Low Levels Of Treatment Research Articles

Hypertension in a resource-limited setting: Poor Outcomes on Short-term Follow-up in an Urban Hospital in Maputo, Mozambique.

Mozambique has low levels of detection, treatment, and control of hypertension. However, data on target organ damage and clinical outcomes are lacking. The authors aimed at characterizing the clinical profile, pattern of target organ damage, and short-term outcomes of patients referred to a first referral urban hospital in a low-income setting in Africa. We conducted a prospective descriptive cohort study from February 2016 to May 2017 in Maputo, Mozambique. Adult patients with systolic and diastolic blood pressure ≥180mmHg and/or ≥110mmHg, respectively, or any systolic blood pressure above 140mmHg and/or diastolic blood pressure above 90mmHg in the presence of target organ damage (with or without antihypertensive treatment) were submitted to detailed physical examination, funduscopy, laboratory profile, electrocardiography, and echocardiography. Six months after the occurrence of complications (stroke, heart failure, and renal failure), hospital admission and death were assessed. Overall, 116 hypertensive patients were recruited (mean age 57.5±12.8years old; 111[95.7%] black; 81[70%] female) of which 79 had severe hypertension. The baseline mean values recorded for systolic and diastolic blood pressure were 192.3±23.6 and 104.2±15.2mmHg, respectively. Most patients (93; 80.2%) were on antihypertensive treatment. Patients' risk profile revealed dyslipidemia, obesity, and diabetes in 59(54.1%), 48(42.5%), and 23(19.8%), respectively. Target organ damage was found in 111 patients. The commonest being left atrial enlargement 91(84.5%), left ventricular hypertrophy 57(50.4%), hypertensive retinopathy 30(26.3%), and chronic kidney disease 27(23.3%). Major events during 6-month follow-up were hospitalizations in 10.3% and death in 8.6% of the patients. Worsening of target organ damage occurred in 10 patients: four stroke, two heart failure, and four renal damage. Patients with severe hypertension and target organ damage were young with high-risk profile, low hypertension control, and high occurrence of complications during short-term follow-up. Efforts to improve high blood pressure control are needed to reduce premature mortality in this highly endemic poor setting.

Effect of a blend of artificial sweetener and capsicum on productive performance and blood chemistry in growing lambs

The objective of this study was to investigate the effects of a blend (CapSw) of capsicum (3% approximate concentration of Capsicum oleoresin, Cap) and a high-intensity artificial sweetener (93% approximate concentration of sodium saccharin, Sw) on the growth performance, blood chemistry and cell counts, markers of fat mobilization, and hormones in growing ewe lambs. Thirty-six lambs (47.4 ± 2.62 kg of body weight, Dorset and Suffolk × Hampshire) were used in a 7-wk randomized complete block design experiment. Following a week of adaption, lambs were housed in 9 pens (4 lambs/pen) and pens were blocked based on lambs’ average body weight into 3 blocks of 3 pens each. Treatments were control (basal diet without additives), basal diet with low level of CapSw (86 mg/head per day) and basal diet with high level of CapSw (172 mg/head per day). CapSw tended to linearly decrease (P = 0.002) dry matter intake and had no effect on average daily gain of the lambs and feed efficiency. Treatment had no effects on blood cell counts and concentrations of non-esterified fatty acids, beta-hydroxybutyrate, and glucose. Blood serum insulin concentration was quadratically (lowest in low level of CapSw treatment) decreased (P = 0.002) by CapSw. CapSw tended to quadratically increase (P = 0.07) cortisol and had no effect on haptoglobin concentration in blood serum. In this experiment, dietary supplementation of a blend of capsicum oleoresin and a high-intensity artificial sweetener had no effect on growth performance of lambs, but it appeared to have effect on insulin secretion.

