Culturally adaptive storytelling intervention versus didactic intervention to improve hypertension control in Vietnam- 12 month follow up results: A cluster randomized controlled feasibility trial

INTRODUCTION: Vietnam is experiencing an epidemiologic transition with an increased prevalence of non-communicable diseases. The country needs novel, large-scale, and sustainable interventions to improve hypertension control. We report the 12 month follow-up results of a cluster randomized feasibility trial in Hung Yen province, Vietnam, which evaluated the feasibility and acceptability of two community-based interventions to improve hypertension control: a storytelling and a didactic intervention. METHODS: The storytelling intervention included stories in the patients\u27 own words about coping with hypertension and didactic content about the importance of healthy lifestyle behaviors in controlling elevated blood pressure levels. The didactic intervention included only didactic content, which were general recommendations for managing several important risk factors for hypertension and other non-communicable diseases. The storytelling intervention was delivered by two DVDs three months apart; the didactic intervention included only one DVD. The trial was conducted in patients with poorly controlled hypertension from 4 communes (communities), which were equally randomized to the two interventions. RESULTS: The mean age of the 160 patients was 66 years and 54% were men. Between baseline enrollment and the 12 month follow-up, mean systolic blood pressure declined by 10.8 mmHg (95% CI: 6.5-14.9) in the storytelling group and by 5.8 mmHg (95% CI: 1.6-10.0) in the didactic content group. The storytelling group also experienced more improvement in several health behaviors, including increased levels of physical activity and reduced consumption of salt and alcohol. CONCLUSIONS: We observed considerable long-term beneficial effects of both interventions, especially of our storytelling intervention, among patients with inadequately controlled hypertension. A large scale randomized trial should more systematically compare the short and long-term effectiveness of the two interventions in controlling hypertension. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02483780

Culturally adaptive storytelling intervention versus didactic intervention to improve hypertension control in Vietnam: a cluster-randomized controlled feasibility trial

BACKGROUND: Vietnam is experiencing an epidemiologic transition with an increased prevalence of non-communicable diseases. Novel, large-scale, effective, and sustainable interventions to control hypertension in Vietnam are needed. We report the results of a cluster-randomized feasibility trial at 3 months follow-up conducted in Hung Yen province, Vietnam, designed to evaluate the feasibility and acceptability of two community-based interventions to improve hypertension control: a storytelling intervention, We Talk about Our Hypertension, and a didactic intervention. METHODS: The storytelling intervention included stories about strategies for coping with hypertension, with patients speaking in their own words, and didactic content about the importance of healthy lifestyle behaviors including salt reduction and exercise. The didactic intervention included only didactic content. The storytelling intervention was delivered by two DVDs at 3-month intervals; the didactic intervention included only one installment. The trial was conducted in four communes, equally randomized to the two interventions. RESULTS: The mean age of the 160 study patients was 66 years, and 54% were men. Most participants described both interventions as understandable, informative, and motivational. Between baseline and 3 months, mean systolic blood pressure declined by 8.2 mmHg (95% CI 4.1-12.2) in the storytelling group and by 5.5 mmHg (95% CI 1.4-9.5) in the didactic group. The storytelling group also reported a significant increase in hypertension medication adherence. CONCLUSIONS: Both interventions were well accepted in several rural communities and were shown to be potentially effective in lowering blood pressure. A large-scale randomized trial is needed to compare the effectiveness of the two interventions in controlling hypertension. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02483780

Improving the quality of set yoghurt using milk fat globule membrane fragments

Lacprodan PL20, a dairy ingredient that is rich in protein and polar lipids, was added into set yoghurts produced from nonhomogenized raw milk. The set yoghurts were prepared using concentrations of 2%, 4%, and 6% Lacprodan PL20, while the control sample was only supplemented with skim milk powder. The effect of Lacprodan PL20 concentrations on the physical and chemical properties, rheology, and microstructure of set yoghurt was thoroughly investigated to determine some likely improvement or changes in quality. Consequently, Lacprodan PL20 showed a gradual improvement in the set yoghurt nutritive values, water holding capacity, and apparent viscosity. The results indicated that the firmness of set yoghurt was altered which steadily improved the gel strength, especially at 4% and 6% concentrations. The fermentation process was slightly delayed at 4% and 6% concentrations and pH values were raised as Lacprodan PL20 concentration increased. The microstructures of the set yoghurts produced with Lacprodan PL20, as examined by scanning electron microscopy, revealed compacted structures with fewer and smaller holes in the gel matrices. Also, a slight color change was observed in set yoghurt using a colorimeter. These results vividly showed that Lacprodan PL20, an enriched milk fat globule membrane fragment, has the potential to improve set yoghurt quality by reducing some defects associated with set yoghurt, such as low gel strength, low dry solids, and the likes

Activity and Process Stability of Purified Green Pepper (Capsicum annuum) Pectin Methylesterase

