Letter to the editor 1: Predictors of oesophageal candidiasis in persons with or without HIV infection

Nil

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Child sexual abuse and disclosure in South Western Nigeria: a community based study

Introduction: The true burden of child sexual abuse in Nigeria is not known as most reports are institutional based. This study was designed to determine population level data on the burden and pattern of child sexual abuse among adolescents in South Western Nigeria.
Methods: A community based study among adolescents in SouthWestern Nigeria. Semi- structured interviewer administered questionnaire was used to collect data from respondents selected through a multistage sampling technique. Analysis was with SPSS version 20.
Results: 398 adolescents (314 females and 84 males) aged 10-19 years with a mean age of 15.6 ± 2.0 years participated in the study. Most were single (90.7%), in school (84.2%), and lived with their parents/guardians (89.4%). The prevalence of CSA was 25.7%. Penetrative abuse occurred in 7.5%, and forced abuse in 46.2% of cases. Perpetrators were mostly boyfriends (31.2%) and neighbours (16.1%). Intra-familial abuse occurred in 7.5% of cases. Only 34.4% of cases ever disclosed the abuse.
Conclusion: CSA is common in the community, with perpetrators majorly persons known to the adolescents. A large number of cases are not reported. Efforts should be made to educate children and their parents on various ways to reduce child sexual abuse and its consequences.

Keywords: Adolescent, child, sexual abuse.

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Non- adherence to anti-retroviral medication in Shiraz, 2014: a cross sectional study

Background: Medication adherence is a dynamic and complex behavioral process, which is strongly influenced by personal, social and environmental factors.
Objectives: To determine the prevalence and factors affecting non-adherence to medication among HIV-infected patients.
Methods and materials:
Design: A cross-sectional study.
Setting: Voluntary Counseling and Testing Center (VCT), Shiraz, Fars province, in the South of Iran.
Patients: Among HIV-positive patients who received anti-retroviral therapy, 214 adult patients were selected through convenience sampling. Their medication adherence was checked by interview and counting the pills on visits during two months. Clinical and laboratory data were obtained from the patients' records.
Results: Non-adherence and adherence groups included 30.4% (65) and 69.6% (149) of the patients, respectively. The mean age of patients was 40.80±7.77 years, and ranged from 20 to 65 years. Majority of cases (65%) were male. A significant relationship was found between non-adherence to medications and the variables of transmission method, marital status, housing status, and CD4, but there was no significant relationship with gender.
Conclusion: The prevalence of medication adherence was similar to other regions with limited financial resources. To increase patient's medication adherence, they should be exposed to motivational interventions to promote their drug consumption, social and occupational support.

Keywords: Prevalence, adherence, anti-retroviral medication, HIV.

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Sexuality experiences of secondary school students in Nakuru, Kenya: a cross-sectional study

Background: Adolescence is a phase where one is inquisitive about sex and sexuality. It is but natural to exchange the half-baked feelings and experiences with peers. These days the environment that includes public media has sexually suggestive flavors.
Objective: This study was conducted to find out the sexual experiences of a selected, few school going adolescents.
Methods: A cross-sectional study utilizing stratified sampling to enroll 200 students from secondary schools in Nakuru County, Kenya. A self-administered questionnaire was used to collect data. The data was entered and analyzed in SPSS® version 22. Chi-square test of independence and Fisher's Exact Test were performed to test for associations.
Results: The study found that a large number have had sexual experiences of varying type. It was interesting to learn from the survey that a large number of older adolescents wish that their parents should have talked to them about sexual matters. There is a general conservative outlook that the students had. Although a small percentage had sexual experiences at a very young age, many of them valued ethics and morality.
Conclusion: There is urgency for intervention by the parents and the church in filing the gap in sexual knowledge.

Keywords: Sexuality experiences, secondary school students, Nakuru, Kenya.

