Regional Health Research Articles

The Urban Bias in Latin American Avoidable Mortality.

In 1977, Michael Lipton introduced the Urban Bias Thesis as a framework for understanding how most economic policy initiatives have contributed to the overdevelopment of urban areas and the underdevelopment of rural areas. In Latin America, there has historically been a positive correlation between urbanization and mortality decline, as the region's health transition generally began in the main cities and tended to proceed more rapidly in countries with higher levels of urbanization. This paper seeks evidence of a residual urban bias in the region's mortality patterns. Using a sample of Latin American countries over the 2000-2010 period, I analyse the disparities in mortality patterns and avoidable causes of death by looking closely at urban and rural areas using continuum categories. The results indicate that the urban advantage does persist and that rural-urban mortality differentials have consistently favoured the largest cities. The metropolitan advantage in mortality is an outcome of lower mortality in causes of death that are avoidable through primary interventions. Even in scenarios of high mortality at younger adult ages (15-44), the metropolitan advantage remains, due primarily to unsuccessful efforts to reduce mortality in populations aged 45years and over outside the main and large cities.

ICF based comparison of musculoskeletal health in regions of Poland and Spain.

The International Classification of Functioning, Disability and Health (ICF) is the framework for describing disability. The aim of the study was to compare differences in health status between the populations of the Podkarpackie region of Poland and the Castilla y León region of Spain, using the ICF core set for post-acute musculoskeletal conditions. A total of 840 people were included in the study. The brief version of ICF core set for post-acute musculoskeletal conditions was used in the study. Information obtained from semi-structured interviews and a physiotherapy assessment was recoded into ICF qualifiers to obtain comparable data. Significant differences in functioning were found between the two samples, with a higher prevalence in all the ICF entities for the Spanish sample. Similarities were found in the ICF components 'Body Functions' and 'Environmental Factors', with the most prevalent ICF entities being 'b280 Sensation of pain' and 'e225 Climate' respectively. For 'Activities and Participation', differences were observed, with 'd430 Lifting and carrying objects' being the most common for the Spanish sample and 'd450 Walking' for the Polish sample. Significant differences were found between the two samples, indicating better musculoskeletal health in the Polish sample. Future research using the ICF Core Sets in practice should be expanded and carried out in other countries to improve the ability to make comparisons between populations and to develop policies for territorial equity in health.Trial registration: NCT06283407.

Nutrition among nursing home residents: results from the NutriCare study

BackgroundOlder adults living in nursing homes (NHs) are considered a vulnerable population in terms of nutrition. The aim of the present study was to explore the usual intake of energy, macronutrients, and specific food groups, along with offers in the NH menus on a nationally representative sample of Slovenian NH residents and compare dietary patterns with the established recommendations.MethodsThe study was conducted as part of a cross-sectional NutriCare study on 317 residents (65–101 years) from 20 Slovenian NHs in 9 health regions. Relatively independent residents were selected using quota sampling by sex and age. Data collection involved interviews and anthropometric measurements. Usual dietary intake was assessed by a multiple-source method from two 24-h dietary recalls and food frequency questionnaires. Adherence of dietary intake to the recommendations and dietary composition of NH menus were assessed. The Mini Nutritional Assessment (MNA) was used to explore nutritional status.ResultsNotable variability in energy and macronutrient intakes was observed with some participants showing intakes below and others above the recommended values. A high prevalence of BMI > 30 kg/m2 was observed in 39% of participants, indicating potential discrepancies between total energy intake and expenditure. The usual intake of fat was 36% of total energy intake (TEI). The intake of foods of animal origin exceeded dietary guidelines. Intake of carbohydrates (46% TEI in men and 47% TEI in women) as well as dietary fibre (20 g/day for both sexes) was below recommendations. A scarce intake of fruits, vegetables, and cereals was observed. In total, 40% of men and 35% of women had usual daily protein intakes lower than 1 g/kg of body weight. The protein content of breakfast and dinner could be improved. NH residents consumed little food from outside NH. The usual nutrient and food group intakes of residents reflected the NH menu offers.ConclusionThe study results on the usual intake of energy, macronutrients, specific food groups, and offers in the NH menus indicate the potential for optimisation. According to the World Health Organisation, the prevalence of BMI > 30 kg/m2 is notable and warrants attention. Careful meal planning and regular monitoring of the nutritional status of NH residents should be considered.

