insurance/jobs and lack of provider access, which impacted their ability to perform self-care. Conclusions: COVID-19 increased focused attention on self-care but also created barriers for sub-Saharan African Immigrants. Most impacted was self-care maintenance. Interventions to promote self-care in this population should leverage heightened vigilance to self-care and address challenges around access to resources.

Non-modifiable and Modifiable Risk Factors in Vascular Ageing Extremes: The African-PREDICT Study

Abstract Background Cardiovascular risk factors accelerate vascular ageing beyond chronological age, hence early vascular ageing (EVA). Carotid to femoral pulse wave velocity (cfPWV) is a measure of vascular ageing and is used to identify EVA and supernormal vascular ageing (SUPERNOVA). Vascular ageing is not completely understood in African populations. Therefore, we aimed to phenotype young South African adults stratified by cfPWV extremes in terms of non-modifiable and modifiable risk factors. This study included 1133 young adults (mean age: 24.5 years). We measured cfPWV using applanation tonometry. Body composition measures, self-reported 24-h dietary intake, smoking and alcohol consumption were included. Fasting blood samples were analysed for biochemical risk factors. Three groups based on cfPWV percentiles were compared and included SUPERNOVA (≤ 10th percentile), average vascular ageing (AVA, between 10 to 90th percentile) and EVA (≥ 90th percentile). Results Chronological age, male sex, smoking, alcohol use, and blood pressure were incrementally higher across PWV groups (all p trend ≤ 0.007). Black ethnicity was higher (p = 0.038) in the SUPERNOVA group. In exploratory factor analysis, a factor pattern including mean arterial pressure and fasting glucose showed beneficial odds (OR 0.62, p = 0.002) for SUPERNOVA and higher likelihood (OR 2.10, p < 0.001) for EVA. Another factor pattern of socio-economic status and total dietary fat showed lower odds (OR 0.64, p = 0.003) for EVA. Conclusion Poor lifestyle behavioural risk factors seem detrimental in the EVA group conferring a possible higher risk of future CVD.

Cognitive Difficulty in Middle Eastern and North African Adults Living in the United States Compared With Other Racial and Ethnic Categories, 2017-2021.

Objectives. To estimate the odds of having cognitive difficulties among Middle Eastern and North African (MENA) American adults and compare these odds with those of White, Black, Hispanic/Latino, Asian, American Indian or Alaska Native (AI/AN), and Native Hawaiian/Other Pacific Islander adults nationally and in the 4 states with the largest MENA populations (California, New York, Michigan, and Texas) after adjusting for sociodemographic factors. Methods. We analyzed 2017-2021 American Community Survey data (aged ≥ 45 years; n = 7 284 988), comparing presence of cognitive difficulties by race/ethnicity. Results. MENA adults had greater odds of reporting cognitive difficulties than did White (odds ratio [OR] = 1.49; 95% confidence interval [CI] = 1.42, 1.56), Black (OR = 1.20; 95% CI = 1.14, 1.26), Hispanic (OR = 1.46; 95% CI = 1.39, 1.53), Asian (OR = 1.31; 95% CI = 1.25, 1.38), and AI/AN (OR = 1.07; 95% CI = 1.01, 1.14) adults. In all 4 states, odds of having cognitive difficulties were higher among MENA than Asian adults. Other racial/ethnic comparisons differed by state. Conclusions. A separate checkbox for MENA Americans approved by the Office of Management and Budget is important so health outcomes can be studied in more detail and funds can be allocated for research and resources at state and national levels. (Am J Public Health. 2024;114(11):1265-1274. https://doi.org/10.2105/AJPH.2024.307803).

Exploring optimal methods for age-at-death estimation using pulp/tooth area ratios: a South African study.