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Congenital genital abnormalities detected during routine circumcision at a South African institution: a retrospective record review

Background: Due to the reduction in HIV transmission through male medical circumcisions (MMC), numerous clinics throughout South Africa offer a voluntary free service to boys from the age of ten years and above. An examination prior to the procedure may detect congenital abnormalities missed after birth.
Objectives: The aim of this study was to measure the incidence of these abnormalities, determine the demographic and clinical characteristics of this group and determine what referral systems, interventions, and follow-up is available to them.
Methods: The study was a descriptive, observational, retrospective analysis of de-identified medical records at a routine MMC service at a Johannesburg clinic in 2015. The participants were male patients between the ages of 10 – 49.
Results: Out of 1548 participants, 91.0% (n=1409) had a normal genital examination while 3.7% (n=57) had an abnormal examination and 5.1% (n=79) had no examination recorded. Thirty five congenital anomalies were detected and only 2 patients (diagnosed with hypospadias) were seen at the urology out-patient's department.
Conclusion: The incidence of congenital genital abnormalities of males presenting for routine circumcision is low. Despite the low incidence the effect on fertility, sexuality, ability to urinate and on psychological wellbeing is significant. Referral services to the urology department should be restructured to improve all outcomes.

Keywords: Congenital genital abnormalities, circumcision, South Africa.

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Peer pressure and home environment as predictors of disruptive and risky sexual behaviours of secondary school adolescents

Background: Not much is understood about the predictive power of home environment and peer pressure on disruptive behaviour and risky sexual behaviour of adolescents.
Objectives: The study investigated the predictive power of home environment and peer pressure on disruptive behaviour and risky sexual behaviour of adolescents in secondary school class two in Enugu State, Nigeria. Four research questions and four null hypotheses guided the study.
Methods: The design was a cross sectional survey of correlational study. The study was carried out in the six Education zones in Enugu State, Nigeria. The population was all the 31,680 senior secondary class two (SS11) adolescents in 285 secondary schools in Enugu State, Nigeria in 2015/2016 academic session. The instruments for data collection were an observation schedule, an interview session and a structured questionnaire of four clusters. To determine the R-squares for each regression model, a multivariate multiple regression model was conducted using "MANOVA" and "MVREG".
Results: This study indicates adolescents who reported their home environments to be stimulated displayed compliant behavior and none or lowered risky sexual behaviour, whilst those with chaotic and unstimulated home environment displayed disruptive behaviours. It was found that adolescents who show a heightened sensitivity to positive peer pressure demonstrated compliant and no or lowered risky sexual behavior whilst, those that are engaged with negative peer pressure strongly exhibit disruptive and risky sexual behaviour.
Conclusion: Unstimulated home environment and negative peer group could consequently interact to predispose these adolescents to disruptive behaviour and risky sexual behaviour.

Keywords: Home, peer group, disruptive, behaviour, adolescents.

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Compliance with epidemic-prone diseases surveillance and response guidelines among health officers at surveillance units in South-West Nigeria

Introduction: Although compliance with surveillance guidelines is crucial to epidemic diseases control, determinants of use of these guidelines in Nigeria are poorly documented. We assess health workers compliance and factors associated with the surveillance and response guidelines for epidemic-prone diseases in South-West Nigeria.
Methods: In a cross-sectional study, 199 disease surveillance and notification officers in Oyo state were interviewed using a questionnaire on knowledge of disease surveillance and performance of surveillance activities. Data were analysed using descriptive statistics, chi-square and multiple logistic regression at P= 0.05.
Results: Most surveillance units submitted disease outbreaks reports (81.48% at the health facility and 100% at the local government level). Timeliness and completeness of weekly reporting were 94% and 95% respectively. a quarter (25.9%) adhered to national case definitions guidelines. About 85.7% did laboratory case confirmation while 2.6% did facility level data analysis. Predictors for six months reporting activity include attending a training on surveillance and reporting (OR=7.92; CI=1.65–37.92), fund adequacy (OR=27.81; CI=7.68–100.60) and knowledge of surveillance dataflow (OR=4.80; CI=1.64–14.10).
Conclusion: In addition to provision of adequate financial and laboratory resources, surveillance activities would benefit from continuous training on surveillance data flow.

