Factors associated with retreatment tuberculosis in Tshwane, South Africa : the role of tobacco smoking

There is evidence from international studies that tobacco smoking increases the risk of tuberculosis recurrence through its effects on the immunological and barrier functions of the airways. In this cross-sectional study, the association between current tobacco smoking and retreatment tuberculosis was studied in a population of 1 926 South African tuberculosis patients with high human immunodeficiency virus (HIV) co-infection rates. Retreatment tuberculosis was more common in male and among HIV-positive participants currently on antiretroviral treatment, or with unknown antiretroviral treatment status. However, we did not find an association between smoking and retreatment tuberculosis. A longitudinal study is needed to confirm these findings.http://www.sajei.co.za/index.php/SAJEIhb201

Predictors of tobacco smoking abstinence among tuberculosis patients in South Africa

This study examines predictors of smoking cessation in tuberculosis patients with high HIV co-infection rates in a South African primary care setting. Current smokers were randomly allocated to brief motivational interviewing (n = 205) or receipt of a brief message (n = 204). Multi-level logistic regression was performed to identify predictors of sustained 3- and 6-month abstinence and 7-day point prevalence abstinence (PPA) at 1 month, with the facility as a random effect. The intervention was ineffective among smokers with high nicotine-dependence at 1 month, but was effective for all smokers over longer periods. Higher baseline self-efficacy predicted the 1-month 7-day PPA, but not sustained abstinence. HIV-positive participants' odds of sustained abstinence were about three times higher than those of their HIV-negative counterparts. Results support a more intensive motivational intervention and/or coping skills' training to increase self-efficacy and abstinence rates. Tobacco cessation services can be introduced in tuberculosis services where high HIV co-infection rates occur.The KNCV Tuberculosis Foundation (Grant 12.402.2/MvdW/U.10.0696/cal), Global Bridges Health Care Alliance for Tobacco Dependence Treatment and the National Research Foundation of South Africa (Grant# 80843).http://link.springer.com/journal/108652016-06-30hb201

Tobacco use patterns in tuberculosis patients with high rates of human immunodeficiency virus co-infection in South Africa

BACKGROUND: Tuberculosis (TB) patients who smoke tobacco are at an increased risk for adverse TB treatment outcomes. This study describes tobacco use patterns among newly diagnosed TB patients, their readiness to quit, and their beliefs about tobacco-related health effects in a high HIV-burden setting in South Africa. Socio-economic and demographic factors associated with smoking were also determined. METHODS: This was a cross-sectional analysis of baseline data collected for a smoking cessation study at six large tuberculosis clinics in a South African township (N = 1926). We collected information on current and past tobacco use, socio-economic and demographic status, beliefs regarding the harmful effects of smoking and quit behaviour, and motivation, using structured interviewer-administered questionnaires. TB- and HIV-related information was obtained from patient records. Data analysis entailed descriptive statistics, followed by multivariate logistic regression with backward elimination, adjusted for clustering by facility. RESULTS: Just over one fifth of respondents (21.8%, 420/1924) reported currently smoking tobacco (males 37.6%, females 4.6%). By contrast, only 1.8% (35/1918) of all respondents reported being past smokers. Of the current smokers, about half (51.8%, 211/407) had previously attempted to quit, mainly for health reasons. The majority of respondents (89.3%, 1675/1875) believed tobacco smoking was harmful for their health and smokers were highly motivated to quit (median score 9, interquartile range 7–10). Smoking was less common among female respondents (Odds Ratio [OR] 0.10, 95% Confidence Interval [CI] 0.06-0.19) and respondents who had completed high school (OR 0.57, 95% CI 0.39-0.84), but was more common among respondents who do occasional work (OR 2.82, 95% CI 1.58-5.02), respondents who to bed hungry regularly (OR 4.19, 95% CI 2.42-7.25), those who have an alcohol problem (OR 5.79, 95% CI 3.24-10.34) and those who use illicit substances (OR 10.81, 95% CI 4.62-25.3). CONCLUSIONS: Despite documented evidence of its harmful effects, smoking is prevalent among male TB patients in this high HIV-prevalence population. Few patients have managed to quit smoking on their own. However, patients are highly motivated to stop smoking. We recommend implementing and evaluating a smoking cessation programme in tandem with TB services.The KNCV Tuberculosis Foundation (Grant 12.402.2/MvdW/U.10.0696/cal), the Global Bridges Health Care Alliance for Tobacco Dependence Treatment and the National Research Foundation of South Africahttp://www.biomedcentral.com/1471-2458/13/1031am201

Effects of fetal position on the loading of the fetal brain during the onset of the second stage of labour

