Gender differences in barriers to alcohol and other drug treatment in Cape Town, South Africa

Objective: The study aimed to identify gender differences in barriers to alcohol and other drug (AOD) treatment use among disadvantaged communities in Cape Town, South Africa. The Behavioral Model of Health Services Utilization was used as an analytic framework. Method: A case-control design was used to compare 434 individuals with AOD problems from disadvantaged communities who had accessed treatment with 555 controls who had not accessed treatment on a range of variables. Logistic regression procedures were employed to examine the unique profile of variables associated with treatment utilization for male and female participants. Results: Few gender differences emerged in terms of the pattern of variables associated with AOD treatment use. Greater awareness of treatment options and fewer geographic access and affordability barriers were strongly associated with an increased likelihood of AOD treatment use for both men and women from disadvantaged communities. However, while similar types of barriers to treatment were reported by men and women, these barriers had a greater impact on treatment utilization for women compared to men. Conclusion: Compared to men, women from disadvantaged communities in South Africa do not have equal access to AOD treatment. Recommendations on how to reduce these barriers and ways to improve AOD treatment use among women from disadvantaged communities in South Africa are provided.Keywords: Health care quality; Access and evaluation; Gender; Substance abuse treatment centres; South Afric

Correction of severe columella and tip retraction in silicone implanted Asian short noses.

BACKGROUND: Silicone Implants and other alloplastic materials are frequently used in rhinoplasty to augment Asian short noses. However, nasal deformities as a result of implant-related infections are increasing in incidence. The resulting tissue scarrings hinder the application of traditional techniques of lengthening short noses. The following paper presents a technique to correct severe postoperative retractions of the tip and columella caused by silicone implants. METHODS: We present a retrospective case study of two Asian patients with recurrent acute infections, secondary to silicone dorsum implants, leading to chronic inflammation of the tip and columella. The treatment consisted of implant removal and the immediate nasal reconstruction by combining uni- or bilateral gingivobuccal flaps along with L-shaped costal cartilage grafting. To evaluate the surgical results, various anthropometric measurements, particularly the nasal length (NL) and nasal tip projection (NTP) of pre- and postoperative profile photographs, were analyzed. RESULTS: Successful nasal lengthening and correction of columellar retraction were achieved. In case I, postoperative NTP and NL increased by 34.7% and 21.1%, respectively. In case II, NL and NTP increased by 23.8% and 10.6%, respectively. However, case II presented necrosis of the distal extremity of one gingivobuccal flap without rib graft resorption, which later healed by secondary intention. CONCLUSION: Pronounced columellar retraction in severe short noses can be successfully managed with a combination of gingivobuccal flaps along with L-shaped costal cartilage grafting. The use of autologous materials decreases the risk of long-term extrusion through the tip. The gingivobuccal flap provides vascularity to the exposed rib cartilage on the columella and prevents its resorption

“Craving”: exploring the components of the desires for alcohol questionnaire (DAQ) and the relation to the severity of alcohol problems

Objective: the aims of this study were: 1) to explore the components of craving, as measured by the Desires for Alcohol Questionnaire (DAQ); and 2) to examine how craving may relate to the severity of alcohol problems. Method: 106 patients seeking treatment for an alcohol use disorder (AUD) completed the DAQ and Alcohol Use Disorder Identification Test (AUDIT). The overall sample was predominantly male (63%) with a mean age of 44 years. 61% of the participants were abstinent from alcohol at the time of the study. Principal components analysis was conducted on the DAQ for the overall, abstinent and currently drinking samples. Correlations were computed between the DAQ and AUDIT scores, and differences in craving between the abstinent and currently drinking samples were investigated. Results: components of craving, as measured by the DAQ, included the desire to drink, the ability to control drinking, positive reinforcement and negative reinforcement. Drinkers displayed stronger cravings (Mdn=47.00, IQR=32.0 – 65.0) than those currently abstinent (Mdn=33.00, IQR=26.0 – 43.0; U=850.0, z=3.127, p&lt;.01, r=0.30). Intensity of craving increases with severity of an AUD in current drinkers (r=.739, p&lt;.001). Conclusions: due to the small sample size, the results of the study should be regarded as preliminary. The components of craving, as measured by the DAQ, support those previously identified in the literature. The study supports the notion that craving is positively associated with the severity of an alcohol use disorder<br/