Keywords: Epidemic-prone diseases, case definitions guidelines, surveillance and response.

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Effect of pregnancy on sexual function of couples

Objective: Sexual function is an important part of each human being's personality and in the general couple relationship, with an obvious impact on quality of life and safe sexual performance during pregnancy is important for couples. The objective of this study was to assess effects of pregnancy on sexual function of couples.
Materials: In a prospective cohort study 123 couples were enrolled in the study when women were first diagnosed to be pregnant. During their pre-natal visits, Sexual function of couples was evaluated using the Iranian Version Index of Erectile Function (IIEF) in men and Female Sexual Function Index (FSFI) in women in three trimesters. Statistical analysis was performed.
Results: Indices of sexual function showed significant regressions over time during pregnancy. The greatness of the problem was highest during the third trimester. Female sexual arousal and sexual satisfaction domain scores had the major correlation to IIEF total score. On the other hand, male intercourse satisfaction domain score had the maximum correlation to FSFI total score. A strong correlation between male and female sexual function was observed.
Conclusion: Sexual function is a widespread problem during pregnancy among Iranian couples. Therefore, pregnant women and their husbands need counseling about healthy sexual function in pregnancy.

Keywords: Sexual activity, pregnant woman, husband.

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MicroRNA expression profiling in human acute organophosphorus poisoning and functional analysis of dysregulated miRNAs

Objective: Acute organophosphorus(OP) pesticide poisoning is associated with dysfunctions in multiple organs, especially skeletal muscles, the nervous system and the heart. However, little is known about the specific microRNA (miRNA) changes that control the pathophysiological processes of acute OP poisoning damage. We aimed to explore miRNA expression profiles and gain insight into molecular mechanisms of OP toxic effects.
Methods: MicroRNA expression was analyzed by TaqMan Human MicroRNA Array analysis and subsequent validated with quantitive PCR. The targets of the significantly different miRNAs were predicted with miRNA prediction databases, and pathway analysis of the predicted target genes was performed using bioinformatics resources.
Results: 37 miRNAs were significantly different in the sera of poisoned patients compared to the healthy controls, including 29 miRNAs that were up-regulated and 8 miRNAs that were down-regulated. Functional analysis indicated that many pathways potentially regulated by these miRNAs are involved in skeletal muscle, nervous system and heart disorders.
Conclusion: This study mapped changes in the serum miRNA expression profiles of poisoning patients and predicted functional links between miRNAs and their target genes in the regulation of acute OP poisoning. Our findings are an important resource for further understanding the role of these miRNAs in the regulation of OP-induced injury.

Keywords: MicroRNA, expression profiles, human, acute organophosphorus pesticide poisoning, signaling pathways.

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How do Spondias mombin L (Anacardiaceae) leaves extract increase uterine smooth muscle contractions to facilitate child birth in parturient women?

Background: Spondias mombin L. (Anacardiaceae) leaves were used in Togolese folk to treat dystocia, expel placenta and manage post-partum hemorrhage during child birth.
Objectives: This study aimed to establish how the extract of S. mombin leaves increase uterine smooth muscle contractions relevant to its traditional use to facilitate child birth.
Methods: Tests were performed on uterus muscle strips from Sprague-Dawley rats. Central portion of uterine horns were dissected, cleaned of surrounding fat and loose connective tissue, and cut longitudinally into strips which were placed in the organ bath for isometric tension record in presence of different substances.
Results: S. mombin leaves extract increased uterine spontaneous contractions. This effect was reduced by indomethacin (2 x 10-6 M), yohimbine (2 x 10-6 M) and 2- aminoethoxydiphenyl borate (2-APB) (5 x 10-5 M), but not by atropine (3.45 x 10-8 M) and cholesterol (2.5 mg/ml).
Conclusion: The pharmacological justification for the traditional use of S. mombin leaves to treat dystocia and expel placenta was that its hydro-ethanolic extract induced prostaglandins release, α2-adrenoceptors stimulation, calcium release from internal stores and lifted inhibitory effect of cholesterol on uterine contractions in order to increase uterine smooth muscle contractions.

