Knowledge, attitude and practices of patients receiving maintenance haemodialysis in Bloemfontein, South Africa

Introduction: In sub-Saharan Africa, a paucity of data exists in respect of the knowledge, attitudes and practices (KAP) of patientson maintenance haemodialysis (MHD) regarding the dietary adaptations they should make.Methods: In a descriptive, cross-sectional study, conducted in 2017, questionnaires were administered during structured interviews with 75 participants in five MHD-units in Bloemfontein to assess socio-demographics and KAP regarding the ‘renal’ diet.Results: The median age was 50.5 years; 70.7% of participants were male. Overall, 49.4% scored low (< 50%) on knowledge regarding restricted foods, food content of restricted minerals, and phosphate binders; 60.0% reported negative attitudes towards the diet, and 61.4% reported poor adherence practices. Participants with tertiary education (28.0%) had significantly higher knowledge scores than participants with only primary school education (6.7%) (95% CI 3.9%; 73.5%), or those who had only partially completed secondary school (17.3%) (95% CI 6.3%; 64.0%). Only 21.0% reported having received written, and 30.7% verbal, nutrition education in their home language, while 24.0% reported never receiving nutrition education in either their home or second language. Having received nutrition education in a home language and/or second language was associated with significantly higher knowledge scores (95% CI 3.7%; 49.5%). Most (77.3%) reported zero to one consultation with a dietitian per MHD year (NKF-K/DOQI recommends at least three/MHD year).Conclusion: This population on MHD presented with poor KAP regarding the ‘renal’ diet, and inadequate involvement of dietitians in their treatment. Receiving nutritional education in a first or second language significantly increased knowledge of, and insight into, the required dietary adaptations

Nutritional status of undergraduate healthcare students at the University of the Free State

Objectives: This study aimed to evaluate the lifestyle habits of South African students preparing for careers in health care that could influence the efficacy of their counselling practices on risk factors for noncommunicable diseases (NCDs) as future healthcare professionals.Design: Cross-sectional descriptive study.Setting and subjects: One hundred and sixty-one students (median age 21.5 years, 75.8% women) enrolled in the Faculty of Health Sciences at the University of the Free State.Outcome measures: Anthropometry was measured and structured questionnaires administered to assess dietary and lifestyle habits.Results: Many students were at risk of NCDs, with 19.8% being overweight or obese (body mass index > 25 kg/m2), 11.8% had a waist circumferences above gender-specific cut-off points, 98.1% consumed < 3 servings of vegetables/day, 58.4% consumed < 2 servings of fruit/day, 83% consumed < 2 servings of dairy products/day, 60% did not eat a beta-carotenerich fruit or vegetable daily, 31% did not eat a vitamin C-rich fruit or vegetable daily, 62% never consumed legumes, 43% reported a high intake of fats and sweets, 11% smoked a median of 3.5 cigarettes/day and 63% consumed a median of three drinks of alcohol/day on a median of four days (95% weekend days) per month. Fifty-nine per cent were active and 39% were very active owing to busy class schedules, but only 32% participated in formal exercise and sports.Conclusion: The poor dietary and lifestyle habits of most participants highlight the need to not just educate, but better empower these students to deal with the growing public health problem of obesity and related NCDs in the country.Keywords: students, healthcare professionals, diet, anthropometry, lifestyl

The Canonical Perfect Bose Gas in Casimir Boxes

We study the problem of Bose-Einstein condensation in the perfect Bose gas in the canonical ensemble, in anisotropically dilated rectangular parallelpipeds (Casimir boxes). We prove that in the canonical ensemble for these anisotropic boxes there is the same type of generalized Bose-Einstein condensation as in the grand-canonical ensemble for the equivalent geometry. However the amount of condensate in the individual states is different in some cases and so are the fluctuations.Comment: 23 page

Proof of Bose-Einstein Condensation for Interacting Gases with a One-Particle Spectral Gap

