Accompanying measures to general budget support in Sub-Saharan Africa

As a financial contribution harmonised among donors, general budget support facilitates the implementation of national poverty reduction strategies and promotes governance in partner countries. Apart from this financial contribution to the national budget, the standard budget support package also involves intensive policy dialogue between donors and the partner government, as well as accompanying measures to strengthen country systems. In the portfolio of German development cooperation, accompanying measures to budget support have gained in importance. This evaluation was designed to examine if, how and under which circumstances accompanying measures to budget support can contribute to the objectives of budget support. Questions on the relevance, effectiveness and success factors of these measures were answered based on a literature study, a portfolio analysis, an online survey and semi-structured interviews. Furthermore, the interrelations between accompanying measures and other elements of the package of budget support were analysed

Begleitende Maßnahmen der allgemeinen Budgethilfe in Subsahara-Afrika

Allgemeine Budgethilfe unterstützt mit einem unter Gebern harmonisierten finanziellen Beitrag die Umsetzung nationaler Armutsbekämpfungsstrategien und fördert die Regierungsführung in Partnerländern. Neben dem finanziellen Beitrag zum Staatshaushalt besteht das Budgethilfe-Paket aus einem intensiven Politikdialog zwischen Gebern und der Partnerregierung, sowie aus Begleitenden Maßnahmen zur Stärkung der Partnersysteme. Im Portfolio der deutschen EZ haben Begleitende Maßnahmen der Budgethilfe an Bedeutung gewonnen. Mit der Evaluierung wurde untersucht, ob, wie und unter welchen Umständen Begleitende Maßnahmen der Budgethilfe zu den Zielen der Budgethilfe beitragen können. Auf Basis von Literaturstudium, einer Portfolioanalyse, einer Online-Befragung und semi-strukturierten Interviews wurden Fragen nach Relevanz, Wirkungsweise und Erfolgsfaktoren dieser Maßnahmen beantwortet. Außerdem wurden die Wechselwirkungen zwischen Begleitenden Maßnahmen und anderen Elementen des Budgethilfe-Pakets untersucht

Behavioral Health Risk Factors and Motivation to Change among Cardiovascular General Hospital Patients Aged 50 to 79 Years

Little is known about the (co-)occurrence of smoking, alcohol at-risk drinking, physical inactivity and overweight, and the motivation to change these behavioral health risk factors (HRFs) in older general hospital patients with cardiovascular disease. Between October and December 2016, all consecutively admitted patients aged 50 to 79 years were proactively recruited on 3 cardiology wards and asked to participate in a survey on HRFs and behavior change motivation. Of the eligible patients, 80.4% participated in the survey (n = 328). The mean age was 66.5 years (standard deviation 9.0), and 65.5% were male. At least 1 HRF was present in 91.8% (n = 280), at least 2 HRFs in 54.4% (n = 166), and 3 or 4 HRFs in 12.1% (n = 37) of participants. The proportion of older adults who contemplated or were changing or planning to change their behavior to meet health behavior recommendations ranged between 66.0% (smoking) and 93.2% (alcohol consumption). The results indicate a notable co-occurrence of behavioral HRFs in older patients with cardiovascular disease. The majority of older adults were at least considering changing the respective behavior. To prevent and treat diseases efficiently, hospitalization may be a suitable moment for systematic multiple HRF screening and intervention.Peer Reviewe

Early cortical surface plasticity relates to basic mathematical learning

Children lay the foundation for later academic achievement by acquiring core mathematical abilities in the first school years. Neural reorganization processes associated with individual differences in early mathematical learning, however, are still poorly understood. To fill this research gap, we followed a sample of 5-6-year-old children longitudinally to the end of second grade in school (age 7–8 years) combining magnetic resonance imaging (MRI) with comprehensive behavioral assessments. We report significant links between the rate of neuroplastic change of cortical surface anatomy, and children's early mathematical skills. In particular, most of the behavioral variance (about 73%) of children's visuospatial abilities was explained by the change in cortical thickness in the right superior parietal cortex. Moreover, half of the behavioral variance (about 55%) of children's arithmetic abilities was explained by the change in cortical folding in the right intraparietal sulcus. Additional associations for arithmetic abilities were found for cortical thickness change of the right temporal lobe, and the left middle occipital gyrus. Visuospatial abilities were related to right precentral and supramarginal thickness, as well as right medial frontal gyrus folding plasticity. These effects were independent of other individual differences in IQ, literacy and maternal education. Our findings highlight the critical role of cortical plasticity during the acquisition of fundamental mathematical abilities

Extensive alterations of the whole-blood transcriptome are associated with body mass index: results of an mRNA profiling study involving two large population-based cohorts