Machine learning insights into regional dynamics and prevalence of COVID-19 variants in US health and human services regions

BackgroundThe COVID-19 pandemic arising from the emergence of SARS-CoV-2 in late 2019 has led to global devastation with millions of lives lost by January 2024. Despite the WHO’s declaration of the end of the global health emergency in May 2023, the virus persists, propelled by mutations. Variants continue to challenge vaccination efforts, underscoring the necessity for ongoing vigilance. This study aimed at contributing to a more data-driven approach to pandemic management by employing random forest regression to analyze regional variant prevalence.MethodsThis study utilized data from various sources including National COVID Cohort Collaborative database, Bureau of Transportation Statistics, World Weather Online, EPA, and US Census. Key variables include pollution, weather, travel patterns, and demographics. Preprocessing steps involved merging and normalization of datasets. Training data spanned from January 2021 to February 2023. The Random Forest (RF) Regressor was chosen for its accuracy in modeling. To prevent data leakage, time series splits were employed. Model performance was evaluated using metrics such as MSE and R-squared.ResultsThe Alpha variant was predominant in the Southeast, with less than 80% share even at its peak. Delta surged initially in Kansas City and maintained dominance there for over 5 months. Omicron subvariant BA.5 spread nationwide, becoming predominant across all Health and Human Services regions simultaneously, with New York seeing the earliest and fastest decline in its share. Variant XBB.1.5 concentrated more in the Northeast, but limited data hindered full analysis. Using RF Regressor, key features affecting spread patterns were identified, with high predictive accuracy. Each variant showed specific environmental correlations; for instance, Alpha with air quality index, Delta with ozone density, BA.5 with UV index, and XBB.1.5 with land area and income. Correlation analysis further highlighted variant-specific associations.ConclusionsThis research provides a comprehensive analysis of the regional distribution of COVID-19 variants, offering critical insights for devising targeted public health strategies. By utilizing machine learning, the study uncovers the complex factors contributing to variant spread and reveals how specific factors contribute to variant prevalence, offering insights crucial for pandemic management.

Emergency department use before cancer diagnosis in Ontario, Canada: a population-based study.

Although suspicions of cancer may be raised in patients who visit the emergency department, little is known about emergency department use before a cancer diagnosis. We sought to describe emergency department use among patients in Ontario within the 90 days before confirmed cancer diagnosis and to evaluate factors associated with this emergency department use. We conducted a retrospective, population-based study of patients aged 18 years or older who had a confirmed cancer diagnosis in Ontario from 2014 to 2021 using linked administrative databases. The primary outcome was any emergency department visit within 90 days before the cancer diagnosis date. We used multivariable logistic regression to evaluate factors associated with emergency department use, such as demographics (e.g., age, sex, rurality, Ontario Health region, indicators of marginalization), comorbidities, previous emergency department visits and hospital admissions, continuity of primary care, type of cancer, and year of cancer diagnosis. We included 651 071 patients with cancer. Of these, 229 683 (35.3%) had an emergency department visit within 90 days before diagnosis, 51.4% of whom were admitted to hospital from the emergency department. Factors associated with increased odds of emergency department use before cancer diagnosis included rurality (odds ratio [OR] 1.15, 95% confidence interval [CI] 1.13-1.17), residence in northern Ontario (North East region OR 1.14, 95% CI 1.10-1.17 and North West region OR 1.27, 95% CI 1.21-1.32, v. Toronto region), and living in the most marginalized areas (material resources OR 1.37, 95% CI 1.35-1.40 and housing OR 1.09, 95% CI 1.06-1.11, v. least marginalized quintile). We observed significant variation in emergency department use by cancer type, with high odds of emergency department use among patients with intracranial, pancreatic, liver or gallbladder, or thoracic cancer. Emergency department use is common before cancer diagnosis, with about one-third of patients with cancer in Ontario using the emergency department before diagnosis. Understanding why patients visit the emergency department before cancer diagnosis is important, particularly for patients who live in rural or marginalized areas, or those who have specific cancer types.

