CDC health risk appraisal user manual

Bibliography: p. 58-59

Assessment of Carbon Stock and Greenhouse Gas Emissions of Selected Coffee-Based Agroforestry Farms in Timor Leste

Agroforestry is an important carbon sequestration strategy because of carbon storage potential in its multiple plant species and soil as well as its applicability in agricultural lands and in reforestation.  The study was conducted in selected coffee-based agroforestry farms in Gleno, Ermera District, Timor Leste to determine the amount of carbon stocks and greenhouse gas emissions in the management of coffee-based agroforestry farms. Results reveal that agroforestry coffee cropping pattern had a carbon stock composed of 6.425 Mg ha-1 biomass, 2.01 Mg ha-1 necromass, and 157.17 Mg ha-1 soil organic carbon. For the carbon stock stored in the monoculture coffee cropping pattern, a biomass of 5.321 Mg ha-1, necromass of 1.32 Mg ha-1, and soil organic carbon of 128.74. Mg ha-1 were recorded while for the pruned coffee cropping pattern, biomass of 2.771 Mg ha-1, necromass of 1.82 Mg ha-1, and soil organic carbon of 69.29 Mg ha-1 were found.  Moreover, the greenhouse gas emission CO2 absorbed by coffee plants across cropping patterns were the following: agroforestry coffee, 24.156 t/ha-1, monoculture coffee, 19.520 t/ha-1 and pruned coffee, 10.177 t/ha-1.  Abovementioned results reveal that coffee-based agroforestry system a coffee-based agroforestry is considered as an effective solution in combatting heightened atmospheric GHGs concentration and climate change while at the same time addressing concerns on socio-economic stability

‘Doing’ hypertension: Experiential knowledge and practice in the self-management of ‘high blood’ in the Philippines

Patients’ embodied experiences do not always correspond to the biomedical concepts of particular diseases. Drawing from year-long fieldwork in the Philippines that involved semi-structured interviews, focus group discussions and digital diaries, we examine how individuals ‘do’ hypertension through their embodied experiences and the knowledge and practice that emerge from them. Drawing inspiration from Annemarie Mol’s work on the notion of ‘multiplicity’ of disease, our analysis was informed by a commitment to privileging patients’ embodied experiences and the multiple ontologies of hypertension. We find that for patients diagnosed with hypertension in the Philippines, symptoms enact illness; patients rely on their own embodied knowledge to define their illness’ nature (e.g., diagnosis), experience (e.g., frequency of symptoms and non-chronicity) and praxis (e.g., self-care practices). We show how this knowledge gained from having embodied experiences of living with the disease interacts in various ways with biomedical knowledge, other diagnostic labels and clinical practices, to shape how hypertension manifests and is managed by patients. Beyond interrogating the relationship between what counts as a ‘disease’ and what is considered a ‘symptom’, our findings underscore the need to pay attention instead to the mutually co-constitutive processes of embodied experiences and disease categories in co-producing patient knowledge

Spatiotemporal pattern of global forest change over the past 60 years and the forest transition theory

Forest ecosystems play an indispensable role in addressing various pressing sustainability and social-ecological challenges such as climate change and biodiversity loss. However, global forest loss has been, and still is today, an important issue. Here, based on spatially explicit data, we show that over the past 60 years (1960–2019), the global forest area has declined by 81.7 million ha (i.e. 10% more than the size of the entire Borneo island), with forest loss (437.3 million ha) outweighing forest gain (355.6 million ha). With this forest decline and the population increase (4.68 billion) over the period, the global forest per capita has decreased by over 60%, from 1.4 ha in 1960 to 0.5 ha in 2019. The spatiotemporal pattern of forest change supports the forest transition theory, with forest losses occurring primarily in the lower income countries in the tropics and forest gains in the higher income countries in the extratropics. Furthermore, economic growth has a stronger association with net forest gain than with net forest loss. Our results highlight the need to strengthen the support given to lower income countries, especially in the tropics, to help improve their capacity to minimize or end their forest losses. To help address the displacement of forest losses to the lower income countries in the tropics, higher income nations need to reduce their dependence on imported tropical forest products

Strengths and Weaknesses of Digital Diaries as a Means to Study Patient Pathways: Experiences With a Study of Hypertension in the Philippines

