The epidemiology of skin cancer and public health strategies for its prevention in Southern Africa

Skin cancer is a non-communicable disease that has been underexplored in Africa, including Southern Africa. Exposure to solar ultraviolet radiation (UVR) is an important, potentially modifiable risk factor for skin cancer. The countries which comprise Southern Africa are Botswana, Lesotho, Namibia, South Africa, and Swaziland. They di er in population size and composition and experience di erent levels of solar UVR. Here, the epidemiology and prevalence of skin cancer in Southern African countries are outlined. Information is provided on skin cancer prevention campaigns in these countries, and evidence sought to support recommendations for skin cancer prevention, especially for people with fair skin, or oculocutaneous albinism or HIV-AIDS who are at the greatest risk. Consideration is given to the possible impacts of climate change on skin cancer in Southern Africa and the need for adaptation and human behavioural change is emphasized.Table S1: Absence (x) or presence (X) of evidence of online skin cancer prevention campaigns (any focus—could be in relation to albinism) in English by country in Africa. Websites valid as at the 17 December 2019.The South African Medical Research Council and the National Research Foundation (South Africa).http://www.mdpi.com/journal/ijerpham2020Geography, Geoinformatics and Meteorolog

Dwelling characteristics influence indoor temperature and may pose health threats in LMICs

BACKGROUND: Shelter and safe housing is a basic human need that brings about a sense of ownership, selfsufficiency, and citizenship. Millions of people around the world live in inadequate dwellings in unhealthy areas, such as urban slums. These dwellings may experience indoor temperatures that impact inhabitants’ health. Indoor dwelling temperatures vary depending on many factors including geographic location, such as inland versus coastal. In an era of climate change, understanding how dwelling characteristics influence indoor temperature is important, especially in low- and middle-income countries, to protect health. OBJECTIVE: To assess indoor temperature in low-cost dwellings located in a coastal setting in relation to dwelling characteristics. METHODS: Indoor temperature and relative humidity loggers were installed from 1 June 2017 to 15 May 2018 in 50 dwellings in two settlements in a coastal town on the east coast of South Africa. Ambient outdoor temperature data were obtained from the national weather service, indoor temperature data were converted into apparent temperature, and heat index calculations were made to consider possible heat-health risks. A household questionnaire and dwelling observation assessment were administered. A mixed-effects linear regression model was constructed to consider the impact of dwelling characteristics on indoor apparent temperature. FINDINGS: Among 17 dwellings with all data sets, indoor temperatures were consistently higher than, and well correlated (r = 0.92) with outdoor temperatures. Average differences in indoor and outdoor temperatures were about 4°C, with statistically significant differences in percentage difference of indoor/outdoor between seasons (p < 0.001). Heat indices for indoor temperatures were exceeded mostly in summer, thereby posing possible health risks. Dwellings with cement floors were statistically significantly cooler than any other floor type across all seasons. CONCLUSIONS: Low-cost dwellings experienced temperatures indoors higher than outdoor temperatures in part due to floor type. These results help inform interventions that consider housing and human health (n = 289).The South African Medical Research Council (SAMRC), the Nelson Mandela University (NMU) and the National Research Foundation (South Africa).https://www.annalsofglobalhealth.orgpm2020Geography, Geoinformatics and Meteorolog

‘Preventing the next pandemic’ – A 2020 UNEP Frontiers Series Report on zoonotic diseases with reflections for South Africa

Zoonoses account for about 25% of the infectious disease burden in low-income countries. Poverty might increase the risk for zoonotic disease where the active human–livestock and human–wildlife interfaces can increase the likelihood of disease transmission. A combined disease burden exists for people in areas such as tropical and subtropical Africa, where there is likelihood of co-infection with zoonotic diseases and other pathogenic or infectious diseases, such as malaria, tuberculosis and HIV.1 Many endemic zoonoses remain widely neglected in such settings, undetected and underreported, because their impacts are borne largely by impoverished and marginalised communities. Due to these unique contexts, the prevention and management of emerging and endemic zoonotic diseases in many African countries is a complex undertaking needing evidence-based guidance. In early 2020, the United Nations Environment Programme (UNEP) and the International Livestock Research Institute (ILRI) took on the urgent task to provide an up-to-date, rapid scientific assessment on zoonotic diseases as part of the UNEP’s Frontiers Report Series. The goal of the report is to provide relevant information for policymakers on how to ‘prevent the next pandemic’ by interrogating what is known about zoonotic diseases and how best one can break the chain of transmission. As the world presently faces the SARS-CoV-2 pandemic, this timely report helps decisionmakers with evidence-based actions, not only to flatten the curve of COVID-19 incidence, but to answer questions about zoonoses in general and plan for the future. In this Commentary, we give a brief overview of UNEP’s latest report and then relate some of the key messages and recommendations for policymakers to a South African context.http://www.sajs.co.zahj2020Geography, Geoinformatics and MeteorologyMammal Research InstituteZoology and Entomolog

Identifying Treatments for Taste and Smell Disorders: Gaps and Opportunities.

