Establishment of some microflora-associated characteristics in ex-germfree rats and the developmental pattern

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Influences of some exogenous factors on the gastrointestinal ecosystem

An intestinal ecosystem has three major actors, i.e., the macroorganism, the microflora and the environment. Influences of some exogenous factors on functions of the intestinal microbes and their interactions within the ecosystem in vivo, have been studied by utilizing the so-called microflora-associated characteristic (MAC) / germ-free animal characteristic (GAC) concept. The parameters were bile acid, urobilinogen, cholesterol faecal tryptic activity (FTA) mucin, beta-aspartylglycine, short-chain fatty acids (SCFAs). The establisment of MACs h 35 germ-free rats was followed. The microbes were introduced in different ways and a faecal enema and social contacts with conventional rats gave rapidly an development of microbial functions. The establishment could be clustered into two groups, I ) a rapid development probably depending on the microbes involved ll ) a wider time range, probably depending on the way of introduction. The influence of diet was investigated in patients with Crohn's disease, receiving total parenteral nutrition (TPN) and in healthy volunteers given a balanced diet, enteral nutrition (EN), by following six MACs. The results showed greater influence of TPN than EN on bile acids, cholesterol and FTA. Diarrhoea is one of the most common side-effects of antimicrobial treatment, so-called antibiotic-associated diarrhoea (AAD). SCFAs were investigated in 31 AAD patients and the total amount SCFAs and their distribution were significantly changed compared to healthy adults. Five other MACs were also studied and formation of coprostanol and urobilinogen and faecal tryptic activity were significantly altered in the AAD patients compared to healthy persons. Six MACs were studied in nine AAD patients given a faecal enema. Most of the patients were cured within 4 days. No relapses occurred within 18 months. Different probiotics have been used in order to avoid diarrhoea connected with antimicrobial treatment and an investigation was performed to evaluate the influence of a probiotic on 7alpha-dehydroxylation. A suspension of Lactobacillus delbruekii and Streptococcus thermophilus (LS) was given to 20 rats together with and without clindamycin. This antibiotic has a pronounced effect on most MACs h studies of healthy human and showed similar influence in rats on 7alpha-dehydroxylation. The micbes per se in LS are not claimed to 7alpha-dehydroxylate bile acids. In the present study, 7alpha-dehydroxylation was significantly reduced in the rats receiving clindamycin alone, but concomitantly use of LS reduced significantly the antimicrobial effect. Thus, the probiotics significantly influenced on a MAC not related to the microbes per se. In conclusion, the first contacts with microbes are of importance for the establishment of intestinal ecosystems. The metabolic activities of an intestinal ecosystem can be influenced by several exogenous factors such as diet and antimicrobial drugs. Probiotics as well as enemas containing a species-specific faecal flora may restore altered functions. The intestinal ecosystem is a complex interplay, with all main actors involved in maintaining a "balanced unbalance

Perceptions of inhibitors and facilitators for adhering to hypertension treatment among insured patients in rural Nigeria: a qualitative study

Universal health care coverage has been identified as a promising strategy for improving hypertension treatment and control rates in sub Saharan Africa (SSA). Yet, even when quality care is accessible, poor adherence can compromise treatment outcomes. To provide information for adherence support interventions, this study explored what low income patients who received hypertension care in the context of a community based health insurance program in Nigeria perceive as inhibitors and facilitators for adhering to pharmacotherapy and healthy behaviors. We conducted a qualitative interview study with 40 insured hypertensive patients who had received hypertension care for > 1 year in a rural primary care hospital in Kwara state, Nigeria. Supported by MAXQDA software, interview transcripts were inductively coded. Codes were then grouped into concepts and thematic categories, leading to matrices for inhibitors and facilitators of treatment adherence. Important patient-identified facilitators of medication adherence included: affordability of care (through health insurance); trust in orthodox "western" medicines; trust in Doctor; dreaded dangers of hypertension; and use of prayer to support efficacy of pills. Inhibitors of medication adherence included: inconvenient clinic operating hours; long waiting times; under-dispensing of prescriptions; side-effects of pills; faith motivated changes of medication regimen; herbal supplementation/substitution of pills; and ignorance that regular use is needed. Local practices and norms were identified as important inhibitors to the uptake of healthier behaviors (e.g. use of salt for food preservation; negative cultural images associated with decreased body size and physical activity). Important factors facilitating such behaviors were the awareness that salt substitutes and products for composing healthier meals were cheaply available at local markets and that exercise could be integrated in people's daily activities (e.g. farming, yam pounding, and household chores). With a better understanding of patient perceived inhibitors and facilitators of adherence to hypertension treatment, this study provides information for patient education and health system level interventions that can be designed to improve compliance. ISRCTN4789440