Barriers to Adherence to Diet and Exercise Recommendation amongst Type 2 Diabetes Mellitus Patients

Diet modification and exercise require commitment to long term established behavioural change and are often very difficult. The study aimed at assessing the barriers to adherence to diet and exercise recommendations among Type 2 Diabetes Mellitus (DM) patients seeking healthcare at Agogo Presbyterian Hospital, Ghana. A sample size of 212 respondents aged ≥30 years who have been diagnosed of Type 2 DM for at least one year were sampled using stratified and simple random sampling techniques. The data collected was analyzed using Statistical Package for Social Sciences (SPSS) version 20.0. The study revealed that rates of non-adherence were 34.9% and 19.3% for diet and exercise respectively. Reasons for exercise  non-adherence included inadequate understanding about exercise (66.0%), perception that exercise could potentially exacerbate their illness (46.4%), being far away from home (16.5%) and busy schedule (15.5%), while the main reasons for non-adherence to diet were inadequate understanding about dietary recommendations (52.3%), eating outside home (32.4%), poor self-control (17.6%), financial constraints (14.9) and situation at home (12.1%). The study also found a strong positive correlation (r=0.984*, p<0.05) between respondents’ age and adherence to exercise recommendation. It is recommended that education on the type of exercise, time and duration of the exercise and the different food combinations for the Type 2 DM should be intensified in diabetic clinics. Keywords: Aerobic, Barriers, Diabetes, Diet and Exercise, Adherence

Meta- Analysis for Studying Racial Disparities in All-Cause Mortality for Persons with End-Stage Kidney Disease

Meta-analysis is a powerful method for combining and analyzing data from different studies, offering clearer and more reliable results than individual studies alone. This study will primarily focus on the methodology of meta-analysis and its effective use in research. Key components of meta-analysis, such as the calculation of effect sizes, the implementation of both fixed and random effects models, and homogeneity assessment, will be thoroughly examined. These techniques enable meta-analysis to yield more comprehensive and accurate findings. To demonstrate a practical application of meta-analysis, this study will present preliminary results from an analysis of all-cause mortality data in patients with End-Stage Kidney Disease (ESKD), particularly focusing on racial disparities. Research has highlighted significant racial disparities in the incidence and prevalence of ESKD, with African Americans and other minority groups being disproportionately affected. There is a notable gap in understanding the disparities concerning mortality rates. The preliminary results from this meta-analysis will offer initial insights into the patterns and magnitude of racial disparities in ESKD mortality rates

Grafting for sustainable management of Fusarium wilt disease in tomato production in Ghana

Fusarium wilt disease limits tomato production, especially in Ghana. In managing the Fusarium wilt disease, two rootstocks (Solanum torvum and Solanum macrocarpon) were used in grafting experiments. Plant growth, yield, disease severity and incidence of both grafted plants, and non-grafted plants were evaluated in a pot experiment and also under a naturally infected open field condition at Berekum. During the early stage (14 days after inoculation) under artificial inoculation conditions, grafted plants exhibited higher photosynthetic rates (10.41 μmol−2s−1) compared to the non-grafted plants (8.36 μmol−2s−1). Under naturally infested field conditions, chlorophyll content and photosynthetic rate of non-grafted plants decreased. Solanum lycopersicum grafted onto S. macrocarpon and S. torvum were moderately susceptible (20%–40%) to Fusarium oxysporum. However, the non-grafted plants were highly susceptible (50%–100%). Yield from the pot experiment for S. lycopersicum grafted onto S. macrocarpon was significantly higher (453.1 g/plant), compared to S. lycopersicum grafted onto S. torvum (350.3 g/plant) and the non-grafted plant (205 g/plant). However, in naturally infected field, the grafted plants increased in fruit yield compared to the non-grafted tomato plants. Solanum macrocarpon and S. torvum as rootstocks offered resistance against F. oxysporum and showed significantly lower disease progression, than the non-grafted plants (P < 0.05). This study revealed that grafting is an effective tool for the management of Fusarium wilt disease and for tomato growth and yield improvement

Non-adherence to ivermectin in onchocerciasis-endemic communities with persistent infection in the Bono Region of Ghana : a mixed-methods study

