THE ATTITUDES OF OLDER SOUTH AFRICANS TOWARDS EUTHANASIA

The purpose of this study was to determine the attitudes of older South African adults (65 years and older) towards euthanasia. The subjects of the study were people 65 years of age and older who resided in homes for the aged within the rural and urban areas of the Cape Town Metropolis. An equal number of subjects from the African, Coloured and European communities were randomly selected. A biographical questionnaire, the Euthanasia Attitude Scale and the Purpose In Life Test were administered. The influence of four variables – namely age, ethnicity, meaning in life and health – was investigated. A Pearson correlation coefficient analysis and a one-way ANOVA analysis were used. Age was the only variable found to have a significant correlation with euthanasia. The findings are discussed and certain recommendations are made

Subjective Well-being of Primary Health Care Patients in the Western Cape, South Africa

Background: Patients living with a chronic illness face many challenges in their lives such as an altered body image, physical pain or discomfort, the need for frequent medical visits and the negative side effects of treatment. To this extent their sense of personal or subjective well-being may be compromised by the severity and chronicity of their illness. The aim of the present study was to explore the level of subjective well-being and its relationship with coping, quality of life and support from family and friends among a sample of Black South Africans attending semi-rural public clinics for treatment for hypertension and diabetes. This study was part of a larger project on treatment adherence to medication among patients living with these conditions. Methods: A convenience sample of 117 patients aged between 22 and 82 years (M=52.36, SD=13.24), receiving treatment for hypertension (n=79) or diabetes (n=24) at three primary health care clinics in the Boland area of the Western Cape were asked to participate in this study. Of the total sample, 14 (12%) were diagnosed with both conditions. Participants were asked to complete a questionnaire battery consisting of the Satisfaction with Life Scale, the Coping Strategy Indicator, the Functioning Assessment of Non-Life Threatening Conditions and the Perceived Social Support Scale. Results: The mean score of the Satisfaction with Life Scale was 28.70, which was significantly higher than those of other studies using this mea-sure. In order to address the problem of experiment-wise error, commonly associated with the use of multiple statistical comparisons, we used the Bonferronni correction in arriving at probability levels in determining statistical significance. On average the sample as a whole appeared to be largely satisfied. The mean scores on the two of the subscales of the Coping Strategy Indicator were significantly different from those obtained from other South African samples. On the Functioning Assessment of Non-Life Threatening Conditions, the mean scores on the subscales but not the total score was significantly higher than other South African samples. Conclusions: In general, participants scored significantly higher on all of the measuring instruments compared with other South African samples, indicating high levels of life satisfaction, coping, and support from others. We found no relationship between life satisfaction and gender. Age however correlated positively with satisfaction with Life, Support from family, social and emotional well being and Quality of Life, which concurs with the findings of previous studies. Contrary to other studies we found a significant negative correlation between education and SWLS but no relationship between employment and SWLS. Our sample also reported higher levels of support from friends and family that were significantly higher than those of other South African samples. The mean scores on all the subscales of the Coping Strategy Indicator were higher than that of other South African samples. South African Family Practice Vol. 50 (3) 2008: pp. 68-68

Priority water research questions for South Africa developed through participatory processes

This paper describes a collaborative process of identifying and prioritising current and future water research questions from a wide range of water  specialists within South Africa. Over 1 600 questions were collected,  reduced in number and prioritised by specialists working in water research and practice. A total of 59 questions were finally proposed as an outcome of the study and are categorised under the themes of change, data, ecosystems, governance, innovation and resources. The questions range in scale, challenge and urgency, and are also aligned with prevailing  paradigms in water research. The majority of the questions dealt with relatively short- to medium-term research requirements and most focused on immediate issues such as water supply, service delivery and technical solutions. Formulations of long-term research questions were sparse,  partly because some of the principles and methods used in this study were difficult to apply in the South African context, and also because researchers are influenced by addressing what are believed to be the more immediate, short-term water-related challenges in South Africa. This is the first  initiative of its kind to produce a comprehensive and inclusive list of research priorities for water in South Africa.Keywords: research, questions, collaboration, prioritisation, South Afric

Can medical therapy mimic the clinical efficacy or physiological effects of bariatric surgery?

The number of bariatric surgical procedures performed has increased dramatically. This review discusses the clinical and physiological changes, and in particular, the mechanisms behind weight loss and glycaemic improvements, observed following the gastric bypass, sleeve gastrectomy and gastric banding bariatric procedures. The review then examines how close we are to mimicking the clinical or physiological effects of surgery through less invasive and safer modern interventions that are currently available for clinical use. These include dietary interventions, orlistat, lorcaserin, phentermine/topiramate, glucagon-like peptide-1 receptor agonists, dipeptidyl peptidase-4 inhibitors, pramlintide, dapagliflozin, the duodenal–jejunal bypass liner, gastric pacemakers and gastric balloons. We conclude that, based on the most recent trials, we cannot fully mimic the clinical or physiological effects of surgery; however, we are getting closer. A ‘medical bypass' may not be as far in the future as we previously thought, as the physician's armamentarium against obesity and type 2 diabetes has recently got stronger through the use of specific dietary modifications, novel medical devices and pharmacotherapy. Novel therapeutic targets include not only appetite but also taste/food preferences, energy expenditure, gut microbiota, bile acid signalling, inflammation, preservation of β-cell function and hepatic glucose output, among others. Although there are no magic bullets, an integrated multimodal approach may yield success. Non-surgical interventions that mimic the metabolic benefits of bariatric surgery, with a reduced morbidity and mortality burden, remain tenable alternatives for patients and health-care professionals

Metabolic phenotype-microRNA data fusion analysis of the systemic consequences of Roux-en-Y gastric bypass surgery.