Age-at-death estimation is pivotal in the identification of unknown human decedents in forensic medicine. The pulp/tooth area ratio (PAR) method, assessing pulp cavity size as a marker of secondary dentine apposition, is widely utilised for adult age estimation. Despite extensive evaluation of this technique, the influence of image type and enamel area inclusion on method accuracy is insufficiently explored. The present study evaluated the PAR method's applicability using maxillary canines from a South African cadaveric sample, examining reliability, sex bias, and accuracy across different image types and enamel area considerations. An observational, cross-sectional study design was followed. Fifty-two adult maxillary canines were radiographed, sectioned, and analysed using stereomicroscopy. Labiolingual and mesiodistal periapical radiographs, alongside labiolingual stereomicroscopic tooth section images, were analysed using ImageJ to calculate PARs. Age estimation linear regression models were developed for each image type, with and without enamel area inclusion. Models were compared for performance and accuracy using best-subsets regression and cross-validation analyses. Results indicated that the PAR method is a reliable, sex-independent technique, providing relatively accurate age-at-death estimates for South African adults. Image type significantly influenced accuracy, with tooth section images exhibiting the best/lowest error values, followed by labiolingual and mesiodistal radiographs, respectively. Exclusion of enamel area consistently enhanced model performance across all image types. This study contributes valuable data to the underexplored field of dental age estimation techniques for South African adults, highlighting optimal approaches when applying the PAR method to maxillary canines. Additionally, it introduces a refined stereomicroscopic technique, augmenting and enhancing existing practices.

Nutrient intake of young South African adults from the baseline of the African-PREDICT cohort study.

This study aimed to describe and compare the nutrient intake of young adults in the African Prospective Study on the Early Detection and Identification of Cardiovascular Disease and Hypertension (African-PREDICT) study according to ethnicity and socioeconomic status (SES). Cross-sectional analysis of baseline nutrient intakes in the African-PREDICT study. North West Province, South Africa. Black and white adults (n=1153), aged 20-30 years, were classified into three SES groups. Dietary data were collected using three multiple-pass 24-hour dietary recalls. Among all participants, over 70% failed to meet the Estimated Energy Requirements and the Estimated Average Requirements (EAR) for 17 of the 19 reported micronutrients. Across SES groups, more than 50% of participants consistently did not meet the EAR for calcium, magnesium, folate, pantothenic acid, and biotin, as well as vitamins A, C, D, and E. Participants' distribution by nutrient pattern tertiles showed high adherence to two patterns: one rich in animal protein and saturated fat, and the other in magnesium, potassium, calcium, phosphorus, and fiber. This was seen only in white participants and high SES. Black participants and low SES showed higher adherence to a plant protein, B-vitamins, zinc, and iron nutrient pattern. The dietary intake of young adults in this study was restricted, with none of the groups meeting nutrient requirements for essential nutrients. Further research is needed to establish a direct link between nutrient patterns and the early detection and identification of cardiovascular diseases and hypertension.

The predisposing factors to heart failure diagnosis and early mortality among young adults in Africa: a narrative review