Prevalence and risk factors for depression in native and immigrant pregnant women in a Health Region- retrospective cohort study.

Prevalence and risk factors for depression in native and immigrant pregnant women in a Health Region- retrospective cohort study.

Increased Prevalence of Bell's Palsy in First Nations Populations with Type 2 Diabetes Mellitus in Manitoba.

Bell's palsy is acute facial palsy due to inflammation involving the facial nerve related to infections. Rates have not been noted to differ by ethnicity. We studied the lifetime prevalence in First Nations and all other Manitobans in people with type 2 diabetes mellitus aged 7 and older in 2013-2014 and 2016-2017. We found a crude lifetime prevalence of 9.9% [95% CI 9.4-10.4%] in the First Nations population versus 3.9% [95% CI 3.8-4.0%] in all other Manitobans. It is unknown if there were differences in glycemic control. The increased prevalence was found in all five provincial health regions. This study indicates that ethnicity may be an important risk factor for Bell's palsy.

Radiation adaptive response for constant dose-rate irradiation in high background radiation areas

AbstractThe presented paper describes the problem of human health in regions with high level of natural ionizing radiation in various places in the world. The radiation adaptive response biophysical model was presented and calibrated for the special case of constant dose-rate irradiation. The calibration was performed for the data of residents of several high background radiation areas, like Ramsar in Iran, Kerala in India or Yangjiang in China. Studied end-points were: chromosomal aberrations, cancer incidence and cancer mortality. For the case of aberrations, among collected publications about 45% have shown the existence of adaptive response. Average reduction of chromosomal aberrations was ∼ 10%, while for the case of cancer incidence it was ∼ 15% and ∼ 17% for cancer mortality (each taking into account only results showing adaptive response). Results of the other 55% of data regarding chromosomal aberrations have been tested with the LNT (linear no-threshold) hypothesis, but results were inconsistent with the linear model. The conditions for adaptive response occurrence are still unknown, but it is postulated to correlate with the distribution of individual radiosensitivity among members of surveyed populations.

Clinical Implications of Social Anxiety Disorder (SAD) and its Detection Methods- A Systematic Review

Background: A common symptom of SAD is significant impairment in interpersonal relationships that can affect various aspects of life as well as daily functioning and lead to decreased quality of life. Individuals with high social anxiety will tend to withdraw from social environments. Purpose: This can eventually lead to loneliness and depression. Therefore, early detection is needed to find a diagnosis early on and prevent the condition from worsening. This review aims to determine the clinical picture in patients with SAD and to find out the instruments that /have been used for clinical enforcement in the field. Methods: We conducted a comprehensive search for full-text articles comprising case reports, case-control studies, cohort studies, and cross-sectional studies published between January 1, 2013, and December 30, 2023. The search encompassed databases such as PubMed, ScienceDirect, SAGE, and Scopus. It's important to note that this review does not delve into other clinical conditions associated with Social Anxiety Disorder (SAD), such as anxiety and depression, as they have been addressed in separate discussions. Additionally, the identification of anxiety and depression is excluded from this review. Results: Out of 78 articles that were screened, only 56 met the eligibility criteria to be selected for further review. The initial steps that need to be taken include 1) defining the research objectives; 2) establishing inclusion criteria; 3) developing a search strategy for data retrieval or study selection; 4) collecting data; 5) assessing the quality of studies; and 6) synthesizing the results. Risk of bias was performed using FEAT principles and reviewers’ discussion. A total of 11 final articles that were reviewed showed a significant correlation between anxiety disorder and detection. Conclusion: As individuals with SAD are large in number, based on this review, early detection is required using methods used by local health regions such as through interviews or clinical symptom assessment. This aims to find cases as quickly as possible and provide appropriate interventions.

