South Africa's salt reduction strategy: Are we on track, and what lies ahead?

On 2 September 2016, 25 local and international participants from various sectors met in Cape Town to take stock of South Africa (SA)’s progress in salt reduction and develop a roadmap for action. SA is centre stage on salt reduction globally, being the first country to mandate salt reduction across a wide range of processed foods. Excessive salt intake contributed by processed foods and discretionary sources motivated SA to implement a public awareness campaign in parallel with legislation to reduce salt intake to the World Health Organization target of 5 g per day. Five priority areas were identified for continued action on salt reduction, including obtaining research funds for continued monitoring and compliance of salt reduction targets. Determining the contribution of foods eaten out of home to total salt intake and implementing strategies to address this sector were also highlighted as key actions. Lastly, implementing the next stage of the Salt Watch awareness campaign to change

No evidence of an 11.16 MeV 2+ state in 12C

An experiment using the 11B(3He,d)12C reaction was performed at iThemba LABS at an incident energy of 44 MeV and analyzed with a high energy-resolution magnetic spectrometer, to re-investigate states in 12C published in 1971. The original investigation reported the existence of an 11.16 MeV state in 12C that displays a 2+ nature. In the present experiment data were acquired at laboratory angles of 25-, 30- and 35- degrees, to be as close to the c.m. angles of the original measurements where the clearest signature of such a state was observed. These new low background measurements revealed no evidence of the previously reported state at 11.16 MeV in 12C

Improving cost-effectiveness of hypertension management at a community health centre

Objectives. To describe the pattern of prescribing for hypertension at a community health centre (CHC) and to evaluate the impact of introducing treatment guidelines and restricting availability of less cost-effective antihypertensive drugs on prescribing patterns, costs of drug treatment and blood pressure (BP) control.Design. Before/after intervention study.Setting. Medium-sized CHC in the Cape Flats area of Cape Town.Subjects. 1 084 hypertensive patients attending the CHC, who had at least two prescriptions for antihypertensive drugs during a 1-year period starting on 1 January 1992. Interventions. 1. Implementation of stepped-care guidelines for hypertension, specifying treatment with more cost-effective drugs and minimising drug treatment. 2. Reducing availability for routine prescribing by CHC doctors of 10 less cost-effective antihypertensive drugs or drug combinations.Outcome measures. 1. Mean number of drugs prescribed per patient. 2. Proportion of prescriptions for: each major class of antihypertensive drug; restricted availability and freely prescribable drugs; and more and less cost-effective drugs. 3. Mean monthly cost of drugs prescribed per patient. 4. Mean blood pressure and proportion of BP readings controlled (<160/95 mmHg) or uncontrolled (≥160/95 mmHg).Results. A mean of 1.7 active drugs was prescribed per patient per visit. The most frequently prescribed drugs were thiazide-like diuretics (44.8%), centrally acting agents (28.4%) and b-blockers (13.2%). Mean monthly drug costs per patient decreased significantly by R1.99 (24.2%) from R8.24 to R6.25 between the first and last prescription for each patient (exclusive of any reduction due to withdrawal of treatment). This was attributable to reduced prescribing of more expensive drugs withdrawn from routine use and a 51.1% increase in prescribing of the most cost-effective drugs. The overall annual cost-saving of the changes in prescribing for this CHC are estimated at R75 150. Blood pressure control did not change significantly.Conclusion. The pattern of changes in prescribing and drug costs was consistent with a causal effect of the interventions. The study demonstrates the potential forimproving cost-effectiveness of hypertension care in primary care in South Africa and the potential for research in this setting

Hypertension care at a Cape Town community health centre

Objectives. To describe the demographic profile of hypertensive patients and the quality of care for hypertension at a Cape Town community health centre (CHC).Design. Prospective, descriptive study.Setting and subjects. Medium-sized CHC, attended by 1098 hypertensive patients during a 1-year period from 1 January 1992.Outcome measures. Default rate - proportion of due visits not attended. Loss to follow-up - proportion of patients persistently defaulting or not responding to recall. Frequency of blood pressure measurement - per 12 due visits. Compliance - proportion of patients collecting ≥ 75% of antihypertensive drugs. Blood pressure control - mean blood pressure of aggregated readings; and proportion controlled (<160/95 mmHg) on the basis of all blood pressure readings and mean blood pressures of individual patients with two or more readings during the study period.Results. More than half (51.6%) of the hypertensive patients were aged ≥ 65 years; 81.7% were female. The default rate was between 11.9% and 19.4%. Compliance was high (76.9%). Loss to follow-up was 8.1 %. Blood pressure was recorded a mean of 4.0 times per 12 due visits. There were no significant gender differences with regard to these measures. Mean blood pressure was 158.3/89.6 mmHg. Over half (56.7%) of all individual readings over the year were uncontrolled and 51.4% of patients were found to be uncontrolled when categorised by their mean blood pressure. Control was significantly poorer among women ≥ 65 years.Conclusion. We found better compliance, more frequent blood pressure measurement, and lower defaulting and loss to follow-up compared with previous South African studies in similar settings. Despite this, blood pressure control was mediocre. Possible explanations for this are discussed. The low proportion of male hypertensives attending the CHC suggests that the accessibility or acceptability of care is poor for this group. The study illustrates the potential for research in this setting and for the use of computers to monitor the quality of primary care.

