An audit of the uptake of key PMTCT interventions in the pre and post who rapid advice periods at the university college hospital, Ibadan

Prevention of vertical transmission of HIV may require the uptake of the culturally unacceptable options of cesarean delivery and formula feeding. The successful use of HAART, as enumerated by the WHO 2009 rapid advice, has the potential for facilitating the uptake of the more culturally acceptable vaginal delivery and breast feeding. These recommendations became operational at the PMTCT unit, University College Hospital, Ibadan. This retrospective study describes the impact of these recommendations on the uptake of PMTCT interventions at our center. The pre-rapid advice period was June 2009 to April 2011 and the post rapid period May 2011 till December 2012. Pre-rapid advise, antiretrovirals administered was zidovudine or Combivir for women with CD4 >200cells / ml and Combivir/nevirapine for CD4 <200 Cells/ ml. Post-rapid, all were eligible for HAART (mostly efavirenz/ truvada or efavirenz/ Combivir). Six weeks post-natally, the options adopted were documented and are presented here. Information from 1165 women was available. Thirty three (2.8%) did not have adequate information and were excluded. There were 711 women pre-rapid advise and 421 women post rapid. The women's characteristics were not significantly different over both periods, 69.0% had >6 years of education, 97.0% were married and slightly over half (56.9%) were involved with traders. Overall, more women were delivered by the vaginal route than Caesarean Delivery (70.5% vs. 29.5%), while more breastfed compared to formula feeding (67.2% vs. 32.8%). In the post rapid period (compared to the pre- rapid) advise, more women had vaginal delivery (73.5% vs. 64.8%, p = 0.54), more women breast-fed (77.0% vs. 50.1%, p= 0.00) and fewer women used contraception (21.5% vs. 27.3%, p= 0.023). The commonest method was the condom (83.4%). The new WHO guidelines appear to have facilitated a shift in uptake of the more culturally acceptable options of vaginal delivery and breast feeding. A follow-up evaluation of the infant HIV status will ascertain the ultimate impact on MTCT

Obstetric and newborn outcomes and risk factors for low birth weight and preterm delivery among HIV-infected pregnant women at the university college hospital Ibadan

There remains uncertainty about the impact of HIV on pregnancy outcomes and effects of highly active antiretroviral therapy on fetal development. This study describes obstetric outcomes among HIV positive parturients at the University College Hospital, Ibadan. HIV positive parturients were identified in the birth register. During the 30-month period, 318 of 6203 deliveries were HIV positive (5.1%) with 97.6% record retrieval. The mean age of the HIV positive parturients was 31.66 years (± 4.66); the mean gestational age at delivery was 38.02 weeks (± 2.75) and the mean birth weight 2.85kg (±0.59). There were 35.8% (109) preterm births, 2.9% stillbirths and 21.5% low birth weights. The regimen most commonly (198, 64.5%) used was a non-nucleoside reverse transcriptase (NNRTI) based HAART. Preterm births were similar following spontaneous vaginal delivery (31.5%) and elective section (31%) but higher (41.3%) with emergency section (ñ=0.4).On univariate analysis, the preterm infants had lower mean birth weights (2.46±0.61 vs 2.96±0.44; ñ=0.000). The proportion of preterm births was higher among Low birth weight infants (71.9% vs 28.1%; ñ=0.00). Variables with more preterm births were age >35 years (51.6%), ≤6years of schooling (51.5% vs 48.4%) and being on combination ARV (PI, 37.5% or non-PI, 36.2%). However, these differences did not attain statistical significance. Low birth weight infants had mothers who had higher mean ages (33.28 years ± 4.59 vs 31.28 years ± 4.59, ñ= 0.02), lower mean gestational age at delivery (35.72 weeks ± 3.16 vs 38.49 weeks ± 2.1, ñ= 0.00). Variables with more low birth weight include <12years of schooling and being on mono/ dual therapy (31.8%). These differences were not statistically significant. On logistic regression, factors that retained an association with low birth weight were mean maternal age at delivery (ñ= 0.002; â= 0.904; 95% CI, 0.848 – 0.966) and being on mono/ dual therapy (ñ= 0.039; â= 3.042; 95% CI, 1.055 – 8.768). The only factor that retained an association with preterm birth was mean maternal age at delivery (ñ= 0.015; â= 0.935; 95% CI, 0.886 – 0.987). HIV positive (especially older) women, have high rates of preterm deliveries and low birth weights. The beneficial effects of HAART on mother-to-child transmission are indisputable but monitoring antiretroviral therapy in pregnancy remains a priority and antenatal surveillance should include fetal growth assessment.

