Bringing the lab bench to the field: Point-of-care testing for enhancing health research and stakeholder engagement in rural/remote, indigenous, and resource-limited contexts.

Point-of-care testing (POCT) allows researchers and health-care providers to bring the lab bench to the field, providing essential health information that can be leveraged to improve health care, accessibility, and understanding across clinical and research settings. Gaps in health service access are most pronounced in what we term RIR settings-rural/remote regions, involving Indigenous peoples, and/or within resource-limited settings. In these contexts, morbidity and mortality from infectious and non-communicable diseases are disproportionately higher due to numerous geographic, economic, political, and sociohistorical factors. Human biologists and global health scholars are well-positioned to contribute on-the-ground-level insights that can serve to minimize global health inequities and POCT has the potential to augment such approaches. While the clinical benefits of POCT include increasing health service access by bringing testing, rapid diagnosis, and treatment to underserved communities with limited pathways to centralized laboratory testing, POCT also provides added benefits to both health-focused researchers and their participants. Through portable, minimally invasive devices, researchers can provide actionable health data to participants by coupling POCT with population-specific health education, discussing results and their implications, creating space for participants to voice concerns, and facilitating linkages to treatment. POCT can also strengthen human biology research by shedding light on questions of evolutionary and biocultural importance. Here, we expand on the epidemiological and research value, as well as practical and ethical challenges of POCT across stakeholders (i.e., participant, community, health researcher, and trainee). Finally, we emphasize the immense opportunities of POCT for fostering collaborative research and enhancing access to health delivery and information and, by extension, helping to mitigate persistent global health inequities.

Soil-transmitted helminth infection and intestinal inflammation among the Shuar of Amazonian Ecuador.

OBJECTIVES: Little research exists documenting levels of intestinal inflammation among indigenous populations where exposure to macroparasites, like soil-transmitted helminths (STHs), is common. Reduced STH exposure is hypothesized to contribute to increased prevalence of elevated intestinal inflammation in wealthy nations, likely due to coevolutionary histories between STHs and human immune systems that favored anti-inflammatory pathways. Here, we document levels of intestinal inflammation and test associations with STH infection among the Shuar of Ecuador, an indigenous population undergoing socioeconomic/lifestyle changes that influence their hygienic environment. We predict that fecal calprotectin (FC; a measure of intestinal inflammation) will be lower in STH infected individuals and that FC will be negatively associated with infection intensity. METHODS: Stool samples to analyze FC levels and STH infection were collected from 69 Shuar participants (ages 5-75 years). Children (<15 years) and adults (15+ years) were analyzed separately to understand the role of exposure in immune system development and the intestinal inflammatory response. RESULTS: Two species of STH were present: Ascaris lumbricoides and Trichuris trichiura. The relationships between infection and intestinal inflammation were age- and species-specific. While no significant relationships were found among adults, children who were singly infected with T. trichiura had lower FC levels than uninfected children. Infection intensity was not significantly associated with FC in children or adults. CONCLUSIONS: These preliminary results provide limited support for our hypotheses, documenting tentative age- and species-specific associations between FC and infection status. Findings may point to the importance of species-specific STH exposure during immune system development.

High energy requirements and water throughput of adult Shuar forager-horticulturalists of Amazonian Ecuador.

OBJECTIVES: We measured total energy expenditure (TEE; kcal/d) and water throughput (L/d) among Shuar forager-horticulturalists from Amazonian Ecuador to compare their daily energy and water demands to adults in other small-scale and industrialized populations. METHODS: TEE and water throughput were measured using the doubly labeled water method among 15 Shuar adults (eight women, seven men; age range 18-60 years) living in a relatively remote village. We used multiple regression to assess the effects of anthropometric variables (body size, fat free mass, age, and sex) on TEE and water throughput. We also compared Shuar TEE and water throughput to those of other small-scale and industrialized societies. RESULTS: TEE among Shuar adults (men: 4141 ± 645 kcal/d, women: 2536 ± 281 kcal/d) was most strongly correlated with fat free mass. Estimated physical activity levels (PAL) calculated as (TEE/estimated BMR), were greater for men (2.34 ± 0.29) than women (1.83 ± 0.14, P < 0.001). Water throughput was also greater among Shuar men (9.37 ± 2.34 L/d) than women (4.76 ± 0.36 L/d, P < 0.001). Shuar TEE and water throughput were elevated compared to adults in industrialized populations. DISCUSSION: TEE and PAL of Shuar men are among the highest recorded during normal daily life, and likely reflect both high levels of physical activity and cultural dietary practices. Drinking large amounts of chicha, a traditional carbohydrate-rich drink made from manioc, likely contributes to the high levels of water throughput among Shuar men, and may contribute to elevated TEE.

Common risk factors for chronic non-communicable diseases among older adults in China, Ghana, Mexico, India, Russia and South Africa: the study on global AGEing and adult health (SAGE) wave 1.

