‘The mercurial piece of the puzzle’: Understanding stigma and HIV/AIDS in South Africa

Although stigma and its relationship to health and disease is not a new phenomenon, it has not been a major feature in the public discourse until the emergence of HIV. The range of negative responses associated with the epidemic placed stigma on the public agenda and drew attention to its complexity as a phenomenon and concept worthy of further investigation. Despite the consensus that stigma is one of the major contributors to the rapid spread of HIV and the frequent use of the term in the media and among people in the street, the exact meaning of ‘stigma’ remains ambiguous. The aim of this paper is to briefly re-visit some of the scholarly deliberations and further interrogate their relevance in explaining HIV-related stigma evidenced in South Africa. In conclusion a model is presented. Its usefulness – or explanatory potential – is that it attempts to provide a comprehensive framework that offers insights into the individual as well as the social/structural components of HIV-related stigma in a particular context. As such, it has the potential to provide more nuanced understandings as well as to alert us to knowledge-gaps in the process.Keywords: stigma, HIV/AIDS, South Afric

The present and future role of community pharmacy in South Africa

A thesis submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa, in fulfilment of the requirements for the Degree of Doctor of Philosophy. This thesis is presented as a series of manuscripts. 1997The recent political transformation which has taken place in South Africa has set the scene for a metamorphosis of thinking paradigms and structures, in society in general, and in the health arena in particular One of the main shifts has been the growing emphasis on Primary Health Care and its implementation, a move which has necessitated a reevaluation of the roles which the various health professions fulfil within this framework. The need for new types of solutions to respond to peoples’ health needs, along with the poor fit between research and the knowledge required to improve the situation, has contributed to the movement now referred to widely as the “New Public Health”.IT201

Real-time analysis of endogenous Wnt signalling in 3D mesenchymal stromal cells

Wnt signalling has been implicated in the regulation of stem cell self-renewal and differentiation; however, the majority of in vitro studies are carried out using monolayer 2D culture techniques. Here, we used mesenchymal stromal cell (MSC) EGFP reporter lines responsive to Wnt pathway activation in a 3D spheroid culture system to mimic better the in vivo environment. Endogenous Wnt signalling was then investigated under basal conditions and when MSCs were induced to undergo osteogenic and adipogenic differentiation. Interestingly, endogenous Wnt signalling was only active during 3D differentiation whereas 2D cultures showed no EGFP expression throughout an extended differentiation time-course. Furthermore, exogenous Wnt signalling in 3D adipogenic conditions inhibited differentiation compared to unstimulated controls. In addition, suppressing Wnt signalling by Dkk-1 restored and facilitated adipogenic differentiation in MSC spheroids. Our findings indicate that endogenous Wnt signalling is active and can be tracked in 3D MSC cultures where it may act as a molecular switch in adipogenesis. The identification of the signalling pathways that regulate MSCs in a 3D in vivo-like environment will advance our understanding of the molecular mechanisms that control MSC fate

Time‐trends in rates of hospital admission of adolescents for violent, self‐inflicted or drug/alcohol‐related injury in England and Scotland, 2005‐2011:Population‐based analysis

Background: Incidence of emergency admissions for violent injury in 10- to 18-year olds decreased in England and Scotland between 2005 and 2011, but more steeply in Scotland. To generate hypotheses about causes of these differences, we determined whether trends were consistent across admissions for three common types of adversity-related injury (violent, self-inflicted and drug/alcohol-related). / Methods: Emergency admissions to NHS hospitals were captured using Hospital Episode Statistics and Scottish Morbidity Records. Adversity-related injury was defined using ICD-10 codes. Analyses were stratified by sex/age groups (10-12, 13-15 and 16-18 years) and adjusted for background trends in admissions for injury. / Results: During 2005-2011, rates declined in all sex/age groups in Scotland (reductions adjusted for background trends ranged from -22.0 to -103.7/100 000) and in girls and boys aged <16 years in England (adjusted reductions -12.0 to -49.9/100 000). However, these rates increased in England for both sexes aged 16-18 years (adjusted increases, girls 71.8/100 000; boys 28.0/100 000). However, throughout 2005-11 overall rates remained relatively similar in England and Scotland for both sexes aged <16 years, and remained higher in Scotland for both sexes aged 16-18 years. / Conclusions: A greater decline in the rates of emergency admissions for adversity-related injury for adolescents in Scotland compared with England could signal more effective policies in Scotland for reducing violence, self-harm, drug/alcohol misuse

Identifying adverse childhood experiences with electronic health records of linked mothers and children in England: a multistage development and validation study

