Test-retest reliability of IPAQ environmental- module in an African population

<p>Abstract</p> <p>Background</p> <p>There is overwhelming evidence of the benefits of physical activity and the physical environment is increasingly recognized as a promising determinant of physical activity participation. The influence of the environment on physical activity has not been evaluated among black Africans and no specific measure exists for assessing environmental factors related to physical activity in an African environment. The IPAQ E- module was designed to assess environmental factors for physical activity participation and was considered to be relevant to all countries regardless of the stage of economic development. The objective of this study was to assess the test- retest reliability of IPAQ E- module in an African population.</p> <p>Methods</p> <p>One hundred and three clinical students of a University in Nigeria were invited to participate in the reliability testing of IPAQ E- module. Sixteen of the 17- items on the environmental measure were assessed for test- retest reliability using intraclass correlation coefficient (ICC) with 95% Confidence interval (CI) overall and by gender. The measure addressed items regarding residential density, access to destinations, neighborhood infrastructures, aesthetic qualities, social environment, street connectivity and neighborhood safety.</p> <p>Results</p> <p>Of the total respondents, 51.5% were males and 48.5% were females. Overall, the intraclass correlation coefficient (ICC) ranged from 0.43 to 0.91. The item regarding many interesting things to look at (aesthetic) produced the overall highest reliability score (ICC = 0.91, 95% CI = 0.86 – 0.94), while the item regarding safety from crime during the day (neighborhood safety) produced the lowest overall score (ICC = 0.43, 95% CI = 0.26 – 0.57). Reliability of items on neighborhood infrastructures ranged between substantial agreement to almost perfect agreement overall (ICC = 0.66 – 0.88) and by gender (male- ICC = 0.68 – 0.90 and female- ICC = 0.63 – 0.86). The access to destination items (ICC = 0.49 – 0.74), social environment (ICC = 0.62) and street connectivity (ICC = 0.78) all had acceptable reliability overall. Meaningful differences were found between males and females on two items on neighborhood safety and one item on access to destinations.</p> <p>Conclusion</p> <p>The test- retest of IPAQ E- module resulted in moderate to almost perfect agreement for most of the items with few meaningful differences by gender. Environmental items of physical activity in an African population exhibited reliability similar to that in other environments. These results suggest that IPAQ E- module may be a useful measure for assessing environmental correlates of physical activity among population in Africa.</p

Isolation and characterisation of nitrilase producing Aspergillus species recovered from solid waste leachates at two dump sites in Lagos, Nigeria

Aims: Nitrile compounds are cyanogenic intermediates, products, byproducts and waste products of agriculture, chemical and pharmaceutical industries and fossil fuels degradation. The enzymatic hydrolysis of nitriles to non-toxic carboxylic acids or amides plays an increasingly important role in environment remediation. This study aimed at exploring the potential of Aspergilli in the detoxification nitrile compounds at two selected dump sites in Lagos, Nigeria. Methodology and results: Decomposing solid waste leachate samples (SWL) were randomly collected at two selected dump sites namely Olusosun (Ojota) and Isolo (Oke-Afa). Samples per site were pooled, processed by selective enrichment and screened for the presence of Aspergilli by culture technique and intergenic spacer sequencing (ITS). Biomass generation and pH changes in the culture fluids were monitored at 4-days interval by dry weight measurements. Nitrilase production was determined spectrophotometrically. Two nitrilase producing Aspergillus strains: Aspergillus fumigatus strain WO2 with accession number MF78882 and Aspergillus niger strain WO7 with accession number MH542673 were identified. Growth investigation revealed biomass generations of 17.8 g and 23.8 g dry weight per one liter media for A. fumigatus strain WO2 and A. niger strain WO7 respectively. Progressive pH monitoring showed decline from 7.2 to 4.5 and 7.2 to 6.2 was obtained for strains WO2 and WO7 respectively, during nitrilase production at different yields of 0.0150 and 0.0161 mg/mL/min respectively. Conclusion, significance and impact of study: This study supports the studied dump sites as important sources of nitrilase-producing A. fumigatus and A niger strains with potentials as cost-effective environmental bioremediation agents in Nigeria

Assessment of job satisfaction among dentists working in different settings in the Tshwane metro

INTRODUCTION: Job satisfaction of dentists is important, as dentists are critical in the delivery of comprehensive health care. Whilst job satisfaction among dentists has been widely investigated elsewhere, it is poorly researched in South Africa. AIMS AND OBJECTIVES: To assess job satisfaction among dentists working in Tshwane district. DESIGN: A cross-sectional study. METHODS: Data were collected using a self-administered, validated, modified questionnaire adapted from the Dentists' Satisfaction Survey. Demographic data and the responses associated with job satisfaction in various settings were collected. Two of the questions were qualitative and open-ended. Data were analysed using statistical software package (STATA) version 10. Ethical clearance was obtained and all data were anonymous. RESULTS: The response rate was 77% and 53 %( 41) of respondents were female. Perception of income, relationships with patients and personal time were significantly positively associated with job satisfaction. Patient happiness with treatment, the autonomy and flexibility of private practice and imparting knowledge also contributed to job satisfaction. Unrealistic expectations of patients, long working hours, restricted funding and lack of equipment contributed to job dissatisfaction. CONCLUSION: Overall the dentists were satisfied, however, satisfaction and dissatisfaction were conditional and influenced by factors such as perception of income and unrealistic patient expectations.https://www.sada.co.za/the-sadjam2020Community DentistrySchool of Health Systems and Public Health (SHSPH

