An Intervention for Pulmonary Rehabilitators to Develop a Social Identity for Patients Attending Exercise Rehabilitation: A Feasibility and Pilot Randomised Control Trial Protocol

Background: Chronic obstructive pulmonary disease (COPD) is a degenerative condition that can impair health related quality of life (HRQoL). A number of self-management interventions, employing a variety of behavioural change techniques (BCTs), have been adopted to improve HRQoL for COPD patients. However, a lack of attention has been given to group management interventions with an emphasis on incorporating BCTs into rehabilitators practice. This study aims to pilot and feasibly explore a social identity group- management intervention, delivered by COPD rehabilitation staff to patients attending exercise pulmonary rehabilitation. Doing so will help inform the plausibility of the intervention before conducting a full trial to evaluate its effectiveness to improve HRQoL. Methods: This is a two center, randomized cross-over controlled trial. Two pulmonary rehabilitation centres based in the UK will be randomly allocated to two treatment arms (standard care and intervention). Outcome measurements relating to HRQoL and social identity will be completed pre and post exercise rehabilitation. Focus group interviews will be conducted at the end of exercise rehabilitation to capture participants’ contextualised experiences of the intervention. COPD rehabilitators will undertake semi-structured interviews at the end of the trial to garner their holistic perspectives of intervention fidelity and implementation. Discussion: This is the first study to adopt a social identity approach to develop a rehabilitator-led, group management intervention for COPD patients attending exercise pulmonary rehabilitation. The results of this study will provide evidence for the feasibility and sample size requirements to inform a larger study, which can ascertain the intervention’s effectiveness for improving HRQoL for COPD patients. Trial Registration: ClinicalTrials.gov Identifier: NCT02288039. Date 31st October 2014

Impact of a community-based cardiovascular disease service intervention in a highly deprived area

Objective: To examine the effects on emergency hospital admissions, length of stay and emergency re-admissions of providing a consultant-led, community-based cardiovascular diagnostic, treatment and rehabilitation service, based in a highly deprived area in the North West of England. Methods: A longitudinal matched controlled study using difference-in-differences analysis compared the change in outcomes in the intervention population, to the change in outcomes in a matched comparison population that had not received the intervention, five years before and after implementation. The outcomes were emergency hospitalisations, length of inpatient stay, and re-admission rates for cardiovascular disease (CVD). Results: Findings show that the intervention was associated with 66 fewer emergency CVD admissions per 100,000 population per year [95% CI 22.13 to 108.98] in the post-intervention period, relative to the control group. No significant measurable effects on length of stay or emergency re-admission rates were observed. Conclusion: This consultant-led, community-based cardiovascular diagnostic, treatment and rehabilitation service, was associated with a lower rate of emergency hospital admissions in a highly disadvantaged population. Similar approaches could be an effective component of strategies to reduce unplanned hospital admissions

Thymosin Beta 4 Prevents Oxidative Stress by Targeting Antioxidant and Anti-Apoptotic Genes in Cardiac Fibroblasts

Thymosin beta-4 (Tβ4) is a ubiquitous protein with diverse functions relating to cell proliferation and differentiation that promotes wound healing and modulates inflammatory responses. The effecter molecules targeted by Tβ4 for cardiac protection remains unknown. The purpose of this study is to determine the molecules targeted by Tβ4 that mediate cardio-protection under oxidative stress.Rat neonatal fibroblasts cells were exposed to hydrogen peroxide (H(2)O(2)) in presence and absence of Tβ4 and expression of antioxidant, apoptotic and pro-fibrotic genes was evaluated by quantitative real-time PCR and western blotting. Reactive oxygen species (ROS) levels were estimated by DCF-DA using fluorescent microscopy and fluorimetry. Selected antioxidant and antiapoptotic genes were silenced by siRNA transfections in cardiac fibroblasts and the effect of Tβ4 on H(2)O(2)-induced profibrotic events was evaluated.Pre-treatment with Tβ4 resulted in reduction of the intracellular ROS levels induced by H(2)O(2) in the cardiac fibroblasts. This was associated with an increased expression of antioxidant enzymes Cu/Zn superoxide dismutase (SOD) and catalase and reduction of Bax/Bcl(2) ratio. Tβ4 treatment reduced the expression of pro-fibrotic genes [connective tissue growth factor (CTGF), collagen type-1 (Col-I) and collagen type-3 (Col-III)] in the cardiac fibroblasts. Silencing of Cu/Zn-SOD and catalase gene triggered apoptotic cell death in the cardiac fibroblasts, which was prevented by treatment with Tβ4.This is the first report that exhibits the targeted molecules modulated by Tβ4 under oxidative stress utilizing the cardiac fibroblasts. Tβ4 treatment prevented the profibrotic gene expression in the in vitro settings. Our findings indicate that Tβ4 selectively targets and upregulates catalase, Cu/Zn-SOD and Bcl(2), thereby, preventing H(2)O(2)-induced profibrotic changes in the myocardium. Further studies are warranted to elucidate the signaling pathways involved in the cardio-protection afforded by Tβ4

