Can biomedical and traditional health care providers work together? Zambian practitioners' experiences and attitudes towards collaboration in relation to STIs and HIV/AIDS care: a cross-sectional study

BACKGROUND: The World Health Organization's World health report 2006: Working together for health underscores the importance of human resources for health. The shortage of trained health professionals is among the main obstacles to strengthening low-income countries' health systems and to scaling up HIV/AIDS control efforts. Traditional health practitioners are increasingly depicted as key resources to HIV/AIDS prevention and care. An appropriate and effective response to the HIV/AIDS crisis requires reconsideration of the collaboration between traditional and biomedical health providers (THPs and BHPs). The aim of this paper is to explore biomedical and traditional health practitioners' experiences of and attitudes towards collaboration and to identify obstacles and potential opportunities for them to collaborate regarding care for patients with sexually transmitted infections (STIs) and HIV/AIDS. METHODS: We conducted a cross-sectional study in two Zambian urban sites, using structured questionnaires. We interviewed 152 biomedical health practitioners (BHPs) and 144 traditional health practitioners (THPs) who reported attending to patients with STIs and HIV/AIDS. RESULTS: The study showed a very low level of experience of collaboration, predominated by BHPs training THPs (mostly traditional birth attendants) on issues of safe delivery. Intersectoral contacts addressing STIs and HIV/AIDS care issues were less common. However, both groups of providers overwhelmingly acknowledged the potential role of THPs in the fight against HIV/AIDS. Obstacles to collaboration were identified at the policy level in terms of legislation and logistics. Lack of trust in THPs by individual BHPs was also found to inhibit collaboration. Nevertheless, as many as 40% of BHPs expressed an interest in working more closely with THPs. CONCLUSION: There is indication that practitioners from both sectors seem willing to strengthen collaboration with each other. However, there are missed opportunities. The lack of collaborative framework integrating maternal health with STIs and HIV/AIDS care is at odds with the needed comprehensive approach to HIV/AIDS control. Also, considering the current human resources crisis in Zambia, substantial policy commitment is called for to address the legislative obstacles and the stigma reported by THPs and to provide an adequate distribution of roles between all partners, including traditional health practitioners, in the struggle against HIV/AIDS

Neutralization Serotyping of BK Polyomavirus Infection in Kidney Transplant Recipients

BK polyomavirus (BKV or BKPyV) associated nephropathy affects up to 10% of kidney transplant recipients (KTRs). BKV isolates are categorized into four genotypes. It is currently unclear whether the four genotypes are also serotypes. To address this issue, we developed high-throughput serological assays based on antibody-mediated neutralization of BKV genotype I and IV reporter vectors (pseudoviruses). Neutralization-based testing of sera from mice immunized with BKV-I or BKV-IV virus-like particles (VLPs) or sera from naturally infected human subjects revealed that BKV-I specific serum antibodies are poorly neutralizing against BKV-IV and vice versa. The fact that BKV-I and BKV-IV are distinct serotypes was less evident in traditional VLP-based ELISAs. BKV-I and BKV-IV neutralization assays were used to examine BKV type-specific neutralizing antibody responses in KTRs at various time points after transplantation. At study entry, sera from 5% and 49% of KTRs showed no detectable neutralizing activity for BKV-I or BKV-IV neutralization, respectively. By one year after transplantation, all KTRs were neutralization seropositive for BKV-I, and 43% of the initially BKV-IV seronegative subjects showed evidence of acute seroconversion for BKV-IV neutralization. The results suggest a model in which BKV-IV-specific seroconversion reflects a de novo BKV-IV infection in KTRs who initially lack protective antibody responses capable of neutralizing genotype IV BKVs. If this model is correct, it suggests that pre-vaccinating prospective KTRs with a multivalent VLP-based vaccine against all BKV serotypes, or administration of BKV-neutralizing antibodies, might offer protection against graft loss or dysfunction due to BKV associated nephropathy

