The impact of obesity and inflammation on metabolic risk factors for cardiovascular disease and type two diabetes in black and white South African women

[T]he overall aim of this thesis was to investigate the ethnic-specific role of inflammation in obesity and related metabolic risk factors associated with T2DM and CVD in apparently healthy black and white premenopausal South African women

Microfinance Services and Government Regulations: Reflections on Performance of Small Holder Coffee Entrepreneurs in Uganda

Small-scale enterprises are lauded around the world for their contribution to economic development. Resources and capabilities play an important role as accelerators of entrepreneurial activity and also increase enterprise performance. This research strived to understand how Microfinance services affect the performance of smallholder coffee entrepreneurs but also examine government regulations as a moderating variable for the association between microfinance and the performance of smallholder coffee entrepreneurs. The study was guided by the resource-based view supported by dynamic capability and contingency theories. Data on 400 Ugandan coffee entrepreneurs was gathered and statistically tested using a multiple linear regression model. Study scores noted that financial training, microcredit, saving mobilization, and farm inputs positively influence the performance of smallholder coffee entrepreneurs. The findings also established that government regulations negatively moderate the association between microfinance services and the performance of smallholder coffee entrepreneurs. The study contributes to the growing agricultural entrepreneurship literature by demonstrating the performance of coffee entrepreneurs amidst microfinance and strict government regulations

Co-design of the EMBED-Care Framework as an intervention to enhance shared decision-making for people affected by dementia and practitioners, comprising holistic assessment, linked with clinical decision support tools: A qualitative study

Introduction: Shared decision-making intends to align care provision with individuals’ preferences. However, the involvement of people living with dementia in decision-making about their care varies. We aimed to co-design the EMBED-Care Framework, to enhance shared decision-making between people affected by dementia and practitioners.// Methods: A theory and evidence driven co-design study was conducted, using iterative workshops, informed by a theoretical model of shared decision-making and the EMBED-Care Framework (the intervention) for person-centred holistic palliative dementia care. The intervention incorporates a holistic outcome measure for assessment and review, linked with clinical decision-support tools to support shared decision-making. We drew on the Medical Research Council (MRC) guidance for developing and evaluating complex interventions. Participants included people with dementia of any type, current or bereaved family carers and practitioners. We recruited via established dementia groups and research and clinical networks. Data were analysed using reflexive thematic analysis to explore how and when the intervention could enhance communication and shared decision-making, and the requirements for use, presented as a logic model.// Results: Five co-design workshops were undertaken with participants comprising people affected by dementia (n = 18) and practitioners (n = 36). Three themes were generated, comprising: (1) ‘knowing the person and personalisation of care’, involving the person with dementia and/or family carer identifying the needs of the person using a holistic assessment. (2) ‘engaging and considering the perspectives of all involved in decision-making’ required listening to the person and the family to understand their priorities, and to manage multiple preferences. (3) ‘Training and support activities’ to use the Framework through use of animated videos to convey information, such as to understand the outcome measure used to assess symptoms.// Conclusions: The intervention developed sought to enhance shared decision-making with individuals affected by dementia and practitioners, through increased shared knowledge of individual priorities and choices for care and treatment. The workshops generated understanding to manage disagreements in determining priorities. Practitioners require face-to-face training on the intervention, and on communication to manage sensitive conversations about symptoms, care and treatment with individuals and their family. The findings informed the construction of a logic model to illustrate how the intervention is intended to work

Wheat NAC transcription factor <i>NAC5‐1</i> is a positive regulator of senescence