BACKGROUND: Electronic health records (EHRs) of mothers and children provide an opportunity to identify adverse childhood experiences (ACEs) during crucial periods of childhood development, yet well developed indicators of ACEs remain scarce. We aimed to develop clinically relevant indicators of ACEs for linked EHRs of mothers and children using a multistage prediction model of child maltreatment and maternal intimate partner violence (IPV). METHODS: In this multistage development and validation study, we developed a representative population-based birth cohort of mothers and children in England, followed from up to 2 years before birth to up to 5 years after birth across the Clinical Practice Research Datalink (CPRD) GOLD (primary care), Hospital Episode Statistics (secondary care), and the Office for National Statistics mortality register. We included livebirths in England between July 1, 2004, and June 30, 2016, to mothers aged 16-55 years, who had registered with a general practitioner (GP) that met CPRD quality standards before 21 weeks of gestation. The primary outcome (reference standard) was any child maltreatment or maternal IPV in either the mother's or child's record from 2 years before birth (maternal IPV only) to 5 years after birth. We used seven prediction models, combined with expert ratings, to systematically develop indicators. We validated the final indicators by integrating results from machine learning models, survival analyses, and clustering analyses in the validation cohort. FINDINGS: We included data collected between July 1, 2002, and June 27, 2018. Of 376 006 eligible births, we included 211 393 mother-child pairs (422 786 patients) from 400 practices, of whom 126 837 mother-child pairs (60·0%; 240 practices) were randomly assigned to a derivation cohort and 84 556 pairs (40·0%; 160 practices) to a validation cohort. We included 63 indicators in six ACE domains: maternal mental health problems, maternal substance misuse, adverse family environments, child maltreatment, maternal IPV, and high-risk presentations of child maltreatment. Excluding the seven indicators in the reference standard, 56 indicators showed high discriminative validity for the reference standard of any child maltreatment or maternal IPV between 2 years before and 5 years after birth (validation cohort, area under the receiver operating characteristic curve 0·85 [95% CI 0·84-0·86]). During the 2 years before birth and 5 years after birth, the overall period prevalence of maternal IPV and child maltreatment (reference standard) was 2·3% (2876 of 126 837 pairs) in the derivation cohort and 2·3% (1916 of 84 556 pairs) in the validation cohort. During the 2 years before and after birth, the period prevalence was 39·1% (95% CI 38·7-39·5; 34 773 pairs) for any of the 63 ACE indicators, 22·2% (21·8-22·5%; 20 122 pairs) for maternal mental health problems, 15·7% (15·4-16·0%; 14 549 pairs) for adverse family environments, 8·1% (7·8-8·3%; 6808 pairs) for high-risk presentations of child maltreatment, 6·9% (6·7-7·2%; 7856 pairs) for maternal substance misuse, and 3·0% (2·9-3·2%; 2540 pairs) for any child maltreatment (2·4% [2·3-5·6%; 2051 pairs]) and maternal IPV (1·0% [0·8-1·0%; 875 pairs]). 62·6% (21 785 of 34 773 pairs) of ACEs were recorded in primary care only, and 72·3% (25 140 cases) were recorded in the maternal record only. INTERPRETATION: We developed clinically relevant indicators for identifying ACEs using the EHRs of mothers and children presenting to general practices and hospital admissions. Over 70% of ACEs were identified via maternal records and were recorded in primary care by GPs within 2 years of birth, reinforcing the importance of reviewing parental and carer records to inform clinical responses to children. ACE indicators can contribute to longitudinal surveillance informing public health policy and resource allocation. Further evaluation is required to determine how ACE indicators can be used in clinical practice. FUNDING: None

Prospectus, October 7, 2004

https://spark.parkland.edu/prospectus_2004/1022/thumbnail.jp

Impact of perinatal asphyxia on parental mental health and bonding with the infant: a questionnaire survey of Swiss parents

Objective To compare current mental health symptoms and infant bonding in parents whose infants survived perinatal asphyxia in the last 2 years with control parents and to investigate which sociodemographic, obstetric and neonatal variables correlated with parental mental health and infant bonding in the asphyxia group. Design Cross-sectional questionnaire survey of parents whose children were registered in the Swiss national Asphyxia and Cooling register and of control parents (Post-traumatic Diagnostic Scale, Hospital Anxiety and Depression Scale, Mother-to-Infant Bonding Scale). Results The response rate for the asphyxia group was 46.5%. Compared with controls, mothers and fathers in the asphyxia group had a higher frequency of post-traumatic stress disorder (PTSD) symptoms (p&lt;0.001). More mothers (n=28, 56%) had a symptom diagnosis of either full or partial PTSD than controls (n=54, 39%) (p=0.032). Similarly, more fathers (n=31, 51%) had a symptom diagnosis of either partial or full PTSD than controls (n=19, 33%) (p=0.034). Mothers reported poorer bonding with the infant (p=0.043) than controls. Having a trauma in the past was linked to more psychological distress in mothers (r=0.31 (95% CI 0.04 to 0.54)) and fathers (r=0.35 (95% CI 0.05 to 0.59)). For mothers, previous pregnancy was linked to poorer bonding (r=0.41 (95% CI 0.13 to 0.63)). In fathers, therapeutic hypothermia of the infant was related to less frequent PTSD symptoms (r=−0.37 (95% CI −0.61 to −0.06)) and past psychological difficulties (r=0.37 (95% CI 0.07 to 0.60)) to more psychological distress. A lower Apgar score was linked to poorer bonding (r=−0.38 (95% CI −0.64 to −0.05)). Conclusions Parents of infants hospitalised for perinatal asphyxia are more at risk of developing PTSD than control parents

Long-Term Crop Rotation Diversification Enhances Maize Drought Resistance Through Soil Organic Matter

Climate change adaptation requires building agricultural system resilience to warmer, drier climates. Increasing temporal plant diversity through crop rotation diversification increases yields of some crops under drought, but its potential to enhance crop drought resistance and the underlying mechanisms remain unclear. We conducted a drought manipulation experiment using rainout shelters embedded within a 36-year crop rotation diversity and no-till experiment in a temperate climate and measured a suite of soil and crop developmental and eco-physiological traits in the field and laboratory. We show that diversifying maize-soybean rotations with small grain cereals and cover crops mitigated maize water stress at the leaf and canopy scales and reduced yield losses to drought by 17.1 ± 6.1%, while no-till did not affect maize drought resistance. Path analysis showed a strong correlation between soil organic matter and lower maize water stress despite no significant differences in soil organic matter between rotations or tillage treatments. This positive relationship between soil organic matter and maize water status was not mediated by higher soil water retention or infiltration as often hypothesized, nor differential depth of root water uptake as measured with stable isotopes, suggesting that other mechanisms are at play. Crop rotation diversification is an underappreciated drought management tool to adapt crop production to climate change through managing for soil organic matter

Prospectus, October 21, 2004

https://spark.parkland.edu/prospectus_2004/1024/thumbnail.jp