Factors influencing micro and small enterprises’ access to finance since the adoption of multi-currency system in Zimbabwe.

Access to financial services is key to Micro and Small Enterprises’ (MSEs) operation and growth in Zimbabwe. A survey was done in a small town (Bindura), medium size city (Kadoma) and the city of Harare (large city) to determine major factors influencing MSEs’ access to finance since the adoption of the multi-currency system in Zimbabwe. A pilot study was done in the city of Gweru to 10 MSEs’. Structured questionnaires were administered to MSEs that have been operating for at least one year as well as registered with the respective town councils and a total of 115 responses were obtained in all the 3 urban areas. The model used was the Binary Logistic model. The best model selected was based on the Omnibus Tests of model coefficients, the Chi-Square tests, the Cox and Snell R-Sqaure and the Nagelkerke R-Squared values. The importance of each factor was determined using the Wald statistic value. The results showed that formality, value of assets, business sector, operating period, financial performance and size are all important factors in determining access to finance.MSEs; Finance; Multi-Currency; Logistic Regression

Predicting Dental Caries Outcomes in Children: A “Risky” Concept

In recent years, unprecedented gains in the understanding of the biology and mechanisms underlying human health and disease have been made. In the domain of oral health, although much remains to be learned, the complex interactions between different systems in play have begun to unravel: host genome, oral microbiome with its transcriptome, proteome and metabolome, and more distal influences, including relevant behaviors and environmental exposures. A reasonable expectation is that this emerging body of knowledge can help improve the oral health and optimize care for individuals and populations. These goals are articulated by the National Institutes of Health as “precision medicine” and the elimination of health disparities. Key processes in these efforts are the discovery of causal factors or mechanistic pathways and the identification of individuals or population segments that are most likely to develop (any or severe forms of) oral disease. This article critically reviews the fundamental concepts of risk assessment and outcome prediction, as they relate to early childhood caries (ECC)—a common complex disease with significant negative impacts on children, their families, and the health system. The article highlights recent work and advances in methods available to estimate caries risk and derive person-level caries propensities. It further discusses the reasons for their limited utility in predicting individual ECC outcomes and informing clinical decision making. Critical issues identified include the misconception of defining dental caries as a tooth or surface-level condition versus a person-level disease; the fallacy of applying population-level parameters to individuals, termed privatization of risk; and the inadequacy of using frequentist versus Bayesian modeling approaches to derive individual disease propensity estimates. The article concludes with the notion that accurate caries risk assessment at the population level and “precision dentistry” at the person level are both desirable and achievable but must be based on high-quality longitudinal data and rigorous methodology

The diagnosis and treatment of impending coronary thrombosis

A journal article on the diagnosis and treatment of coronary thrombosis

Adult HIV care resources, management practices and patient characteristics in the Phase 1 IeDEA Central Africa cohort

Introduction: Despite recent advances in the management of HIV infection and increased access to treatment, prevention, care and support, the HIV/AIDS epidemic continues to be a major global health problem, with sub-Saharan Africa suffering by far the greatest humanitarian, demographic and socio-economic burden of the epidemic. Information on HIV/AIDS clinical care and established cohorts’ characteristics in the Central Africa region are sparse. Methods: A survey of clinical care resources, management practices and patient characteristics was undertaken among 12 adult HIV care sites in four countries of the International Epidemiologic Databases to Evaluate AIDS Central Africa (IeDEA-CA) Phase 1 regional network in October 2009. These facilities served predominantly urban populations and offered primary care in the Democratic Republic of Congo (DRC; six sites), secondary care in Rwanda (two sites) and tertiary care in Cameroon (three sites) and Burundi (one site). Results: Despite some variation in facility characteristics, sites reported high levels of monitoring resources, including electronic databases, as well as linkages to prevention of mother-to-child HIV transmission programs. At the time of the survey, there were 21,599 HIV-positive adults (median age=37 years) enrolled in the clinical cohort. Though two-thirds were women, few adults (6.5%) entered HIV care through prevention of mother-to-child transmission services, whereas 55% of the cohort entered care through voluntary counselling and testing. Two-thirds of patients at sites in Cameroon and DRC were in WHO Stage III and IV at baseline, whereas nearly all patients in the Rwanda facilities with clinical stage information available were in Stage I and II. WHO criteria were used for antiretroviral therapy initiation. The most common treatment regimen was stavudine/lamivudine/nevirapine (64%), followed by zidovudine/lamivudine/nevirapine (19%). Conclusions: Our findings demonstrate the feasibility of establishing large clinical cohorts of HIV-positive individuals in a relatively short amount of time in spite of challenges experienced by clinics in resource-limited settings such as those in this region. Country differences in the cohort's site and patient characteristics were noted. This information sets the stage for the development of research initiatives and additional programs to enhance adult HIV care and treatment in Central Africa

Folate intake and the risk of oral cavity and pharyngeal cancer: A pooled analysis within the International Head and Neck Cancer Epidemiology Consortium.

