A case control study of breast cancer risk and exposure to injectable progestogen contraceptives

No Abstract

Intra-osseous calcifying tendinitis of the infraspinatus tendon with erosion into the greater tuberosity

Calcific tendinitis is a condition characterised by the abnormal deposition of calcium hydroxyapatite crystals within the tendons of the rotator cuff. The characteristic appearance is that of acute or chronic shoulder pain combined with radiographic evidence of calcifications within the rotator cuff tendons. It is a specific disease entity which needs to be differentiated from other causes of rotator cuff calcium deposition. We present a case of calcific tendinitis with secondary erosion at the humeral insertion of the infraspinatus tendon. Conventional radiography proved unsuccessful in the initial diagnosis of the condition. Advanced modalities including both computed tomography (CT) and magnetic resonance imaging (MRI) proved to be both diagnostic and pivotal in the further management of the patient.http://www.saoa.org.zaam2016Radiolog

Grass Diversity and Pasture Quality Baseline Assessement in Central Madagascar

Poaceae family contributes to Madagascar’s biodiversity hotspot with 217 of 541 grass species endemic to the island, although their forage value is unknown, at least in the scientific literature. Our research aims 1) to describe the diversity of native and endemic grasses thereby recognising the role of grass species diversity in forage and ecosystem management and 2) to provide new knowledge about pasture management based on the relationship between grazing capacity and productivity within experimental pastureland plots under different fire and grazing treatments. Our study seeks to provide information to inform improvements in livestock nutrition via grazing management of natural pastures in central Madagascar, specifically around the Ankafobe, Ibity and Itremo Protected Areas. Sampling in different grassy habitats was undertaken to develop a grass checklist and overview of grass diversity across the project sites. Further, in the communal and experimental pastures standardised grass surveys were carried out to compare grazing capacity and biomass productivity in the experimental pastures. Our regional survey recorded 123 Poaceae species during the first year: including 90% native species (of which 34% were endemic) and 10% introduced species. Thirty species, all C4 and belonging to PACMAD clade, are found within established pasture grasslands. Across communal pastures the most frequently recorded species and thus most frequently grazed are Loudetia simplex, Aristida rufescens, Panicum luridum, Schizachyrium sanguineum, Hyparrhenia rufa and Aristida tenuissima – these species are predominantly associated with fire. The grazing capacity baseline, at about 0.7 to 0.8 ha/zebu/year, is similar across all experimental sites that are also characterised by having a similar climate, acidic soils with low nitrogen and phosphorus, and., Annual biomass production appears to be driven by fire frequency: at both Itremo and Ankafobe, where fire is an annual occurrence, biomass yield is 2.4-2.9t/ha whereas at Ibity, where fire frequency is fire every 3-4 years, biomass productivity is 6.9t/ha. However, it is unclear how these productivity estimates relate to forage quality; the relationship will be the subject of future work

Smallholder Zebu and Forage Production Development in Central Madagascar

Poverty in the Central Highlands of Madagascar is partly driven by inefficient exploitation of native forages and poor livestock nutrition. Zebus are of importance as cultural symbols, but this tradition has grown disconnected from agricultural policy. This project is working with three central highland communities near the protected areas of Itremo, Ibity and Ankafobe, to boost rangeland productivity and trial management methods which will support key forage grasses and improve livestock nutrition. A severe nitrogen deficiency compounded by extremely acidic soil conditions and low phosphorus is observed across the three sites. The lowest grazing capacity of an estimated 0.7 livestock unit per hectare and biomass production of 1600 kg/ha is observed at Ankafobe, the highest elevation windy site with fires that are almost annual. Low production is due to acidic soils with a lack of phosphorus as well as likely iron toxicity. The project works with 90 households owning a total 150 female zebu, 1-5 per household. The project initiated 3 demonstration farms to show the planting of sorghum for silage, harvesting of the native grasses for hay, and building a secure barn meeting at least minimum animal care standards, using local materials to protect the livestock from the weather and theft which is sadly perceived to be common. In the first year the project produced the highest yields in the most remote and fertile site of Itremo, with 365 kg of sorghum silage from 0.5 ha and 165 kg of Brachiaria hay from 0.5 ha. Five households based in the milk producing region of eastern Ibity have completed new barns. Fifty percent of households at Ibity successfully fed silage and hay to their zebu for the first time. Madagascar remains famous for subsistence farming and rural poverty with a long-term decline in livestock, but substantial opportunity nevertheless exists for integrated crop and livestock production, alongside the protection of biodiversity in nearby forests

Southern African pasture and forage science entering the 21st century : past to present

Given the global challenges of mitigating and alleviating land degradation and ensuring food security, particularly through protein production, pasture and forage science together with rangeland science will remain imperative to sustainable livestock production systems. Recognising the scientific principles developed in this discipline the past 50 years and more in Southern Africa, customary to our diverse and unique environmental conditions will continue to guide and identify future research priorities. A journey from the past to the present can assist in avoiding reinvention and repetition of pasture research. This review highlights how research priorities have either remained the same over time or where research has received less or more priority. The review further illustrates that there has been more interest in species adaptation to drought, pasture and forage water relations, alternative pasture and forage species, and the combination of pasture species in the 21st century than in the 20th century. In conclusion, the soil–plant– livestock complex can serve as a conceptual basis for more effective research together with pasture breeding and nutrition. Finally, researching pasture and forage sciences in an inter- and multi-disciplinary manner clearly supports the principles of holism applied by General JC Smuts, one of the first pioneers of pasture and forage sciences.http://www.tandfonline.com/loi/tarf20hb2016Plant Production and Soil Scienc

