Addressing the intersection between alcohol consumption and antiretroviral treatment : needs assessment and design of interventions for primary healthcare workers, the Western Cape, South Africa

Background: At the points where an infectious disease and risk factors for poor health intersect, while health problems may be compounded, there is also an opportunity to provide health services. Where human immunodeficiency virus (HIV) infection and alcohol consumption intersect include infection with HIV, onward transmission of HIV, impact on HIV and acquired immunodeficiency syndrome (AIDS) disease progression, and premature death. The levels of knowledge and attitudes relating to the health and treatment outcomes of HIV and AIDS and the concurrent consumption of alcohol need to be determined. This study aimed to ascertain the knowledge, attitudes and practices of primary healthcare workers concerning the concurrent consumption of alcohol of clinic attendees who are prescribed antiretroviral drugs. An assessment of the exchange of information on the subject between clinic attendees and primary healthcare providers forms an important aspect of the research. A further objective of this study is an assessment of the level of alcohol consumption of people living with HIV and AIDS attending public health facilities in the Western Cape Province in South Africa, to which end, the study reviewed health workers' perceptions of the problem's extent. A final objective is to contribute to the development of evidence-based guidelines for AIDS patients who consume alcohol when on ARVs. The overall study purpose is to optimise antiretroviral health outcomes for all people living with HIV and AIDS, but with specific reference to the clinic attendees studied in this research. Methods: Overall the research study utilised mixed methods. Three group-specific questionnaires were administered between September 2013 and May 2014. The resulting qualitative data presented here supplements the results of the quantitative data questionnaires for HIV and AIDS clinic attendees, which have been analysed and written up separately. This arm of the research study comprised two, separate, semi-structured sets of interviews: one face-to-face with healthcare workers at the same primary healthcare clinics from which the clinic attendees were sampled, and the other with administrators from the local government health service via email. The qualitative analysis from the primary healthcare worker interviews has been analysed using thematic content analysis. Results: The key capacity gaps for nurses include the definition of different patterns and volumes of alcohol consumption, resultant health outcomes and how to answer patient questions on alcohol consumption while on antiretroviral treatment. Not only did the counsellors lack knowledge regarding alcohol abuse and its treatment, but they were also they were unclear on their role and rights in relation to their patients. Doctors highlighted the need for additional training for clinicians in diagnosing alcohol use disorders and information on the pharmacological interventions to treat alcoholism. Conclusion: Pertinent knowledge regarding patient alcohol consumption while taking ARVs needs to be disseminated to primary healthcare workers

Pressure Induced Charge Disproportionation in LaMnO3_{3}

We present a total energy study as a function of volume in the cubic phase of LaMnO$_{3}$. A charge disproportionated state into planes of Mn$^{3+}$O$_{2}$/Mn$^{4+}$O$_{2}$ was found. It is argued that the pressure driven localisation/delocalisation transition might go smoothly through a region of Mn$^{3+}$ and Mn$^{4+}$ coexistence.Comment: 3 pages, 1 figure, Conference Proceedings: Nanospintronics: Design and Realization (Kyoto, Japan 24-28 May, 2004

Burden of fetal alcohol syndrome in a rural West Coast area of South Africa

Background. Fetal alcohol syndrome (FAS) is common in parts of South Africa; rural residence is a frequently cited risk factor. We conducted a FAS school prevalence survey of an isolated rural community in a West Coast village of Western Cape Province, so obtaining the first directly measured rate, focusing specifically on a South African rural area, of FAS and partial FAS (PFAS). Methods. The study area (Aurora village), a community of about 2 500 people in a grain-producing region, has one primary school. All learners were eligible for study inclusion. Initial anthropometry screening was followed by a diagnostic stage entailing examination by a dysmorphologist for features of FAS, neurodevelopmental assessment, and an interview assessing maternal alcohol consumption. Results. Of 160 learners screened, 78 (49%) were screen-positive, of whom 63 (81%) were clinically assessed for FAS. The overall FAS/PFAS rate among the screened learners was 17.5% (95% confidence interval 12.0 - 24.2%), with 16 (10.0%) children having FAS and 12 (7.5%) PFAS. High rates of stunting, underweight and microcephaly were noted in all learners, especially those with FAS or PFAS. Five (18%) mothers of affected children were deceased by the time of assessment. Conclusion. We describe very high rates of FAS/PFAS in an isolated rural part of the Western Cape that is not located in a viticultural region. Our study suggests that the prevalence of FA S may be very high in isolated communities, or in particular hot-spots. It adds to the growing evidence that FAS/PFAS is a significant, and underestimated, health problem in South Africa. Expanded screening and surveillance programmes, and preventive interventions, are urgently needed