Postnatal β2 adrenergic treatment improves insulin sensitivity in lambs with IUGR but not persistent defects in pancreatic islets or skeletal muscle

Placental insufficiency causes intrauterine growth restriction (IUGR) and disturbances in glucose homeostasis with associated β adrenergic receptor (ADRβ) desensitization. Our objectives were to measure insulin-sensitive glucose metabolism in neonatal lambs with IUGR and to determine whether daily treatment with ADRβ2 agonist and ADRβ1/β3 antagonists for 1 month normalizes their glucose metabolism. Growth, glucose-stimulated insulin secretion (GSIS) and glucose utilization rates (GURs) were measured in control lambs, IUGR lambs and IUGR lambs treated with adrenergic receptor modifiers: clenbuterol atenolol and SR59230A (IUGR-AR). In IUGR lambs, islet insulin content and GSIS were less than in controls; however, insulin sensitivity and whole-bodyGUR were not different from controls.Of importance, ADRβ2 stimulation with β1/β3 inhibition increases both insulin sensitivity and whole-body glucose utilization in IUGR lambs. In IUGR and IUGR-AR lambs, hindlimb GURs were greater but fractional glucose oxidation rates and ex vivo skeletal muscle glucose oxidation rates were lower than controls. Glucose transporter 4 (GLUT4) was lower in IUGR and IUGR-AR skeletal muscle than in controls but GLUT1 was greater in IUGR-AR. ADRβ2, insulin receptor, glycogen content and citrate synthase activity were similar among groups. In IUGR and IUGR-AR lambs heart rates were greater, which was independent of cardiac ADRβ1 activation. We conclude that targeted ADRβ2 stimulation improved whole-body insulin sensitivity but minimally affected defects in GSIS and skeletal muscle glucose oxidation. We show that risk factors for developing diabetes are independent of postnatal catch-up growth in IUGR lambs as early as 1 month of age and are inherent to the islets and myocytes

An updated systematic review of epidemiological evidence on hormonal contraceptive methods and HIV acquisition in women

We are grateful to Sharon Achilles for her thoughtful input related to describing potential biological mechanisms, and to all study investigators who provided additional information about their analyses. WHO provided support for the writing of this systmatic review and for the writing group to attend a working meeting in Geneva, Switzerland in October 2015. D.J.W. was partially funded by NIH DP2-HD-08-4070. The review was conducted independently of the WHO guidance development process; and conclusions represent the independent opinions of the authors. The findings and conclusions in this article do not necessarily reflect the positions and policies of the donor. Role of authors: The World Health Organization (J.N.K. and P.S.S.) initiated the idea to conduct this systematic review update. C.B.P. led the conduct of the systematic review, including conducting the systematic literature search and drafting the manuscript. C.B.P., K.M.C., and P.C.H. screened titles, abstracts, and full-text manuscripts to determine study inclusion. S.J.P. conducted the statistical meta-analysis. All coauthors (C.B.P., K.M.C., P.C.H., S.J.P., T.C., J.N.K., D.J.W., and P.S.S.) participated in framing the study question, developing the quality criteria, abstracting study information and assessing study quality, interpreting the data, and contributing to the writing and editing of the manuscript. Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official positions of the Guttmacher Institute, the Centers for Disease Control and Prevention, the World Health Organization, the National Institutes of Health, or other institutions with which the authors are affiliated.Peer reviewedPublisher PD

Wavelet signatures of KK-splitting of the Isoscalar Giant Quadrupole Resonance in deformed nuclei from high-resolution (p,p′') scattering off 146,148,150^{146,148,150}Nd

The phenomenon of fine structure of the Isoscalar Giant Quadrupole Resonance (ISGQR) has been studied with high energy-resolution proton inelastic scattering at iThemba LABS in the chain of stable even-mass Nd isotopes covering the transition from spherical to deformed ground states. A wavelet analysis of the background-subtracted spectra in the deformed 146,148,150Nd isotopes reveals characteristic scales in correspondence with scales obtained from a Skyrme RPA calculation using the SVmas10 parameterization. A semblance analysis shows that these scales arise from the energy shift between the main fragments of the K = 0, 1 and K = 2 components.Comment: 7 pages, 6 figure