Using a specially tuned mean-field Bose gas as a reference system, we establish a positive lower bound on the condensate density for continuous Bose systems with superstable two-body interactions and a finite gap in the one-particle excitations spectrum, i.e. we prove for the first time standard homogeneous Bose-Einstein condensation for such interacting systems

Striking variations in consultation rates with general practice reveal family influence

BACKGROUND: The reasons why patients decide to consult a general practitioner vary enormously. While there may be individual reasons for this variation, the family context has a significant and unique influence upon the frequency of individuals' visits. The objective of this study was to explore which family factors can explain the differences between strikingly high, and correspondingly low, family consultation rates in families with children aged up to 21. METHODS: Data were used from the second Dutch national survey of general practice. This survey extracted from the medical records of 96 practices in the Netherlands, information on all consultations with patients during 2001. We defined, through multilevel analysis, two groups of families. These had respectively, predominantly high, and low, contact frequencies due to a significant family influence upon the frequency of the individual's first contacts. Binomial logistic regression analyses were used to analyse which of the family factors, related to shared circumstances and socialisation conditions, can explain the differences in consultation rates between the two groups of families. RESULTS: In almost 3% of all families, individual consultation rates decrease significantly due to family influence. In 11% of the families, individual consultation rates significantly increase due to family influence. While taking into account the health status of family members, family factors can explain family consultation rates. These factors include circumstances such as their economic status and number of children, as well as socialisation conditions such as specific health knowledge and family beliefs. The chance of significant low frequencies of contact due to family influences increases significantly with factors such as, paid employment of parents in the health care sector, low expectations of general practitioners' care for minor ailments and a western cultural background. CONCLUSION: Family circumstances can easily be identified and will add to the understanding of the health complaints of the individual patient in the consulting room. Family circumstances related to health risks often cannot be changed but they can illuminate the reasons for a visit, and mould strategies for prevention, treatment or recovery. Health beliefs, on the other hand, may be influenced by providing specific knowledge

Vessel co-option mediates resistance to anti-angiogenic therapy in liver metastases

The efficacy of angiogenesis inhibitors in cancer is limited by resistance mechanisms that are poorly understood. Notably, instead of through the induction of angiogenesis, tumor vascularization can occur through the nonangiogenic mechanism of vessel co-option. Here we show that vessel co-option is associated with a poor response to the anti-angiogenic agent bevacizumab in patients with colorectal cancer liver metastases. Moreover, we find that vessel co-option is also prevalent in human breast cancer liver metastases, a setting in which results with anti-angiogenic therapy have been disappointing. In preclinical mechanistic studies, we found that cancer cell motility mediated by the actin-related protein 2/3 complex (Arp2/3) is required for vessel co-option in liver metastases in vivo and that, in this setting, combined inhibition of angiogenesis and vessel co-option is more effective than the inhibition of angiogenesis alone. Vessel co-option is therefore a clinically relevant mechanism of resistance to anti-angiogenic therapy and combined inhibition of angiogenesis and vessel co-option might be a warranted therapeutic strategy

PORTEC-4a: International randomized trial of molecular profile-based adjuvant treatment for women with high-intermediate risk endometrial cancer

Background Vaginal brachytherapy is currently recommended as adjuvant treatment in patients with highintermediate risk endometrial cancer to maximize local control and has only mild side effects and no or limited impact on quality of life. However, there is still considerable overtreatment and also some undertreatment, which may be reduced by tailoring adjuvant treatment to the patients’ risk of recurrence based on molecular tumor characteristics. Primary objectives To compare the rates of vaginal recurrence in women with high-intermediate risk endometrial cancer, treated after surgery with molecularintegrated risk profile-based recommendations for either observation, vaginal brachytherapy or external pelvic beam radiotherapy or with standard adjuvant vaginal brachytherapy Study hypothesis Adjuvant treatment based on a molecular-integrated risk profile provides similar local control and recurrence-free survival as current standard adjuvant brachytherapy in patients with high-intermediate risk endometrial cancer, while sparing many patients the morbidity of adjuvant t