Pectin methylesterase (PME) from green bell peppers (Capsicum annuum) was extracted and purified by affinity chromatography on a CNBr-Sepharose-PMEI column. A single protein peak with pectin methylesterase activity was observed. For the pepper PME, a biochemical characterization in terms of molar mass (MM), isoelectric points (pI), and kinetic parameters for activity and thermostability was performed. The optimum pH for PME activity at 22 °C was 7.5, and its optimum temperature at neutral pH was between 52.5 and 55.0 °C. The purified pepper PME required the presence of 0.13 M NaCl for optimum activity. Isothermal inactivation of purified pepper PME in 20 mM Tris buffer (pH 7.5) could be described by a fractional conversion model for lower temperatures (55?57 °C) and a biphasic model for higher temperatures (58?70 °C). The enzyme showed a stable behavior toward high-pressure/temperature treatments. Keywords: Capsicum annuum; pepper; pectin methylesterase; purification; characterization; thermal and high-pressure stabilit

Assessment of the Effectiveness of Ich Tam Khang as a Supportive Therapy for Chronic Heart Failure

Background: Heart failure is a chronic disease needing lifelong management. Despite the advances that have been made in the treatment of the disease, both the longevity and quality of life for those with chronic heart failure remain impaired. A more effective therapeutic approach with less negative side effects is still needed. In this study, we evaluate Ich Tam Khang (ITK), the poly-ingredient herbal and nutritional preparation with multiple physiological actions, as a supportive therapy for patients with chronic heart failure.Aims of Study: To evaluate the effectiveness and safety of Ich Tam Khang as an adjunctive treatment of chronic heart failure.Methods: A total of 60 patients with chronic congestive heart failure were enrolled in this open label, cross-sectional and prospective study. All patients were treated with a conventional regimen (digoxin, diuretics, angiotensin-converting-enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs), beta blockers) for at least 4 weeks before being divided into two equal groups. In the treated patients with ITK, patients received conventional therapy plus 4 tablets ITK per day added in two divided doses. In the control patients, all patients kept the same conventional regimen without ITK. All patients were followed up for 3 months for clinical and para-clinical outcomes.Result: The symptoms of heart failure (dyspnea, palpitation, peripheral edema, neck vein distention, heptojugular reflex) decreased. Heart rate and blood pressure stabilized during treatment in the treated patients with ITK. Additionally, total cholesterol and HDL-cholesterol normalized in the patients treated with ITK. Most of echocardiography parameters in the ITK treated patients were superior to the control patients. ITK is safe and it has no side effects.Conclusion: ITK as a combination of herbal and nutritional preparation is effective in reducing heart failure symptoms, improving patient's quality of life for the patients with decompensated heart failure and reducing total cholesterol and LDL-C

Risk Factors for Non-communicable Diseases in Vietnam: A Focus on Pesticides

Agent Orange, which was sprayed in southern Vietnam by the American government, was the main source of dioxin exposure in Vietnam. From the early 1990s, agriculture of Vietnam has attained advances under intensive cultivation. Both production and yields per crop has raised significantly at the farm level, but, on the other hand, the quantity of pesticides used in agriculture has been increased in the absence of regulations and good practices. Illegal business of pesticides with false labels, as well as marketing of expired or poor quality products in stores without license are so popular in Vietnam. Misuse and improper use in agriculture in Vietnam has led to a variety of problems, such as environment pollution (including food producing animals) and adverse health impact on animals and humans. Open dumpsites worsen the general scenario. Similar to the environmental exposure, human exposure to DDT in Vietnam was ranked among the highest worldwide, with recognized effects. Exposed communities have to face birth defects, health disorders and non-communicable diseases (NCDs), from metabolic syndrome, asthma, infertility and other reproductive disorders through to diabetes, obesity, cardiovascular and neurodegenerative diseases, and cancer. A common feature of many chronic disorders and NCDs is metabolic disruption: environmental chemical factors disturb cellular homeostasis, thus affecting the ability of the body to restore a functional internal environment. Among these, endocrine disrupting pesticides can interfere with the action of hormones including metabolic hormones, and are likely to represent the main concern for developmentally-induced NCDs. Since pesticides are often persistent and bio-accumulate in the food chain through the living environment of food-producing organisms, this paper discusses relevant aspects of risk assessment, risk communication and risk management

Clinical significance of VEGF-A, -C and -D expression in esophageal malignancies

Vascular endothelial growth factors ( VEGF)- A, - C and - D are members of the proangiogenic VEGF family of glycoproteins. VEGF-A is known to be the most important angiogenic factor under physiological and pathological conditions, while VEGF-C and VEGF-D are implicated in the development and sprouting of lymphatic vessels, so called lymphangiogenesis. Local tumor progression, lymph node metastases and hematogenous tumor spread are important prognostic factors for esophageal carcinoma ( EC), one of the most lethal malignancies throughout the world. We found solid evidence in the literature that VEGF expression contributes to tumor angiogenesis, tumor progression and lymph node metastasis in esophageal squamous cell carcinoma ( SCC), and many authors could show a prognostic value for VEGF-assessment. In adenocarcinoma (AC) of the esophagus angiogenic properties are acquired in early stages, particularly in precancerous lesions like Barrett's dysplasia. However, VEGF expression fails to give prognostic information in AC of the esophagus. VEGF-C and VEGF-D were detected in SCC and dysplastic lesions, but not in normal mucosa of the esophagus. VEGF-C expression might be associated with lymphatic tumor invasion, lymph node metastases and advanced disease in esophageal SCC and AC. Therapeutic interference with VEGF signaling may prove to be a promising way of anti-angiogenic co-treatment in esophageal carcinoma. However, concrete clinical data are still pending