Knowledge regarding Heart Failure: A Reflection on Current Disease Knowledge State among Iranian Patients with Heart Failure

Background: Heart failure (HF) is a serious problem with an increasing prevalence globally. Low level of HF knowledge may cause low compliance and low quality of life and, poor self-care. On the other hand, assessing the level of HF knowledge is necessary in order to apply educational programs. Aims and objectives: the aim was to determine knowledge regarding HF among Iranian patients with HF. Study Design: This was a cross sectional study. Setting: We conducted this study at the HF clinic of Tehran Heart Center (THC) affiliated with Tehran University of Medical Sciences (TUMS, Tehran, Iran). Materials and Methods: In this cross-sectional study, 190 patients older than 18 years old, with confirmed diagnosis of HF for at least 3 months by an HF specialist, NYHA function class II to IV and an ability of reading and writing Farsi language were included during June 2017 and January 2018 by consecutive sampling. Data were gathered in a short form, including demographic and clinical variables. Knowledge regarding HF was measured by the Dutch HF knowledge scale (Cronbach’s alpha=0.62) with 15- multiple choice item. The score range varied between 0 (no knowledge) and 15 (optimum knowledge). Scores were reported totally and in 3 areas of knowledge. Scores higher than the median was considered as higher knowledge. Statistics: The SPSS software version 16 was used to describe data. Normality of continuous variables was checked by the Kolmogorov-Smirnoff test. Frequency and partial frequency distribution were used to describe Categorical variables. While, we used mean, median, standard deviation, and IQR for describing continuous variables. Results: From June 2017 to January 2018, 160/190 patients with median age (IQR) of 59 (16) years old participated in the study (response rate of 84.2%). 67.5% of study patients were male (83.5%). 87.5% of then were married. The majority of patients were with NYHA function class II (60.6%), and with an etiology of ischemic heart disease (65.0%). The median and IQR of total, general, HF treatment, and symptoms/ symptom recognition knowledge were 8 (7-10), 12 (9-14), 2 (1.25-3), and 4 (3-5), respectively. Low level of total, general, HF treatment, and symptoms and symptom recognition knowledge among Iranian patients with HF were 55%, 60%, 58.8%, and 71.9%, respectively. Conclusion: Patients with HF had low levels of total, general, HF treatment, and symptoms/symptom recognition knowledge. Thus, there is an essential need to be improved by an appropriate intervention, especially on knowledge of symptoms /symptom recognition.

Knowledge on primary and secondary prevention of asthma among caregivers of asthmatic children admitted to paediatric wards in Gampaha District

Introduction: Asthma is considered to be one of the major public health problems. The accurate knowledge of caregiver on asthma is important for the management. Objectives: To describe the knowledge on primary and secondary prevention of asthma among caregivers of asthmatic children admitted to the paediatric wards in the district of Gampaha Methods: A descriptive cross-sectional study was carried out among 577 caregivers of inward asthmatic children. Pre-tested interviewer- and self-administered questionnaires were used to assess the knowledge on asthma. The grand score of knowledge on asthma was calculated out of 34. The 75th percentile value was considered to differentiate ‘good’ knowledge from ‘poor’ knowledge. Multiple logistic regression was applied to determine the factors associated with poor knowledge on asthma. Results were expressed in adjusted odds ratio (aOR) and 95% confidence interval (CI). Results: The mean score for knowledge on asthma was 20.6 (SD=4.42) ranging from 7 to 30. Among the caregivers, 369 (64%) had poor knowledge on asthma. Low educational level of the caregiver (aOR=2.48; 95% CI=1.59, 3.86) and being under prophylaxis treatment for less than one year (aOR=2.49; 95% CI=1.50, 4.13) were the determinants of poor knowledge on asthma. Conclusions: Majority of the caregivers’ knowledge on asthma was poor. The caregivers’ low educational level and shorter duration of prophylaxis treatment for the children were associated with poor knowledge on asthma.

Comparison of Acute and Chronic Toxicity Laboratory Bioassay Endpoints with Benthic Community Responses in Field-Exposed Contaminated Sediments.

