Food security in the free state province: Meaning making as democratic agency

People\u27s stories are powerful means of explaining their realities, for their narratives reveal what meanings they make of the situations they are living, how they face these situations and what strategies they formulate to overcome them. Their meaning making is one of the most powerful tools of their agency, and this is what this study reveals. In it, I tell the stories of people in the Free State Province, South Africa, who face food insecurity within abundance, and their critical consciousness and agency as they struggle to survive in their democracy. Poverty is a rawness...Poverty is struggle... Poverty is shame...these were some of the themes running through people\u27s narratives as they explained their lives. Most studies on food insecurity focus on what resources are needed to produce more food, but few examine the issue of food insecurity as one of social, economic, political, and historic inequality and inequity. Neither do they do so through the qualitative inquiry lens of what meanings the people involved in the food system - and particularly the food insecure - make of food insecurity. Studies of this nature are greatly needed, and this is one such study. It is based on the premise that the food insecure of the Free State Province are theorists of their own reality and are agents in confronting the challenges of multidimensional poverty that they face. This study reveals that their food insecurity is not necessarily based on the lack of food, that is, that they go hungry day after day because there is not enough food in the province. Instead, the fundamental problem is their tenuous economic access to food, i.e. that there is food, but poor people cannot have a sustainable access to it through their own means because they are too poor. This study has shown that poor people perceive their main problem as being their poverty. Moreover, the findings reveal that because of this poverty that they live, some of them compare their present day situation to the apartheid era, casting a favourable light on that era in terms of people having food and employment; two of the issues that are their gravest concerns. Through my study, I make the case that it is fundamental that the voices of the food insecure be heard, and most importantly, that they be included in formulation of poverty alleviation and food insecurity in South Africa

Epidemiology and knowledge of selfcare of diabetes mellitus, obesity and hypertension in Guyana and beneficial use of Momordica charantia, in combination with daily exercise and diet modification, to treat these non-communicable diseases

