Burden of podoconiosis in poor rural communities in Guliso woreda, western Ethiopia

Background. Podoconiosis is an environmental lymphoedema affecting people living and working barefoot on irritant red clay soil. Podoconiosis is relatively well described in southern Ethiopia, but remains neglected in other parts of the Ethiopian highlands. This study aimed to assess the burden of podoconiosis in rural communities in western Ethiopia. Methodology/Principal Findings. A cross-sectional study was conducted in Gulliso woreda (district), west Ethiopia. A household survey in the 26 rural kebeles (villages) of this district was conducted to identify podoconiosis patients and to measure disease prevalence. A more detailed study was done in six randomly selected kebeles to describe clinical features of the disease, patients’ experiences of foot hygiene, and shoe wearing practice. 1,935 cases of podoconiosis were registered, giving a prevalence of 2.8%. The prevalence was higher in those aged 15 – 64 years (5.2%) and in females than males (prevalence ratio 2.6:1). 90.3% of patients were in the 15 – 64 year age group. In the detailed study, 335 cases were interviewed and their feet assessed. The majority of patients were farmers, uneducated, and poor. Two-third of patients developed the disease before the age of thirty. Almost all patients (97.0%) had experienced adenolymphangitis (ALA - red, hot legs, swollen and painful groin) at least once during the previous year. Patients experienced an average of 5.5 ALA episodes annually, each of average 4.4 days, thus 24 working days were lost annually. The incidence of ALA in podoconiosis patients was higher than that reported for filariasis in other countries. Shoe wearing was limited mainly due to financial problems. Conclusions. We have documented high podoconiosis prevalence, frequent adenolymphangitis and high disease-related morbidity in west Ethiopia. Interventions must be developed to prevent, treat and control podoconiosis, one of the core neglected tropical diseases in Ethiopia

Regulating the effects of depletion through monitoring

A robust finding is that participants who perform a depleting initial self-regulatory task are less persistent on a contiguous second task than are those who perform a less arduous initial self-regulatory task. We explain this regulatory depletion effect in terms of a monitoring process. According to this view, depleted individuals focus on the resources they have devoted to a second task, neglect to monitor their performance against their standards for such activities, and prematurely suspend their performance. Consistent with this view, we demonstrate that the regulatory depletion effect can be eliminated when individuals are encouraged to monitor their performance against some standard (Studies 1, 2, and 4) or when they have a proclivity to engage in such monitoring (Studies 3 and 4). © 2008 by the Society for Personality and Social Psychology, Inc.postprin

Individual correlates of podoconiosis in areas of varying endemicity: a case-control study

BACKGROUND Podoconiosis is a non-filarial form of elephantiasis resulting in lymphedema of the lower legs. Previous studies have suggested that podoconiosis arises from the interplay of individual and environmental factors. Here, our aim was to understand the individual-level correlates of podoconiosis by comparing 460 podoconiosis-affected individuals and 707 unaffected controls. METHODS/PRINCIPAL FINDINGS This was a case-control study carried out in six kebeles (the lowest governmental administrative unit) in northern Ethiopia. Each kebele was classified into one of three endemicity levels: 'low' (prevalence 5%). A total of 142 (30.7%) households had two or more cases of podoconiosis. Compared to controls, the majority of the cases, especially women, were less educated (OR = 1.7, 95% CI = 1.3 to 2.2), were unmarried (OR = 3.4, 95% CI = 2.6-4.6) and had lower income (t = -4.4, p<0.0001). On average, cases started wearing shoes ten years later than controls. Among cases, age of first wearing shoes was positively correlated with age of onset of podoconiosis (r = 0.6, t = 12.5, p<0.0001). Among all study participants average duration of shoe wearing was less than 30 years. Between both cases and controls, people in 'high' and 'medium' endemicity kebeles were less likely than people in 'low' endemicity areas to 'ever' have owned shoes (OR = 0.5, 95% CI = 0.4-0.7). CONCLUSIONS Late use of shoes, usually after the onset of podoconiosis, and inequalities in education, income and marriage were found among cases, particularly among females. There were clustering of cases within households, thus interventions against podoconiosis will benefit from household-targeted case tracing. Most importantly, we identified a secular increase in shoe-wearing over recent years, which may give opportunities to promote shoe-wearing without increasing stigma among those at high risk of podoconiosis

Effectiveness of a simple lymphoedema treatment regimen in podoconiosis management in southern Ethiopia: one year follow-up

Background: Podoconiosis is a non-filarial elephantiasis caused by long-term barefoot exposure to volcanic soils in endemic areas. Irritant silicate particles penetrate the skin, causing a progressive, debilitating lymphoedema of the lower leg, often starting in the second decade of life. A simple patient-led treatment approach appropriate for resource poor settings has been developed, comprising (1) education on aetiology and prevention of podoconiosis, (2) foot hygiene (daily washing with soap, water and an antiseptic), (3) the regular use of emollient, (4) elevation of the limb at night, and (5) emphasis on the consistent use of shoes and socks. Methodology/Principal Findings: We did a 12-month, non-comparative, longitudinal evaluation of 33 patients newly presenting to one clinic site of a non-government organization (the Mossy Foot Treatment & Prevention Association, MFTPA) in southern Ethiopia. Outcome measures used for the monitoring of disease progress were (1) the clinical staging system for podoconiosis, and (2) the Amharic Dermatology Life Quality Index (DLQI), both of which have been recently validated for use in this setting. Digital photographs were also taken at each visit. Twenty-seven patients completed follow up. Characteristics of patients completing follow-up were not significantly different to those not. Mean clinical stage and lower leg circumference decreased significantly (mean difference -0.67 (95% CI -0.38 to -0.96) and -2.00 (95% CI -1.26 to -2.74), respectively, p<0.001 for both changes). Mean DLQI diminished from 21 (out of a maximum of 30) to 6 (p<0.001). There was a non-significant change in proportion of patients with mossy lesions (p = 0.375). Conclusions/Significance: This simple, resource-appropriate regimen has a considerable impact both on clinical progression and self-reported quality of life of affected individuals. The regimen appears ideal for scaling up to other endemic regions in Ethiopia and internationally. We recommend that further research in the area include analysis of cost-effectiveness of the regimen