Prescribing indicators at primary health care centers within the WHO African region: a systematic analysis (1995-2015)

Abstract Background Rational medicine use is essential to optimize quality of healthcare delivery and resource utilization. We aim to conduct a systematic review of changes in prescribing patterns in the WHO African region and comparison with WHO indicators in two time periods 1995–2005 and 2006–2015. Methods Systematic searches were conducted in PubMed, Scopus, Web of science, Africa-Wide Nipad, Africa Journals Online (AJOL), Google scholar and International Network for Rational Use of Drugs (INRUD) Bibliography databases to identify primary studies reporting prescribing indicators at primary healthcare centres (PHCs) in Africa. This was supplemented by a manual search of retrieved references. We assessed the quality of studies using a 14-point scoring system modified from the Downs and Black checklist with inclusions of recommendations in the WHO guidelines. Results Forty-three studies conducted in 11 African countries were included in the overall analysis. These studies presented prescribing indicators based on a total 141,323 patient encounters across 572 primary care facilities. The results of prescribing indicators were determined as follows; average number of medicines prescribed per patient encounter = 3.1 (IQR 2.3–4.8), percentage of medicines prescribed by generic name =68.0 % (IQR 55.4–80.3), Percentage of encounters with antibiotic prescribed =46.8 % (IQR 33.7–62.8), percentage of encounters with injection prescribed =25.0 % (IQR 18.7–39.5) and the percentage of medicines prescribed from essential medicines list =88.0 % (IQR 76.3–94.1). Prescribing indicators were generally worse in private compared with public facilities. Analysis of prescribing across two time points 1995–2005 and 2006–2015 showed no consistent trends. Conclusions Prescribing indicators for the African region deviate significantly from the WHO reference targets. Increased collaborative efforts are urgently needed to improve medicine prescribing practices in Africa with the aim of enhancing the optimal utilization of scarce resources and averting negative health consequences

Prescribing patterns in dementia: a multicentre observational study in a German network of CAM physicians

<p>Abstract</p> <p>Background</p> <p>Dementia is a major and increasing health problem worldwide. This study aims to investigate dementia treatment strategies among physicians specialised in complementary and alternative medicine (CAM) by analysing prescribing patterns and comparing them to current treatment guidelines in Germany.</p> <p>Methods</p> <p>Twenty-two primary care physicians in Germany participated in this prospective, multicentre observational study. Prescriptions and diagnoses were reported for each consecutive patient. Data were included if patients had at least one diagnosis of dementia according to the 10th revision of the International Classification of Diseases during the study period. Multiple logistic regression was used to determine factors associated with a prescription of any anti-dementia drug including <it>Ginkgo biloba</it>.</p> <p>Results</p> <p>During the 5-year study period (2004-2008), 577 patients with dementia were included (median age: 81 years (IQR: 74-87); 69% female). Dementia was classified as unspecified dementia (57.2%), vascular dementia (25.1%), dementia in Alzheimer's disease (10.4%), and dementia in Parkinson's disease (7.3%). The prevalence of anti-dementia drugs was 25.6%. The phytopharmaceutical <it>Ginkgo biloba </it>was the most frequently prescribed anti-dementia drug overall (67.6% of all) followed by cholinesterase inhibitors (17.6%). The adjusted odds ratio (AOR) for receiving any anti-dementia drug was greater than 1 for neurologists (AOR = 2.34; CI: 1.59-3.47), the diagnosis of Alzheimer's disease (AOR = 3.28; CI: 1.96-5.50), neuroleptic therapy (AOR = 1.87; CI: 1.22-2.88), co-morbidities hypertension (AOR = 2.03; CI: 1.41-2.90), and heart failure (AOR = 4.85; CI: 3.42-6.88). The chance for a prescription of any anti-dementia drug decreased with the diagnosis of vascular dementia (AOR = 0.64; CI: 0.43-0.95) and diabetes mellitus (AOR = 0.55; CI: 0.36-0.86). The prescription of <it>Ginkgo biloba </it>was associated with sex (female: AOR = 0.41; CI: 0.19-0.89), patient age (AOR = 1.06; CI: 1.02-1.10), treatment by a neurologist (AOR = 0.09; CI: 0.03-0.23), and the diagnosis of Alzheimer's disease (AOR = 0.07; CI: 0.04-0.16).</p> <p>Conclusions</p> <p>This study provides a comprehensive analysis of everyday practice for treatment of dementia in primary care in physicians with a focus on CAM. The prescribing frequency for anti-dementia drugs is equivalent to those found in other German studies, while the administration of <it>Ginkgo biloba </it>is significantly higher.</p

International consensus statement for the screening, diagnosis, and treatment of adolescents with concurrent Attention-Deficit/Hyperactivity Disorder and substance use disorder

Education and Child Studie

Chemistry of the calcium ionophores

RESP-748