In 2018, The World Health Organization (WHO) identified chronic non-communicable diseases (NCDs) or chronic diseases (CDs) as cardiovascular diseases (CVDs), diabetes mellitus (DM) obesity, cancer, stroke, chronic respiratory diseases (CRD), cerebrovascular disease (CVD), kidney failure (KF) and dental diseases. CVDs are further classified into heart failure or cardiomyopathy, hypertension, atherosclerosis, coronary artery diseases (CAD), sudden cardiac death (SCD), arrhythmias and others. DM, obesity and hypertension are three major global health NCDs affecting people in both developed and low-and middle- income developing countries such as Guyana. These diseases are interrelated where obesity is a risk factor for DM and both obesity and DM are risk factors for hypertension. The prevalence of all three NCDs are very high, and they are also very costly to treat in Guyana. Diabetes is classified mainly into type 1 DM (T1DM) and type 2 DM (T2DM) and 85-90% of diabetics suffer from T2DM. Obesity is when someone has a basal metabolic index (BMI) of 30 and over. Likewise, hypertension (HTN) or high blood pressure (HBP) is when someone has elevated BP over20/90 mm Hg and over. Modern life- style habits including overeating but not the right food, sedentary living, stress, genetic pre-disposition and others risk factors can lead obesity, diabetes and hypertension. Guyana is cursed with the ‘obese-diabetic-hypertensive time bomb’. This study investigated the epidemiology and cost-effective ways to treat these NCDs in Guyana and how knowledge of obesity and diabetic self-care management can prevent long–term complications associated with obesity and DM. In tackling the scientific problem, this study investigated the roles of regular exercise, diet modification and use of bitter melon or corilla (Momordica charantia), a local anti-diabetic vegetable in Guyana to treat obesity, diabetes and hypertension in newly diagnosed patients. The main epidemiological findings in this study reveal that the three NCDs increased in prevalence gradually over the years especially among both adult males and females but significantly more so among females, especially when they reach the ages between 46 to 69 years. In addition, almost twenty five percent of adult Guyanese failed to diagnose their medical conditions and many of those who are diagnosed prefer to seek advice from a traditional healer and take herbal remedies to treat their diseases rather than taking prescribed drugs. Data also show that such NCDs as diabetes, hypertension and CVDs are responsible for more deaths in Guyana and rank high globally. Initial time-course treatment and glucose tolerance tests (GTTs) reveal that M charantia consumption (5-20 grams twice daily as either a juice (weight/volume) can reduce blood sugar, blood pressure and other blood biomarkers such as total lipids (cholesterol) and triglycerides significantly (p<0.05) in diabetes-treated patients after 6 weeks compared to week 1 of the study (These effects were dose-dependent. The results also show that the hypoglycaemic effects were more pronounced when M charantia was combined with diet modification, exercise and the orthodox medicine, diamicron MR. M charantia had no synergistic effect on blood glucose when it was combined with dimicron MR. Measurement of blood cation levels using inductively -coupled plasma mass spectrometry (ICPMS) in plasma from diabetic and age-matched healthy control subjects reveal no significant change in the levels of the cations. Chemical analysis of M charantia revealed that it is rich in vitamin C, some cations, phenolic contents and antioxidant compounds Similarly, daily intake of M charantia either alone or in combination with physical activity and diet modification can reduce body weight and significantly (p<0.05) decrease blood pressure (BP), total lipids and triglycerides in obese subjects after 6 weeks of treatment compared to the start of the study (In newly diagnosed hypertensive patients, M charantia either alone or combined with regular exercise and diet modification can reduce significantly (p<0.05) high blood pressure after 6 weeks of treatment compared to week 1 at the start of the study. M charantia had no significant effect on BP when it was combined with orthodox medicine, amlodipine, a calcium channel blocker). The results also show that knowledge of the respondents using a questionnaire about T2DM self-care management was overall poor. Thus, the study concluded that the higher the level of knowledge about T2DM self-care, the less likely the diabetic patients will develop diabetes-related complications, as noted by the higher scoring of the control group. Therefore, effective health promotion and education programmes are recommended to target T2DM patients, as well as pre-diabetic and non-diabetic persons (chapter 6). However, obese patients have a good knowledge of obesity, but they were still obese. In conclusion, the results of this study have shown that M charantia, diet modification and daily exercise, either alone or in combination have potential cost-effective effects in treating diabetes, obesity and hypertension and knowledge of self-care management about diabetes can delay end-organ complications

Diabetic Foot Infections and Problems in Guyana

Diabetes mellitus (DM) is a major global metabolic disorder currently affecting more than 465 million people. If diagnosed late or left untreated, DM can induce a number of long-term complications which are due to DM-induced hyperglycaemia leading to nephropathy, cardiomyopathy, neuropathy, retinopathy, impotence, foot ulcers and amputations. Diabetic foot problems (DFB) are major concerns for the patients as they affect their quality of life and exert great financial burden on them, especially for people from a low income developing country as Guyana. In 2019, it was estimated that the expenditure for diagnosis, treatment and care for diabetic foot patients was USAD$75 million in Guyana. Both obesity and diabetes are on the increase in Guyana with almost 11 - 12% of the adult population have DM, due to obesity (diabesity) and more women compared to men. Moreover, there is an unacceptable high rate of amputations due to lack of organised foot-care programme and the absence of national guidelines in its management. There are various aspects of good diabetic foot care and this article now reviews what has been achieved and what needs prioritisation to improve the management of diabetic foot problems in Guyana among patients with diabetes mellitus. ’The Guyana Diabetes and Foot Care Project” has made significant improvement in this area but the lack of specialist vascular surgical service is obvious

Diabetic Cardiomyopathy and the Role of Regular Exercise in Preventing the Disease: A Review