Abstract Introduction Heart failure (HF) is a major health concern mainly diagnosed among elderly individuals. Primarily, researchers have focused on this age group, nevertheless, compared to individuals from other regions of the world, Africans presents with HF two decades sooner (52 versus 79 years). Even though it manifests early, young persons (18–35 years old) are also diagnosed with HF with prognoses comparable to the older group. Less is known about how much study is concentrated on this age range, although globally, young adults of African origin make up the majority of those with an early onset of heart failure. Additionally, obtaining information about how HF impacts African youth remains challenging. Purpose To determine the cause of Africans' early HF diagnosis as well as the risk factors for HF diagnosis and early mortality among young adults. Methodology Three electronic databases— MEDLINE Ovid, Scopus, and CINAHL Plus—were searched using the Boolean operators. The first retrieved hits were checked for relevancy by titles and abstracts. Then, publications were fully screened for inclusion in the review based on the pre-established criteria. Also, reference lists of the articles were snowballed for pertinent studies. The scientific integrity of the studies was evaluated using a guided, in-depth peer-reviewed article on how to critically analyse clinical research and the Critical Appraisal Skill Programme (CASP) tool cohort checklist. Pertinent information regarding the study was analysed using a narrative review methodology. Eleven (11) articles out of the 135 pulled from the databases met the requirements for inclusion in the review after a thorough screening. One article was eliminated upon critical evaluation of the research's methodology, and an eligible article was discovered from snowballing reference lists. Therefore, only 11 articles qualified for this review study. Results Findings from the review show that HF is diagnosed earlier among Africans due to the early presentation of the major causes of HF before the age of 30 years. Rheumatic heart disease, cardiomyopathy, ischemic heart disease, HTN, and pulmonary illnesses (COPD, TB, and pulmonary arterial hypertension) are known aetiologies. More so, young adults who are diabetic, obese, have hyperlipidaemia or smoke cigarettes are more likely to develop HF. Furthermore, socioeconomic status, alcohol use, smoking, renal dysfunction, higher serum levels of brain natriuretic peptide (BNP) and creatine kinase (Isomer MB), cardiogenic shock, and decreased ejection fraction were the predictors of death with significant p-values (0.05). Conclusion Although HF affects young African adults disproportionately causing them to live lower quality of life and shorter lives, no research before this has been conducted. Therefore, further study is required to understand how HF affects this target age range (18 to 35 years) and to develop a long-term plan to fight this illness before it worsens.

The Effects of Behaviorally Informed Messages on COVID-19 Vaccination Intentions and Behavior: Evidence from Randomized Survey Experiments in South Africa

With COVID-19 vaccination rates remaining below optimal levels, scalable interventions to shift vaccination intentions are needed. We embedded two randomized experiments in South Africa’s COVID-19 Vaccine Survey (CVACS) to investigate the potential to change vaccine intentions and behavior. In Experiment 1, 3510 unvaccinated South African adults were randomly assigned to a no-message control group, a social norm message, or a message highlighting that vaccines were free, available and easy to obtain. The free and easy message significantly increased vaccine intentions but did not increase other outcome measures. The social proof message was associated with an increase in self-reported vaccination status at follow-up (not significant at traditional statistical thresholds). In Experiment 2, 3608 unvaccinated South African adults were randomly assigned to a no-message control group, a message highlighting gaining greater freedoms, or a message highlighting being part of the solution to the pandemic. Neither value proposition message increased vaccination intentions. Light-touch and scalable messages informed by behavioral science and social marketing principles may increase vaccination intentions and uptake, However, more attention should be paid to understanding the behavioral barriers experienced by different population segments, and to tailoring and targeting messaging to those barriers and segments.

Disparities in Tobacco Smoking by Sex and Employment Status: Results from South Africa’s First Global Adult Tobacco Survey

Background/Objectives: Tobacco smoking is a cause of premature death and illness globally. This study examined the prevalence and factors associated with tobacco smoking among South African adults according to sex, education, and employment status among socio-demographic subgroups. Methods: Data were obtained from the 2021 South African Global Adult Tobacco Survey (a nationally representative household survey using a multi-stage stratified cluster random sampling design). The 6,311 participants were aged 15+ years. Descriptive statistics, chi-square tests, and multiple logistic regression analysis were used to investigate relationships between current smoking and socio-demographic variables. Results: Smoking prevalence was 25.8% (n = 1573) (41.2% among men, 11.5% among women; 29.9% among working individuals, 23.1% among non-working individuals). The multiple logistic regression results showed that males aged 45–64 were twice as likely to be currently smoking than males aged 15–24. Coloured (of mixed race) males were twice as likely to smoke as Black African males. Males with secondary/post-secondary education were less likely to smoke compared to males with no education. Coloured females were seven times and White females were almost five times more likely to smoke than Black African females. Females with post-secondary education were less likely to smoke than those with no formal education. Females earning an income were more likely to smoke compared to those with no income. Non-working participants aged 25–44 and 45–64 were more likely to smoke compared to those aged 15–24 years. Working and non-working Coloured and working White individuals were three times more likely to smoke than working or non-working Black Africans. Conclusion: Groups with higher identified smoking prevalence may indicate where smoking cessation interventions should be targeted to reduce national smoking prevalence.