Keywords: Spondias mombin, uterus, contractions, calcium.

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Neonatal mortality at the neonatal unit: the situation at a teaching hospital in Ghana

Background: The first 28 days of life- the neonatal period is the most vulnerable time for a child's survival. Globally, neonatal mortality has seen a downward trend in recent years. The main objective of this study was to determine the percentage of neonatal mortality and to provide information on factors associated with neonatal mortality at the neonatal unit of a tertiary health facility or teaching hospital.
Methods: Data of neonates admitted to the neonatal in-patient unit of the Komfo Anokye Teaching Hospital (KATH) in Ghana from January 2013 to May 2014 were analyzed. Logistic regression model was performed to assess the association between neonatal mortality and predictors.
Results: A total of 5,195 neonatal admissions were recorded. The overall percentage of neonatal mortality was 20.2%. Infants with very low birth weight, having 5-minute Apgar score lower than 4, newborns with pre-term delivery, being referred from other health facilities, and being diagnosed with respiratory distress and birth asphyxia had a higher percentage of neonatal mortality.
Conclusion: The mortality at the neonatal in-patient unit at the Komfo Anokye Teaching Hospital in Ghana is very high. There is the need for continuous attention and interventions to help reduce the risk of mortality among neonates admitted to the facility.

Keywords: Logistic regression, neonatal mortality, Kumasi.

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Estimation of salivary cortisol level in post-menopausal women with psychosomatic disorders

Background: Stress is an undesirable or health threatening response of the body, which is brought on by deleterious external influences (stressors). Objective measurement of psychosocial stress helps in assessment of pivotal role of stress in precipitation of multitude of health problems and a solution to the same. Salivary biomarkers are suggested to provide a reliable and non-invasive method for the estimation of these general health problems. Salivary cortisol is such biomarker used as tool in the examination of human physiological stress response. Post-menopausal women show an increase in stress levels and hence suffer with multiple health related problems. Hence the present study aimed to estimate salivary cortisol levels in post-menopausal women with clinically diagnosed psychosomatic disorder/disorders of the head and neck region, so as to establish salivary cortisol as a biochemical indicator of stress.
Methods: Thorough intra-oral and extra-oral examination was performed to check for the presence of psychosomatic disorder of head and neck. Unstimulated saliva was collected from 100 post-menopausal women with and 100 without clinically diagnosed psychosomatic disorder/disorders through 'Spit Technique'. Salivary cortisol was estimated using ELISA method.
Results: The results were statistically significant as they showed that the salivary cortisol was in higher levels in post- menopausal women with clinically diagnosed psychosomatic disorder/disorders.
Conclusion: The geriatric patients feel that they have very little skills or resources to deal with the high levels of stress that they are experiencing and hence suffer from lack of self-worth. The results of this study recommend that stress evaluation should be done on a regular basis for all post- menopausal women. For individuals who do not reveal their psychological distress, salivary analysis of cortisol may be used as an aid to diagnose their situation in conjunction with clinical diagnosis.

Keywords: Post-menopausal women, psychosomatic disorder, head and neck, salivary cortisol, biomarker.