Abstract: BackgroundThe World Health Organization has proposed that onchocerciasis elimination (interruption) of transmission be verified in 12 (approximately a third) endemic countries by 2030. The strategy to reach this goal is based on ivermectin Mass Drug Administration (MDA) with high geographical and therapeutic coverage. In addition to coverage, high levels of treatment adherence are paramount. We investigated factors associated with ivermectin intake in an area of Ghana with persistent Onchocerca volvulus infection.MethodsIn August 2021, a cross-sectional mixed-methods study was conducted in 13 onchocerciasis-endemic communities in the Bono Region of Ghana. Individuals aged >= 10 years were invited to participate in a questionnaire survey. A total of 48 focus group discussions and in-depth interviews with 10 community drug distributors and 13 community leaders were conducted.ResultsA total of 510 people participated in the study [median age: 32, interquartile range 30 (20-50) years]; 274 (53.7%) were females. Of the total, 320 (62.7%) declared that they adhered to each treatment round and 190 (37.3%) admitted they had not taken ivermectin during at least one MDA round, since becoming eligible for treatment. Of 483 participants with complete information, 139 (28.8%) did not take ivermectin during the last round (March 2021), and 24 (5.0%) had never taken ivermectin (systematic non-adherers). Reasons for not taking ivermectin included previous experience/fear of side-effects, being absent during MDA, pregnancy, the desire to drink alcohol, and drug distribution challenges. Being male, having good knowledge and perception of the disease, and not having secondary or higher level of formal education were significantly associated with higher odds of ivermectin intake.ConclusionsA relatively high level of non-adherence to ivermectin treatment was documented. There is a need for targeted educational and behavioural change campaigns to reverse these trends and ensure a steady course toward meeting onchocerciasis elimination targets in Ghana

Thigh-length compression stockings and DVT after stroke

Controversy exists as to whether neoadjuvant chemotherapy improves survival in patients with invasive bladder cancer, despite randomised controlled trials of more than 3000 patients. We undertook a systematic review and meta-analysis to assess the effect of such treatment on survival in patients with this disease

Azithromycin in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

Background Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatory actions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19. Methods In this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), several possible treatments were compared with usual care in patients admitted to hospital with COVID-19 in the UK. The trial is underway at 176 hospitals in the UK. Eligible and consenting patients were randomly allocated to either usual standard of care alone or usual standard of care plus azithromycin 500 mg once per day by mouth or intravenously for 10 days or until discharge (or allocation to one of the other RECOVERY treatment groups). Patients were assigned via web-based simple (unstratified) randomisation with allocation concealment and were twice as likely to be randomly assigned to usual care than to any of the active treatment groups. Participants and local study staff were not masked to the allocated treatment, but all others involved in the trial were masked to the outcome data during the trial. The primary outcome was 28-day all-cause mortality, assessed in the intention-to-treat population. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936. Findings Between April 7 and Nov 27, 2020, of 16 442 patients enrolled in the RECOVERY trial, 9433 (57%) were eligible and 7763 were included in the assessment of azithromycin. The mean age of these study participants was 65·3 years (SD 15·7) and approximately a third were women (2944 [38%] of 7763). 2582 patients were randomly allocated to receive azithromycin and 5181 patients were randomly allocated to usual care alone. Overall, 561 (22%) patients allocated to azithromycin and 1162 (22%) patients allocated to usual care died within 28 days (rate ratio 0·97, 95% CI 0·87–1·07; p=0·50). No significant difference was seen in duration of hospital stay (median 10 days [IQR 5 to >28] vs 11 days [5 to >28]) or the proportion of patients discharged from hospital alive within 28 days (rate ratio 1·04, 95% CI 0·98–1·10; p=0·19). Among those not on invasive mechanical ventilation at baseline, no significant difference was seen in the proportion meeting the composite endpoint of invasive mechanical ventilation or death (risk ratio 0·95, 95% CI 0·87–1·03; p=0·24). Interpretation In patients admitted to hospital with COVID-19, azithromycin did not improve survival or other prespecified clinical outcomes. Azithromycin use in patients admitted to hospital with COVID-19 should be restricted to patients in whom there is a clear antimicrobial indication. Funding UK Research and Innovation (Medical Research Council) and National Institute of Health Research