Incorporation of leguminous cover crops in smallholder cassava-based production system in Western Tanzania.

Small-scale crop production in many parts of Tanzania is constrained by many problems among which soil fertility degradation is a major problem. Over 80% of cassava (Manihot esculenta) production in Tanzania is done by the small-scale farmers who continuously cultivate their fields, but use limited inputs to restore depleted plant nutrients. The objective of this study was to examine the best legume species that could be incorporated in cassava (Manihot esculenta) production systems under farmers? conditions and result in increase in soil fertility and crop yields. Mucuna pruriens and Canavalia ensiformis were either incorporated with cassava (Manihot esculenta) or planted as sole crop in rotation with cassava. Mucuna pruriens and Canavalia ensiformis were found to produce almost similar amount of biomass. The two legumes, however, produced higher biomass in rotation than intercropping system. The amount of biomass produced by Mucuna pruriens and Canavalia ensiformis in rotation system was 6.28 t.ha-1 and 5.31 t.ha-1, respectively. The Mucuna use represents an input of nitrogen into the soil which simulates a saving cost of 181.42 and 141.96 US$ ha-1. In the first year, cassava root yields were significantly increased (p < 0.05) over control (continuous sole cassava) (1.44 t.ha-1) by the use of intercropping of cassava (Manihot esculenta) with Mucuna pruriens (2.41 t.ha-1) and or Canavalia ensiformis (2.25 t.ha-1). Intercropping and rotation of cassava with legumes increase cassava yield and represent a sustainable alternative to reduce the farms? dependence on external inputs and to enhance inherent soil fertility.Made available in DSpace on 2018-01-29T23:38:16Z (GMT). No. of bitstreams: 1 Incorporationleguminous.pdf: 1067716 bytes, checksum: 0ca29656ac050122146628eb1cbddc49 (MD5) Previous issue date: 2017-12-27bitstream/item/171782/1/Incorporation-leguminous.pd

A gendered analysis of climate variability and change impacts and adaptations in semi arid area farming systems and natural resources management

Climate change and climate variability is increasingly threatening the livelihoods of many Tanzanians especially those living in semi-arid rural areas. The most affected are those; with low incomes, less food, poor access to health services, unstable energy supplies, and living in fragile natural ecosystems. Generally, women and men contribute differently to climate change; likewise, they are affected differently and react differently to its impact. The overall objective of the study was to assess the impact of climate change on rural livelihoods' and how households in semi-arid areas of Tanzania adapt based on gender. The study was conducted in Iramba and Meatu Districts. The study adopted a Sustainable livelihood Approach (SLA) developed by DFID (1992) in the analysis of climate change impacts and households' adaptation. Data was collected using qualitative methods such as focus group discussions and key informant interviews, informal interviews and observations. Findings from the study show that, climate change impacts affect almost everybody in the studied communities; however, differences by gender exist. These findings thus suggest that adaptation to climate change impacts vary across genders due to differences in roles and responsibilities, power relations and access to and control over resources.Research ReportClimate Change Impacts, Adaptation and Mitigation' (CCIAM) Programme in Tanzani

Climate change and its variability on crop production in semiarid areas of Iramba and Meatu Districts, Tanzania