Support for e-cigarette regulations among Australian young adults

Background: Surveying support for various regulatory options relating to e-cigarettes can assist policymakers to identify those that have broad support and are therefore likely to be easier to implement. However, data on support for potential e-cigarette regulations in Australia are limited. To inform regulatory efforts, the present study assessed attitudes to the regulation of e-cigarettes among Australian young adults, the most prevalent users of e-cigarettes and therefore the most likely population segment to be affected by e-cigarette regulations. Methods: A total of 1116 Australians aged 18 to 25 years (59% female) completed an online survey where they were presented with various statements relating to the regulation of e-cigarettes and asked to report on the extent to which they agreed or disagreed with each. Statements presented either a restrictive or non-restrictive approach to e-cigarette regulation. Results: Across all statements, 10-22% of respondents responded "don't know" while 23-35% neither agreed nor disagreed, indicating general ambivalence. There was a moderate level of support (33-37%) for regulating e-cigarette sales/use and treating e-cigarettes like tobacco products. Only 20% of respondents were in favour of allowing the use of e-cigarettes in smoke-free areas. Smokers, e-cigarette users, and those who did not believe in the harms associated with e-cigarettes were typically less likely than other respondents to support restrictive approaches. Conclusions: The young Australian adults surveyed were somewhat supportive of restrictions around the sale and use of e-cigarettes, but generally opposed outright bans and any need for a prescription from a medical practitioner. Increasing awareness of the harms associated with the use of e-cigarettes represents a potential strategy to gaining regulatory support

What is behind smoker support for new smokefree areas? National survey data

BACKGROUND: Some countries have started to extend indoor smokefree laws to cover cars and various outdoor settings. However, policy-modifiable factors around smoker support for these new laws are not well described. METHODS: The New Zealand (NZ) arm of the International Tobacco Control Policy Evaluation Survey (ITC Project) derives its sample from the NZ Health Survey (a national sample). From this sample we surveyed adult smokers (n = 1376). RESULTS: For the six settings considered, 59% of smokers supported at least three new completely smokefree areas. Only 2% favoured smoking being allowed in all the six new settings. Support among Maori, Pacific and Asian smokers relative to European smokers was elevated in multivariate analyses, but confidence intervals often included 1.0.Also in the multivariate analyses, "strong support" by smokers for new smokefree area laws was associated with greater knowledge of the second-hand smoke (SHS) hazard, and with behaviours to reduce SHS exposure towards others. Strong support was also associated with reporting having smokefree cars (aOR = 1.68, 95% CI = 1.21 - 2.34); and support for tobacco control regulatory measures by government (aOR = 1.63, 95% CI = 1.32 - 2.01). There was also stronger support by smokers with a form of financial stress (not spending on household essentials). CONCLUSIONS: Smokers from a range of population groups can show majority support for new outdoor and smokefree car laws. Some of these findings are consistent with the use of public health strategies to support new smokefree laws, such as enhancing public knowledge of the second-hand smoke hazard

Iron Behaving Badly: Inappropriate Iron Chelation as a Major Contributor to the Aetiology of Vascular and Other Progressive Inflammatory and Degenerative Diseases

The production of peroxide and superoxide is an inevitable consequence of aerobic metabolism, and while these particular "reactive oxygen species" (ROSs) can exhibit a number of biological effects, they are not of themselves excessively reactive and thus they are not especially damaging at physiological concentrations. However, their reactions with poorly liganded iron species can lead to the catalytic production of the very reactive and dangerous hydroxyl radical, which is exceptionally damaging, and a major cause of chronic inflammation. We review the considerable and wide-ranging evidence for the involvement of this combination of (su)peroxide and poorly liganded iron in a large number of physiological and indeed pathological processes and inflammatory disorders, especially those involving the progressive degradation of cellular and organismal performance. These diseases share a great many similarities and thus might be considered to have a common cause (i.e. iron-catalysed free radical and especially hydroxyl radical generation). The studies reviewed include those focused on a series of cardiovascular, metabolic and neurological diseases, where iron can be found at the sites of plaques and lesions, as well as studies showing the significance of iron to aging and longevity. The effective chelation of iron by natural or synthetic ligands is thus of major physiological (and potentially therapeutic) importance. As systems properties, we need to recognise that physiological observables have multiple molecular causes, and studying them in isolation leads to inconsistent patterns of apparent causality when it is the simultaneous combination of multiple factors that is responsible. This explains, for instance, the decidedly mixed effects of antioxidants that have been observed, etc...Comment: 159 pages, including 9 Figs and 2184 reference