The impact of early outcome events on the effect of tranexamic acid in post-partum haemorrhage: an exploratory subgroup analysis of the WOMAN trial.

BACKGROUND: In severe post-partum haemorrhage, death can occur within hours of bleeding onset so interventions to control the bleeding must be given immediately. In clinical trials of treatments for life-threatening bleeding, established treatments are given priority and the trial treatment is usually given last. However, enrolling patients in whom severe maternal morbidity or death is imminent or inevitable at the time of randomisation may dilute the effects of a trial treatment. METHODS: We conducted an exploratory analysis of data from the WOMAN trial, an international, randomised placebo-controlled trial of the effects of tranexamic acid on death and surgical intervention in 20,060 women with post-partum haemorrhage. We assessed the impact of early maternal death or hysterectomy due to exsanguination on the effect of tranexamic acid on each of these respective outcomes. We conducted repeated analyses excluding patients with these outcomes at increasing intervals from the time of randomisation. We quantified treatment effects using risk ratios (RR) and 99% confidence intervals (CI) and prepared cumulative failure plots. RESULTS: Among 14,923 women randomised within 3 h of delivery (7518 tranexamic acid and 7405 placebo), there were 216 bleeding deaths (1.5%) and 383 hysterectomies due to bleeding (2.8%). After excluding deaths from exsanguination at increasing time intervals following randomization, there was a significant reduction in the risk of death due to bleeding with tranexamic acid (RR = 0.41; 99% CI 0.19-0.89). However, after excluding hysterectomies at increasing time intervals post-randomization, there was no reduction in the risk of hysterectomy due to bleeding with tranexamic acid (RR = 0.79; 99% CI 0.33-1.86). CONCLUSIONS: Findings from this analysis provide further evidence that tranexamic acid reduces the risk of death from exsanguination in women who experience postpartum haemorrhage. It is uncertain whether tranexamic acid reduces the risk of hysterectomy for bleeding after excluding early hysterectomies. TRIAL REGISTRATION: ISRCTN trial registration number ISRCTN76912190, 8 Dec 2008; ClinicalTrials.gov number NCT00872469, 30 March 2009; PACTR number PACTR201007000192283, 9 Feb 2010; EudraCT number 2008-008441-38, 8 Dec 2010 (retrospectively registered)

Growth Faltering and Developmental Delay in HIV-Exposed Uninfected Ugandan Infants: A Prospective Cohort Study

BACKGROUND: HIV-exposed but uninfected (HEU) infants are at increased risk of impaired early linear growth and cognitive development. We examined associations between prenatal and postnatal growth and subsequent neurodevelopment in Ugandan HEU infants, hypothesizing that early insults may explain alterations in both somatic growth and brain development. METHODS: We prospectively followed a cohort of HEU infants from birth to 18 months of age, and measured length/height, weight, head, and arm circumference longitudinally. The Malawi Development Assessment Tool (MDAT, 12 and 18 months) and the Color Object Association Test (18 months) were used for developmental assessments. RESULTS: Among 170 HEU infants, the prevalence of low-birth weight and failure to thrive was 7.6% and 37%, respectively. HEU infants had MDAT scores that were similar to the reference population. The mean (SD) score on the Color Object Association Test was 5.5 (3.1) compared with 6.9 (5.3) in developmentally normal children. Developmental ability at age 18 months showed strong cross-sectional correlation with weight-for-age (ρ = 0.36, P < 0.0001), length/height-for-age (ρ = 0.41, P < 0.0001), head circumference-for-age (ρ = 0.26, P = 0.0011), and mid-upper arm circumference-for-age (ρ = 0.34, P = 0.0014). There was a statistically significant correlation between birth weight and MDAT z-score at 18 months (ρ = 0.20, P = 0.010). Failure to thrive was associated with lower MDAT z-score [median -0.13 (IQR -0.75 to +0.14) versus +0.14 (IQR -0.44 to +0.63), P = 0.042]. CONCLUSION: Growth faltering in HEU infants was associated with lower attainment of developmental milestones at age 18 months. Our findings point to a simple screening method for identifying HEU infants at risk for developmental intervention

Tranexamic acid for the prevention of postpartum bleeding in women with anaemia: study protocol for an international, randomised, double-blind, placebo-controlled trial.