The rise of digital mobile communications has made possible novel research methods that can provide a better understanding of patients’ experience of non-communicable diseases. This study explores the opportunities and challenges in employing “digital diaries” via mobile phones to track the lived experiences of people with hypertension in the Philippines. Following in-depth interviews, 40 hypertensive adults were invited to submit digital diaries over 12 months. Mobile phones were found to be an efficient way of reaching participants, although it was difficult to collect in-depth narratives about their experiences using the medium beyond nominal responses about symptoms and treatment. Possible explanations include the asymptomatic nature of hypertension, which limited the participants’ experiences of the illness, as well as the platform itself, which our mostly-elderly, low-income participants may not be comfortable with. Despite these challenges, “digital diaries” hold potential for the study of other chronic conditions, provided that researchers engage in extensive co-production with participants to understand their preferences. Researchers also need more training in the use of these methods appropriately as part of a suite of methods for capturing the experience of people living with chronic illness

Participant Use of Digital Diaries in Qualitative Research: A Strong Structuration Analysis

Lived experiences of chronic conditions are marked by fluidity and change, which should be considered if care is to be truly patient-centered. Seeking to capture this fluidity, we used digital diaries via mobile phones to communicate with hypertensive patients in the Philippines over approximately 12 months. This paper draws on Strong Structuration Theory to conceptualize the complex array of factors shaping participants’ usage (and non-usage) of the diaries, thereby offering a comprehensive understanding of how the diaries were perceived and used. We draw on qualitative data from 42 participants (73 baseline/follow-up interviews and 37 digital diaries), purposively selected from a larger pool of quantitative participants, as well as existing literature and our own study documents. The Philippines ‘digital divide\u27 presented barriers to the usage of the diaries, stemming from a lack of access and mobile signal especially in socioeconomically marginalized rural areas. Within this context, the sharing of mobile phones both enabled and constricted diary participation. Guided by Strong Structuration Theory, we observed three cycles of structuration evident in participants’ usage of diaries. The first pertained to the frequency and mode of engagement. A low level of engagement was observed, stemming from negative or ambivalent attitudes toward texting and other factors. Conversely, mobile phone ‘top-ups’ enabled participation. Participant usage of the diaries as tools for monitoring hypertension and to request health advice comprise the second and third structuration cycles. These usages contrast with researchers’ intended usage of the diaries and with the original brief given to participants. The conflict between participants’ and researchers’ understanding of the appropriate uses of the diaries represents the dynamic field of position-practice relations, wherein agents are situated and interact, either perpetuating or challenging existing societal structures. Our findings underline the importance of considering macro- and meso-level factors when considering or conducting research using digital diaries

(De)Constructing ‘Therapeutic Itineraries’ of Hypertension Care: A Qualitative Study in the Philippines

Hypertension, a major risk factor for non-communicable diseases, remains poorly controlled in many countries. In the Philippines, it is still one of the leading causes of preventable deaths despite the accessibility and availability of essential technologies and medicine to detect and treat hypertension. This paper characterizes the ‘therapeutic itineraries’ of people with hypertension from poor communities in rural and urban settings in the Philippines. We employ longitudinal qualitative methodology comprised of repeat interviews and digital diaries using mobile phones from 40 recruited participants in 12 months. Our findings demonstrate that therapeutic itineraries, rather than being organized according to categories that stem from the structure of the health system (i.e., diagnosis, treatment, follow-up, adherence), diverge from clinical pathways. Therapeutic itineraries begin at a stage we label as ‘pre-diagnosis’ (PD). Following this, itineraries diverge according to two possible entry points into the healthcare system: via incidental diagnosis (ID) whereby participants were diagnosed with hypertension without deliberately seeking care for hypertension-related symptoms and symptom-driven diagnosis (SD) whereby their diagnosis was obtained during a clinical encounter specifically prompted by hypertension-related symptoms. Participants whose itineraries follow the SD route typically oscillated between periods of regular and intermittent medical treatment, while participants who were diagnosed incidentally (ID) typically opted for self-care As we follow our participants\u27 therapeutic itineraries, we explore the confluence of factors informing their care journey, namely, their conceptions of hypertension, their social relationships, as well the choices and trade-offs they make. We conclude with policy implications from our findings, chief of which is our proposition that models of care based on mere access and availability of clinical interventions fail to reflect the complexity of people\u27s lay understanding and their lived experiences of hypertension and are thus ultimately unhelpful in improving its control

Production and Characterization of Guinea Pig Recombinant Gamma Interferon and Its Effect on Macrophage Activation

