Prevalence and treatment of hypertension, diabetes and asthma in Kenya: A representative household survey in eight counties in 2016

Objectives: In 2014, 27% of total deaths in Kenya were due to non-communicable diseases (NCDs). The objectives of this study were: 1) To report on the prevalence of households with members diagnosed and treated for hypertension, diabetes, and asthma in eight counties in Kenya, and 2) To explore possible reasons for the variation in prevalence of these three NCDs in the different counties. Design, Setting andSubjects: A total of 7,870 households in a representative sample in eight Kenyan counties were screened for the presence of any non-communicable disease. Diagnosis and treatment data on these NCDs was collected and compared using county specific independent data from the 2014 Kenyan Demographic Health Survey (DHS).Main Outcome Measures: Over all the eight surveyed counties, 10.7% of households reported having one or more individuals with an NCD. The county specific prevalence varied from 3% to 30.2%. Of the 7,870 households surveyed, 6.9% reported having a diagnosis of hypertension, 3.2% of asthma, and 2.3% of diabetes.Results: The strongest explanatory variables for the variation in overall prevalence of NCDs related to access to health services and lifestyle risk factors. Conclusion: The prevalence of reported NCDs varies considerably between  counties in Kenya. Reasons may relate to a lack of access to diagnostic facilities or  ifferences in lifestyle risk factors. We recommend a comprehensive field survey of biometric, health access, and lifestyle risk factors to determine the true prevalence and related risk factors for NCDs in Kenya

How do patient characteristics influence informal payments for inpatient and outpatient health care in Albania: Results of logit and OLS models using Albanian LSMS 2005

Abstract Background Informal payments for health care are common in most former communist countries. This paper explores the demand side of these payments in Albania. By using data from the Living Standard Measurement Survey 2005 we control for individual determinants of informal payments in inpatient and outpatient health care. We use these results to explain the main factors contributing to the occurrence and extent of informal payments in Albania. Methods Using multivariate methods (logit and OLS) we test three models to explain informal payments: the cultural, economic and governance model. The results of logit models are presented here as odds ratios (OR) and results from OLS models as regression coefficients (RC). Results Our findings suggest differences in determinants of informal payments in inpatient and outpatient care. Generally our results show that informal payments are dependent on certain characteristics of patients, including age, area of residence, education, health status and health insurance. However, they are less dependent on income, suggesting homogeneity of payments across income categories. Conclusions We have found more evidence for the validity of governance and economic models than for the cultural model.</p

Wilson loops in the adjoint representation and multiple vacua in two-dimensional Yang-Mills theory

$QCD_2$ with fermions in the adjoint representation is invariant under $SU(N)/Z_N$ and thereby is endowed with a non-trivial vacuum structure (k-sectors). The static potential between adjoint charges, in the limit of infinite mass, can be therefore obtained by computing Wilson loops in the pure Yang-Mills theory with the same non-trivial structure. When the (Euclidean) space-time is compactified on a sphere $S^2$, Wilson loops can be exactly expressed in terms of an infinite series of topological excitations (instantons). The presence of k-sectors modifies the energy spectrum of the theory and its instanton content. For the exact solution, in the limit in which the sphere is decompactified, a k-sector can be mimicked by the presence of k-fundamental charges at $\infty$, according to a Witten's suggestion. However this property neither holds before decompactification nor for the genuine perturbative solution which corresponds to the zero-instanton contribution on $S^2$.Comment: RevTeX, 46 pages, 1 eps-figur

Chiral gauge theories and anomalies in the Wilson renormalization group approach

We extend the Wilson renormalization group (RG) formulation to chiral gauge theories and show that local gauge symmetry can be implemented by a suitable choice of the RG flow boundary conditions. Since the space-time dimension is four, there is no ambiguity in handling the matrix \g_5 and left and right fermions are not coupled. As a result the ultraviolet action contains all possible globally chiral invariant interactions. Nevertheless, the correct chiral anomaly is reproduced.Comment: 16 pages, 4 figures, LaTex, uses epsfig, amssym

Effectiveness of community outreach HIV prevention programs in Vietnam: A mixed methods evaluation

Background In 2014, Vietnam was the first Southeast Asian country to commit to achieving the World Health Organization’s 90–90-90 global HIV targets (90% know their HIV status, 90% on sustained treatment, and 90% virally suppressed) by 2020. This pledge represented further confirmation of Vietnam’s efforts to respond to the HIV epidemic, one feature of which has been close collaboration with the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). Starting in 2004, PEPFAR supported community outreach programs targeting high-risk populations (people who inject drugs, men who have sex with men, and sex workers). To provide early evidence on program impact, in 2007–2008 we conducted a nationwide evaluation of PEPFAR-supported outreach programs in Vietnam. The evaluation focused on assessing program effect on HIV knowledge, high-risk behaviors, and HIV testing among high-risk populations—results relevant to Vietnam’s push to meet global HIV goals. Methods We used a mixed-methods cross-sectional evaluation design. Data collection encompassed a quantitative survey of 2199 individuals, supplemented by 125 in-depth interviews. Participants were members of high-risk populations who reported recent contact with an outreach worker (intervention group) or no recent contact (comparison group). We assessed differences in HIV knowledge, risky behaviors, and HIV testing between groups, and between high-risk populations. Results Intervention participants knew significantly more about transmission, prevention, and treatment than comparison participants. We found low levels of injection drug-use-related risk behaviors and little evidence of program impact on such behaviors. In contrast, a significantly smaller proportion of intervention than comparison participants reported risky sexual behaviors generally and within each high-risk population. Intervention participants were also more likely to have undergone HIV testing (76.1% vs. 47.0%, p \u3c 0.0001) and to have received pre-test (78.0% vs. 33.7%, p \u3c 0.0001) and post-test counseling (80.9% vs. 60.5%, p \u3c 0.0001). Interviews supported evidence of high impact of outreach among all high-risk populations. Conclusions Outreach programs appear to have reduced risky sexual behaviors and increased use of HIV testing services among high-risk populations in Vietnam. These programs can play a key role in reducing gaps in the HIV care cascade, achieving the global 90–90-90 goals, and creating an AIDS-free generation