During vaginal labour, the delivery requires the fetal head to mould to accommodate the geometric constraints of the birth canal. Excessive moulding can produce brain injuries and long-term sequelae. Understanding the loading of the fetal brain during the second stage of labour (fully dilated cervix, active pushing, and expulsion of fetus) could thus help predict the safety of the newborn during vaginal delivery. To this end, this study proposes a finite element model of the fetal head and maternal canal environment that is capable of predicting the stresses experienced by the fetal brain at the onset of the second phase of labour. Both fetal and maternal models were adapted from existing studies to represent the geometry of full-term pregnancy. Two fetal positions were compared: left-occiput-anterior and left-occiput-posterior. The results demonstrate that left-occiput-anterior position reduces the maternal tissue deformation, at the cost of higher stress in the fetal brain. In both cases, stress is concentrated underneath the sutures, though the location varies depending on the presentation. In summary, this study provides a patient-specific simulation platform for the study of vaginal labour and its effect on both the fetal brain and maternal anatomy. Finally, it is suggested that such an approach has the potential to be used by obstetricians to support their decision-making processes through the simulation of various delivery scenarios

Efficacy of brief motivational interviewing on smoking cessation at tuberculosis clinics in Tshwane, South Africa : a randomized controlled trial

BACKGROUND AND AIMS : Tuberculosis (TB) patients who smoke risk adverse TB outcomes and other long-term health effects of smoking. This study aimed to determine the efficacy of brief motivational interviewing by lay health-care workers (LHCWs) in assisting TB patients to quit smoking. DESIGN : Multi-centre two-group parallel individual randomized controlled trial. SETTING : Six primary care tuberculosis clinics in a South African township. PARTICIPANTS : Newly diagnosed adult TB patients identified as current smokers were randomized to brief motivational interviewing by a LHCW (intervention group, n = 205) or brief smoking cessation advice from a TB nurse (control group, n = 204). MEASUREMENTS : The primary outcome was self-reported sustained 6-month smoking abstinence. Exhaled carbon monoxide (CO) testing was offered to about half the participants. Secondary outcomes were sustained abstinence at 3 months; 7-day point prevalence abstinence at 1, 3 and 6 months; and quit attempts. Allocation was concealed. Primary analysis relied on intention to treat. Multi-level analysis accounted for site heterogeneity of effect. FINDINGS : Self-reported 6-month sustained abstinence was 21.5% for the intervention group versus 9.3% for the control group [relative risk (RR) = 2.29, 95% confidence interval (CI) = 1.34, 3.92]. Biochemically verified 6-month sustained abstinence was also higher in the intervention group (RR 2.21, 95% CI = 1.08, 4.51) for the 166 participants who were offered carbon monoxide testing. Self-reported 3-month sustained abstinence was 25.4% for the intervention group and 12.8% for the control group (RR = 1.98, 95% CI = 1.24, 3.18). CONCLUSIONS : Motivational interviewing by lay counsellors to promote smoking cessation in tuberculosis patients in South Africa approximately doubled sustained smoking abstinence for at least 6 months compared with brief advice alone.KNCV Tuberculosis Foundation (grant 12.402.2/MvdW/U.10.0696/cal), Global Bridges Health Care Alliance for Tobacco Dependence Treatment and the National Research Foundation of South Africa (grant no. 80843).http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1360-0443hb201

Land in balance: the scientific conceptual framework for land degradation neutrality

The health and productivity of global land resources are declining, while demand for those resources is increasing. The aim of land degradation neutrality (LDN) is to maintain or enhance land-based natural capital and its associated ecosystem services. The Scientific Conceptual Framework for Land Degradation Neutrality has been developed to provide a scientific approach to planning, implementing and monitoring LDN. The Science-Policy Interface of the United Nations Convention to Combat Desertification (UNCCD) led the development of the conceptual framework, drawing in expertise from a diverse range of disciplines. The LDN conceptual framework focuses on the supporting processes required to deliver LDN, including biophysical and socio-economic aspects, and their interactions. Neutrality implies no net loss of the land-based natural capital relative to a reference state, or baseline. Planning for neutrality involves projecting the likely cumulative impacts of land use and land management decisions, then counterbalancing anticipated losses with measures to achieve equivalent gains. Counterbalancing should occur only within individual land types, distinguished by land potential, to ensure “like for like” exchanges. Actions to achieve LDN include sustainable land management (SLM) practices that avoid or reduce degradation, coupled with efforts to reverse degradation through restoration or rehabilitation of degraded land. The response hierarchy of Avoid > Reduce > Reverse land degradation articulates the priorities in planning LDN interventions. The implementation of LDN is managed at the landscape level through integrated land use planning, while achievement is assessed at national level. Monitoring LDN status involves quantifying the balance between the area of gains (significant positive changes in LDN indicators) and area of losses (significant negative changes in LDN indicators), within each land type across the landscape. The LDN indicators (and associated metrics) are land cover (physical land cover class), land productivity (net primary productivity, NPP) and carbon stocks (soil organic carbon (SOC) stocks). The LDN conceptual framework comprises five modules: A: Vision of LDN describes the intended outcome of LDN; B: Frame of Reference clarifies the LDN baseline; C: Mechanism for Neutrality explains the counterbalancing mechanism; D: Achieving Neutrality presents the theory of change (logic model) articulating the impact pathway; and E: Monitoring Neutrality presents the LDN indicators. Principles that govern application of the framework provide flexibility while reducing risk of unintended outcomes.Annette L. Cowie, Barron J. Orr, Victor M. Castillo Sanchez, Pamela Chasek, Neville D. Crossman, Alexander Erlewein, Geertrui Louwagie, Martine Maron, Graciela I. Metternicht, Sara Minelli, Anna E. Tengberg, Sven Walter, Shelley Welto