Sediment toxicity is usually assessed by conducting laboratory bioassays on thoroughly homogenized, field-collected, sediment samples. Although it is generally held that these bioassays provide a conservative assessment of the potential for environmental impact, there are few studies comparing the results of laboratory sediment bioassays with actual measures of benthic community health in exposed field populations. To help inform an understanding of the relative efficacy of laboratory-based bioassays in predicting potential impacts in exposed field populations, a laboratory-to-field comparison study was conducted. Laboratory bioassays included standard 10-d acute toxicity tests measuring survival in 4 species of estuarine/marine amphipods (Eohaustorius estuarius, Ampelisca abdita, Rhepoxinius abronius, and Leptocheirus plumulosus) and 2 longer term, 28-d sublethal tests with a marine polychaete, Neanthes arenaceodentata (survival and growth), and the amphipod L. plumulosus (survival, growth, and reproduction). A highly contaminated and toxic sediment was mixed with a cleaner sediment of similar grain size to produce a series of diluted contaminated sediment treatments (0, 6, 12, 25, and 50%). Sediment treatments were placed in containers and deployed in the field. At specified intervals (at time of deployment and 9 and 12 mo post deployment), containers were retrieved from the field and analyzed for sediment chemistry, infaunal community composition, and toxicity. Laboratory toxicity endpoints were compared with measures of benthic community health to evaluate the ability of the toxicity tests to accurately predict benthic impacts. The results of these comparisons indicate that the laboratory tests evaluated provide conservative estimates of potential benthic community impacts, with both acute and chronic tests detecting effects at lower treatment levels than were detected in exposed field populations using traditional measures of benthic community health. Environ Toxicol Chem 2019;38:1784-1802. Published 2019 Wiley Periodicals, Inc. on behalf of SETAC. This article is a US government work, and as such, is in the public domain in the United States of America.

Application of ANN Predictive Model for the Design of Batch Adsorbers - Equilibrium Simulation of Cr(VI) Adsorption onto Activated Carbon

Background: Escalation of industrial processes continues to increase the concentrations of Cr(VI) in wastewater above permissible discharge limits. Persistent exposure to Cr(VI)may result in deleterious effects on human health, aquatic life, and the environment. Laboratory-scale adsorption studies have proven effective in achieving the low treatment levels demanded by statutory authorities. The eventual design of the pilot and full-scale systems hinges on the ability to predict adsorption behavior mathematically. Objective: The objective of this study is to elucidate the mechanism of Cr(VI) adsorption and to develop an Artificial Neural Network (ANN) model capable of accurately simulating complex multi-layered adsorption processes. Methods: Batch equilibrium experiments were conducted for the removal of Cr(VI) by activated carbon. Conventional two and three-parameter equilibrium models such as the Langmuir, Freundlich, Sips, original BET and modified BET were used to simulate the data and expound the mechanism of adsorption. An ANN model was constructed with the built-in effect of the residual Cr(VI) concentration for the prediction of the equilibrium sorption capacity. Results: The modified BET model was most successful at predicting the monolayer coverage. However, the model failed to capture the complex shape of the isotherm at higher initial concentrations. The highest correlation to the equilibrium data was revealed by the ANN model (R2 = 0.9984). Conclusion: A batch adsorber was successfully designed using mass balance, and incorporating the predictive ability of the ANN model. In spite of the ANN’s ability to simulate the adsorption process, it provides little insight into the mechanism of adsorption. However, its ability to accurately predict Cr(VI) removal enables the up-scaling of the adsorption processes to pilot and full-scale design.

Antidepressants in Surface Waters: Fluoxetine Influences Mosquitofish Anxiety-Related Behavior at Environmentally Relevant Levels.

Pharmaceutical contamination is an increasing problem globally. In this regard, the selective serotonin reuptake inhibitors (SSRIs)-a group of antidepressants-are particularly concerning. By disrupting the serotonergic system, SSRIs have the potential to affect ecologically important behaviors in exposed wildlife. Despite this, the nature and magnitude of behavioral perturbations resulting from environmentally relevant SSRI exposure among species is poorly understood. Accordingly, we investigated the effects of two field-realistic levels of the SSRI fluoxetine (61 and 352 ng/L) on sociability and anxiety-related behaviors in eastern mosquitofish ( Gambusia holbrooki) for 28 days. Additionally, we measured whole-body tissue concentrations of fluoxetine and norfluoxetine. We found that fluoxetine altered anxiety-related behavior but not sociability. Specifically, female fish showed reduced anxiety-related behavior at the lower treatment level, while males showed an increase at the higher treatment level. In addition, we report a biomass-dependent and sex-specific accumulation of fluoxetine and norfluoxetine, with smaller fish showing higher relative tissue concentrations, with this relationship being more pronounced in males. Our study provides evidence for nonmonotonic and sex-specific effects of fluoxetine exposure at field-realistic concentrations. More broadly, our study demonstrated that neuroactive pharmaceuticals, such as fluoxetine, can affect aquatic life by causing subtle but important shifts in ecologically relevant behaviors.