Happy to help? Exploring the factors associated with variations in rates of volunteering across Europe

The frequency of formal volunteering varies widely across European countries, and rates of formal volunteering are especially low among Eastern European countries. Why are there such large differences in volunteering rates when it is known that volunteering is beneficial for well-being? Using data from the latest round of the European Social Survey, we test three hypotheses to explain these cross-national differences in volunteering. We ask whether people in countries with low frequencies of volunteering spend more of their time on informal volunteering activities; whether they differ on socio-demographic variables which are known to be linked to volunteering rates; or whether they show less well-being benefit from formal volunteering. Contrary to the first hypothesis, we find a positive correlation between formal and informal volunteering. We further conclude that national differences in rates of volunteering cannot be fully explained by differences in the social, psychological or cultural factors associated with volunteering nor the outcome of volunteering. It is likely that contextual factors, such as a country’s historical background or institutions, determine levels of volunteering to a large extent

The Spin Structure of the Nucleon

We present an overview of recent experimental and theoretical advances in our understanding of the spin structure of protons and neutrons.Comment: 84 pages, 29 figure

De novo domestication of wild tomato using genome editing

Breeding of crops over millennia for yield and productivity1 has led to reduced genetic diversity. As a result, beneficial traits of wild species, such as disease resistance and stress tolerance, have been lost2. We devised a CRISPR–Cas9 genome engineering strategy to combine agronomically desirable traits with useful traits present in wild lines. We report that editing of six loci that are important for yield and productivity in present-day tomato crop lines enabled de novo domestication of wild Solanum pimpinellifolium. Engineered S. pimpinellifolium morphology was altered, together with the size, number and nutritional value of the fruits. Compared with the wild parent, our engineered lines have a threefold increase in fruit size and a tenfold increase in fruit number. Notably, fruit lycopene accumulation is improved by 500% compared with the widely cultivated S. lycopersicum. Our results pave the way for molecular breeding programs to exploit the genetic diversity present in wild plants

Simulations of Supercollider Physics

The Standard Model of particle physics makes it possible to simulate complete events for physics signatures and their backgrounds in high energy collisions. Knowledge of how the produced particles interact with the materials in a detector makes it possible to simulate the response of any particular detector design to these events and so determine whether the detector could observe the signal. The combination of these techniques has played an important role in the design of new detectors, particularly those for hadron supercolliders where the high rates and small signal cross sections make the experiments very difficult. The technique is reviewed here and illustrated using the simulations of the GEM detector proposed for the Superconducting Super Collider. Although the simulations and results described here are somewhat detector-specific, we believe that they can serve as a useful model for this component of detector design for future hadron supercolliders.Comment: 99 pages, Plain TeX (macros included), includes gzipped tar file with 56/60 EPS figures for dvips. Get complete version from http://penguin.phy.bnl.gov/www/hetpapers.html or ftp://penguin.phy.bnl.gov/pub/papers/gemreview.ps.