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Problems encountered in conventional HIV 1/2 Algorithms: lack of necessity for immunoblot assays to confirm repeated ELISA reactive results

Background: The use of conventional (serologically based) HIV 1/2 diagnostic algorithms has become controversial in recent years.
Objectives: Sera from patients who underwent verification tests were evaluated because repeated ELISA-reactive results demonstrated a HIV1+HIV2 positive band pattern.
Methods: The line immunoassay (LIA) test was used for repeated HIV enzyme immunoassays (EIA)-reactive sera in patients at three centers. The Bio-Rad Geenius™ HIV 1/2 and the HIV-1 RNA tests were used. HIV-1 and RNA HIV-2 were investigated using PCR.
Results: LIA was used to evaluate 3,224 out of 10,591 samples with repeated ELISA reactivity (30%). We found that 32 (1%) of the sera, along with HIV1 bands and HIV2 gp36 bands, were positive. Only 28 of the 32 verified serum samples with gp36 bands were repeated, and no gp36 band positivity was detected using the Bio-Rad Geenius™ HIV-1/2 confirmatory assay in these serum samples. The HIV-2 proviral DNAs were also negative. Therefore, we excluded the possibility of HIV1+2 co-infection. All samples from the 32 patients were positive for HIV-1 RNA.
Conclusion: Our findings highlight the need to exclude confirmatory tests like the LIA test from the current diagnostic HIV algorithm and replace it with rapid HIV-1 and HIV-2 confirmatory immunochromotographic tests.

Keywords: HIV, AIDS, HIV-2.

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Quinine inhibits ovulation and produces oxidative stress in the ovary of cyclic Sprague-Dawley rats

Background: Quinine has been reported to possess anti-spermatogenic activities.
Objectives: This study was carried out to determine the effect of quinine on ovarian function in Sprague-Dawley rats.
Methods: Twenty rats with regular 4-days oestrous cycle divided into 4 groups (N=5) were used. Group I received quinine at 30 mg/kg body weight by gavage for 28 days after which they were sacrificed. The ovaries were excised for biochemical oxidation of glutathione peroxidase (GSH), superoxide dismutase (SOD), catalase and malondialdehyde (MDA). Group II received single dose quinine at 30 mg/kg body weight at 0900 hrs on day of proestrus. Blood was obtained at 1800 hrs for hormonal assay of FSH and LH. The animals were sacrificed the next morning on estrus: oviducts were examined for ova count. Groups III and IV served as controls.
Results: Quinine treated rats recorded zero number of ova compared to control. Serum concentration of LH reduced significantly in the quinine treated group compared to the control. Furthermore, quinine significantly decreased the oxidant status of GSH, SOD and catalase and significantly increased MDA levels in the ovary compared to the control group.
Conclusion: Quinine completely blocks ovulation, suppresses LH surge, and produces oxidative stress in the ovary.

Keywords: Quinine, ovary, LH, ovulation, oxidative stress.

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Secondary hyperparathyroidism among Nigerians with chronic kidney disease

Backround: Secondary hyperparathyroidism (SHPT) is a manifestation of chronic kidney disease mineral bone disorder (CKD-MBD). SHPT is common in patients with chronic kidney disease (CKD) and is associated with significant morbidity and mortality.
Methods: A cross- sectional descriptive study involving 230 patients with CKD.
Results: The mean age of the study population was 44.17±15.24 years. The median intact parathyroid hormone and alkaline phosphatase levels were 96pg/ml (range 4-953pg/ml) and 88 iu/l (range 10-800 iu/l) respectively. The mean (with standard deviation) calcium, serum phosphate, calcium phosphate product and haemoglobin levels were 2.22±0.29mmol/l, 1.8±0.62mmol/l, 3.94±1.42mmol2/l2 and 9.90±1.87g/dl respectively. Majority of patients had advanced CKD with 70.3% of patients in stage G5. The prevalence rates of SHPT, hypocalcaemia, hyperphosphataemia, elevated alkaline phosphatase and elevated calcium phosphate product were 55.2%, 34.8%, 66.1%, 42.2% and 25.2% respectively. Univariate analysis revealed that SHPT was associated with hypocalcaemia, hyperphosphataemia, elevated alkaline phosphatase, proteinuria, anaemia, hypertension, left ventricular hypertrophy and stage of kidney disease; being worse with advancing kidney disease. Independently associated with SHPT were hypocalcaemia (OR=4.84), hyperphosphataemia (OR=3.06), and elevated alkaline phosphatase (OR=2.04).
Conclusion: The prevalence of SHPT in CKD is high, occurs early and is independently associated with hypocalcaemia, hyperphosphataemia and elevated alkaline phosphatase. The prevalence of SHPT also increases with worsening renal function.