Blood pressure screening in Mozambique: the May Measurement Month 2017 project-Sub-Saharan Africa.

Elevated blood pressure (BP) is a growing burden worldwide, leading to over 10 million deaths each year. In Mozambique, two national surveys of risk factors for chronic diseases were done, using the WHO STEPWISE approach, the first in 2005 and the last in 2014/2015. In this period of 10 years, the prevalence of hypertension in the adult population increased from 33.1% to 38.9% and the extremely low levels of awareness, treatment, and control did not change significantly. May Measurement Month (MMM) is a global initiative of the International Society of Hypertension aimed at raising awareness of high BP and to act as a temporary solution to the lack of screening programmes worldwide. An opportunistic cross-sectional survey of volunteers aged ≥18 years was carried out in May 2017. Blood pressure measurement, the definition of hypertension and statistical analysis followed the standard MMM protocol. Screening was conducted by volunteers, mainly in work places, markets, and religious activities, in the capital city, in most of the provincial capitals and some rural districts. About 4454 individuals were screened with a mean age of 39 years, and, after multiple imputation, 1371 (31.1%) had hypertension. Of individuals not receiving anti-hypertensive medication, 1099 (26.6%) were hypertensive. Of individuals receiving antihypertensive medication, 166 (61.6%) had uncontrolled BP. MMM17 was the largest BP screening campaign undertaken in Mozambique. These results suggest that opportunistic screening is an important tool to identify significant numbers of patients with raised BP.

The development of an ultra-short, maternal mental health screening tool in South Africa.

The burden of common perinatal mental disorders (CPMD) in low-and-middle-income countries is substantially higher than high-income countries, with low levels of detection, service provision and treatment in resource-constrained settings. We describe the development of an ultra-short screening tool to detect antenatal depression, anxiety disorders and maternal suicidal ideation. A sample of 376 women was recruited at a primary-level obstetric clinic. Five depression and anxiety symptom-screening questionnaires, demographics and psychosocial risk questionnaires were administered. All participants were assessed with the Mini-International Neuropsychiatric Interview (MINI), a structured, diagnostic interview. Screening tool items were analysed against diagnostic data using multiple logistic regression and receiver operating curve (ROC) analysis. The prevalence of MINI-defined major depressive episode (MDE) and/or anxiety disorders was 33%. Overall, 18% of participants expressed suicidal ideation and behaviour, 54% of these had no depression or anxiety diagnosis. Multiple logistic regression identified four screening items that were independently predictive of MDE and anxiety disorders, investigating depressed mood, anhedonia, anxiety symptoms and suicidal ideation. ROC analysis of these combined items yielded an area under the curve of 0.83 (95% CI 0.78-0.88). A cut-off score of 2 or more offered a sensitivity of 78% and specificity of 82%. This novel screening tool is the first measure of CPMD developed in South Africa to include depressed mood, anxiety symptoms and suicidal ideation. While the tool requires further investigation, it may be useful for the early identification of mental health symptoms and morbidity in the perinatal period.

Prevalence, awareness, treatment and control of hypertension and their determinants: results from a national survey in Kenya