Strengthening public health professionals in policymaking in the Eastern WHO European region

Abstract Background The collaborative research between EUPHA and WHO aimed to explore factors impacting public health professionals’ (PHP) involvement in health policy processes in the Eastern WHO European Region, addressing barriers, enablers, and capacity-building needs. Methods Utilizing a mixed methodology, the study employed document analysis, scoping review, and interviews to triangulate data, with the document analysis focusing on 4 published Essential Public Health Operations Self-Assessment Reports, the scoping review analysing 15 key articles, and 5 semi-structured interviews providing additional insight from key country stakeholders. Results Core findings revealed significant barriers impeding PHPs' participation in policy processes. Among others, these included limited intersectoral collaboration, shortage of skilled public health (PH) personnel, financial resource constraints and inadequate governance structures. Conversely, several enablers were identified, such as a positive trend in increased intersectoral collaboration and innovative governance structures during Covid-19, the development of more trained PHPs and the utilization of International Health Organisations. The two main capacity building needs reported were the importance of modernizing PH education and promoting intersectoral collaboration. Conclusions This study offers a preliminary overview of how PHPs' involvement in health policy processes in these countries can be enhanced: More intersectoral collaboration, updated PH education curricula and trainings, and governance re-design building on positive trends seen during the pandemic. Following actions are recommended: Creation of an international platform for cross-sectoral PH communication & exchange, direct support for universities and PH researchers, development of comprehensive PH trainings, assistance in forming or strengthening national public health associations and identification & sharing of effective local governance practices. Key messages • This research identifies barriers to PHPs’ participation in Eastern WHO European Region's health policy processes, while highlighting enablers like increased collaboration during Covid-19 to build on. • Recommendations to harness the enablers include clear actions such as creating an international public health platform for interaction and exchange or build-up of national public health associations.

The role of governance in shaping health system reform: a case study of the design and implementation of new health regions in Ireland, 2018–2023

Abstract Background This study focuses on the development of new regional health structures in Ireland in the period 2018-2023, one part of a broader health system reform programme aimed at greater universalism, in order to scrutinise how aspects of governance impact on the reform process, from policy design through to implementation. Methods This qualitative, multi-method study draws on document analysis of official documents relevant to the reform process, as well as twelve semi-structured interviews with key informants from across the health sector. Interviews were analysed according to thematic analysis methodology. Conceiving governance as comprising five domains (Transparency, Accountability, Participation, Integrity, Capacity) the research uses the TAPIC framework for health governance as a conceptual starting point and as initial, deductive analytic categories for data analysis. Results The analysis reveals important lessons for policymakers across the five TAPIC domains of governance. These include deficiencies in accountability arrangements, poor transparency within the system and vis-à-vis external stakeholders and the public, and periods during which a lack of clarity in terms of roles and responsibilities for various process and key decisions related to the reform were identified. Inadequate resourcing of implementation capacity, competing policy visions and changing decision-making arrangements, among others, were found to have originated in and continuously reproduced a lack of trust between key institutional actors. Conclusions Large scale health system reform is a complex process and its governance presents distinct challenges and opportunities for stakeholders. To understand and be able to address these, and to move beyond formulaic prescriptions, critical analysis of the historical context surrounding the policy reform and the institutional relationships at its core are needed

Governance and health system reform: a case study of new health regions in Ireland, 2018-2023