Keywords: Secondary hyperparathyroidism, chronic kidney disease, intact parathyroid hormone, hypocalcaemia, hyperphosphataemia, elevated alkaline phosphatase.

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An eight cytokine signature identified from peripheral blood serves as a fingerprint for hepatocellular cancer diagnosis

Background: Hepatocellular carcinoma is an aggressive disease in Asia and Africa with poor prognosis partially due to lack of disease-specific biomarkers.
Objectives: The aim of this study was to assess the concentrations of different cytokines and chemokines in peripheral blood of patients with hepatocellular carcinoma and identify the potential biomarkers that would help in clinical assessment.
Methods: Profiling of 14 cytokines, chemokines and growth factors was performed in peripheral blood of 78 patients and 78 healthy controls using Bio-Plex Human 15-plex assay kit.
Results: The results showed that patients had significantly higher levels of IL-1β (p=0.034), IL-6 (p=2.13e-06),IL-10 (p=0.013), IL-17A (p=0.017), IL-22 (p=0.00276), IL-25 (p=0.0005), but lower levels of IL-4 (p=0.00341) and IL-33 (p=0.00982) in peripheral blood.
Conclusion: We identified a unique eight-peripheral blood cytokines signature for hepatocellular carcinoma detection. This work will serve as the basis for further studies about the clinical value of peripheral blood cytokines in forecasting prognosis

Keywords: Cytokine, peripheral blood, hepatocellular carcinoma, biomarker, diagnosis.

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Sexuality and other issues in Africa and beyond

Nil

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Interleukin-6 gene -572G/C polymorphism and prostate cancer risk

Background: The aim of the present study was to determine whether the interleukin-6 (IL-6) -572G/C polymorphism correlates with prostate cancer.
Methods: According to inclusion and exclusion criteria, the association of the IL-6 -572G/C polymorphism with prostate cancer was searched in databases and analyzed using comprehensive meta-analysis software. Odds ratios (ORs) with 95% confidence intervals (CIs) were used to assess the strength of the associations.
Results: We considered a total of six case-control studies including 2237 patients and 1754 controls and the meta-analysis results showed significant association between the IL-6 -572G/C polymorphism and prostate cancer risk(CC vs GG: OR = 0.49, 95% CI =0.37-0.65;CG vs GG: OR =0.71, 95% CI = 0.58-0.87; the dominant model: OR =0.65, 95% CI = 0.54-0.79;the recessive model: OR =0.70, 95% CI = 0.58-0.85). In stratified analyses by ethnicity, significant associations were found among Asian populations. However, no significant association was found in Caucasian populations.
Conclusion: Our findings demonstrated that the -572G/C polymorphism of the IL-6 gene may be a risk factor for the development of prostate cancer in Asians.

Keywords: Prostate cancer, IL-6 polymorphisms, risk.

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B-mode sonographic evaluation of optic nerve sheath diameter and lens thickness in Nigerian adults with glaucoma

Objective: This study was done to investigate the effect(s) of glaucoma on the ocular optic nerve sheath diameter and lens thickness using B-mode ultrasonography.
Materials and methods: One hundred and twenty study participants were recruited; 60 subjects with glaucoma and 60 age- and sex-matched controls without glaucoma. The optic nerve sheath diameter and lens thickness of both eyes were measured using a linear high frequency transducer with frequency of 6.5-12MHz.
Results: The mean optic nerve sheath diameter of the glaucomatous eyes (3.57 ± 0.19mm and 3.59 ± 0.33mm on the right and left, respectively) were significantly thinner than that of controls (4.23 ± 0.34 mm and 4.26 ± 0.30 mm on the right and left, respectively; p < 0.001). There is increased mean lens thickness in the glaucomatous eyes (4.15 ± 0.43mm and 4.18 ± 0.46mm on the right and left, respectively) than in the controls (4.01 ± 0.56mm and 3.99 ± 0.45mm on the right and left, respectively) with a statistically significant difference seen in the left eye (p = 0.024).
Conclusion: B-mode ultrasound is a reliable tool of assessing the nerve sheath diameter and lens thickness in glaucoma. Optic nerve sheath diameter is reduced in glaucoma

Keywords: Glaucoma, ultrasonography, optic nerve sheath diameter, lens thickness.