BackgroundHypertension is the most important risk factor for cardiovascular diseases and the leading cause of death worldwide. Despite growing evidence that the prevalence of hypertension is rising in sub-Saharan Africa, national data on hypertension that can guide programming are missing for many countries. In this study, we estimated the prevalence of hypertension, awareness, treatment, and control. We further examined the factors associated with hypertension and awareness.MethodWe used data from the 2015 Kenya STEPs survey, a national cross-sectional household survey targeting randomly selected people aged 18–69 years. Demographic and behavioral characteristics as well as physical measurements were collected using the World Health Organization’s STEPs Survey methodology. Descriptive statistics were used to estimate the prevalence, awareness, treatment and control of hypertension. Multiple logistic regression models were used to identify the determinants of hypertension and awareness.ResultsThe study surveyed 4485 participants. The overall age-standardized prevalence for hypertension was 24.5% (95% confidence interval (CI) 22.6% to 26.6%). Among individuals with hypertension, only 15.6% (95% CI 12.4% to 18.9%) were aware of their elevated blood pressure. Among those aware only 26.9%; (95% CI 17.1% to 36.4%) were on treatment and 51.7%; (95% CI 33.5% to 69.9%) among those on treatment had achieved blood pressure control. Factors associated with hypertension were older age (p < 0.001), higher body mass index (BMI) (p < 0.001) and harmful use of alcohol (p < 0.001). Similarly, factors associated with awareness were older age (p = 0.013) and being male (p < 0.001).ConclusionThis study provides the first nationally-representative estimates for hypertension in Kenya. Prevalence among adults is high, with unacceptably low levels of awareness, treatment and control. The results also reveal that men are less aware of their hypertension status hence special attention should focus on this group.

Taxonomy and toxin production of Gambierdiscus carpenteri (Dinophyceae) in a tropical marine ecosystem: The first record from the Philippines

Morphological and phylogenetic analysis showed that the Gambierdiscus isolate from Bolinao, Philippines belongs to the species of G. carpenteri. It was morphologically more similar to the Merimbula strain than the subtropical Florida Keys strain. Growth and toxin production were also investigated at varying levels of temperature, salinity, and irradiance. Gambierdiscus are known to grow favorably in a low light environment. However, this study showed high growth rates of G. carpenteri even at high irradiance levels. Generally, cells produced more toxins at lower treatment levels. Highest cellular toxin content recorded was 7.48 ± 0.49 pg Pbtx eq/cell at culture conditions of 25 °C, 100 μmol photons m−2 s−1, and salinity of 26. Growth rate and toxin production data suggest that cells produced more toxins during the slowest growth at certain range of treatments. This information gives insight into how changes in environmental conditions may affect toxin production and growth of G. carpenteri.

What information needs do people with recently diagnosed diabetes mellitus have and what are the associated factors? A cross-sectional study in Germany

ObjectivesThis study aimed to identify: (1) information needs of people with recently diagnosed type 1 or type 2 diabetes mellitus (DM); (2) information needs within different subgroups; and (3) factors...

The Impact of co-morbid severe mental illness and HIV upon mental and physical health and social outcomes: a systematic review

ABSTRACTOur aim was to review the evidence related to the impact of co-morbid severe mental illness SMI (schizophrenia, schizoaffective and bipolar disorder) and HIV upon mental health, physical health and social outcomes. We carried out a systematic review of scientific evidence, searching online databases (MEDLINE, PsychInfo, EMBASE, Global Health and Scopus) for studies between 1983 and 2017 using search terms for SMI and HIV. Studies were included if they compared health or social outcomes between people living with co-morbid SMI and HIV and people living with either: a) HIV only; or b) SMI only. Outcomes of interest were: mortality, health service use, HIV/SMI-related, co-morbidities, and social outcomes. We identified 20 studies which met our inclusion criteria. Although studies were generally high quality, there was heterogeneity in both selection of outcomes and choice of measure. It was therefore difficult to draw strong conclusions regarding the impact of co-morbid SMI and HIV across any outcome. We found little evidence that co-morbid SMI and HIV were associated with lower levels of treatment, care or poorer clinical outcomes compared to people living with SMI or HIV alone. However, mortality appeared to be higher among the co-morbid group in three out of four analyses identified. Physical and mental co-morbidities and social outcomes were rarely measured. Limited data mean that the impact of co-morbid SMI and HIV is uncertain. In order to develop evidence-based guidelines, there is an urgent need for further research. This may be realized by exploring opportunities for using data from existing cohort studies, routinely collected data and data linkage to investigate important questions relating to this neglected but potentially important area.