There are suggestions of an inverse association between folate intake and serum folate levels and the risk of oral cavity and pharyngeal cancers (OPCs), but most studies are limited in sample size, with only few reporting information on the source of dietary folate. Our study aims to investigate the association between folate intake and the risk of OPC within the International Head and Neck Cancer Epidemiology (INHANCE) Consortium. We analyzed pooled individual-level data from ten case-control studies participating in the INHANCE consortium, including 5,127 cases and 13,249 controls. Odds ratios (ORs) and the corresponding 95% confidence intervals (CIs) were estimated for the associations between total folate intake (natural, fortification and supplementation) and natural folate only, and OPC risk. We found an inverse association between total folate intake and overall OPC risk (the adjusted OR for the highest vs. the lowest quintile was 0.65, 95% CI: 0.43-0.99), with a stronger association for oral cavity (OR = 0.57, 95% CI: 0.43-0.75). A similar inverse association, though somewhat weaker, was observed for folate intake from natural sources only in oral cavity cancer (OR = 0.64, 95% CI: 0.45-0.91). The highest OPC risk was observed in heavy alcohol drinkers with low folate intake as compared to never/light drinkers with high folate (OR = 4.05, 95% CI: 3.43-4.79); the attributable proportion (AP) owing to interaction was 11.1% (95% CI: 1.4-20.8%). Lastly, we reported an OR of 2.73 (95% CI:2.34-3.19) for those ever tobacco users with low folate intake, compared with nevere tobacco users and high folate intake (AP of interaction =10.6%, 95% CI: 0.41-20.8%). Our project of a large pool of case-control studies supports a protective effect of total folate intake on OPC risk

Exploring the genetic basis of chronic periodontitis: a genome-wide approach

Chronic periodontitis (CP) is a common-complex oral disease that affects the majority of the adult population and is a major cause of tooth loss. The disease is characterized by an oral biofilm pathological shift that contributes to cascade of events leading to periodontal destruction. Factors modulating the establishment of a dysbiotic oral microbiome or affecting the host immunity and inflammatory response are promising preventive and therapeutic targets. Although a substantial genetic component of CP is theorized and numerous candidate-gene studies have been completed, to-date no wholegenome association (GWA) studies have been performed. We performed a GWA analysis of CP in well-defined cohort of 4500 white subjects who were participants of the Atherosclerosis Risk In Communities study. Traits of interest were the three-level disease CDC/AAP classification (healthy/mild, moderate, severe CP) and a continuous extent of disease [proportion of sites exhibiting ≥3 mm attachment loss (EAL)] measure. Additionally, we examined three traits of high bacterial colonization defined as the highest quintile of the distribution of “red” and “orange” complex bacteria, and Aggregatibacter actinomycetemcomitans that were quantified using DNA-DNA checkerboard hybridization in a subset of 1020 white study subjects. Genotyping was performed using the Affymetrix 6.0 platform. Imputation to 2.5million markers was based on HapMap II-CEU and a multiple-test corrected significance threshold was applied (P<5x10-8). We detected no genome-wide significant signals. However, we found suggestive evidence of association (P<5x10-6) for CP with ten loci including NPY, NIN, WNT5A for severe, NCR2, EMR1 for moderate CP, and TBX18, ETS1, DYNC2H1, TTC26 and ZC3HAV1 for EAL. Additionally, thirteen loci including KCNK1, FBXO38, IL33, RUNX2, CAMTA1 and VAMP3 provided suggestive signals of association (P<5x10-6) with the examined “high” bacterial colonization traits. The NPY (7p15) locus was replicated in an independent cohort of whites of European descent. These genome-wide scan results from a large well-defined cohort provide information on multiple candidate regions for interrogation in genetic studies of CP. Future investigations providing further replication of these findings may lead to an improved understanding of the complex nature of host-biofilm and -bacteria interactions that characterizes states of health and disease