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Fibroadenoma of the breast in a South African population -a pilot study of the diagnostic accuracy of fine needle aspirate cytology and breast ultrasonography

Background: The triple assessment of clinical breast exam (CBE), fine needle aspirate cytology (FNAC) and breast ultrasonography (US) is used in many settings for the diagnosis of fibroadenoma (FA). The diagnostic accuracy of FNAC and US for FA in South African (SA) women with palpable breast masses (PBM) is unknown.
Objective: To report the diagnostic accuracy of FNAC/US for FA in SA women with PBM.
Methods: We conducted a retrospective pilot diagnostic study of 91 women who presented with PBM to a SA regional academic hospital. Data for CBE, US, unguided FNAC, and open biopsies was collected from study participant medical records and analyzed using diagnostic accuracy tables.
Results: A total of 57/91 (62.6%) study participants had uninterpretable FNAC results. No study participants had uninterpretable US results. The overall diagnostic accuracy of FNAC for FA was 36.3% (95% Confidence Interval - CI: 27.1-46.5%). The overall diagnostic accuracy of US for FA was 83.5% (95% CI: 74.6-89.8%).
Conclusion: The yield of interpretable test results for FNAC was poor in our study. The diagnostic accuracy of US for FA appears to be superior to that of FNAC. Omission of FNAC from the triple assessment in our setting should be considered. .

Keywords: Fibroadenoma, diagnosis, breast ultrasonography, fine needle aspirate cytology.

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PPP1R21 homozygous null variants associated with developmental delay, muscle weakness, distinctive facial features, and brain abnormalities

Clinical Genetics, EarlyView.


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Diabetes Management Among Arab Americans Who Sought Care at a Large Metropolitan Hospital System in Michigan

Abstract

To estimate and compare the management of diabetes among Arab, Asian, non-Hispanic Black, and non-Hispanic Whites attending a large health system in metropolitan Detroit. Data were electronically abstracted for 6622 adult patients with diabetes. Dependent variables were uptake of A1c testing and results, LDL-C testing and results, and eye examination frequency. The independent variable was race/ethnicity. Logistic regression models were used to examine the association between Arab Americans and non-Hispanic Whites for each of the dependent variables while controlling for confounders. Arab Americans were 38% more likely than non-Hispanic Whites to report an A1c > 7% (OR 1.38; 95% CI 1.03, 1.87). Arab Americans were 62% less likely to receive an eye exam compared to non-Hispanic Whites (OR 1.62; 95% CI 1.21, 2.17). Population based studies about diabetes management among Arab Americans will facilitate tailored interventions aimed at preventing/delaying diabetes complications and reducing premature mortality due to diabetes.

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Family Care Curriculum: A Parenting Support Program for Families Experiencing Homelessness