Active study: undetected prevalence and clinical inertia in the treatment of breakthrough cancer pain (BTcP)

To prove if there is clinical inertia in the identification and treatment of episodes of breakthrough cancer pain (BTcP), comparing actual results from clinical practice with clinical oncologists' prior perception. Observational and descriptive study, using information collected by practising medical oncologists, at three moments: (a) questionnaire regarding their professional judgement of the handling of patients with BTcP in their practice, (b) cross-sectional clinical screening, to detect possible existing cases of BTcP in a representative sample of their patients, (c) retrospective self-audit of clinical case histories of patients diagnosed with BTcP to find out about how it has been handled. A random sample on a state level of 108 specialists in medical oncology. 540 patients who suffer some type of cancer pain on the designated study date for each specialist (July-December 2016). The global prevalence of BTcP in the study sample covered 91.3% of the patients who were suffering some type of cancer pain. Barely 2% of the doctors surveyed suspected figures around this mark. 40.9% of the cases had not been previously detected as BTcP by their doctors. Although 90% of the patients who had previously been diagnosed with BTcP received a specific analgesic treatment for the symptoms, 42% of those patients with known BTcP were not able to control their episodes of pain. Clinical inertia is a serious problem in the handling of BTcP in medical oncology services, where it is the subject of a significantly low level of detection and treatment, despite the contrasting perception of specialists.

Socioeconomics differences in absolute cardiovascular disease risk and treatment: Opportunities for reducing inequalities in cardiovascular events in the population

Introduction A large number of cardiovascular disease (CVD) events in the population can be prevented through appropriate management of absolute CVD risk. CVD disproportionately affects socioeconomically disadvantaged individuals, challenging efforts to reduce overall CVD morbidity and mortality in the population. While there are demonstrated links between socioeconomic position and CVD morbidity and mortality, population-level data on variations in absolute CVD risk and treatment are needed to inform interventions and policies to prevent CVD and address inequalities. We estimated absolute and relative socioeconomic inequalities in absolute CVD risk and the use of guideline-recommended medications in the Australian population to identify opportunities to reduce inequalities in CVD events. Methods We used cross-sectional representative population-based data on 4751 men and women aged 45–74 from the 2011–12 Australian National Health Survey, including interview, physical measurement and blood and urine sample data. We used Poisson regression with robust standard errors to calculate prevalence differences (PD) and ratios (PR) for prior CVD, high 5-year absolute risk of a primary CVD event and guideline-recommended medication use, in relation to socioeconomic position measured by highest level of education attained. The models were adjusted for age and sex and then additionally for region of residence and region of birth. Weights were applied to the prevalence estimates to account for the sampling strategy and non-response, and a series of sensitivity analyses were done to assess whether the results were robust to using alternative measures of socioeconomic position. Results Overall, 9.3% of participants had prior CVD and 11.0% had high absolute risk of a primary CVD event. Thirty-four percent of those with prior CVD and 22% of those at high absolute risk of a primary CVD event were using guideline-recommended medications. After adjusting for age and sex, the prevalence of prior CVD and high absolute risk of a primary CVD event increased linearly with decreasing socioeconomic position (test for trend, P = 0.005 and P = 0.001, respectively). People with the lowest (no post-school qualifications) compared to the highest (university degree) socioeconomic position had 1.6 (95% confidence intervals [CI]: 1.1, 2.2) times the prevalence of prior CVD (10.7% vs 6.7%, respectively) and 1.6 (95% CI: 1.2, 2.2) times the prevalence of high absolute risk of a primary CVD event (12.6% vs 7.7%, respectively). In absolute terms, the prevalence of prior CVD and of high absolute risk of a primary CVD event were 4 and 5 percentage points higher, respectively, among the most disadvantaged within the population. Among people with prior CVD those with low compared to high socioeconomic position were 2.1 (95% CI: 1.3, 3.5) times more likely to use lipid- and blood pressure-lowering and antithrombotic medications as recommended in clinical guidelines. Among those at high primary risk there was no clear relationship between socioeconomic position and use of preventive medications. Results were not materially different when additionally adjusted for region of residence and region of birth, or when socioeconomic position was ascertained using measures of income and area-level disadvantage. Conclusion In this nationally representative population-based Australian study, the prevalence of prior CVD and high absolute CVD risk increased with increasing levels of disadvantage. Socioeconomic differentials in high absolute risk of CVD, combined with low treatment levels among high risk individuals, indicates substantial potential to prevent CVD and reduce inequalities in CVD events through appropriate management of high absolute risk in the population.

Mycotoxin zearalenone induced gonadal impairment and altered gene expression in the hypothalamic-pituitary-gonadal axis of adult female zebrafish (Danio rerio).