Comment on "Systematics of the Induced Magnetic Moments in 5d Layers and the Violation of the Third Hund's Rule"

Comment on F. Wilhelm et al., Phys. Rev. Lett. 87, 207202 (2001)Comment: 1 pag

Microstructural modifications in tungsten induced by high flux plasma exposure : TEM examination

We have performed microstructural characterization using transmission electron microscopy (TEM) techniques to reveal nanometric features in the sub-surface region of tungsten samples exposed to high flux, low energy deuterium plasma. TEM examination revealed formation of a dense dislocation network and dislocation tangles, overall resulting in a strong increase in the dislocation density by at least one order of magnitude as compared to the initial one. Plasma-induced dislocation microstructure vanishes beyond a depth of about 10 mu m from the top of the exposed surface where the dislocation density and its morphology becomes comparable to the reference microstructure. Interstitial edge dislocation loops with Burgers vector a(0)/2 and a(0) were regularly observed within 6 mu m of the sub-surface region of the exposed samples, but absent in the reference material. The presence of these loops points to a co-existence of nanometric D bubbles, growing by loop punching mechanism, and sub-micron deuterium flakes, resulting in the formation of surface blisters, also observed here by scanning electron microscopy

Male partners' involvement in prevention of mother-to-child HIV transmission in sub-Saharan Africa : a systematic review

In sub-Saharan Africa (SSA), male partners are rarely present during prevention of mother-to-child transmission (PMTCT) services. This systematic review aims to synthesize, from a male perspective, male partners' perceived roles, barriers and enablers of their involvement in PMTCT, and highlights persisting gaps. We carried out a systematic search of papers published between 2002 and 2013 in English on Google Scholar and PubMed using the following terms: men, male partners, husbands, couples, involvement, participation, Antenatal Care (ANC), PMTCT, SSA countries, HIV Voluntary Counseling and Testing and disclosure. A total of 28 qualitative and quantitative original studies from 10 SSA countries were included. Men's perceived role was addressed in 28% (8/28) of the studies. Their role to provide money for ANC/PMTCT fees was stated in 62.5% (5/8) of the studies. For other men, the financial responsibilities seemed to be used as an excuse for not participating. Barriers were cited in 85.7% (24/28) of the studies and included socioeconomic factors, gender role, cultural beliefs, male unfriendly ANC/PMTCT services and providers' abusive attitudes toward men. About 64% (18/28) of the studies reported enablers such as: older age, higher education, being employed, trustful monogamous marriages and providers' politeness. In conclusion, comprehensive PMTCT policies that are socially and culturally sensitive to both women and men need to be developed

Testate amoebae as proxy for water level changes in a brackish tidal marsh

Few studies have examined testate amoebae assemblages of estuarine tidal marshes. This study investigates the possibility of using soil testate amoebae assemblages of a brackish tidal marsh (Scheldt estuary, Belgium) as a proxy for water level changes. On the marsh surface an elevation gradient is sampled to be analyzed for testate amoebae assemblages and sediment characteristics. Further, vegetation, flooding frequency and soil conductivity have been taken into account to explain the testate amoebae species variation. The data reveal that testate amoebae are not able to establish assemblages at the brackish tidal marsh part with flooding frequencies equal to or higher than 36.5%. Further, two separate testate amoebae zones are distinguished based on cluster analysis. The lower zone’s testate amoebae species composition is influenced by the flooding frequency (~ elevation) and particle size, while the species variability in the higher zone is related to the organic content of the soil and particle size. These observations suggest that the ecological meaning of elevation shifts over its range on the brackish tidal marsh. Testate amoeba assemblages in such a brackish habitat show thus a vertical zonation (RMSEP: 0.19 m) that is comparable to the vertical zonation of testate amoebae and other protists on freshwater tidal marshes and salt marshes