An investigation of factors associated with the health and well-being of HIV-infected or HIV-affected older people in rural South Africa

BackgroundDespite the severe impact of HIV in sub-Saharan Africa, the health of older people aged 50+ is often overlooked owing to the dearth of data on the direct and indirect effects of HIV on older people's health status and well-being. The aim of this study was to examine correlates of health and well-being of HIV-infected older people relative to HIV-affected people in rural South Africa, defined as participants with an HIV-infected or death of an adult child due to HIV-related cause. MethodsData were collected within the Africa Centre surveillance area using instruments adapted from the World Health Organization (WHO) Study on global AGEing and adult health (SAGE). A stratified random sample of 422 people aged 50+ participated. We compared the health correlates of HIV-infected to HIV-affected participants using ordered logistic regressions. Health status was measured using three instruments: disability index, quality of life and composite health score. ResultsMedian age of the sample was 60 years (range 50-94). Women HIV-infected (aOR 0.15, 95% confidence interval (CI) 0.08-0.29) and HIV-affected (aOR 0.20, 95% CI 0.08-0.50), were significantly less likely than men to be in good functional ability. Women's adjusted odds of being in good overall health state were similarly lower than men's; while income and household wealth status were stronger correlates of quality of life. HIV-infected participants reported better functional ability, quality of life and overall health state than HIV-affected participants. Discussion and Conclusions The enhanced healthcare received as part of anti-retroviral treatment as well as the considerable resources devoted to HIV care appear to benefit the overall well-being of HIV-infected older people; whereas similar resources have not been devoted to the general health needs of HIV uninfected older people. Given increasing numbers of older people, policy and programme interventions are urgently needed to holistically meet the health and well-being needs of older people beyond the HIV-related care system. <br/

Sustainability, certification, and regulation of biochar

Biochar has a relatively long half-life in soil and can fundamentally alter soil properties, processes, and ecosystem services. The prospect of global-scale biochar application to soils highlights the importance of a sophisticated and rigorous certification procedure. The objective of this work was to discuss the concept of integrating biochar properties with environmental and socioeconomic factors, in a sustainable biochar certification procedure that optimizes complementarity and compatibility between these factors over relevant time periods. Biochar effects and behavior should also be modelled at temporal scales similar to its expected functional lifetime in soils. Finally, when existing soil data are insufficient, soil sampling and analysis procedures need to be described as part of a biochar certification procedure.O “biochar” tem um tempo de meia-vida no solo relativamente longo e pode alterar substancialmente as propriedades, processos e funções do solo. A perspectiva da aplicação de “biochar” aos solos, em escala global, evidencia a importância de se lhe atribuir um processo de certificação sofisticado e rigoroso. O objetivo deste trabalho foi discutir o conceito da integração das propriedades do “biochar” com os fatores ambientais e socioeconômicos relevantes do local de aplicação selecionado, como parte de um procedimento de certificação sustentável que otimize a complementaridade e a compatibilidade entre esses fatores, em períodos de tempo relevantes. Os efeitos e o comportamento do “biochar” devem, também, ser modelados em escalas temporais similares às de seu tempo de vida funcional nos solos do local selecionado. Finalmente, onde os dados existentes sobre as características do solo forem insuficientes, procedimentos de amostragem e análise do solo devem ser descritos como parte do procedimento de certificação do “biochar”.publishe

Dual and recombinant infections: an integral part of the HIV-1 epidemic in Brazil.

We systematically evaluated multiple and recombinant infections in an HIV-infected population selected for vaccine trials. Seventy-nine HIV-1 infected persons in a clinical cohort study in Rio de Janeiro, Brazil, were evaluated for 1 year. A combination of molecular screening assays and DNA sequencing showed 3 dual infections (3.8%), 6 recombinant infections (7.6%), and 70 (88.6%) infections involving single viral subtypes. In the three dual infections, we identified HIV-1 subtypes F and B, F and D, and B and D; in contrast, the single and recombinant infections involved only HIV-1 subtypes B and F. The recombinants had five distinct B/F mosaic patterns: Bgag-p17/Bgag-p24/Fpol/Benv, Fgag-p17/Bgag-p24/Fpol/Fenv, Bgag-p17/B-Fgag-p24/Fpol/Fenv, Bgag-p17/B-Fgag-p24/Fpol/Benv, and Fgag-p17/B-Fgag-p24/Fpol/Fenv. No association was found between dual or recombinant infections and demographic or clinical variables. These findings indicate that dual and recombinant infections are emerging as an integral part of the HIV/AIDS epidemic in Brazil and emphasize the heterogenous character of epidemics emerging in countries where multiple viral subtypes coexist