Wheat (Triticum aestivum L.) is an important source of both calories and protein in global diets, but there is a trade‐off between grain yield and protein content. The timing of leaf senescence could mediate this trade‐off as it is associated with both declines in photosynthesis and nitrogen remobilization from leaves to grain. NAC transcription factors play key roles in regulating senescence timing. In rice, OsNAC5 expression is correlated with increased protein content and upregulated in senescing leaves, but the role of the wheat ortholog in senescence had not been characterized. We verified that NAC5‐1 is the ortholog of OsNAC5 and that it is expressed in senescing flag leaves in wheat. To characterize NAC5‐1, we combined missense mutations in NAC5‐A1 and NAC5‐B1 from a TILLING mutant population and overexpressed NAC5‐A1 in wheat. Mutation in NAC5‐1 was associated with delayed onset of flag leaf senescence, while overexpression of NAC5‐A1 was associated with slightly earlier onset of leaf senescence. DAP‐seq was performed to locate transcription factor binding sites of NAC5‐1. Analysis of DAP‐seq and comparison with other studies identified putative downstream target genes of NAC5‐1 which could be associated with senescence. This work showed that NAC5‐1 is a positive transcriptional regulator of leaf senescence in wheat. Further research is needed to test the effect of NAC5‐1 on yield and protein content in field trials, to assess the potential to exploit this senescence regulator to develop high‐yielding wheat while maintaining grain protein content

Co-design of a theory-based implementation plan for a holistic eHealth assessment and decision support framework for people with dementia in care homes

Background: Despite positive findings around the use of eHealth in dementia care, it is rarely translated into routine practice. This can be facilitated by early involvement of end-users in the development of an implementation plan. This study aimed to co-design strategies to implement an eHealth intervention, the EMBED-Care Framework, to support assessment and decision-making for people with dementia in care homes.// Methods: A qualitative co-design method was applied through a series of workshops. Participants included family carers and health and social care practitioners. People with dementia were included through a series of stakeholder engagement meetings. The workshops focused on co-developing strategies in response to identified determinants of implementation. A codebook thematic analytic approach was taken, guided by the Normalisation Process Theory (NPT).// Results: Three workshops were conducted from July 2021 to November 2021, attended by 39 participants. Three overarching phases of implementation were identified which aligned with the constructs of the NPT: (a) incentivising adoption of the Framework, which requires promotion of its benefits and alignment with recommendations for good quality dementia care to engage stakeholders, relating to ‘coherence’ and ‘cognitive participation’ constructs; (b) enabling its operation, which requires ensuring compatibility with care home processes, provision of training and support from ‘champions’, relating to ‘collective action’; (c) sustaining use of the Framework, which requires monitoring of implementation and appraisal of its effects, relating to ‘reflexive monitoring’.// Conclusions: We have developed a multi-strategy, theoretically driven plan to implement eHealth to support assessment and decision-making for people with dementia in care homes. Successful implementation requires incentivisation to adopt, ability to operate and motivation to sustain use of eHealth. The plan is strengthened through collaborating with end-users to increase its value, credibility and real-world relevance. The theoretically informed strategies target mechanisms of the NPT, demonstrated to shape the implementation process and outcomes, ready for testing

Wheat NAC transcription factor <i>NAC5‐1</i> is a positive regulator of senescence

Wheat (Triticum aestivum L.) is an important source of both calories and protein in global diets, but there is a trade‐off between grain yield and protein content. The timing of leaf senescence could mediate this trade‐off as it is associated with both declines in photosynthesis and nitrogen remobilization from leaves to grain. NAC transcription factors play key roles in regulating senescence timing. In rice, OsNAC5 expression is correlated with increased protein content and upregulated in senescing leaves, but the role of the wheat ortholog in senescence had not been characterized. We verified that NAC5‐1 is the ortholog of OsNAC5 and that it is expressed in senescing flag leaves in wheat. To characterize NAC5‐1, we combined missense mutations in NAC5‐A1 and NAC5‐B1 from a TILLING mutant population and overexpressed NAC5‐A1 in wheat. Mutation in NAC5‐1 was associated with delayed onset of flag leaf senescence, while overexpression of NAC5‐A1 was associated with slightly earlier onset of leaf senescence. DAP‐seq was performed to locate transcription factor binding sites of NAC5‐1. Analysis of DAP‐seq and comparison with other studies identified putative downstream target genes of NAC5‐1 which could be associated with senescence. This work showed that NAC5‐1 is a positive transcriptional regulator of leaf senescence in wheat. Further research is needed to test the effect of NAC5‐1 on yield and protein content in field trials, to assess the potential to exploit this senescence regulator to develop high‐yielding wheat while maintaining grain protein content

Fasting substrate oxidation in relation to habitual dietary fat intake and insulin resistance in non-diabetic women: a case for metabolic flexibility?