Gamma interferon (IFN-γ) plays a critical role in the protective immune responses against mycobacteria. We previously cloned a cDNA coding for guinea pig IFN-γ (gpIFN-γ) and reported that BCG vaccination induced a significant increase in the IFN-γ mRNA expression in guinea pig cells in response to living mycobacteria and that the virulent H37Rv strain of Mycobacterium tuberculosis stimulated less IFN-γ mRNA than did the attenuated H37Ra strain. In this study, we successfully expressed and characterized recombinant gpIFN-γ with a histidine tag at the N terminus (His-tagged rgpIFN-γ) in Escherichia coli. rgpIFN-γ was identified as an 18-kDa band in the insoluble fraction; therefore, the protein was purified under denaturing conditions and renatured. N-terminal amino acid sequencing of the recombinant protein yielded the sequence corresponding to the N terminus of His-tagged gpIFN-γ. The recombinant protein upregulated major histocompatibility complex class II expression in peritoneal macrophages. The antiviral activity of rgpIFN-γ was demonstrated with a guinea pig fibroblast cell line (104C1) infected with encephalomyocarditis virus. Interestingly, peritoneal macrophages treated with rgpIFN-γ did not produce any nitric oxide but did produce hydrogen peroxide and suppressed the intracellular growth of mycobacteria. Furthermore, rgpIFN-γ induced morphological alterations in cultured macrophages. Thus, biologically active rgpIFN-γ has been successfully produced and characterized in our laboratory. The study of rgpIFN-γ will further increase our understanding of the cellular and molecular responses induced by BCG vaccination in the guinea pig model of pulmonary tuberculosis

Responsive and Equitable Health Systems-Partnership on Non-Communicable Diseases (RESPOND) study: a mixed-methods, longitudinal, observational study on treatment seeking for hypertension in Malaysia and the Philippines.

INTRODUCTION: Hypertension is a leading contributor to the global burden of disease. While safe and effective treatment exists, blood pressure control is poor in many countries, often reflecting barriers at the levels of health systems and services as well as at the broader level of patients' sociocultural contexts. This study examines how these interact to facilitate or hinder hypertension control, taking into account characteristics of service provision components and social contexts. METHODS AND ANALYSIS: The study, set in Malaysia and the Philippines, builds on two systematic reviews of barriers to effective hypertension management. People with hypertension (pre-existing and newly diagnosed) will be identified in poor households in 24-30 communities per country. Quantitative and qualitative methods will be used to examine their experiences of and pathways into seeking and obtaining care. These include two waves of household surveys of 20-25 participants per community 12-18 months apart, microcosting exercises to assess the cost of illness (including costs due to health seeking activities and inability to work (5 per community)), preliminary and follow-up in-depth interviews and digital diaries with hypertensive adults over the course of a year (40 per country, employing an innovative mobile phone technology), focus group discussions with study participants and structured assessments of health facilities (including formal and informal providers). ETHICS AND DISSEMINATION: Ethical approval has been granted by the Observational Research Ethics Committee at the London School of Hygiene and Tropical Medicine and the Research Ethics Boards at the Universiti Putra Malaysia and the University of the Philippines Manila. The project team will disseminate findings and engage with a wide range of stakeholders to promote uptake and impact. Alongside publications in high-impact journals, dissemination activities include a comprehensive stakeholder analysis, engagement with traditional and social media and 'digital stories' coproduced with research participants

Executive functions and bone health: a focus on cognitive impulsivity and bone mineral density

Background: It is known that cognitive impairment is associated with low bone mineral density (BMD) and that low BMD is also observed in elderly people with neurodegenerative diseases, in which executive functions (EF) could be decreased. A limited number of studies investigated the association between EF with BMD and fracture risk in elderly women. Aims: The aim of this study was to explore the association between cognitive impulsivity, BMD and fall risk in a sample of postmenopausal women evaluated for osteoporosis. Methods: We consecutively recruited women who obtained a score ≥ 24 at the Mini Mental State Examination (MMSE). Cognitive impulsivity was evaluated by the Stroop Colour and Word Test (SCWT). BMD was detected by dual-energy X-ray absorptiometry at lumbar spine and femoral neck. Results: Cognitive impulsivity, as evidenced by the greater number of errors at the SCWT, was significantly related with BMD values at lumbar spine and femoral neck (r= -0.39, p= 0.01 and r= 0.43, p= 0.008; respectively), suggesting a neuropsychological impairment in patients assessed for osteoporosis. Moreover, interference effect on response time was significantly associated with higher prevalence of falls (r= 0.342; p= 0.031). Discussion and Conclusions: Our findings suggested a potential involvement of cognitive impulsivity on BMD and risk of fall. This is a relevant issue in clinical practice for both clinical psychologists and physicians who evaluate postmenopausal women, to eventually predict risk of fracture