Social discounting in a symmetric giving and taking frame: An artifactual field experiment with young South African adults.

In the dictator game, the evidence that giving is equivalent to taking is mixed. The purpose of this study was to investigate framing effects (giving/taking) on social-discounting rates among young African adults from an informal settlement in South Africa. Employing a within-participant design, these young adults completed a series of incentivized dictator games with an isomorphically equivalent giving and taking frame at each of eight social distances. Altruism was measured by the social-discounting rate, and framing effects were assessed using generalized linear regression. The study provides empirical evidence that prosocial behavior among young South African adults is subject to framing because exponential, hyperbolic, and q-exponential social-discounting rates in all instances were lower in the taking than in the giving frame. This difference may be the result of greater "egalitarianism" and "selflessness" elicited by the taking frame, which likely is a product of the experiment's particular social and economic field context. More comparative research is required to establish the working of specific mechanics of morality that may operate differently in diverse socioeconomic contexts, thus contributing to elucidating the heterogeneous nature of findings in this area of study.

Effect of a cash transfer intervention on memory decline and dementia probability in older adults in rural South Africa

Evidence on cash transfers as a population-level intervention to support healthy cognitive aging in low-income settings is sparse. We assessed the effect of a cash transfer intervention on cognitive aging outcomes in older South African adults. We leveraged the overlap in the sampling frames of a Phase 3 randomized cash transfer trial [HIV Prevention Trial Network (HPTN) 068, 2011-2015] and an aging cohort [Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community (HAALSI), 2014-2022] in rural Mpumalanga Province, South Africa. In 2011/12, young women and their primary caregivers were randomly assigned 1:1 to receive a monthly cash transfer or control. In 2014/2015, 862 adults aged 40+ y living in trial households were enrolled in the HAALSI cohort, with cognitive data collected in three waves over 7 y. We estimated the impact of the intervention on rate of memory decline and dementia probability scores. Memory decline in the cash transfer arm was 0.03 SD units (95% CI: 0.002, 0.05) slower per year than in the control arm. Dementia probability scores were three percentage points lower in the cash transfer arm than the control arm (β = -0.03; 95% CI: -0.05, -0.001). Effects were consistent across subgroups. A modestly sized household cash transfer delivered over a short period in mid- to later-life led to a meaningful slowing of memory decline and reduction in dementia probability 7 y later. Cash transfer programs could help stem the tide of new dementia cases in economically vulnerable populations in the coming decades.

A GWAS of ACE Inhibitor-Induced Angioedema in a South African Population.

Angiotensin-converting enzyme inhibitor-induced angioedema (AE-ACEI) is a life-threatening adverse event and, globally, the commonest cause of emergency presentations with angioedema. Several large genome-wide association studies (GWAS) have found genomic associations with AE-ACEI. However, despite African Americans having a 5-fold increased risk of AE-ACEI, there are no published GWAS from Africa. The aim of this study was to conduct a case-control GWAS of AE-ACEI in a South African population and perform a meta-analysis with an African American and European American population. The GWAS included 202 South African adults with a history of AE-ACEI and 513 controls without angioedema following angiotensin-converting enzyme inhibitor (ACEI) treatment for at least 2 years. A meta-analysis was conducted with GWAS summary statistics from an African American and European American cohort (from Vanderbilt/Marshfield with 174 cases and 489 controls). No SNPs attained genome-wide significance. However, 26 SNPs in the post-imputation standard GWAS of the South African cohort and 37 SNPs in the meta-analysis were associated to AE-ACEI with suggestive threshold(p-value<5.0×10-06). Some of these SNPs were found to be located close to the genes PRKCQ and RIMS1, previously linked with drug-induced angioedema, and also close to the CSMD1 gene linked to ACEI cough, providing replication at the gene level, but with novel lead SNPs. Our results highlight the importance of African populations to detect novel variants in replication studies. Further increased sampling across the continent and matched functional work are needed to confirm the importance of genetic variation in understanding the biology of AE-ACEI.