Diabetes mellitus (DM) is a major global metabolic disorder currently affecting over 450 million people and this number is rising rapidly. Heart failure (HF) is the major cause of death among diabetic patients. The disorder is due to elevated blood glucose level beyond physiological range or hyperglycaemia (HG), which in turn leads to a number of long-term complications, including diabetic cardiomyopathy (DC) over time. Around 80% of all diabetics will eventually die from DC. If left untreated, DC has been shown to be a critical factor in HF, independent of atherosclerosis, hypertension and valvular malfunction. The inability to maintain glucose homeostasis in the myocardium compromises cardiac structure and function in human diabetic subjects and also in animals with experimental diabetes. Daily exercise is known to protect the heart from sudden cardiac death. Exercise training (ET) is a beneficial non-pharmacological intervention for the treatment of cardiovascular diseases (CVDs). ET can induce cardio-protection in normal hearts and also in a partially diseased heart through a range of molecular mechanisms. The cardio-protective effect of ET is associated with the improvement of antioxidant capacity, mitochondrial viability and it can activate physiological cardiac growth, which are all mediated via distinct cellular and molecular mechanisms compared to those in pathological hypertrophy. Beneficial cardiac protection following regular ET in diabetes has been reported in both clinical and experimental animal studies. ET is a cost-effective strategy for prevention and treatment DC. However, the cellular and molecular mechanisms underlying DC and HF in diabetes and how regular exercise can reverse the pathology are not fully clear and further research should be carried out

Mechanisms of Diabetes Mellitus-Induced Sudden Cardiac Death

More than 450 million people worldwide have diabetes mellitus (DM), a metabolic disorder characterized by an increase in blood glucose level (hyperglycemia) that arises from insufficient insulin secretion or resistance to insulin’s action. More than 70% of individuals with chronic DM will develop cardiovascular diseases (CVDs) including atherosclerosis and coronary artery diseases (CADs), hypertension, cardiac arrhythmias, cardiomyopathy (heart failure), stroke, and chronic kidney disease. A significant number of these individuals will also succumb to sudden cardiac death (SCD). SCD usually occurs in early morning from abnormal heart rhythms or arrhythmias and ventricular fibrillation. When the pumping action of the heart becomes erratic, a reduction in oxygenated blood to the brain leads to unconsciousness and brain damage. SCD is independent of age and sex and positively correlates with impairment in cardiac metabolism, muscle damage, fibrosis, apoptosis, hypertrophy, ischemia, and deranged cation signaling. This review centers on mechanisms by which intracellular cations (Na+, K+, and Ca2+) handling, inflammation, and oxidative and carbonyl stresses due to diabetes-induced hyperglycemia can lead to the deterioration of excitation/contraction coupling (ECC), impaired contractility, arrhythmias, and SCD in DM patients. It also discusses the beneficial effects of exercise training to attenuate the risk of SCD

Medicinal and anti-oxidant effects of Bitter Melon (Momordica charantia) in the treatment of diabetic cardiomyopathy

Obesity is a major risk factor for diabetes mellitus (DM), which is a major global metabolic health disorder currently affecting over 460 million people and this number is rising rapidly. Heart failure (HF) is the major cause of death among diabetic patients. The disorder is due to elevated blood glucose or hyperglycemia (HG) beyond physiological level, which in turn leads to a number of long-term or end-organ complications over time and over 80% of all diabetics will eventually die from either HF or cardiomyopathy if left untreated. Treatment of DM is very costly and as such, patients turn to non-pharmacological or alternative forms of treatment, including weight loss, diet modifications and plant-based medicines, which are more cost-effective. There are several medicinal plants, which are currently used to treat for DM and they are known to exhibit anti-diabetic properties. One such plant is Momordica charantia, or bitter melon, which is used in many tropical countries as a traditional functional food and medicine, especially for the treatment of obesity, DM, hypertension and cancer. This review is related to the anti-oxidant beneficial effect of Momordica charantia in the treatment of diabetic cardiomyopathy (DCM). The beneficial effects of Momordica charantia in the treatment of obesity, diabetes and cardiovascular diseases (CVDs) have been reported in clinical and experimental animal studies and this review addresses some of these useful effects. However, the cellular and molecular mechanisms underlying its therapeutic antidiabetic effects of M charantia via its anti-oxidant activities are not fully known and further research studies need to be done