Cold atom Clocks and Applications

This paper describes advances in microwave frequency standards using laser-cooled atoms at BNM-SYRTE. First, recent improvements of the $^{133}$Cs and $^{87}$Rb atomic fountains are described. Thanks to the routine use of a cryogenic sapphire oscillator as an ultra-stable local frequency reference, a fountain frequency instability of $1.6\times 10^{-14}\tau^{-1/2}$ where $\tau$ is the measurement time in seconds is measured. The second advance is a powerful method to control the frequency shift due to cold collisions. These two advances lead to a frequency stability of $2\times 10^{-16}$ at $50,000s for the first time for primary standards. In addition, these clocks realize the SI second with an accuracy of$7\times 10^{-16}$, one order of magnitude below that of uncooled devices. In a second part, we describe tests of possible variations of fundamental constants using$^{87}$Rb and$^{133}$Cs fountains. Finally we give an update on the cold atom space clock PHARAO developed in collaboration with CNES. This clock is one of the main instruments of the ACES/ESA mission which is scheduled to fly on board the International Space Station in 2008, enabling a new generation of relativity tests.Comment: 30 pages, 11 figure

The mesolimbic dopaminergic dysfunction in psychosis: a review of the literature

Introdução: Desde há algumas décadas que se pensa que uma hiperactividade dopaminérgica da via mesolímbica esteja implicada na génese dos sintomas positivos da esquizofrenia. Objectivos: Nesta revisão da literatura procurámos interligar as várias áreas do conhecimento actual, procurando fazer a ponte com a prática clínica. Métodos: Foi efectuada uma pesquisa sistemática da literatura em inglês, até Abril de 2014 através da PUBMED utilizando como termos MeSH (medical subject headings) “mesolimbic” e “psychosis”, tendo-se incluído revisões da literatura. Resultados e Conclusões: Foram encontrados 111 artigos, tendo-se excluído 56 por, após leitura do resumo, se concluir que não estavam relacionados com o tema. Dos restantes 55 foram seleccionados 14 artigos tendo sido mantidas as abreviaturas em inglês para facilitar a sua consulta posterior. São apresentadas evidências sobre o papel desempenhado por vários sistemas reguladores no desenvolvimento dos sintomas positivos associados não apenas a esta doença mas às várias perturbações em que ocorrem, assim como a possível relação entre esses vários factores. Entre os vários sistemas discutidos conta-se a influência do neurodesenvolvimento, da regulação pelos receptores nicotí- nicos da acetilcolina, a influência dos canais de potássio KCNQ, a regulação por péptidos neurotransmissores, pela adenosina e pela fosfodiesterase 10A, assim como avanços na compreensão da etiologia da esquizofrenia. Trata-se, portanto, de um enunciado do substrato neurobiológico dos sintomas positivos.Background: For several decades now it is thought that dopamine hyperactivity on the mesolimbic pathway is implied on the genesis of schizophrenic psychotic symptoms. Aims: In this review we sought to interconnect the various areas of current knowledge, seeking to relate them to clinical practice. Methods: A systematic English language PUBMED search was done, using MeSH (medical subject headings) terms “mesolimbic” and “psychosis”, until April 2014, including reviews. Results and Conclusions: We found 111 papers, and excluded 56 after an abstract review. We selected 14 papers of the remaining 55. We present evidence on the part played by the neurodevelopment, acetylcholine nicotinic receptor regulation, influence of KCNQ potassium channels, neurotransmitter peptides, adenosine and phosphodiesterase 10A, as well as advances on understanding the etiology of schizophrenia on the development of psychotic symptoms associated not only with this disease but also with several disturbances on which they can occur, as well as a possible relation between these various influences, where it has been possible to do so. It is, therefore, an enunciation of the neurobiological substrate underlying psychotic symptoms

JAK inhibition differentially affects NK cell and ILC1 homeostasis

Janus kinase (JAK) inhibitors are widely used in the treatment of multiple autoimmune and inflammatory diseases. Immunologic and transcriptomic profiling have revealed major alterations on natural killer (NK) cell homeostasis associated with JAK inhibitions, while information on other innate lymphoid cells (ILCs) is still lacking. Herein, we observed that, in mice, the homeostatic pool of liver ILC1 was less affected by JAK inhibitors compared to the pool of NK cells present in the liver, spleen and bone marrow. JAK inhibition had overlapping effects on the transcriptome of both subsets, mainly affecting genes regulating cell cycle and apoptosis. However, the differential impact of JAK inhibition was linked to the high levels of the antiapoptotic gene Bcl2 expressed by ILC1. Our findings provide mechanistic explanations for the effects of JAK inhibitors on NK cells and ILC1 which could be of major clinically relevance