The meaning of Black history: Development and validation of the Scale of Black History Consciousness.

This article describes the development and validation for a measure designed to assess the importance and meaning of Black history-the Scale of Black History Consciousness (SBHC)-in two independently recruited samples of African descent adults. After iterative exploratory (n = 350) and confirmatory (n = 366) factor analytic procedures, a 12-item measure, with scores of two internally consistent factors (sociopolitical beliefs and empowerment beliefs), emerged as the most parsimonious and psychometrically sound. An assessment of scalar measurement invariance using multiple indicators multiple causes modeling indicated that SBHC factors did not differ across racial-ethnic identification or generational status. Validity evidence was established through an examination of bivariate correlations of the SBHC factors with race centrality and impression management. Additionally, participants who endorsed being in environments where learning about Black history was emphasized reported higher SBHC scores than their counterparts who were not exposed to these environments demonstrating known-groups validity. These results provide initial support for the validity and reliability of the SBHC. Findings from this study advance scholarship about the psychological importance of Black history, and the SBHC can contribute to investigations of African descent adults' beliefs about the value of Black history in their lives. Recommendations for further scale development research and practice applications of the SBHC are also discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The association between tobacco and alcohol use and health outcomes in individuals living with diabetes and prediabetes in South Africa: A cross-sectional study.

Smoking and alcohol misuse are lifestyle factors that can be controlled and have significant health effects. Both these factors increase the risk of developing conditions such as diabetes mellitus because they affect glucose metabolism and can interfere with blood glucose control in individuals with diabetes. Research on tobacco and alcohol use and specific health outcomes among adults with prediabetes or type 2 diabetes mellitus (T2DM) could provide valuable information leading to more efficient treatment and management of this disease. To assess the association between tobacco and alcohol use and specific health outcomes among South African adults with prediabetes or T2DM. Data from the 2016 South African Demographic and Health Survey were analysed using Stata v17. Participants were classified into prediabetes or T2DM groups, based on a glycated haemoglobin cut-off of 5.7% or self-report of a previous diagnosis of T2DM. Exposures of interest were self-reported current tobacco smoking and problem/risky alcohol use. The associations between these exposures and health outcomes in the different groups were assessed using multivariable logistic regression analysis. We adjusted for specific confounders in the regression models. Of a total of 6 108 participants (mean (standard deviation) age 41 (19) years), 72.2% (n=4 409) had prediabetes and 27.8% (n=1 699) T2DM; 17.7% (n=1 084) were current smokers and 9.3% (n=565) reported problem/risky alcohol use. Current smoking was significantly associated with 40% increased odds of shortness of breath (adjusted odds ratio (aOR) 1.40; 95% confidence interval (CI) 1.1 - 1.7; p<0.001) and 67% increased odds of chronic obstructive pulmonary disease (COPD)/asthma (aOR 1.67; 95% CI 1.2 - 2.2; p<0.001). Problem/risky alcohol use was significantly associated with 40% increased odds of COPD/asthma (aOR 1.40; 95% CI 1.1 - 1.7; p=0.001) and 92% increased odds of having cancer (aOR 1.92; 95% CI 1.5 - 2.5; p<0.001). There is a need for targeted smoking cessation programmes and alcohol misuse counselling among individuals living with diabetes and prediabetes.

Quantification of eosinophils in the lower gastrointestinal tract of adults: a review of surgical specimens with normal histology from the Free State province, South Africa.