BACKGROUND: Postpartum haemorrhage (PPH) is responsible for about 100,000 maternal deaths every year, most of which occur in low- and middle-income countries. Tranexamic acid (TXA) reduces bleeding by inhibiting the enzymatic breakdown of fibrin blood clots. TXA decreases blood loss in surgery and reduces death due to bleeding after trauma. When given within 3 h of birth, TXA reduces deaths due to bleeding in women with PPH. However, for many women, treatment of PPH is too late to prevent death. Over one third of pregnant women in the world are anaemic and many are severely anaemic. These women have an increased risk of PPH and suffer more severe outcomes if PPH occurs. There is an urgent need to identify a safe and effective way to reduce postpartum bleeding in anaemic women. METHODS/DESIGN: The WOMAN-2 trial is an international, multicentre, randomised, double-blind, placebo-controlled trial to quantify the effects of TXA on postpartum bleeding in women with moderate or severe anaemia. Ten thousand women with moderate or severe anaemia who have given birth vaginally will be randomised to receive 1 g of TXA or matching placebo by intravenous injection immediately (within 15 min) after the umbilical cord is cut or clamped. The primary outcome is the proportion of women with a clinical diagnosis of primary PPH. The cause of PPH will be described. Data on maternal health and wellbeing, maternal blood loss and its consequences, and other health outcomes will be collected as secondary outcomes. The main analyses will be on an 'intention-to-treat' basis, irrespective of whether the allocated treatment was received. Results will be presented as appropriate effect estimates with a measure of precision (95% confidence intervals). Subgroup analyses will be based on the severity of anaemia (moderate versus severe) and type of labour (induced or augmented versus spontaneous). A study with 10,000 patients will have over 90% power to detect a 25% relative reduction from 10 to 7.5% in PPH. The trial will be conducted in hospitals in Africa and Asia. DISCUSSION: The WOMAN-2 trial should provide reliable evidence for the effects of TXA for preventing postpartum bleeding in women with anaemia. TRIAL REGISTRATION: ISRCTN, ISRCTN62396133 . Registered on 7 December 2017; ClincalTrials.gov, ID: NCT03475342 . Registered on 23 March 2018

Risk factors for peripartum hysterectomy among women with postpartum haemorrhage: analysis of data from the WOMAN trial.

BACKGROUND: Peripartum hysterectomy can cause significant morbidity and mortality. Most studies of peripartum hysterectomy are from high income countries. This cohort study examined risk factors for peripartum hysterectomy using data from Africa, Asia, Europe and the Americas. METHODS: We used data from the World Maternal Antifibrinolytic (WOMAN) trial carried out in 193 hospitals in 21 countries. Peripartum hysterectomy was defined as hysterectomy within 6 weeks of delivery as a complication of postpartum haemorrhage. Univariable and multivariable random effects logistic regression models were used to analyse risk factors. A hierarchical conceptual framework guided our multivariable analysis. RESULTS: Five percent of women had a hysterectomy (1020/20,017). Haemorrhage from placenta praevia/accreta carried a higher risk of hysterectomy (17%) than surgical trauma/tears (5%) and uterine atony (3%). The adjusted odds ratio (AOR) for hysterectomy in women with placenta praevia/accreta was 3.2 (95% CI: 2.7-3.8), compared to uterine atony. The risk of hysterectomy increased with maternal age. Caesarean section was associated with fourfold higher odds of hysterectomy than vaginal delivery (AOR 4.3, 95% CI: 3.6-5.0). Mothers in Asia had a higher hysterectomy incidence (7%) than mothers in Africa (5%) (AOR: 1.2, 95% CI: 0.9-1.7). CONCLUSIONS: Placenta praevia/accreta is associated with a higher risk of peripartum hysterectomy. Other risk factors for hysterectomy are advanced maternal age, caesarean section and giving birth in Asia

Whole genome comparison of a large collection of mycobacteriophages reveals a continuum of phage genetic diversity

The bacteriophage population is large, dynamic, ancient, and genetically diverse. Limited genomic information shows that phage genomes are mosaic, and the genetic architecture of phage populations remains ill-defined. To understand the population structure of phages infecting a single host strain, we isolated, sequenced, and compared 627 phages of Mycobacterium smegmatis. Their genetic diversity is considerable, and there are 28 distinct genomic types (clusters) with related nucleotide sequences. However, amino acid sequence comparisons show pervasive genomic mosaicism, and quantification of inter-cluster and intra-cluster relatedness reveals a continuum of genetic diversity, albeit with uneven representation of different phages. Furthermore, rarefaction analysis shows that the mycobacteriophage population is not closed, and there is a constant influx of genes from other sources. Phage isolation and analysis was performed by a large consortium of academic institutions, illustrating the substantial benefits of a disseminated, structured program involving large numbers of freshman undergraduates in scientific discovery