BACKGROUND/OBJECTIVES: Bariatric surgery offers sustained marked weight loss and often remission of type 2 diabetes, yet the mechanisms of establishment of these health benefits are not clear. SUBJECTS/METHODS: We mapped the coordinated systemic responses of gut hormones, the circulating miRNAome and the metabolome in a rat model of Roux-en-Y gastric bypass (RYGB) surgery. RESULTS: The response of circulating microRNAs (miRNAs) to RYGB was striking and selective. Analysis of 14 significantly altered circulating miRNAs within a pathway context was suggestive of modulation of signaling pathways including G protein signaling, neurodegeneration, inflammation, and growth and apoptosis responses. Concomitant alterations in the metabolome indicated increased glucose transport, accelerated glycolysis and inhibited gluconeogenesis in the liver. Of particular significance, we show significantly decreased circulating miRNA-122 levels and a more modest decline in hepatic levels, following surgery. In mechanistic studies, manipulation of miRNA-122 levels in a cell model induced changes in the activity of key enzymes involved in hepatic energy metabolism, glucose transport, glycolysis, tricarboxylic acid cycle, pentose phosphate shunt, fatty-acid oxidation and gluconeogenesis, consistent with the findings of the in vivo surgery-mediated responses, indicating the powerful homeostatic activity of the miRNAs. CONCLUSIONS: The close association between energy metabolism, neuronal signaling and gut microbial metabolites derived from the circulating miRNA, plasma, urine and liver metabolite and gut hormone correlations further supports an enhanced gut-brain signaling, which we suggest is hormonally mediated by both traditional gut hormones and miRNAs. This transomic approach to map the crosstalk between the circulating miRNAome and metabolome offers opportunities to understand complex systems biology within a disease and interventional treatment setting

Pleosporales

One hundred and five generic types of Pleosporales are described and illustrated. A brief introduction and detailed history with short notes on morphology, molecular phylogeny as well as a general conclusion of each genus are provided. For those genera where the type or a representative specimen is unavailable, a brief note is given. Altogether 174 genera of Pleosporales are treated. Phaeotrichaceae as well as Kriegeriella, Zeuctomorpha and Muroia are excluded from Pleosporales. Based on the multigene phylogenetic analysis, the suborder Massarineae is emended to accommodate five families, viz. Lentitheciaceae, Massarinaceae, Montagnulaceae, Morosphaeriaceae and Trematosphaeriaceae

Normosmic Congenital Hypogonadotropic Hypogonadism Due to TAC3/TACR3 Mutations: Characterization of Neuroendocrine Phenotypes and Novel Mutations

CONTEXT: TAC3/TACR3 mutations have been reported in normosmic congenital hypogonadotropic hypogonadism (nCHH) (OMIM #146110). In the absence of animal models, studies of human neuroendocrine phenotypes associated with neurokinin B and NK3R receptor dysfunction can help to decipher the pathophysiology of this signaling pathway. OBJECTIVE: To evaluate the prevalence of TAC3/TACR3 mutations, characterize novel TACR3 mutations and to analyze neuroendocrine profiles in nCHH caused by deleterious TAC3/TACR3 biallelic mutations. RESULTS: From a cohort of 352 CHH, we selected 173 nCHH patients and identified nine patients carrying TAC3 or TACR3 variants (5.2%). We describe here 7 of these TACR3 variants (1 frameshift and 2 nonsense deleterious mutations and 4 missense variants) found in 5 subjects. Modeling and functional studies of the latter demonstrated the deleterious consequence of one missense mutation (Tyr267Asn) probably caused by the misfolding of the mutated NK3R protein. We found a statistically significant (p<0.0001) higher mean FSH/LH ratio in 11 nCHH patients with TAC3/TACR3 biallelic mutations than in 47 nCHH patients with either biallelic mutations in KISS1R, GNRHR, or with no identified mutations and than in 50 Kallmann patients with mutations in KAL1, FGFR1 or PROK2/PROKR2. Three patients with TAC3/TACR3 biallelic mutations had an apulsatile LH profile but low-frequency alpha-subunit pulses. Pulsatile GnRH administration increased alpha-subunit pulsatile frequency and reduced the FSH/LH ratio. CONCLUSION: The gonadotropin axis dysfunction associated with nCHH due to TAC3/TACR3 mutations is related to a low GnRH pulsatile frequency leading to a low frequency of alpha-subunit pulses and to an elevated FSH/LH ratio. This ratio might be useful for pre-screening nCHH patients for TAC3/TACR3 mutations

Neighborhood fast food restaurants and fast food consumption: A national study

<p>Abstract</p> <p>Background</p> <p>Recent studies suggest that neighborhood fast food restaurant availability is related to greater obesity, yet few studies have investigated whether neighborhood fast food restaurant availability promotes fast food consumption. Our aim was to estimate the effect of neighborhood fast food availability on frequency of fast food consumption in a national sample of young adults, a population at high risk for obesity.</p> <p>Methods</p> <p>We used national data from U.S. young adults enrolled in wave III (2001-02; ages 18-28) of the National Longitudinal Study of Adolescent Health (n = 13,150). Urbanicity-stratified multivariate negative binomial regression models were used to examine cross-sectional associations between neighborhood fast food availability and individual-level self-reported fast food consumption frequency, controlling for individual and neighborhood characteristics.</p> <p>Results</p> <p>In adjusted analysis, fast food availability was not associated with weekly frequency of fast food consumption in non-urban or low- or high-density urban areas.</p> <p>Conclusions</p> <p>Policies aiming to reduce neighborhood availability as a means to reduce fast food consumption among young adults may be unsuccessful. Consideration of fast food outlets near school or workplace locations, factors specific to more or less urban settings, and the role of individual lifestyle attitudes and preferences are needed in future research.</p