Background: Obesity, defined as pathologically increased body mass index (BMI),is strongly related to an increased risk for numerous common cardiovascular and metabolic diseases. It is particularly associated with insulin resistance, hyperglycemia, and systemic oxidative stress and represents the most important risk factor for type 2 diabetes (T2D). However, the pathophysiological mechanisms underlying these associations are still not completely understood. Therefore, in order to identify potentially disease-relevant BMI-associated gene expression signatures, a transcriptome-wide association study (TWAS) on BMI was performed. Methods: Whole-blood mRNA levels determined by array-based transcriptional profiling were correlated with BMI in two large independent population-based cohort studies (KORA F4 and SHIP-TREND) comprising a total of 1977 individuals. Results: Extensive alterations of the whole-blood transcriptome were associated with BMI: More than 3500 transcripts exhibited significant positive or negative BMI-correlation. Three major whole-blood gene expression signatures associated with increased BMI were identified. The three signatures suggested: i) a ratio shift from mature erythrocytes towards reticulocytes, ii) decreased expression of several genes essentially involved in the transmission and amplification of the insulin signal, and iii) reduced expression of several key genes involved in the defence against reactive oxygen species (ROS). Conclusions: Whereas the first signature confirms published results, the other two provide possible mechanistic explanations for well-known epidemiological findings under conditions of increased BMI, namely attenuated insulin signaling and increased oxidative stress. The putatively causative BMI-dependent down-regulation of the expression of numerous genes on the mRNA level represents a novel finding. BMI-associated negative transcriptional regulation of insulin signaling and oxidative stress management provide new insights into the pathogenesis of metabolic syndrome and T2D

New genetic loci link adipose and insulin biology to body fat distribution.

Body fat distribution is a heritable trait and a well-established predictor of adverse metabolic outcomes, independent of overall adiposity. To increase our understanding of the genetic basis of body fat distribution and its molecular links to cardiometabolic traits, here we conduct genome-wide association meta-analyses of traits related to waist and hip circumferences in up to 224,459 individuals. We identify 49 loci (33 new) associated with waist-to-hip ratio adjusted for body mass index (BMI), and an additional 19 loci newly associated with related waist and hip circumference measures (P < 5 × 10(-8)). In total, 20 of the 49 waist-to-hip ratio adjusted for BMI loci show significant sexual dimorphism, 19 of which display a stronger effect in women. The identified loci were enriched for genes expressed in adipose tissue and for putative regulatory elements in adipocytes. Pathway analyses implicated adipogenesis, angiogenesis, transcriptional regulation and insulin resistance as processes affecting fat distribution, providing insight into potential pathophysiological mechanisms

Global variations in diabetes mellitus based on fasting glucose and haemogloblin A1c

Fasting plasma glucose (FPG) and haemoglobin A1c (HbA1c) are both used to diagnose diabetes, but may identify different people as having diabetes. We used data from 117 population-based studies and quantified, in different world regions, the prevalence of diagnosed diabetes, and whether those who were previously undiagnosed and detected as having diabetes in survey screening had elevated FPG, HbA1c, or both. We developed prediction equations for estimating the probability that a person without previously diagnosed diabetes, and at a specific level of FPG, had elevated HbA1c, and vice versa. The age-standardised proportion of diabetes that was previously undiagnosed, and detected in survey screening, ranged from 30% in the high-income western region to 66% in south Asia. Among those with screen-detected diabetes with either test, the agestandardised proportion who had elevated levels of both FPG and HbA1c was 29-39% across regions; the remainder had discordant elevation of FPG or HbA1c. In most low- and middle-income regions, isolated elevated HbA1c more common than isolated elevated FPG. In these regions, the use of FPG alone may delay diabetes diagnosis and underestimate diabetes prevalence. Our prediction equations help allocate finite resources for measuring HbA1c to reduce the global gap in diabetes diagnosis and surveillance.peer-reviewe

Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants

Background Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. Methods We used data from 1990 to 2019 on people aged 30–79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age. Findings The number of people aged 30–79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306–359) million women and 317 (292–344) million men in 1990 to 626 (584–668) million women and 652 (604–698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55–62) of women and 49% (46–52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43–51) of women and 38% (35–41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20–27) for women and 18% (16–21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. Interpretation Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings

Impact of certification on fruit producers in the Sao Francisco Valley in Brazil

Producers and exporters of fresh fruits and vegetables from developingcountries like Brazil are increasingly required to demonstrate the safety andtraceability of their produce up to the consumption stage. In fact, the Brazilianexport market is still relatively underdeveloped, with an export share of only2.4% of the total produced volume. However, certification may also have theeffect of a non-tariff trade barrier, undermining the capability and financialability of especially small-scale farmers in exporting to international markets.This study, therefore, aims at providing an economic analysis of certification onmango and grapes producers. A survey of 303 grapes and mango farmers wasconducted in 2006 in the Juazeiro and Petrolina regions of the Sao FranciscoValley in Brazil. Certified and non-certified farmers as well as those in processto obtain certification were included in the sample. Empirical analysis using alogit model shows that grapes farmers have higher probability to certify thanmango growers. There are two variables which have a positive and significanteffect: education and experience. However, small-scale farms, the dependencyon non-agricultural income and a trust-based arrangement have a negative butsignificant effect