BACKGROUND: Metabolic flexibility described as "the capacity of the body to match fuel oxidation to fuel availability" has been implicated in insulin resistance. We examined fasting substrate oxidation in relation to dietary macronutrient intake, and markers of insulin resistance in otherwise healthy women, with and without a family history of diabetes mellitus (FH DM). METHODS: We measured body composition (dual x-ray absorptiometry), visceral and subcutaneous adipose tissue area (VAT, SAT, using Computerised Tomography), fasting [glucose], [insulin], [free fatty acids], [blood lipids], insulin resistance (HOMA-IR), resting energy expenditure (REE), respiratory exchange ratio(RER) and self-reported physical activity in a convenience sample of 180 women (18-45 yrs). A food frequency questionnaire was used to assess energy intake (EI) and calculate the RER: Food Quotient (FQ) ratio. Only those with EI:REE (1.05 -2.28) were included (N=140). Insulin resistance was defined HOMA-IR (>1.95). RESULTS: The Insulin Resistant (IR) group had higher energy, carbohydrate and protein intakes (p<0.05) and lower PA levels than Insulin Sensitive (IS) group (P<0.001), but there were no differences in RER or RER:FQ between groups. However, nearly 50% of the variance in HOMA-IR was explained by age, body fat %, VAT, RER:FQ and FH DM (adjusted R2=0.50, p<0.0001). Insulin-resistant women, and those with FH DM had a higher RER:FQ than their counterparts (p<0.01), independent of body fat % or distribution. CONCLUSION: In these apparently healthy, weight-stable women, insulin resistance and FH DM were associated with lower fat oxidation in relation to dietary fat intake, suggesting lower metabolic flexibility

The importance of identified cause-of-death information being available for public health surveillance, actions and research

An amendment to the South African Births and Deaths Registration Act has compromised efforts to strengthen local mortality surveillance to provide statistics for small areas and enable data linkage to provide information for public health actions. Internationally it has been recognised that a careful balance needs to be kept between protecting individual patient confidentiality and enabling effective public health intelligence to guide patient care and service delivery and prevent harmful exposures. This article describes the public health benefits of a local mortality surveillance system in the Western Cape Province, South Africa (SA), as well as its potential for improving the quality of vital statistics data with integration into the national civil registration and vital statistics system. It also identifies other important uses for identifiable cause-of-death data in SA that have been compromised by this legislation

Soporte social y estrategias de afrontamiento en internos e internas del establecimiento penitenciario de Quillabamba, Cusco 2018

La presente investigación titulada soporte social y estrategias de afrontamiento en internos e internas del establecimiento penitenciario de Quillabamba, Cusco 2018, tuvo por objetivo identificar el grado de relación entre el soporte social y las estrategias de afrontamiento. El diseño de investigación es no experimental - transversal de alcance descriptivo correlacional. La población estuvo integrada por 332 internos e internas por lo tanto la muestra es de 222, a las cuales se les aplico el Inventario de Soporte Social y el Cuestionario COPE. El análisis de los resultados se realizó a través del paquete estadístico SPSS 23, con un nivel de confianza del 95%. De los resultados se determinó que al 95% de confiabilidad, se afirma que no existe relación entre el soporte social y las estrategias de afrontamiento en los internos e internas del establecimiento penitenciario de Quillabamba, donde se puede concluir que el apoyo social percibido por dicha población no se asocia en las estrategias que desarrollen y empleen para afrontar las situaciones estresantes y/o dificultades.Tesi