Human Norovirus prevalence in Africa:a review of studies from 1990 to 2013

OBJECTIVES: To assess the contribution of Human Norovirus to diarrheal diseases in Africa.   METHODS: We conducted a systematic review of the PubMed and EMBASE databases for published articles of Human Norovirus in Africa between 1990 and 2013. Data were extracted from selected studies and analysed.   RESULTS: A total of 208 eligible studies were identified, of which 55 (from 19 countries) met the inclusion criteria. Many cases were of sporadic gastroenteritis (70.9%) in children (82%), 65.4% of which were seen in an outpatient setting. Over half (59.4%) of affected children were under 5 years of age. The pooled prevalence rate of Human NoV was 11% (95% CI 8-14%) and the meta-analysis indicated significant heterogeneity between the studies. However, the conditional negative binomial regression could not clearly find the factors affecting the Human NoV prevalence rates reported. A close relationship was found between Human Norovirus strains from environmental and clinical samples.   CONCLUSION: Unreported sporadic gastroenteritis cases of Human Norovirus are common in Africa. Most are community-associated infections. Possible environmental transmission routes have been documented. Combined environmental and clinical studies are required for targeted actions to control transmission of Human Norovirus in Africa. Systematic surveillance of Human Norovirus is needed to measure the burden of Norovirus-induced gastroenteritis in Africa and support any requirements for vaccine development. This article is protected by copyright. All rights reserved

Venezuela y Trinidad en 1899: La mirada británica

The objective of this paper is to describe in part the perception that the British colonial authorities in Venezuela and Trinidad had of the relations between this nation and the British colony in 1899. The same is part of a broader study, with the same objective, that covers the period 1899�1903. During this period, two important events are highlighted in the history of the relations between Venezuela and Great Britain; the arbitration process for the Essequibo and the blockage of the Venezuelan coasts in 1902-1903. For the purposes of this study, the focus has been on analyzing an important British source: the correspondence between the British colonial authorities in Trinidad and Venezuela and the Colonial Office in Great Britain, compiled in the Archives of the Colonial Office in the period studied. As has been mentioned above, the purpose is to partially re-create the British perspective of the relations between Venezuela and Great Britain, principally through its colony Trinidad. This re-creation is done from the very pen of the principal British actors of the historical events within these relations. With this, the intention has been to reveal a little known side of a very important year in the life of the young republic and the colony, a year often described in Venezuelan history, with respect to its foreign affairs, as the year in which Venezuela fought against British Imperialism; against the omnipotent aggressor that intended to steal territories that it considered were rightfully Venezuelan.El presente análisis tiene la finalidad de describir en parte la percepción que las autoridades coloniales británicas en Venezuela y Trinidad tenían de las relaciones entre esta nación y la colonia británica en el año 1899 y es parte de un estudio más amplio, con la misma finalidad, que comprende el período 1899-1903. Durante este período se destacan dos acontecimientos en la historia de las relaciones entre Venezuela y Gran Bretaña; el proceso de arbitraje por el Esequibo que culmina en 1899 y el bloqueo de las costas venezolanas en 1902-1903. Para este estudio se ha concentrado principalmente en analizar una fuente británica importante; la correspondencia entre las autoridades británicas en la colonia y en Venezuela con el Ministerio de las Colonias Británicas durante el período señalado, con el objetivo de recrear en parte la opinión británica de las relaciones de Venezuela con Gran Bretaña, principalmente a través de su colonia Trinidad. Esta correspondencia está compilada en los Archivos del Ministerio de las Colonias. La recreación de esta opinión se hace desde la pluma de los principales actores británicos de los acontecimientos históricos vividos en las relaciones entre las partes. Con ello, se ha intentado dibujar el retrato poco conocido de un año muy importante en la vida de la joven república y la colonia británica, un año señalado en la historia venezolana, en cuanto a sus relaciones exteriores, como el año en que Venezuela luchó contra el Imperialismo británico, contra el agresor omnipotente que le intentaba quitar las tierras que consideraba eran suyas por derecho