Abstract

Purpose In the United States, families with children characterize the fastest growing portion of the homeless population. Parenting for families experiencing homelessness presents unique challenges since families facing homelessness are disproportionately more likely to experience a myriad of interpersonal and contextual stressors that heighten the risk of parents engaging in suboptimal parenting approaches. This article describes the development and implementation of the Family Care Curriculum (FCC) train-the-trainer parenting support program specifically designed to support positive parenting in families experiencing homelessness. Description The FCC is a 6-week theory-based parenting intervention aimed to create positive shifts in parental attitudes to enhance sensitive and nurturing parenting and positive parent–child relationships. FCC assists parents in reflecting on how their own experiences contribute to some of their parenting beliefs, patterns, and behaviors. Parents are coached to imagine and understand the emotions, attachment, and developmental needs behind their children's behaviors so they can maintain empathic and nurturing parenting responses in the context of cumulative and chronic stress. Parents are supported through learning to engage in self-care. A unique and important feature of the FCC is the inclusion of a culturally sensitive approach that takes into consideration the effects of racism, classism, and oppression on parent–child relationships. Conclusion FCC was designed, implemented, and championed by expert providers in the fields of family therapy, social work, and pediatrics to support parents experiencing homelessness. FCC adds to the body of effective attachment-based, trauma-informed, and culturally sensitive parenting interventions for improving parent–child relations and family health amongst vulnerable populations.

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Salivary secretion in health and disease

Journal of Oral Rehabilitation, EarlyView.


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Possible association of the TERT promoter polymorphisms rs2735940, rs7712562 and rs2853669 with diabetes mellitus in obese elderly Polish population: results from the national PolSenior study

Abstract

One of the markers of aging is lymphocyte telomere length (LTL), which is affected by genetic constitution of the organism and environmental conditions, such as development and diseases, including diabetes. The relationship of the later seems to be bilateral. The enzyme responsible for the maintenance of telomere length is a subunit of telomerase—telomerase reverse transcriptase (TERT). The aims of the present study were to (1) determine the influence of the TERT promoter sequence SNP variants on relative telomere length (RTL) in an elderly Polish population and (2) explore the potential associations of the SNPs with the type 2 diabetes mellitus (T2DM) in the obese individuals. Two highly homogenous subgroups of PolSenior participants were investigated, the first constituted 70 relatively healthy respondents and the second 70 individuals with T2DM. Telomere length ratio (T/S value) was measured; 1.5 kb part upstream of the transcription start site of the TERT promoter was sequenced, and the frequencies of polymorphisms were calculated and compared against analysed data. Low-frequency SNPs were evaluated but excluded from further comparative analyses to RTL and glucose metabolism markers. No significant difference in telomere length was found between the two studied subgroups. Univariate statistical analyses showed only a weak association of environmental or genetic factors altering this marker of aging. Approximate frequency of four SNPs in TERT promoter sequence was assessed in Polish population aged 65–95 years, but three of them (rs2735940, rs7712562 and rs2853669) were selected for further analyses. The SNP selection was based on their minor allele frequencies in general population and on published data. The univariate analysis has revealed that carriers of CC SNP (rs2853669) have had the shortest RTL in the T2DM group. Multivariate analysis has also revealed that the genetic effect of TERT promoter CC SNP was strengthened by the incidence of T2DM. The additional variation in RTL in paired groups indicates that in addition to T2DM and genetics, there are other factors contributing to development of the age-related diseases.

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Considerations Related to the Definition, Measurement and Analysis of Perceived Motor Competence

Abstract

The promotion of motor competence is integral to a holistic view of children's development. Motor development models address the potential role of actual and perceived motor competence, physical activity and health-related fitness in children's health. Actual motor competence and optimal levels of perceived motor competence seem to be key for engaging children and adolescents in physical activity and sports. Commonly, the assessment of perceived motor competence is carried out by using instruments originally developed to assess different constructs of physical self-perception with the consequent error assumed. The aim of this article is to therefore offer clarification regarding the concept of perceived motor competence in terms of the conceptual and theoretical framework used for its explanation. A hierarchical and multidimensional structure of global self-concept is proposed with perceived motor competence considered as a subdomain of perceived sport/athletic competence (depending on the age or stage of development of the child) and subdivided into different subdomains of perceived competence in stability, locomotion, object control and active play skills. In order to improve consistency in the approach to assessment, it is desirable that researchers report an agreed definition for the construct of perceived motor competence so that readers can recognise the assumptions within the study accurately. Furthermore, it is suggested that instruments characterised by an alignment between actual and perceived motor competence assessments will help us understand more about children's motor perceptions.

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