Food groups and colorectal cancer risk

Most studies of diet and colorectal cancer have considered nutrients and micronutrients, but the role of foods or food groups remains open to debate. To elucidate the issue, we examined data from a case–control study conducted between 1992 and 1997 in the Swiss canton of Vaud. Cases were 223 patients (142 men, 81 women) with incident, histologically confirmed colon (n = 119) or rectal (n = 104) cancer (median age 63 years), linked with the Cancer Registry of the Swiss Canton of Vaud, and controls were 491 subjects (211 men, 280 women, median age 58 years) admitted to the same university hospital for a wide spectrum of acute non-neoplastic conditions unrelated to long-term modifications of diet. Odds ratios (OR) were obtained after allowance for age, sex, education, smoking, alcohol, body mass index, physical activity and total energy intake. Significant associations were observed for refined grain (OR = 1.32 for an increase of one serving per day), and red meat (OR = 1.54), pork and processed meat (OR = 1.27), alcohol (OR = 1.28), and significant protections for whole grain (OR = 0.85), raw (OR = 0.85) and cooked vegetables (OR = 0.69), citrus (OR = 0.86) and other fruits (OR = 0.85), and for coffee (OR = 0.73). Garlic was also protective (OR = 0.32 for the highest tertile of intake). These findings in a central European population support the hypothesis that a diet rich in refined grains and red meat increases the risk of colorectal cancer; they, therefore, support the recommendation to substitute whole grains for refined grain, to limit meat intake, and to increase fruit and vegetable consumption. © 1999 Cancer Research Campaig

Deciding whether to consult the GP or an emergency department: A qualitative study of patient reasoning in Switzerland.

Background: Non-urgent care is an important factor responsible for rising healthcare costs and general practitioners (GPs) are known to be more cost-effective than emergency departments (EDs). Objectives: To understand the reasons why patients confronted with a medical problem perceived as urgent choose to consult either a GP or an ED. Methods: We conducted a qualitative study in Switzerland, using data collected between 2014 and 2015 through semi-structured interviews of adults with non-vital medical problems. Half were recruited after an ambulatory consultation in an ED, and half were patients who consulted their GP. The audio-recorded interviews were transcribed, coded, and analysed according to the constant comparative method. Results: The main reason given by patients who consulted their GP first was the quality of the relationship. The more meaningful the relationship, the more likely patients were to seek advice from their GP. One marker of a privileged relationship was GPs supplying their mobile phone number to the patient. The perceived nature of the complaint, for example, symptoms considered as life-threatening or severe pain, together with the expected waiting time in an ED were additional factors influencing the patients' choice. Conclusion: Our study showed that when patients are confronted with what they perceive as a medical emergency, the quality of the relationship with the GP, in particular the continuity of care provided, seem to be the major reasons why they consult their GP rather than an ED

Dealing with substance use disorders in general practice

Substance use disorders are highly prevalent in South Africa. General practitioners are often the first point of contact and play an essential role in correctly identifying the substance use problem. This article provides an overview of the importance of screening for and assessing substance use disorders and identifying the severity of the substance use disorder, so that the right level of management can be ensured. It also examines associated co-morbidities and provides a general overview of the management of substance use disorders

Constitutively decreased TGFBR1 allelic expression is a common finding in colorectal cancer and is associated with three TGFBR1 SNPs

Purpose: Constitutively decreased TGFBR1 allelic expression is emerging as a potent modifier of colorectal cancer risk in mice and humans. This phenotype was first observed in mice, then in lymphoblastoid cell lines from patients with microsatellite stable colorectal tumors. Patients and Methods: We assessed the frequency of constitutively decreased TGFBR1 allelic expression and association with SNPs covering the TGFBR1 locus using RNA and DNA extracted from the peripheral blood lymphocytes of 118 consecutive patients with biopsy-proven adenocarcinoma of the colon or the rectum. Results: We found that 11(9.3%) of 118 patients exhibited decreased TGFBR1 allelic expression (TGFBR1 ASE). TGFBR1 ASE was strongly associated with three SNPs in linkage disequilibrium with each other: rs7034462 (p = 7.2 × 10-4), TGFBR1*6A (p = 1.6 × 10-4) and rs11568785 (p = 1.4 × 10-4). Conclusion: These results confirm the high prevalence of constitutively decreased TGFBR1 allelic expression among patients with colorectal cancer. The association of this phenotype with TGFBR1*6A, rs7034462 and rs1156875 suggests an association between TGFBR1 SNPs and colorectal cancer, which warrants additional studies

Hapln1b, a central organizer of the ECM, modulates kit signaling to control developmental hematopoiesis in zebrafish

During early vertebrate development, hematopoietic stem and progenitor cells (HSPCs) are produced in hemogenic endothelium located in the dorsal aorta, before they migrate to a transient niche where they expand to the fetal liver and the caudal hematopoietic tissue, in mammals and zebrafish, respectively. In zebrafish, previous studies have shown that the extracellular matrix (ECM) around the aorta must be degraded to enable HSPCs to leave the aortic floor and reach blood circulation. However, the role of the ECM components in HSPC specification has never been addressed. In this study, hapln1b, a key component of the ECM, was specifically expressed in hematopoietic sites in the zebrafish embryo. Gain- and loss-of-function experiments all resulted in the absence of HSPCs in the early embryo, showing that hapln1b is necessary, at the correct level, to specify HSPCs in the hemogenic endothelium. Furthermore, the expression of hapln1b was necessary to maintain the integrity of the ECM through its link domain. By combining functional analyses and computer modeling, we showed that kitlgb interacts with the ECM to specify HSPCs. The findings show that the ECM is an integral component of the microenvironment and mediates the cytokine signaling that is necessary for HSPC specification