The chemical senses of taste and smell play a vital role in conveying information about ourselves and our environment. Tastes and smells can warn against danger and also contribute to the daily enjoyment of food, friends and family, and our surroundings. Over 12% of the US population is estimated to experience taste and smell (chemosensory) dysfunction. Yet, despite this high prevalence, long-term, effective treatments for these disorders have been largely elusive. Clinical successes in other sensory systems, including hearing and vision, have led to new hope for developments in the treatment of chemosensory disorders. To accelerate cures, we convened the Identifying Treatments for Taste and Smell Disorders conference, bringing together basic and translational sensory scientists, health care professionals, and patients to identify gaps in our current understanding of chemosensory dysfunction and next steps in a broad-based research strategy. Their suggestions for high-yield next steps were focused in 3 areas: increasing awareness and research capacity (e.g., patient advocacy), developing and enhancing clinical measures of taste and smell, and supporting new avenues of research into cellular and therapeutic approaches (e.g., developing human chemosensory cell lines, stem cells, and gene therapy approaches). These long-term strategies led to specific suggestions for immediate research priorities that focus on expanding our understanding of specific responses of chemosensory cells and developing valuable assays to identify and document cell development, regeneration, and function. Addressing these high-priority areas should accelerate the development of novel and effective treatments for taste and smell disorders

Decoding human fetal liver haematopoiesis.

Definitive haematopoiesis in the fetal liver supports self-renewal and differentiation of haematopoietic stem cells and multipotent progenitors (HSC/MPPs) but remains poorly defined in humans. Here, using single-cell transcriptome profiling of approximately 140,000 liver and 74,000 skin, kidney and yolk sac cells, we identify the repertoire of human blood and immune cells during development. We infer differentiation trajectories from HSC/MPPs and evaluate the influence of the tissue microenvironment on blood and immune cell development. We reveal physiological erythropoiesis in fetal skin and the presence of mast cells, natural killer and innate lymphoid cell precursors in the yolk sac. We demonstrate a shift in the haemopoietic composition of fetal liver during gestation away from being predominantly erythroid, accompanied by a parallel change in differentiation potential of HSC/MPPs, which we functionally validate. Our integrated map of fetal liver haematopoiesis provides a blueprint for the study of paediatric blood and immune disorders, and a reference for harnessing the therapeutic potential of HSC/MPPs.We acknowledge funding from the Wellcome Human Cell Atlas Strategic Science Support (WT211276/Z/18/Z); M.H. is funded by Wellcome (WT107931/Z/15/Z), The Lister Institute for Preventive Medicine and NIHR and Newcastle-Biomedical Research Centre; S.A.T. is funded by Wellcome (WT206194), ERC Consolidator and EU MRG-Grammar awards and; S.B. is funded by Wellcome (WT110104/Z/15/Z) and St. Baldrick’s Foundation; E.L. is funded by a Wellcome Sir Henry Dale and Royal Society Fellowships, European Haematology Association, Wellcome and MRC to the Wellcome-MRC Cambridge Stem Cell Institute and BBSRC

Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome : Insights from the LUNG SAFE study

Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073publishersversionPeer reviewe

Genomic investigations of unexplained acute hepatitis in children

Since its first identification in Scotland, over 1,000 cases of unexplained paediatric hepatitis in children have been reported worldwide, including 278 cases in the UK1. Here we report an investigation of 38 cases, 66 age-matched immunocompetent controls and 21 immunocompromised comparator participants, using a combination of genomic, transcriptomic, proteomic and immunohistochemical methods. We detected high levels of adeno-associated virus 2 (AAV2) DNA in the liver, blood, plasma or stool from 27 of 28 cases. We found low levels of adenovirus (HAdV) and human herpesvirus 6B (HHV-6B) in 23 of 31 and 16 of 23, respectively, of the cases tested. By contrast, AAV2 was infrequently detected and at low titre in the blood or the liver from control children with HAdV, even when profoundly immunosuppressed. AAV2, HAdV and HHV-6 phylogeny excluded the emergence of novel strains in cases. Histological analyses of explanted livers showed enrichment for T cells and B lineage cells. Proteomic comparison of liver tissue from cases and healthy controls identified increased expression of HLA class 2, immunoglobulin variable regions and complement proteins. HAdV and AAV2 proteins were not detected in the livers. Instead, we identified AAV2 DNA complexes reflecting both HAdV-mediated and HHV-6B-mediated replication. We hypothesize that high levels of abnormal AAV2 replication products aided by HAdV and, in severe cases, HHV-6B may have triggered immune-mediated hepatic disease in genetically and immunologically predisposed children

Statement on air pollution and health

Clean air is vital to life. Suffering and death from polluted air are avoidable. Immediate, necessary action will prevent air pollution and its staggering toll on life and the fiscus.https://www.sajs.co.zaGeography, Geoinformatics and Meteorolog

A global statement for air pollution and health

Air pollution poses a major threat to human health. It is estimated that 91% of the world’s people live in places that did not meet the air quality guidelines of the World Health Organization (WHO, 2019a). Exposure to air pollution is well-established to be associated with adverse health effects, including respiratory conditions, either exacerbating existing diseases or increasing susceptibility to respiratory and other infections (WHO, 2019b). Currently many areas in South Africa exceed National Ambient Air Quality Standards. Priority Areas of air pollution hotspots are being managed to try to improve air quality (SA DEA, 2019).http://www.cleanairjournal.org.zaam2020Geography, Geoinformatics and Meteorolog