Utilizing Three Years of Epidemiological Data from Medical Missions in Cambodia to Shape the Mobile Medical Clinic Formulary

Objective: The purpose of this project was to gather epidemiological data on common diseases and medications dispensed during medical mission teams to Cambodia to shape the mobile medical clinic formulary. Methods: Data for patients seen during week-long, mobile, medical clinics was collected in Cambodia during Septembers 2012 to 2014. Patient’s gender, age, weight, blood pressure, glucose, pertinent laboratory values, diagnoses, and medications dispensed were collected. Blood pressure and glucose were measured in patients 18 years and above. Data collected onto paper intake forms were transferred onto spreadsheets without patient identifying information and analyzed for aggregate means, common diseases, and most dispensed medications. This project received institutional review board approval. Results: A total of 1,015 patients were seen over three years. Women made up 61.4% and the mean age was 41.8 years. The most common diagnosis was gastrointestinal disorders (22.9%), which included gastroesophageal reflux disease and intestinal parasites. Next, 20.1% of patients had hypertension (BP\u3e140/90), 18.0% had presbyopia, 15.4% had back and joint pain, followed by 8.8% with headache, including migraines. Approximately 8.4% of patients had hyperglycemia (RPG \u3e140 mg/dl). Top five medications dispensed were acetaminophen, omeprazole, multivitamin, ibuprofen and metformin. For hypertension, amlodipine and lisinopril were dispensed. Conclusion: Cambodia lacks systematic public health collection of epidemiological data for prevalence of diseases. Hence, investigators collected and analyzed information from week-long mobile medical clinics over three years. Proton-pump inhibitors and H. pylori lab tests are recommended for gastrointestinal disorders. Acetaminophen and ibuprofen are recommended for pain. Angiotensin-converting-enzyme inhibitors and dihydropyridine calcium channel blockers are recommended over diuretics since patients are already dehydrated. Metformin is recommended for diabetes. Vitamins and supplements are recommended for malnourished patients. Hemoglobin machine and urine test strips are suggested. This information should help future teams decide what medications and laboratory tests are most beneficial on medical teams in Cambodia

Homeowner's Guide to Pests of Peaches, Plums and Pecans

9 pp., 6 tablesTo deal with insect and disease problems on peaches, plums and pecans, it is necessary to understand the life cycles of pests and diseases. Pesticide safety instructions and spray equipment also are discussed, and spray schedules are provided

Utilizing three years of epidemiological data from medical missions in Cambodia to shape the mobile medical clinic formulary

Objective: The purpose of this project was to gather epidemiological data on common diseases and medications dispensed during medical mission trips to Cambodia to shape the mobile medical clinic formulary. Methods: Data for patients seen during week-long mobile medical clinics was collected in Cambodia during Septembers 2012 to 2014. Each patient’s gender, age, weight, blood pressure, glucose, pertinent laboratory values, diagnoses, and medications dispensed were collected. Blood pressure and glucose levels were measured in patients 18 years and above. Data collected onto paper intake forms were transferred onto spreadsheets without patient identifying information and analyzed for aggregate means, common diseases, and most dispensed medications. This project received institutional review board approval. Results: A total of 1,015 patients were seen over three years. Women made up 61.4%, and the mean age was 41.8 years. The most common diagnosis was gastrointestinal disorders (22.9%) that included gastroesophageal reflux disease and intestinal parasites. Next, 20.1% of patients had hypertension (BP>140/90), 18.0% had presbyopia, 15.4% had back and joint pain, followed by 8.8% with headache, including migraines. Approximately 8.4% of patients had hyperglycemia (RPG >140 mg/dl). The top five medications dispensed were acetaminophen, omeprazole, multivitamin, ibuprofen, and metformin. For hypertension, amlodipine and lisinopril were dispensed. Conclusion: Cambodia lacks systematic public health collection of epidemiological data for prevalence of diseases. Hence, investigators collected and analyzed information from week-long mobile medical clinics over three years. Proton-pump inhibitors and H. pylori lab tests were recommended for gastrointestinal disorders. Acetaminophen and ibuprofen were recommended for pain. Angiotensin-converting-enzyme inhibitors and dihydropyridine calcium channel blockers were recommended over diuretics since patients were already dehydrated. Metformin was recommended for diabetes. Vitamins and supplements were recommended for malnourished patients. Hemoglobin machines and urine test strips were suggested. This information should help future teams decide what medications and laboratory tests would be the most beneficial for use by medical teams in Cambodia

Impact of obstructive sleep apnea on cardiometabolic health in a random sample of older adults in rural South Africa: building the case for the treatment of sleep disorders in underresourced settings