Decomposing and interpreting spatial effects in spatio-temporal analysis : evidences for spatial data pooled over time

Empirical applications using individual spatial data pooled over time usually neglect the fact that such data are not only spatially localized: they are also collected over time, i.e. temporally localized. So far, little effort has been devoted to proposing a global way for dealing with spatial data (cross-section) pooled over time, such as real estate transactions, business start-up, crime and so on. However, the spatial effect, in such a context, can be decomposed in two different components: a multidirectional spatial effect (same time period) and a unidirectional spatial effect (previous time period). Based on real estate literature, this chapter presents different spatio-temporal autoregressive (STAR) models and shows how spatial econometrics models can be extended for empirical investigation. Using a Monte Carlo experiment, we underline the effect of neglecting the decomposition of the spatial effect on the bias of the autoregressive coefficients as well as on the interpretation of the marginal effect. An empirical experiment using apartment sales in Paris between 1990 and 2003 supports the global results obtained through the Monte Carlo experiment

Efeitos da suplementação de creatina na captação de glicose em ratos submetidos ao exercício físico Effects of creatine supplementation on glucose uptake in rats submitted to exercise training

Estudos recentes têm sugerido que a suplementação de creatina é capaz de modular a homeostase da glicose, aumentando sua captação pelos tecidos periféricos. O objetivo deste trabalho foi investigar o efeito da suplementação de creatina na tolerância à glicose e no conteúdo de glicogênio muscular e hepático em ratos submetidos ou não à atividade física por quatro e oito semanas. Ratos Wistar foram divididos em dois grupos: quatro e oito semanas de intervenção. Posteriormente, cada grupo foi subdividido em quatro subgrupos, de acordo com a ingestão do suplemento e o treinamento: controle cedentário, controle treinado, suplementado sedentário e suplementado treinado. Os animais tiveram livre acesso à água e ração; o grupo suplementado teve 2% de sua ração sob a forma de creatina monoidratada. Os grupos exercitados nadaram 40 minutos por dia, quatro dias por semana, com carga entre 2 e 5% do seu peso amarrado ao peito. Após quatro e oito semanas, o teste oral de tolerância à glicose e as dosagens de glicogênio muscular e hepático foram realizadas. Não foram observadas diferenças significativas entre os grupos no teste de tolerância oral à glicose e no conteúdo de glicogênio muscular e hepático. Este estudo mostrou que a suplementação de creatina não exerceu influência na tolerância à glicose nem nas concentrações de glicogênio em ratos submetidos ou não à atividade física por quatro ou oito semanas.<br>Recently, studies have suggested that creatine supplementation can modulate glucose homeostasis by increasing glucose uptake in peripheral tissues. The aim of this study was to investigate the effects of creatine supplementation on glucose tolerance, muscle and hepatic glycogen content in rats submitted or not to physical activity for four and eight weeks. Wistar rats were divided in two groups: four and eight weeks of intervention. Afterwards, each group was subdivided in four subgroups, according to supplement intake and exercise: Sedentary Control; Trained Control; Supplemented Sedentary; and Supplemented Trained. The animals had free access to water and chow and the supplemented groups had two % of their diet as creatine monohydrated. The exercise groups swam for 40 minutes a day, four days a week, with two to five % of their body weight attached to their chests. After four and eight weeks, oral glucose tolerance tests were performed and both hepatic and muscle glycogen were determined. No significant differences were observed between groups on glucose tolerance and glycogen content in muscle and hepatic tissue. This study shows that creatine supplementation does not influence neither glucose tolerance nor glycogen concentrations in rats submitted or not to physical activity for four and eight weeks