Quantification of Field Resistance to Verticillium dahliae in Eight Russet-Skinned Potato Cultivars Using Real-Time PCR

Abstract Changes in potato production over the past 10 to 20 years, have resulted in increased emphasis being placed on breeding for resistance to Verticillium wilt, caused by Verticillium dahliae Kleb. While many russet-skinned cultivars recently have been released with reported resistance to Verticillium wilt, information is lacking on the level of pathogen colonization, and therefore, the level of true genetic resistance is not known. Eight russet-skinned cultivars were grown in field trials with low and high levels of V. dahliae in the soil, and evaluated for wilt, stem colonization, yield, and tuber vascular discoloration. A recently developed QPCR assay was validated, with strong relationships to culture plating assays over three stem sampling dates. Additionally, stem colonization levels, as determined by QPCR, were related to wilt and tuber vascular discoloration. However, total yield did not exhibit a strong relationship to any other parameter evaluated in this study. Results from these studies indicate that varying levels of true resistance are present in the russet-skinned cultivars evaluated, and that the QPCR assay can be reliable in rapidly evaluating resistance to V. dahliae under field conditions. Based on pathogen quantification using stem colonization derived from traditional plating assays and QPCR, the resistance level of several cultivars is more clearly defined and discussed. Resumen Los cambios en la producción de papa en los pasados 10 a 20 años, han resultado en un aumento en el énfasis ubicado en el mejoramiento para la resistencia al marchitamiento por Verticillium, causado por Verticillium dahliae Kleb. Mientras que muchos cultivares de piel tipo russet se han liberado recientemente con resistencia reportada al marchitamiento por Verticillium, la información carece del nivel de colonización del patógeno, y de aquí que no se conozca el nivel de resistencia genética verdadera. Se sembraron ocho cultivares con piel tipo russet en ensayos de campo con niveles bajo y alto de V. dahliae en el suelo, y evaluados para marchitez, colonización del tallo, rendimiento, y decoloración vascular del tubérculo. Se evaluó recientemente un ensayo QPCR, con relaciones fuertes a ensayos de cultivos en placas sobre tres fechas de muestreo del tallo. Adicionalmente, los niveles de colonización del tallo, como se determinaron por QPCR, se relacionaron al marchitamiento y a la decoloración vascular del tubérculo. No obstante, el rendimiento total no exhibió una relación fuerte a ningún otro parámetro evaluado en este estudio. Los resultados de estos estudios indican que están presentes diversos niveles de resistencia verdadera en las variedades de piel tipo russet evaluadas, y que el ensayo de QPCR puede ser confiable en la evaluación rápida de resistencia a V. dahliae bajo condiciones de campo. Con base en la cuantificación del patógeno mediante el uso de la colonización del tallo derivada de los ensayos tradicionales de placas y QPCR, el nivel de resistencia de varios cultivares está más claramente definido y discutido

A new twist on sea silk : the peculiar protein ultrastructure of fan shell and pearl oyster byssus

11 pagesInternational audienceNumerous mussel species produce byssal threads - tough proteinaceous fibers, which anchor mussels in aquatic habitats. Byssal threads from Mytilus species, which are comprised of modified collagen proteins - have become a veritable archetype for bio-inspired polymers due to their self-healing properties. However, threads from different species are comparatively much less understood. In particular, the byssus of Pinna nobilis comprises thousands of fine fibers utilized by humans for millennia to fashion lightweight golden fabrics known as sea silk. P. nobilis is very different from Mytilus from an ecological, morphological and evolutionary point of view and it stands to reason that the structure-function relationships of its byssus are distinct. Here, we performed compositional analysis, X-ray diffraction (XRD) and transmission electron microscopy (TEM) to investigate byssal threads of P. nobilis, as well as a closely related bivalve species (Atrina pectinata) and a distantly related one (Pinctada fucata). This comparative investigation revealed that all three threads share a similar molecular superstructure comprised of globular proteins organized helically into nanofibrils, which is completely distinct from the Mytilus thread ultrastructure, and more akin to the supramolecular organization of bacterial pili and F-actin. This unexpected discovery hints at a possible divergence in byssus evolution in Pinnidae mussels, perhaps related to selective pressures in their respective ecological niches