STUDY OBJECTIVES: The association between obstructive sleep apnea (OSA) and increased cardiometabolic risk (CMR) has been well documented in higher-income countries. However, OSA and its association with CMR have not yet been investigated, based on objective measures, in southern Africa. We measured polysomnography-derived sleep characteristics, OSA prevalence, and its association with cardiometabolic diseases in a rural, low-income, African-ancestry sample of older adult participants in South Africa. METHODS: Seventy-five participants completed the study. Body mass index, hypertension, diabetes, dyslipidemia, and HIV status were determined. A continuous CMR score was calculated using waist circumference, random glucose, high-density-lipoprotein cholesterol, triglycerides, and mean arterial blood pressure. Sleep architecture, arousal index, and apnea-hypopnea index for detection of the OSA (apnea-hypopnea index ≥ 15 events/h) were assessed by home-based polysomnography. Associations between CMR score and age, sex, socioeconomic status, apnea-hypopnea index, and total sleep time were investigated by multivariable analysis. RESULTS: In our sample (53 women, age 66.1 ± 10.7 years, 12 HIV+), 60.7% of participants were overweight/obese, 61.3% were hypertensive, and 29.3% had undiagnosed OSA. Being older (P = .02) and having a higher body mass index (P = .02) and higher waist circumference (P < .01) were associated with OSA. Apnea-hypopnea index severity (β = 0.011; P = .01) and being a woman (β = 0.369; P = .01) were independently associated with a higher CMR score in socioeconomic status- and age-adjusted analyses. CONCLUSIONS: In this South African community with older adults with obesity and hypertension, OSA prevalence is alarming and associated with CMR. We show the feasibility of detecting OSA in a rural setting using polysomnography. Our results highlight the necessity for actively promoting health education and systematic screening and treatment of OSA in this population to prevent future cardiovascular morbidity, especially among women

Sleep disorders in low- and middle-income countries: a call for action

Letter to the editor

Adolescents, Adults and Rewards: Comparing Motivational Neurocircuitry Recruitment Using fMRI

Background: Adolescent risk-taking, including behaviors resulting in injury or death, has been attributed in part to maturational differences in mesolimbic incentive-motivational neurocircuitry, including ostensible oversensitivity of the nucleus accumbens (NAcc) to rewards. Methodology/Principal Findings: To test whether adolescents showed increased NAcc activation by cues for rewards, or by delivery of rewards, we scanned 24 adolescents (age 12–17) and 24 adults age (22–42) with functional magnetic resonance imaging while they performed a monetary incentive delay (MID) task. The MID task was configured to temporally disentangle potential reward or potential loss anticipation-related brain signal from reward or loss notification-related signal. Subjects saw cues signaling opportunities to win or avoid losing $0,$.50, or $5 for responding quickly to a subsequent target. Subjects then viewed feedback of their trial success after a variable interval from cue presentation of between 6 to17 s. Adolescents showed reduced NAcc recruitment by reward-predictive cues compared to adult controls in a linear contrast with non-incentive cues, and in a volume-of-interest analysis of signal change in the NAcc. In contrast, adolescents showed little difference in striatal and frontocortical responsiveness to reward deliveries compared to adults. Conclusions/Significance: In light of divergent developmental difference findings between neuroimaging incentive paradigms (as well as at different stages within the same task), these data suggest that maturational differences i

Led into Temptation? Rewarding Brand Logos Bias the Neural Encoding of Incidental Economic Decisions

Human decision-making is driven by subjective values assigned to alternative choice options. These valuations are based on reward cues. It is unknown, however, whether complex reward cues, such as brand logos, may bias the neural encoding of subjective value in unrelated decisions. In this functional magnetic resonance imaging (fMRI) study, we subliminally presented brand logos preceding intertemporal choices. We demonstrated that priming biased participants' preferences towards more immediate rewards in the subsequent temporal discounting task. This was associated with modulations of the neural encoding of subjective values of choice options in a network of brain regions, including but not restricted to medial prefrontal cortex. Our findings demonstrate the general susceptibility of the human decision making system to apparently incidental contextual information. We conclude that the brain incorporates seemingly unrelated value information that modifies decision making outside the decision-maker's awareness

Fostering coastal resilience to climate change vulnerability in Bangladesh, Brazil, Cameroon and Uruguay: a cross-country comparison

© 2017, Springer Science+Business Media B.V. This paper describes a comparative study of four different cases on vulnerability, hazards and adaptive capacity to climate threats in coastal areas and communities in four developing countries: Bangladesh, Brazil, Cameroon and Uruguay. Coastal areas are vulnerable to sea-level rise (SLR), storm surges and flooding due to their (i) exposure, (ii) concentration of settlements, many of which occupied by less advantaged groups and (iii) the concentration of assets and services seen in these areas. The objective of the paper is twofold: (i) to evaluate current evidence of coastal vulnerability and adaptive capacity and (ii) to compare adaptation strategies being implemented in a sample of developing countries, focusing on successful ones. The followed approach for the case evaluation is based on (i) documenting observed threats and damages, (ii) using indicators of physical and socioeconomic vulnerability and adaptive capacity status and (iii) selecting examples of successful responses. Major conclusions based on cross-case comparison are (a) the studied countries show different vulnerability, adaptive capacity and implementation of responses, (b) innovative community-based (CBA) and ecosystem-based adaptation (EbA) and (c) early warning systems are key approaches and tools to foster climate resilience. A recommendation to foster the resilience of coastal communities and services is that efforts in innovative adaptation strategies to sea-level rise should be intensified and integrated with climate risk management within the national adaption plans (NAPAs) in order to reduce the impacts of hazards