Eosinophils are normal residents of the gastrointestinal tract (GIT). They are noted in small numbers with significant variation between anatomic locations. An idiopathic increase of eosinophils is known as eosinophilic gastrointestinal disease (EGID). EGIDs are a heterologous group of disorders that produce a range of enteric and colonic syndromes. Their incidence has been increasing worldwide. Our study aimed to quantify eosinophils in each segment of the GIT in surgical specimens with normal histology to facilitate the histological diagnosis of EGID. Similarly, we aimed to describe the effect of race and gender on gastrointestinal eosinophil numbers. A retrospective, quantitative comparative study was performed. We assessed 360 surgical specimens with normal histology from the lower gastrointestinal tract of African and Caucasian adults from the Free State Province, South Africa. The number of eosinophils per mm² was counted. Overall, comparable eosinophil values were noted for both males and females, and African and Caucasian South Africans. However, Caucasians recorded a higher concentration of eosinophils in the appendix and the left colon. Eosinophils were most numerous in the lamina propria, with only small numbers present in the epithelium. Our results show that the South African population has similar eosinophil distribution trends to international studies. However, South Africans had far fewer eosinophils than Japanese and North American adults in each segment. Specific eosinophil reference ranges were formulated to quantify reference ranges of eosinophils in the lower GIT, allowing for the accurate diagnosis of EGIDs in our population in future.

Low-Dose Triple-Pill vs Standard-Care Protocols for Hypertension Treatment in Nigeria

With the high burden of hypertension in sub-Saharan Africa, there is a need for effective, safe and scalable treatment strategies. To compare, among Black African adults, the effectiveness and safety of a novel low-dose triple-pill protocol compared with a standard-care protocol for blood pressure lowering. Randomized, parallel-group, open-label, multicenter trial conducted in public hospital-based family medicine clinics in Nigeria. Black African adults with uncontrolled hypertension (≥140/90 mm Hg) who were untreated or receiving a single blood pressure-lowering drug. Participants were randomly allocated to low-dose triple-pill or standard-care protocols. The triple-pill protocol involved a novel combination of telmisartan, amlodipine, and indapamide in triple one-quarter, one-half, and standard doses (ie, 10/1.25/0.625 mg, 20/2.5/1.25 mg, and 40/5/2.5 mg), with accelerated up-titration. The standard-care protocol was the Nigeria hypertension treatment protocol starting with amlodipine (5 mg). The primary effectiveness outcome was the reduction in home mean systolic blood pressure, and the primary safety outcome was discontinuation of trial treatment due to adverse events, both from randomization to month 6. The first participant was randomized on July 19, 2022, and the last follow-up visit was on July 18, 2024. Among 300 randomized participants (54% female; mean age, 52 years; baseline mean home blood pressure, 151/97 mm Hg; and clinic blood pressure, 156/97 mm Hg), 273 (91%) completed the trial. At month 6, mean home systolic blood pressure was on average 31 mm Hg (95% CI, 28 to 33 mm Hg) lower in the triple-pill protocol group and 26 mm Hg (95% CI, 22 to 28 mm Hg) lower in the standard-care protocol group (adjusted difference, -5.8 mm Hg [95% CI, -8.0 to -3.6]; P < .001]). At month 6, clinic blood pressure control (<140/90 mm Hg) was 82% vs 72% (risk difference, 10% [95% CI, -2% to 20%]) and home blood pressure control (<130/80 mm Hg) was 62% vs 28% (risk difference, 33% [95% CI, 22% to 44%]) in the triple-pill compared with the standard-care protocol group; these were 2 of 21 prespecified secondary effectiveness end points. No participants discontinued trial treatment due to adverse events. Among Black African adults with uncontrolled hypertension, a low-dose triple-pill protocol achieved better blood pressure lowering and control with good tolerability compared with the standard-care protocol. Pan African Clinical Trials Registry Identifier: PACTR202107579572114.

Vessel density, macula thickness and foveal avascular zone measurements in young African adults with moderate myopia: A pilot study.