In the present study, we aimed to assess the adverse effects of zearalenone (ZEA) at environmentally relevant concentrations (0.5, 1, 5 and 10μgl-1 ) on hypothalamic-pituitary-gonadal axis associated reproductive function using zebrafish model. ZEA was exposed to female zebrafish for 21days to assess growth indices such as condition factor, hepatosomatic index, gonadosomatic index and caspase 3 activity. Further, expression of estrogen receptor (ER) α and CYP19a1b genes in the brain, ERα and vitellogenin (Vtg) genes in the liver and follicle-stimulating hormone receptor, luteinizing hormone receptor, ERα, steroidogenic acute regulatory protein, 3β-hydroxysteroid dehydrogenase (HSD), 17-βHSD and CYP19a1 genes in the ovary were also investigated. Our results showed that there were no significant changes in the condition factor and hepatosomatic index, whereas a significant (P<.05) reduction in the gonadosomatic index, increase in caspase 3 activities and Vtg expression was observed at higher concentration. However, no significant changes were observed at lower treatment levels. Further, we also observed significant (P<.05) upregulation in ERα, Vtg, luteinizing hormone receptor, steroidogenic acute regulatory protein, 3β-HSD, 17β-HSD, CYP19a1 and CYP19a1b genes in treatment groups with higher levels of ZEA. Moreover, in histopathological examination, we observed oocyte atresia and oocyte membrane detachment in ovaries at the highest concentration. In conclusion, the present study revealed the negative impact of ZEA on zebrafish reproductive system by involvement of the hypothalamic-pituitary-gonadal axis-associated reproductive function.

Reduced mortality and subsequent fracture risk associated with oral bisphosphonate recommendation in a fracture liaison service setting: A prospective cohort study

ObjectiveOsteoporotic fragility fractures, that are common in men and women, signal increased risk of future fractures and of premature mortality. Less than one-third of postmenopausal women and fewer men are prescribed active treatments to reduce fracture risk. Therefore, in this study the association of oral bisphosphonate recommendation with subsequent fracture and mortality over eight years in a fracture liaison service setting was analysed.Materials and methodsIn this prospective cohort study, 5011 men and women aged >50 years, who sustained a clinical fracture, accepted the invitation to attend the fracture liaison service of the West Glasgow health service between 1999 and 2007. These patients were fully assessed and all were recommended calcium and vitamin D. Based on pre-defined fracture risk criteria, 2534 (50.7%) patients were additionally also recommended oral bisphosphonates. Mortality and subsequent fracture risk were the pre-defined outcomes analysed using Cox proportional hazard models.ResultsThose recommended bisphosphonates were more often female (82.9 vs. 72.4%), were older (73.4 vs. 64.4 years), had lower bone mineral density T-score (-3.1 vs. -1.5) and more had sustained hip fractures (21.7 vs. 6.2%; p < 0.001). After adjustments, patients recommended bisphosphonates had lower subsequent fracture risk (Hazard Ratio (HR): 0.60; 95% confidence interval (CI): 0.49–0.73) and lower mortality risk (HR: 0.79, 95%CI: 0.64–0.97).ConclusionOf the patients, who are fully assessed after a fracture at the fracture liaison service, those with higher fracture risk and a recommendation for bisphosphonates had worse baseline characteristics. However, after adjusting for these differences, those recommended bisphosphonate treatment had a substantially lower risk for subsequent fragility fracture and lower risk for mortality. These community-based data indicate the adverse public health outcomes and mortality impacts of the current low treatment levels post fracture could be improved by bisphosphonate recommendation for both subsequent fracture and mortality.