African development, 2016, 32 (Special issue): 10-19Climate change and its variability are increasingly threatening livelihoods of Tanzania’s predominantly rural population and in particular those households with low incomes. Based on the above reality, a study was conducted in two semi-arid areas of central Tanzania. The overall objective was to determine how climate change and its variability have affected rural households’ crop production over time. Specifically, the paper aims at; assessing farmers’ preferred food and cash crops, determining the impact of rainfall variability on crop production in the semi-arid areas of central Tanzania and determining communities’ perception of climate change. The study on which the paper is based used a mixed method approach whereby both quantitative and qualitative data were collected to complement each other thus improving quality of the results regarding the impact of climate change and its variability on rural households’ crop production. Primary data was collected using a pre-structured questionnaire and focus group discussions’ checklist. Whereas quantitative data was analyzed using the Statistical Software for Social Scientists, qualitative data was analyzed using content analysis. Findings generally show that climate change and climate variability have occurred in the study area and consequently crop production has adversely been affected leading to households’ vulnerability to food insecurity. In addition, food shortages have become frequent threatening households livelihood security. Based on the findings, rural households’ capacity to respond to the challenges of climate change and climate variability is a matter of urgency. Therefore, the government, in addition to the efforts already undertaken, should put in place institutional and policy framework to support rural households’ efforts to minimize the impacts of the phenomena

Knowledge, attitudes and practices on childhood TB among healthcare workers

BACKGROUND: Increasing childhood TB case detection requires the deployment of diagnostic services at peripheral healthcare level. Capacity and readiness of healthcare workers (HCWs) are key to the delivery of innovative approaches.METHODS: In 2019, HCWs from five district hospitals (DHs) and 20 primary healthcare centres (PHCs) in Cambodia, Cameroon, Cote d´Ivoire, Sierra Leone and Uganda completed a self-administered knowledge-attitudes-practices (KAP) questionnaire on childhood TB. We computed knowledge and attitudes as scores and identified HCW characteristics associated with knowledge scores using linear regression.RESULT: Of 636 eligible HCWs, 497 (78%) participated. Median knowledge scores per country ranged between 7.4 and 12.1 (/18). Median attitude scores ranged between 2.8 and 3.3 (/4). Between 13.3% and 34.4% of HCWs reported diagnosing childhood with (presumptive) TB few times a week. Practising at PHC level, being female, being involved in indirect TB care, having a non-permanent position, having no previous research experience and working in Cambodia, Cameroon, Cote d´Ivoire and Sierra Leone as compared to Uganda were associated with a lower knowledge score.CONCLUSION: HCWs had overall limited knowledge, favourable attitudes and little practice of childhood TB diagnosis. Increasing HCW awareness, capacity and skills, and improving access to effective diagnosis are urgently needed

ePOCT+ and the medAL-; suite; : development of an electronic clinical decision support algorithm and digital platform for pediatric outpatients in low- and middle-income countries

Electronic clinical decision support algorithms (CDSAs) have been developed to address high childhood mortality and inappropriate antibiotic prescription by helping clinicians adhere to guidelines. Previously identified challenges of CDSAs include their limited scope, usability, and outdated clinical content. To address these challenges we developed ePOCT+, a CDSA for the care of pediatric outpatients in low- and middle-income settings, and the medical algorithm suite (medAL-suite), a software for the creation and execution of CDSAs. Following the principles of digital development, we aim to describe the process and lessons learnt from the development of ePOCT+ and the medAL-suite. In particular, this work outlines the systematic integrative development process in the design and implementation of these tools required to meet the needs of clinicians to improve uptake and quality of care. We considered the feasibility, acceptability and reliability of clinical signs and symptoms, as well as the diagnostic and prognostic performance of predictors. To assure clinical validity, and appropriateness for the country of implementation the algorithm underwent numerous reviews by clinical experts and health authorities from the implementing countries. The digitalization process involved the creation of medAL-creator, a digital platform which allows clinicians without IT programming skills to easily create the algorithms, and medAL-reader the mobile health (mHealth) application used by clinicians during the consultation. Extensive feasibility tests were done with feedback from end-users of multiple countries to improve the clinical algorithm and medAL-reader software. We hope that the development framework used for developing ePOCT+ will help support the development of other CDSAs, and that the open-source medAL-suite will enable others to easily and independently implement them. Further clinical validation studies are underway in Tanzania, Rwanda, Kenya, Senegal, and India