Abstract Background While the significance of good governance is recognised within health systems research, its role in health system reform is underexplored. This research focuses on the establishment of new decentralised regional health structures in Ireland in the period 2018-2023, examining how aspects of governance impacted the decentralisation reform process, from policy design through to implementation. Methods The research applied a qualitative, multi-method approach involving analysis of official documents relevant to the regional decentralisation process, and 12 semi-structured interviews with key informants from across the health sector. The research applies the TAPIC framework for health governance as its analytic framework and the data is analysed using thematic analysis. Results Deficiencies in accountability arrangements, poor transparency within the system and vis-à-vis external stakeholders, and a lack of clarity of roles and responsibilities for various process and key decisions related to the reform were identified as undermining progress at various stages of Ireland’s decentralisation reform process. An underlying distrust between key institutional actors was identified. These findings are grounded in complex social, cultural, and political and institutional developments in Ireland’s history. Also of note is the interwovenness of the five TAPIC domains and the importance of engaging with the complexity and relationality intrinsic to health system reform processes to achieve the aim(s) of the reform in question. Conclusions Large scale health system reform is a complex process and its governance presents distinct challenges and opportunities for stakeholders. To understand and address these, critical analysis of the historical context surrounding the policy reform and the institutional relationships at its core are needed. Key messages • Governance plays a crucial if overlooked role in health systems reform. Effective governance arrangements are central to the successful design and implementation of reform initiatives. • Ensuring a strong link between policy design and implementation processes is crucial to the success of health systems reform.

Residential mobility and social capital: Regional analysis in Finland

AbstractMultiple factors can influence the rates of residential mobility flows between different regions of a country. Studies have often focused on demographic and economic factors, but social conditions may be relevant as well. We examined whether different indicators of social capital (i.e., social support, loneliness, social trust, community participation, cultural activities, and meeting other people) were associated with population migration rates across 299 municipalities of Finland. Data for the social characteristics were derived from the Regional Health and Wellbeing study (n = 100,750 respondents) aggregated to the level of municipalities using multilevel regression with post‐stratification (median number of participants was 115 individuals per municipality, range from 5 to 10,616). Residential mobility rates were derived from census data. Municipalities with higher levels of social support, higher social trust, more cultural activities, and more frequent social contacts had higher net migration rates, that is, more people moving in than out of the municipality. Social support, cultural activities, and community participation were associated with higher in‐migration. Social trust and frequency of meeting people were associated with lower out‐migration. The findings provide empirical support for the hypothesis that regions with stronger social capital are more attractive destinations for within‐country residential mobility.

Spatial and temporal distribution of american tegumentary leishmaniasis in a health region of Northeastern Brazil, 2007-2022

Spatial and temporal distribution of american tegumentary leishmaniasis in a health region of Northeastern Brazil, 2007-2022

Strabismus surgery in topical anaesthesia with intraoperative suture adjustment in Graves' orbitopathy.

To report the results of strabismus surgery in a series of patients with Graves' orbitopathy (GO), using topical anaesthesia with intraoperative suture adjustment. All first-time strabismus surgeries in patients with GO in our department during the years 2014-2021 (n = 45) were assessed retrospectively. Among these, 31% came from outside our health region due to increased complexity of the strabismus condition. Orbital decompression surgery had been carried out in 58% of the patients prior to strabismus surgery. Patients with less than 2 months of follow-up were excluded from the study. Median follow-up time was 22 months. Among the total patient material, 37 (82%) could be operated with topical anaesthesia with intraoperative suture adjustment. There were no cases with triggering of the oculo-cardiac reflex during the procedure. Among the 36 patients operated with topical anaesthesia and follow-up time ≥2 months, 11 (31%) needed further surgery. Late overcorrection after recession of the inferior rectus was seen in 19%. At the last control examination, 32 (89%) were diplopia-free in primary and down-gaze position, either with or without weak prisms. Strabismus surgery in topical anaesthesia with intraoperative suture adjustment appears to be a suitable and safe procedure in most patients with GO, including difficult and complex cases. The patients should be informed about the possibility of additional surgery and/or post-operative need for prism glasses.

Effectiveness of accelerated diagnostic protocols for reducing emergency department length of stay in patients presenting with chest pain: A systematic review and meta-analysis.

