Low utilization of health care services following screening for hypertension in Dar es Salaam (Tanzania): a prospective population-based study

Drug therapy in high-risk individuals has been advocated as an important strategy to reduce cardiovascular disease in low income countries. We determined, in a low-income urban population, the proportion of persons who utilized health services after having been diagnosed as hypertensive and advised to seek health care for further hypertension management. A population-based survey of 9254 persons aged 25-64 years was conducted in Dar es Salaam. Among the 540 persons with high blood pressure (defined here as BP >or= 160/95 mmHg) at the initial contact, 253 (47%) had high BP on a 4th visit 45 days later. Among them, 208 were untreated and advised to attend health care in a health center of their choice for further management of their hypertension. One year later, 161 were seen again and asked about their use of health services during the interval. Among the 161 hypertensive persons advised to seek health care, 34% reported to have attended a formal health care provider during the 12-month interval (63% public facility; 30% private; 7% both). Antihypertensive treatment was taken by 34% at some point of time (suggesting poor uptake of health services) and 3% at the end of the 12-month follow-up (suggesting poor long-term compliance). Health services utilization tended to be associated with older age, previous history of high BP, being overweight and non-smoking, but not with education or wealth. Lack of symptoms and cost of treatment were the reasons reported most often for not attending health care. Low utilization of health services after hypertension screening suggests a small impact of a patient-centered screen-and-treat strategy in this low-income population. These findings emphasize the need to identify and address barriers to health care utilization for non-communicable diseases in this setting and, indirectly, the importance of public health measures for primary prevention of these diseases

Association Between Tuberculosis, Diabetes and 25 Hydroxyvitamin D in Tanzania: A Longitudinal Case Control Study.

Vitamin D level is inversely associated with tuberculosis (TB) and diabetes (DM). Vitamin D could be a mediator in the association between TB and DM. We examined the associations between vitamin D, TB and DM. Consecutive adults with TB and sex- and age-matched volunteers were included in a case-control study in Dar es Salaam, Tanzania. Glycemia and total vitamin D (25(OH)D) were measured at enrolment and after TB treatment in cases. The association between low 25(OH)D (<75 nmol/l) and TB was evaluated by logistic regression adjusted for age, sex, body mass index, socioeconomic status, sunshine hours, HIV and an interaction between low 25(OH)D and hyperglycemia. The prevalence of low 25(OH)D was similar in TB patients and controls (25.8 % versus 31.0 %; p = 0.22). In the subgroup of patients with persistent hyperglycemia (i.e. likely true diabetic patients), the proportion of patients with low 25(OH)D tended to be greater in TB patients (50 % versus 29.7 %; p = 0.20). The effect modification by persistent hyperglycemia persisted in the multivariate analysis (pinteraction = 0.01). Low 25(OH)D may increase TB risk in patients with underlying DM. Trials should examine if this association is causal and whether adjunct vitamin D therapy is beneficial in this population

Review and perspectives of electrostatic turbulence and transport studies in the basic plasma physics device TORPEX

TORPEX is a basic plasma physics toroidal device located at the CRPP-EPFL in Lausanne. In TORPEX, a vertical magnetic field superposed on a toroidal field creates helicoidal field lines with both ends terminating on the torus vessel. We review recent advances in the understanding and control of electrostatic interchange turbulence, associated structures and their effect on suprathermal ions. These advances are obtained using high-resolution diagnostics of plasma parameters and wave fields throughout the whole device cross-section, fluid models and numerical simulations. Furthermore, we discuss future developments including the possibility of generating closed field line configurations with rotational transform using an internal toroidal wire carrying a current. This system will also allow the study of innovative fusion-relevant configurations, such as the snowflake divertor

Basic investigations of turbulence and interactions with plasma and suprathermal ions in the TORPEX device with open and closed field lines

TORPEX is a flexible device dedicated to investigating basic plasma physics phenomena of importance for fusion. It can feature a simple magnetized toroidal (SMT) configuration with a dominant toroidal magnetic field and a small vertical field component, or accommodate closed field-line configurations of increasing complexity. Among these are simple plasmas limited by the vessel on the low field side, single or double-null X-points, and even advanced divertor configurations like snowflakes. Using an extensive set of diagnostics, systematic studies of plasma instabilities, their development into turbulence and meso-scale structures, and their effects on both thermal and suprathermal plasma components are performed. The impact of the experimental results obtained on TORPEX is enlarged by their systematic application to model validation, performed using rigorous methodologies for quantitative experiment-theory comparisons. In the past two years, we conducted investigations of suprathermal ion-turbulence interaction on SMT plasmas. These investigations reveal that the transport of suprathermal ions is generally non-diffusive and can be super- or sub-diffusive depending on two parameters: the suprathermal ion energy normalized to the electric temperature and the electric potential fluctuations normalized to the electron temperature. The orbit averaging mechanism predicted to reduce the effect of turbulence on the suprathermal ions in burning plasmas has been clearly identified, both for gyro- and drift-orbits. To better mimic the SOL-edge magnetic geometry in tokamak, we have installed a current-carrying conductor suspended in the center of the chamber to produce magnetic configurations that creates closed-field line configurations. First experiments are devoted to the characterization of the background plasma and fluctuation features in the presence of quasi circular-shaped flux surfaces. Measurements of toroidal and poloidal wave numbers indicate field aligned modes. Further studies are under way to compare the experimental measurements with the simulation results and assess the main instability driving mechanism