Relationship between self-reported dietary intake and physical activity levels among adolescents: The HELENA study

Background Evidence suggests possible synergetic effects of multiple lifestyle behaviors on health risks like obesity and other health outcomes. Therefore it is important to investigate associations between dietary and physical activity behavior, the two most important lifestyle behaviors influencing our energy balance and body composition. The objective of the present study is to describe the relationship between energy, nutrient and food intake and the physical activity level among a large group of European adolescents. Methods The study comprised a total of 2176 adolescents (46.2% male) from ten European cities participating in the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) study. Dietary intake and physical activity were assessed using validated 24-h dietary recalls and self-reported questionnaires respectively. Analyses of covariance (ANCOVA) were used to compare the energy and nutrient intake and the food consumption between groups of adolescents with different physical activity levels (1st to 3rd tertile). Results In both sexes no differences were found in energy intake between the levels of physical activity. The most active males showed a higher intake of polysaccharides, protein, water and vitamin C and a lower intake of saccharides compared to less active males. Females with the highest physical activity level consumed more polysaccharides compared to their least active peers. Male and female adolescents with the highest physical activity levels, consumed more fruit and milk products and less cheese compared to the least active adolescents. The most active males showed higher intakes of vegetables and meat, fish, eggs, meat substitutes and vegetarian products compared to the least active ones. The least active males reported the highest consumption of grain products and potatoes. Within the female group, significantly lower intakes of bread and cereal products and spreads were found for those reporting to spend most time in moderate to vigorous physical activity. The consumption of foods from the remaining food groups, did not differ between the physical activity levels in both sexes. Conclusion It can be concluded that dietary habits diverge between adolescents with different self-reported physical activity levels. For some food groups a difference in intake could be found, which were reflected in differences in some nutrient intakes. It can also be concluded that physically active adolescents are not always inclined to eat healthier diets than their less active peers.The HELENA study took place with the financial support of the European Community Sixth RTD Framework Programme (Contract FOOD-CT: 2005-007034). This work was also partially supported by the European Union, in the framework of the Public Health Programme (ALPHA project, Ref: 2006120), the Swedish Council for Working Life and Social Research (FAS), the Spanish Ministry of Education (EX-2007-1124, and EX-2008-0641), and the Spanish Ministry of Health, Maternal, Child Health and Development Network (number RD08/0072) (JPRL, LAM)

Prevalence, years lived with disability, and trends in anaemia burden by severity and cause, 1990-2021: findings from the Global Burden of Disease Study 2021

Background Anaemia is a major health problem worldwide. Global estimates of anaemia burden are crucial for developing appropriate interventions to meet current international targets for disease mitigation. We describe the prevalence, years lived with disability, and trends of anaemia and its underlying causes in 204 countries and territories. Methods We estimated population-level distributions of haemoglobin concentration by age and sex for each location from 1990 to 2021. We then calculated anaemia burden by severity and associated years lived with disability (YLDs). With data on prevalence of the causes of anaemia and associated cause-specific shifts in haemoglobin concentrations, we modelled the proportion of anaemia attributed to 37 underlying causes for all locations, years, and demographics in the Global Burden of Disease Study 2021. Findings In 2021, the global prevalence of anaemia across all ages was 24·3% (95% uncertainty interval [UI] 23·9–24·7), corresponding to 1·92 billion (1·89–1·95) prevalent cases, compared with a prevalence of 28·2% (27·8–28·5) and 1·50 billion (1·48–1·52) prevalent cases in 1990. Large variations were observed in anaemia burden by age, sex, and geography, with children younger than 5 years, women, and countries in sub-Saharan Africa and south Asia being particularly affected. Anaemia caused 52·0 million (35·1–75·1) YLDs in 2021, and the YLD rate due to anaemia declined with increasing Socio-demographic Index. The most common causes of anaemia YLDs in 2021 were dietary iron deficiency (cause-specific anaemia YLD rate per 100 000 population: 422·4 [95% UI 286·1–612·9]), haemoglobinopathies and haemolytic anaemias (89·0 [58·2–123·7]), and other neglected tropical diseases (36·3 [24·4–52·8]), collectively accounting for 84·7% (84·1–85·2) of anaemia YLDs. Interpretation Anaemia remains a substantial global health challenge, with persistent disparities according to age, sex, and geography. Estimates of cause-specific anaemia burden can be used to design locally relevant health interventions aimed at improving anaemia management and prevention. Funding Bill & Melinda Gates Foundation