In recent years, there has been an increase in the use of accelerated diagnostic protocols (ADPs) and high-sensitivity troponin assays (hsTn) for the assessment of chest pain in emergency departments (EDs). This study aimed to quantitatively summarize the operational and clinical outcomes of ADPs implemented for patients with suspected cardiac chest pain. To be considered eligible for inclusion, studies must have implemented some form of ADP within the ED for evaluating adult (age ≥18 years) patients presenting with chest pain using Tn assays. The primary outcome was ED length of stay (LOS). Secondary outcomes included the proportion of patients admitted and the proportion with 30-day major adverse cardiac events (MACE). Thirty-seven articles involving 404,566 patients met the inclusion criteria, including five randomized controlled trials (RCTs) and 32 observational studies. A significant reduction in total ED LOS was reported in 22 observational studies and four RCTs. Emergency departments with longer baseline ED LOS showed significantly larger reductions in LOS after ADP implementation. This observed association persisted after adjusting for both the change in serial Tn measurement interval and transition from conventional Tn assay to an hsTn assay (β = -0.26; 95% CI, -0.43 to -0.10). Three studies reported an increase in the proportion of patients admitted after introducing an ADP, one of which was significant while 15 studies reported a significant decrease in admission proportion. There was moderate heterogeneity among the 13 studies that reported MACE proportions, with a non-significant pooled risk ratio of 0.95 (95% CI, 0.86-1.04). Implementation of ADPs for chest pain presentations decreases ED LOS, most noticeably within sites with a high baseline LOS; this decreased LOS is seen even in the absence of any change in troponin assay type. The decrease in LOS occurred alongside reductions in hospital admissions, while not increasing MACE. The observed benefits translated across multiple countries and health regions.

Outcomes of antenatal depression in women and the new-born: a retrospective cohort study.

To determine what effect maternal antenatal depression has on pregnancy and infant outcomes in the Lleida health region. Retrospective observational cohort study in pregnant women between 2012 and 2018 in the Lleida health region. Variables included age, body mass index, caesarean section, pre-eclampsia, birth weight, and Apgar score. We performed multivariate analysis, with linear regression coefficients and 95% confidence interval (CI). Antenatal depression was diagnosed in 2.54% pregnant women from a total sample of 17177. Depression is significantly associated with a higher risk pregnancy and low birth weight. Pre-eclampsia, 1-minute Apgar score, and caesarean section were not significantly associated with depression. Antenatal depression increases the risk of pregnancy complications. In addition, depression in the mother increases the probability of low birth weight.

Assessing the burden of submicroscopic Plasmodium infections in a pre-elimination malaria setting in sub-Saharan Africa, Guinea-Bissau.

Submicroscopic Plasmodium infections can be a source of persistent malaria transmission. The aim of this study was to assess their frequency, distribution, morbidity and associated factors in a pre-elimination malaria setting in sub-Saharan Africa, Guinea-Bissau, where the Plasmodium falciparum is the predominant Plasmodium species. Dried fingerprick whole blood samples from 601 participants in the 2017 national, household-based, cross-sectional survey to estimate malaria prevalence were subjected to DNA extraction. The DNA was used in nested end-point PCR assays targeting genus- and species-specific regions of the Plasmodium 18S rRNA genes. Statistical analysis of socio-demographic, clinical and molecular data was carried out using the Statistical Package for the Social Sciences, version 29. Factors associated with submicroscopic P. falciparum infections and their magnitude were sought using Chi-square test and multiple logistic regression models, respectively. Statistically significant level was considered at P-value < 0.05. Nested PCR assays detected submicroscopic P. falciparum infections in 20.3% (95% CI = 16.8-23.8) of individuals microscopically negative for Plasmodium species in the general population and in 21.4% (95% CI = 9.9-36.5) of microscopically negative pregnant women. Submicroscopic Plasmodium malariae infections were also detected as co-infections in 3.0% individuals who were microscopically positive only for P. falciparum. Infections with other Plasmodium species were not detected. Submicroscopic P. falciparum infections were not associated with age, sex, or the presence of fever. A logistic regression model adjusted for ethnicity and health region showed that individuals from the Balanta and Bijagos ethnic groups, most of whom live in the low malaria-transmission areas of Quinara and Bissau, and the Bijagos archipelago, respectively, were less likely to have submicroscopic P. falciparum infections than individuals from the large Fula ethnic group, most of whom live in the high malaria-transmission area of Gabu. Submicroscopic P. falciparum infections were not associated with anaemia in children under 5years of age. The results obtained highlight the contribution of asymptomatic and submicroscopic P. falciparum infections to malaria transmission in high malaria-transmission areas and the need for molecular-based tools to detect submicroscopic Plasmodium species.