Podoconiosis in East and West Gojam Zones, Northern Ethiopia

Background: Podoconiosis is a neglected tropical disease (NTD) that is prevalent in red clay soil-covered highlands of tropical Africa, Central and South America, and northern India. It is estimated that up to one million cases exist in Ethiopia. This study aimed to estimate the prevalence of podoconiosis in East and West Gojam Zones of Amhara Region in northern Ethiopia. Methodology/Principal Findings: A cross-sectional household survey was conducted in Debre Eliyas and Dembecha woredas (districts) in East and West Gojam Zones, respectively. The survey covered all 17,553 households in 20 kebeles (administrative subunits) randomly selected from the two woredas. A detailed structured interview was conducted on 1,704 cases of podoconiosis identified in the survey. Results: The prevalence of podoconiosis in the population aged 15 years and above was found to be 3.3% (95% CI, 3.2% to 3.6%). 87% of cases were in the economically active age group (15–64 years). On average, patients sought treatment five years after the start of the leg swelling. Most subjects had second (42.7%) or third (36.1%) clinical stage disease, 97.9% had mossy lesions, and 53% had open wounds. On average, patients had five episodes of acute adenolymphangitis (ALA) per year and spent a total of 90 days per year with ALA. The median age of first use of shoes and socks were 22 and 23 years, respectively. More men than women owned more than one pair of shoes (61.1% vs. 50.5%; x2 = 11.6 p = 0.001). At the time of interview, 23.6% of the respondents were barefoot, of whom about two-thirds were women. Conclusions: This study showed high prevalence of podoconiosis and associated morbidities such as ALA, mossy lesions and open wounds in northern Ethiopia. Predominance of cases at early clinical stage of podoconiosis indicates the potential for reversing the swelling and calls for disease prevention interventions

Preventing Advanced Persistent Threats in Complex Control Networks

An Advanced Persistent Threat (APT) is an emerging attack against Industrial Control and Automation Systems, that is executed over a long period of time and is difficult to detect. In this context, graph theory can be applied to model the interaction among nodes and the complex attacks affecting them, as well as to design recovery techniques that ensure the survivability of the network. Accordingly, we leverage a decision model to study how a set of hierarchically selected nodes can collaborate to detect an APT within the network, concerning the presence of changes in its topology. Moreover, we implement a response service based on redundant links that dynamically uses a secret sharing scheme and applies a flexible routing protocol depending on the severity of the attack. The ultimate goal is twofold: ensuring the reachability between nodes despite the changes and preventing the path followed by messages from being discovered.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

Rat Race Dynamics and Crazy Companies: The Diffusion of Technologies and Social Behavior

How and why do technologies spread when and where they do? What are the implications and consequences for the structure, wealth, and management of human organizations? These expansive questions were the subject of the presentations and discussions of the International Conference on Diffusion of Technologies and Social Behavior, summarized in this chapter. The chapter is organized under the following headings: empirical regularities; theoretical issues; predictability; roles of time and space; definition of niche and innovation; selection dynamics; role of marketing; social aspects of diffusion; globalization of diffusion processes; and applications of diffusion. While the chapter treats some questions for policy in both the public and private sectors, it emphasizes research needs and opportunities in the diffusion field

Community-based control of a neglected tropical disease: the mossy foot treatment and prevention association

Podoconiosis (endemic non-filarial elephantiasis, also known as mossy foot) is a non-communicable disease now found exclusively in the tropics, caused by the conjunction of environmental, genetic, and economic factors. Silicate particles formed by the disintegration of lava in areas of high altitude (over 1,000 m) and seasonal rainfall (over 1,000 mm per annum) penetrate the skin of barefoot subsistence farmers, and in susceptible individuals cause lymphatic blockage and subsequent elephantiasis [1]. Although an estimated one million Ethiopians (of a total population of 77 million) are afflicted with podoconiosis [2], which creates a huge economic burden in endemic areas [3], no national policy has yet been developed to control or prevent the condition, and most affected communities remain unaware of treatment options

Unsplittable coverings in the plane

A system of sets forms an {\em $m$-fold covering} of a set $X$ if every point of $X$ belongs to at least $m$ of its members. A $1$-fold covering is called a {\em covering}. The problem of splitting multiple coverings into several coverings was motivated by classical density estimates for {\em sphere packings} as well as by the {\em planar sensor cover problem}. It has been the prevailing conjecture for 35 years (settled in many special cases) that for every plane convex body $C$, there exists a constant $m=m(C)$ such that every $m$-fold covering of the plane with translates of $C$ splits into $2$ coverings. In the present paper, it is proved that this conjecture is false for the unit disk. The proof can be generalized to construct, for every $m$, an unsplittable $m$-fold covering of the plane with translates of any open convex body $C$ which has a smooth boundary with everywhere {\em positive curvature}. Somewhat surprisingly, {\em unbounded} open convex sets $C$ do not misbehave, they satisfy the conjecture: every $3$-fold covering of any region of the plane by translates of such a set $C$ splits into two coverings. To establish this result, we prove a general coloring theorem for hypergraphs of a special type: {\em shift-chains}. We also show that there is a constant $c>0$ such that, for any positive integer $m$, every $m$-fold covering of a region with unit disks splits into two coverings, provided that every point is covered by {\em at most} $c2^{m/2}$ sets