Improved Dynamical Constraints on the Masses of the Central Black Holes in Nearby Low-mass Early-type Galactic Nuclei And the First Black Hole Determination for NGC 205

We improve the dynamical black hole (BH) mass estimates in three nearby low-mass early-type galaxies--NGC 205, NGC 5102, and NGC 5206. We use new \hst/STIS spectroscopy to fit the star formation histories of the nuclei in these galaxies, and use these measurements to create local color--mass-to-light ratio (\ml) relations. We then create new mass models from \hst~imaging and combined with adaptive optics kinematics, we use Jeans dynamical models to constrain their BH masses. The masses of the central BHs in NGC 5102 and NGC 5206 are both below one million solar masses and are consistent with our previous estimates, $9.12_{-1.53}^{+1.84}\times10^5$\Msun~and $6.31_{-2.74}^{+1.06}\times10^5$\Msun~(3$\sigma$ errors), respectively. However, for NGC 205, the improved models suggest the presence of a BH for the first time, with a best-fit mass of $6.8_{-6.7}^{+95.6}\times10^3$\Msun~(3$\sigma$ errors). This is the least massive central BH mass in a galaxy detected using any method. We discuss the possible systematic errors of this measurement in detail. Using this BH mass, the existing upper limits of both X-ray, and radio emissions in the nucleus of NGC 205 suggest an accretion rate $\lesssim$$10^{-5}$ of the Eddington rate. We also discuss the color--\mleff~relations in our nuclei and find that the slopes of these vary significantly between nuclei. Nuclei with significant young stellar populations have steeper color--\mleff~relations than some previously published galaxy color--\mleff~relations.Comment: 31 pages, 19 figures, 6 tables, Accepted to Ap

Low prevalence of cysticercosis and Trichinella infection in pigs in rural Cambodia

Cysticercosis and Trichinella spp. infection are parasitic zoonoses prevalent among pigs in Southeast Asia, where pork is the most important source of meat. In rural Cambodia, many pigs are raised extensively in family backyards, and information regarding the prevalence in rural small-scale pig production is very limited. This study was conducted in four provinces in north-eastern Cambodia to determine the seroprevalence of porcine cysticercosis and Trichinella spp. infection in rural villages, and to identify possible risk factors. Only households with less than 10 pigs above three months old were eligible. In total, 139 households participated, and 242 blood samples were collected. Farmers were interviewed about food and hygiene habits, disease knowledge and practices. The serum samples were analysed by ELISA to determine antigens to Taenia spp. cysticerci or antibodies to Trichinella spp. muscle larvae. Positivity among the pigs was 11.2% (95% CI 7.5–15.8) for Taenia spp. cysts and 2.5% (95% CI 0.9–5.4) for Trichinella spp. Cysticerci were more common in the province Preah Vihear (p < 0.001) than in the other provinces. Risk factors associated with porcine cysticercosis were management systems for the pigs and access to human faeces (p < 0.001). Trichinella spp. infection in pigs was more common in the province Ratanakiri (p = 0.001). The main risk factor associated with Trichinella spp. transmission was feeding pigs with food waste (p = 0.048). More men had heard about cysticercosis than women (p = 0.002), and men also consumed undercooked pork meat to a greater extent (p = 0.004). Although the present study is relatively small, several risk factors could be identified for porcine infection with Taenia spp. and Trichinella spp., which can be used to guide future interventions to improve both porcine and human health in these provinces

Significant Impact of Sequence Variations in the Nucleoprotein on CD8 T Cell-Mediated Cross-Protection against Influenza A Virus Infections

Background: Memory CD8 T cells to influenza A viruses are widely detectable in healthy human subjects and broadly cross-reactive for serologically distinct influenza A virus subtypes. However, it is not clear to what extent such pre-existing cellular immunity can provide cross-subtype protection against novel emerging influenza A viruses. Methodology/Principal: Findings We show in the mouse model that naturally occurring sequence variations of the conserved nucleoprotein of the virus significantly impact cross-protection against lethal disease in vivo. When priming and challenge viruses shared identical sequences of the immunodominant, protective NP366/Db epitope, strong cross-subtype protection was observed. However, when they did not share complete sequence identity in this epitope, cross-protection was considerably reduced. Contributions of virus-specific antibodies appeared to be minimal under these circumstances. Detailed analysis revealed that the magnitude of the memory CD8 T cell response triggered by the NP366/Db variants was significantly lower than those triggered by the homologous NP366/Db ligand. It appears that strict specificity of a dominant public TCR to the original NP366/Db ligand may limit the expansion of cross-reactive memory CD8 T cells to the NP366/Db variants. Conclusions/Significance: Pre-existing CD8 T cell immunity may provide substantial cross-protection against heterosubtypic influenza A viruses, provided that the priming and the subsequent challenge viruses share the identical sequences of the immunodominant, protective CTL epitopes