BACKGROUND: Behavioral risk factors such as tobacco use, unhealthy diet, insufficient physical activity and the harmful use of alcohol are known and modifiable contributors to a number of NCDs and health mediators. The purpose of this paper is to describe the distribution of main risk factors for NCDs by socioeconomic status (SES) among adults aged 50 years and older within a country and compare these risk factors across six lower- and upper-middle income countries. METHODS: The study population in this paper draw from SAGE Wave 1 and consisted of adults aged 50-plus from China (N=13,157), Ghana (N=4,305), India (N=6,560), Mexico (N=2,318), the Russian Federation (N=3,938) and South Africa (N=3,836). Seven main common risk factors for NCDs were identified: daily tobacco use, frequent heavy drinking, low level physical activity, insufficient vegetable and fruit intake, high risk waist-hip ratio, obesity and hypertension. Multiple risk factors were also calculated by summing all these risk factors. RESULTS: The prevalence of daily tobacco use ranged from 7.7% (Ghana) to 46.9% (India), frequent heavy drinker was the highest in China (6.3%) and lowest in India (0.2%), and the highest prevalence of low physical activity was in South Africa (59.7%). The highest prevalence of respondents with high waist-to-hip ratio risk was 84.5% in Mexico, and the prevalence of self-reported hypertension ranging from 33% (India) to 78% (South Africa). Obesity was more common in South Africa, the Russia Federation and Mexico (45.2%, 36% and 28.6%, respectively) compared with China, India and Ghana (15.3%, 9.7% and 6.4%, respectively). China, Ghana and India had a higher prevalence of respondents with multiple risk factors than Mexico, the Russia Federation and South Africa. The occurrence of three and four risk factors was more prevalent in Mexico, the Russia Federation and South Africa. CONCLUSION: There were substantial variations across countries and settings, even between upper-middle income countries and lower-middle income countries. The baseline information on the magnitude of the problem of risk factors provided by this study can help countries and health policymakers to set up interventions addressing the global non-communicable disease epidemic.

Prevalence of loss of all teeth (edentulism) and associated factors in older adults in China, Ghana, India, Mexico, Russia and South Africa.

Little information exists about the loss of all one's teeth (edentulism) among older adults in low- and middle-income countries. This study examines the prevalence of edentulism and associated factors among older adults in a cross-sectional study across six such countries. Data from the World Health Organization (WHO's) Study on global AGEing and adult health (SAGE) Wave 1 was used for this study with adults aged 50-plus from China (N = 13,367), Ghana (N = 4724), India (N = 7150), Mexico (N = 2315), Russian Federation (N = 3938) and South Africa (N = 3840). Multivariate regression was used to assess predictors of edentulism. The overall prevalence of edentulism was 11.7% in the six countries, with India, Mexico, and Russia has higher prevalence rates (16.3%-21.7%) than China, Ghana, and South Africa (3.0%-9.0%). In multivariate logistic analysis sociodemographic factors (older age, lower education), chronic conditions (arthritis, asthma), health risk behaviour (former daily tobacco use, inadequate fruits and vegetable consumption) and other health related variables (functional disability and low social cohesion) were associated with edentulism. The national estimates and identified factors associated with edentulism among older adults across the six countries helps to identify areas for further exploration and targets for intervention.

Seasonal and socioeconomic influences on thyroid function among the Yakut (Sakha) of Eastern Siberia.

OBJECTIVES: Previous research has shown that the extreme cold and short day lengths of polar winters promote increased production and uptake of thyroid hormones, resulting in marked declines in free triiodothyronine (fT3). However, this "polar T3 syndrome" has been documented almost exclusively on small samples of male sojourners and little is known about seasonal changes in thyroid function among indigenous circumpolar groups. The present study addresses this gap by examining seasonal changes in thyroid hormone levels among the indigenous Yakut (Sakha) of northeastern Siberia. METHODS: Anthropometric dimensions and thyroid measures (fT3, free thyroxine [fT4], thyroid-stimulating hormone [TSH]) were obtained on two occasions (July/August, 2009 and January 2011) on a sample of 134 Yakut adults (51 men, 83 women) from the village of Berdygestiakh, Sakha Republic/Yakutia, Russia. RESULTS: Yakut men and women both displayed significant declines in fT3 and fT4, and significant increases in TSH from summer to winter despite showing only modest seasonal changes in body mass and composition. Among men, gains in fat-free mass (FFM) were associated with larger reductions in fT3 and greater increases in TSH. Men living more traditional lifeways showed larger winter declines in fT4 and greater increases in TSH. CONCLUSIONS: The Yakut exhibited significant winter declines in fT3 levels similar to other circumpolar groups studied. However, the magnitude of seasonal change was greater in the Yakut, perhaps reflecting their distinctive metabolic physiology. Lifestyle factors play a mediating role in thyroid responses, such that men with more traditional lifeways had more exaggerated seasonal changes.

Lifestyle incongruity, stress and immune function in indigenous Siberians: the health impacts of rapid social and economic change.

The purpose of this study was to investigate the impact of economic and cultural change on immune function and psychosocial stress in an indigenous Siberian population. We examined Epstein-Barr virus antibodies (EBV), an indirect biomarker of cell-mediated immune function, in venous whole blood samples collected from 143 Yakut (Sakha) herders (45 men and 98 women) in six communities using a cross-sectional study design. We modeled economic change through the analysis of lifestyle incongruity (LI), calculated as the disparity between socioeconomic status and material lifestyle, computed with two orthogonal scales: market and subsistence lifestyle. EBV antibody level was significantly negatively associated with both a market and a subsistence lifestyle, indicating higher cell-mediated immune function associated with higher material lifestyle scores. In contrast, LI was significantly positively associated with EBV antibodies indicating lower immune function, and suggesting higher psychosocial stress, among individuals with economic status in excess of material lifestyle. Individuals with lower incongruity scores (i.e., economic status at parity with material resources, or with material resources in excess of economic status) had significantly lower EBV antibodies. The findings suggest significant health impacts of changes in material well-being and shifting status and prestige markers on health during the transition to a market economy in Siberia. The findings also suggest that relative, as opposed to absolute, level of economic status or material wealth is more strongly related to stress in the Siberian context.