Ethnopharmacological Insights into the Use of Chenopodium ambrosioides for Cough Treatment among Togolese Traditional Healers

Togo has an ethnobotanical potential with a great diversity of medicinal plants widely used to treat human diseases. Cough associated with respiratory diseases is one of the pathologies traditionally treated with medicinal plants in Togo. Chenopodium ambrosioides (L.) is a species used in the traditional treatment of cough in Togo. The aim of this study was to document the ethnopharmacological uses of Chenopodium ambrosioides in Togolese traditional medicine for treatment of cough. An ethnopharmacological survey was conducted using the semi-structured interview method among Traditional Medicine Practitioners (TMPs) from six health districts spread across four health regions. The ethnopharmacological and ethnobotanical data collected were analyzed using the User Value (UV) and Frequency of Citation (FC) of medicinal plants associated with the species. A total of 127 TMPs participated in this study and 96 (76%) of them were male and 31 (34%) were female. 73% of the informants claimed usually use Chenopodium ambrosioides in the cough treatment compared to 27% who claimed to not use it to treat cough. Chenopodium ambrosioides was used in combination with fifty-two (52) other botanical species in the treatment of cough and in the study area, Abrus precatorius Linn. (13.59%) followed by Ocimum gratissimum Linn. (11.58%), Zingiber officinale Rosc. Trans. Linn. (9.73%), Mangifera indica Linn. (6.21%), Eucalyptus citriodora Hooker (4.87%), Xylopia aethiopica (Dunal) A. Rich. (4.36%) and Eugenia caryophyllata Thunb. (4.19%) were the most popular plants used for cough treatment among the plants recorded. Sixteen (16) other pathologies including pulmonary infections are also treated by Chenopodium ambrosioides (L.). Abscesses, intestinal parasitic diseases, incurable wounds, stomach aches and headaches are the most pathologies commonly treated by this plant. The whole plant (72%) and leaves (22%) are the primary parts utilized for medicinal purposes. Decoction (77.50%) is the main preparation method, with oral (80.83%) and cutaneous (10.83%) routes being the most common modes of administration. The findings from this study provide a solid ethnopharmacological foundation for future pharmacological and toxicological investigations into Chenopodium ambrosioides (L.).

Grain Lysine enrichment and improved stress tolerance in rice through protein engineering.

Amino acids are a major source of nourishment for people living in regions where rice is a staple food. However, rice grain is deficient in essential amino acids, such as lysine. The activity of dihydrodipicolinate synthase (DHDPS) enzyme is crucial for lysine production in higher plants, but it is highly regulated through a feedback inhibition by its end product lysine, leading to its limited activity in the grain and resulting in low lysine accumulation. We identified lysine binding sites in the DHDPS enzyme and introduced key mutations to make it lysine feedback insensitive. Using in vivo analysis and functional complementation assays, we confirmed that protein engineering of the DHDPS renders it insensitive to lysine. Expression of mutated DHDPS resulted in 29 % higher lysine and 15 % higher protein accumulation in rice grains than the wild type. Importantly, the lysine content in transgenic grains was maintained in cooked rice. Further, the transgenic plants exhibited enhanced stress tolerance along with better antioxidant levels, improved photosynthesis, and higher grain yield compared to wild type plants. We have shown for the first time in rice that protein engineering of DHDPS can lead to accumulation of lysine in grains and impart abiotic stress tolerance. This approach could improve health in regions with nutrient deficiencies and environmental stressors that challenge food production and human health.