Racial and cultural minority experiences and perceptions of health care provision in a mid-western region

BackgroundDisparities across a number of health indicators between the general population and particular racial and cultural minority groups including African Americans, Native Americans and Latino/a Americans have been well documented. Some evidence suggests that particular groups may receive poorer standards of care due to biased beliefs or attitudes held by health professionals. Less research has been conducted in specifically non-urban areas with smaller minority populations.MethodsThis study explored the self-reported health care experiences for 117 racial and cultural minority Americans residing in a Mid-Western jurisdiction. Prior health care experiences (including perceived discrimination), attitudes towards cultural competence and satisfaction with health care interactions were ascertained and compared across for four sub-groups (African-American, Native American, Latino/a American, Asian American). A series of multiple regression models then explored relationships between a concert of independent variables (cultural strength, prior experiences of discrimination, education level) and health care service preferences and outcomes.ResultsOverall, racial/cultural minority groups (African Americans, Native Americans, Latino/a Americans, and Asian Americans) reported general satisfaction with current healthcare providers, low levels of both health care provider racism and poor treatment, high levels of cultural strength and good access to health care services. Native American participants however, reported more frequent episodes of poor treatment compared to other groups. Incidentally, poor treatment predicted lower levels of treatment satisfaction and racist experiences predicted being afraid of attending conventional health care services. Cultural strength predicted a preference for consulting a health care professional from the same cultural background.ConclusionsThis study provided a rare insight into minority health care expectations and experiences in a region with comparatively lower proportions of racial and cultural minorities. Additionally, the study explored the impact of cultural strength on health care interactions and outcomes. While the bulk of the sample reported satisfaction with treatment, the notable minority of participants reporting poor treatment is still of some concern. Cultural strength did not appear to impact health care behaviours although it predicted a desire for cultural matching. Implications for culturally competent health care provision are discussed within.

Treatment gap for anxiety disorders is global: Results of the World Mental Health Surveys in 21 countries.

Anxiety disorders are a major cause of burden of disease. Treatment gaps have been described, but a worldwide evaluation is lacking. We estimated, among individuals with a 12-month DSM-IV (where DSM is Diagnostic Statistical Manual) anxiety disorder in 21 countries, the proportion who (i) perceived a need for treatment; (ii) received any treatment; and (iii) received possibly adequate treatment. Data from 23 community surveys in 21 countries of the World Mental Health (WMH) surveys. DSM-IV mental disorders were assessed (WHO Composite International Diagnostic Interview, CIDI 3.0). DSM-IV included posttraumatic stress disorder among anxiety disorders, while it is not considered so in the DSM-5. We asked if, in the previous 12 months, respondents felt they needed professional treatment and if they obtained professional treatment (specialized/general medical, complementary alternative medical, or nonmedical professional) for "problems with emotions, nerves, mental health, or use of alcohol or drugs." Possibly adequate treatment was defined as receiving pharmacotherapy (1+ months of medication and 4+ visits to a medical doctor) or psychotherapy, complementary alternative medicine or nonmedical care (8+ visits). Of 51,547 respondents (response=71.3%), 9.8% had a 12-month DSM-IV anxiety disorder, 27.6% of whom received any treatment, and only 9.8% received possibly adequate treatment. Of those with 12-month anxiety only 41.3% perceived a need for care. Lower treatment levels were found for lower income countries. Low levels of service use and a high proportion of those receiving services not meeting adequacy standards for anxiety disorders exist worldwide. Results suggest the need for improving recognition of anxiety disorders and the quality of treatment.

A global, spatially-explicit assessment of irrigated croplands influenced by urban wastewater flows

When urban areas expand without concomitant increases in wastewater treatment capacity, vast quantities of wastewater are released to surface waters with little or no treatment. Downstream of many urban areas are large areas of irrigated croplands reliant on these same surface water sources. Case studies document the widespread use of untreated wastewater in irrigated agriculture, but due to the practical and political challenges of conducting a true census of this practice, its global extent is not well known except where reuse has been planned. This study used GIS-based modeling methods to develop the first spatially-explicit estimate of the global extent of irrigated croplands influenced by urban wastewater flows, including indirect wastewater use. These croplands were further classified by their likelihood of using poor quality water based on the spatial proximity of croplands to urban areas, urban wastewater return flow ratios, and proportion of wastewater treated. This study found that 65% (35.9 Mha) of downstream irrigated croplands were located in catchments with high levels of dependence on urban wastewater flows. These same catchments were home to 1.37 billion urban residents. Of these croplands, 29.3 Mha were located in countries with low levels of wastewater treatment and home to 885 million urban residents. These figures provide insight into the key role that water reuse plays in meeting the water and food needs of people around the world, and the need to invest in wastewater treatment to protect public health.