The aim of this study was to investigate the association between macula thickness and vessel density in African myopic and emmetropic eyes through the use of Spectral Domain Optical Coherence Tomography (OCT). The study population comprised African adults aged 18-35 years old. The study was conducted at a University eye clinic located in Durban, South Africa. Purposive sampling was utilised to obtain 59 participants of whom 24 were myopes and 35 were emmetropes. Vessel density (VD), foveal avascular zone (FAZ) and retinal thickness (RT) were obtained using the Heidelberg Spectralis OCT with angiography. Thereafter, a multivariate linear regression was used to investigate associations between the spherical equivalent myopic refractive error and VD, FAZ and RT for the myopic group only. Myopic participants had a mean spherical equivalent (MSE) and standard deviation (SD) of -4.79 D (1.27) while the emmetropic group had an MSE (SD) of -0.32 D (0.46). Both superficial and deep VD were significantly decreased at the central fovea (radius (r) = 0.4 mm), peri-foveal (r = 1.10-1.45 mm) and para-foveal (r = 0.75-1.10 mm) sectors in myopes when compared with emmetropes. Myopes showed a significant reduction in RT in the inner retinal layer across the inferior and temporal zones of the peri-foveal region as well as the inferior and temporal zones of the para-foveal region when compared with emmetropes. A significantly smaller FAZ was found at both the superficial and deep vascular plexuses (p < 0.001). In African myopes, significant associations were not found between MSE and VD or FAZ and macula retinal thickness. Retinal vascular and thickness reduction may occur in young African adults with moderate myopia. A broad-based study targeting VD and IRT in African myopes is proposed to confirm preclinical myopic macula disruptions in adults of African ethnicity. OCT angiography should be considered when monitoring progressive myopia.

Cumulative Trauma Exposure and Post-Traumatic Stress Symptoms Among Older Adults in South Africa: Does Post-Traumatic Growth Moderate This Link?

ABSTRACT The study explored the interplay between PTG and PTSS in older South African adults exposed to trauma. A quantitative cross-sectional design was employed. 195 participants from a low-resourced setting in South Africa were interviewed using the UCLA Life Adversities Screener, the PTSD Checklist (DSM-5), and the PTG-Inventory. Hayes Model SPSS Macro PROCESS for moderation was used. Overall, the relationship between cumulative trauma exposure and PTSS was moderated by the PTG level (b = -0.09, SE = 0.04, p = .0113). The findings suggest that cumulative trauma exposure is a significant predictor of PTSS, and the relationship is moderated by the threshold level of PTG. Higher levels of PTG mitigated the effect of cumulative trauma exposure on PTSS.

Cardiometabolic disease risk in relation to objectively measured physical activity, sedentary behaviour in South African adults with knee and hip osteoarthritis

Purpose This study aimed to investigate the relationship between cardiometabolic disease risk and time spent in device-measured activity behaviours in a cohort of people with advanced osteoarthritis (OA) awaiting joint replacement surgery. Materials and methods Cardiometabolic risk biomarkers were assessed in people with OA (n = 96; hip n = 38, knee n = 58; mean (SD) age = 64.3 (9.8) years; 71% female). Physical activity (PA) and sedentary behaviour (SB) were measured by accelerometer over seven days (24 h/day). Results There were similar patterns of PA and SB between the hip and knee OA participants except for total number of steps (hip = 3365 (2926) vs knee 4344 (2836) steps/day; p = 0.018) and total stepping time (hip = 50.8 (38.2) vs knee = 67.2 (38.5) min/day; p = 0.005). Each additional cardiometabolic risk factor accumulated was associated with a 26.3 min/day increase in sedentary behaviour (p = 0.032; 95% CI: 2.3, 50.2), a 26.3 min/day decrease in upright time (p = 0.032; −50.2, –2.3) and a 23.6 min/day decrease in standing time (p = 0.032; −45.1, –2.1). Conclusions In people with hip or knee OA, increased cardiometabolic disease risk was associated with more sitting and less upright and standing time. Findings support targeting reductions in sedentary behaviour for improvements in cardiometabolic health in people with osteoarthritis. IMPLICATIONS FOR REHABILITATION Knee and hip osteoarthritis is a condition which is associated with an increased risk of cardiometabolic disease but also due to the low levels of physical activity and high levels of sedentary behaviour. Offsetting sedentary behaviour with light physical activity offers a feasible interventional target to reduce the risk of cardiometabolic disease in people with hip and knee osteoarthritis.