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1.
Rev Infirm ; 70(268): 32-34, 2021 Feb.
Artículo en Francés | MEDLINE | ID: mdl-33608094

RESUMEN

South Africa is the sub-Saharan African country most affected by the COVID-19 pandemic. Health professionals, particularly nurses, are strongly mobilised to fight the epidemic and care for the sick. In addition to their conditions and overwork, many health care workers are infected with severe acute respiratory syndrome coronavirus 2, which causes illness and death. With the threat of a second epidemic wave, this complicated health situation could deteriorate further.


Asunto(s)
Cuidadores , /epidemiología , Humanos , Sudáfrica/epidemiología
2.
Int J Mol Sci ; 22(4)2021 Feb 08.
Artículo en Inglés | MEDLINE | ID: mdl-33567580

RESUMEN

SARS-CoV-2 exploits angiotensin-converting enzyme 2 (ACE2) as a receptor to invade cells. It has been reported that the UK and South African strains may have higher transmission capabilities, eventually in part due to amino acid substitutions on the SARS-CoV-2 Spike protein. The pathogenicity seems modified but is still under investigation. Here we used the experimental structure of the Spike RBD domain co-crystallized with part of the ACE2 receptor, several in silico methods and numerous experimental data reported recently to analyze the possible impacts of three amino acid replacements (Spike K417N, E484K, N501Y) with regard to ACE2 binding. We found that the N501Y replacement in this region of the interface (present in both the UK and South African strains) should be favorable for the interaction with ACE2, while the K417N and E484K substitutions (South African strain) would seem neutral or even unfavorable. It is unclear if the N501Y substitution in the South African strain could counterbalance the K417N and E484K Spike replacements with regard to ACE2 binding. Our finding suggests that the UK strain should have higher affinity toward ACE2 and therefore likely increased transmissibility and possibly pathogenicity. If indeed the South African strain has a high transmission level, this could be due to the N501Y replacement and/or to substitutions in regions located outside the direct Spike-ACE2 interface but not so much to the K417N and E484K replacements. Yet, it should be noted that amino acid changes at Spike position 484 can lead to viral escape from neutralizing antibodies. Further, these amino acid substitutions do not seem to induce major structural changes in this region of the Spike protein. This structure-function study allows us to rationalize some observations made for the UK strain but raises questions for the South African strain.


Asunto(s)
Sustitución de Aminoácidos , /virología , Simulación por Computador , Dominios y Motivos de Interacción de Proteínas/genética , Receptores Virales/metabolismo , Glicoproteína de la Espiga del Coronavirus/metabolismo , /química , Anticuerpos Neutralizantes/inmunología , Anticuerpos Antivirales/inmunología , Sitios de Unión , Humanos , Unión Proteica , Receptores Virales/química , /metabolismo , Sudáfrica/epidemiología , Glicoproteína de la Espiga del Coronavirus/química , Reino Unido/epidemiología
4.
BMJ Open ; 11(1): e047016, 2021 01 26.
Artículo en Inglés | MEDLINE | ID: mdl-33500292

RESUMEN

OBJECTIVES: To describe the characteristics, clinical management and outcomes of patients with COVID-19 at district hospitals. DESIGN: A descriptive observational cross-sectional study. SETTING: District hospitals (4 in metro and 4 in rural health services) in the Western Cape, South Africa. District hospitals were small (<150 beds) and led by family physicians. PARTICIPANTS: All patients who presented to the hospitals' emergency centre and who tested positive for COVID-19 between March and June 2020. PRIMARY AND SECONDARY OUTCOME MEASURES: Source of referral, presenting symptoms, demographics, comorbidities, clinical assessment and management, laboratory turnaround time, clinical outcomes, factors related to mortality, length of stay and location. RESULTS: 1376 patients (73.9% metro, 26.1% rural). Mean age 46.3 years (SD 16.3), 58.5% females. The majority were self-referred (71%) and had comorbidities (67%): hypertension (41%), type 2 diabetes (25%), HIV (14%) and overweight/obesity (19%). Assessment of COVID-19 was mild (49%), moderate (18%) and severe (24%). Test turnaround time (median 3.0 days (IQR 2.0-5.0 days)) was longer than length of stay (median 2.0 day (IQR 2.0-3.0)). The most common treatment was oxygen (41%) and only 0.8% were intubated and ventilated. Overall mortality was 11%. Most were discharged home (60%) and only 9% transferred to higher levels of care. Increasing age (OR 1.06 (95% CI 1.04 to 1.07)), male (OR 2.02 (95% CI 1.37 to 2.98)), overweight/obesity (OR 1.58 (95% CI 1.02 to 2.46)), type 2 diabetes (OR 1.84 (95% CI 1.24 to 2.73)), HIV (OR 3.41 (95% CI 2.06 to 5.65)), chronic kidney disease (OR 5.16 (95% CI 2.82 to 9.43)) were significantly linked with mortality (p<0.05). Pulmonary diseases (tuberculosis (TB), asthma, chronic obstructive pulmonary disease, post-TB structural lung disease) were not associated with increased mortality. CONCLUSION: District hospitals supported primary care and shielded tertiary hospitals. Patients had high levels of comorbidities and similar clinical pictures to that reported elsewhere. Most patients were treated as people under investigation. Mortality was comparable to similar settings and risk factors identified.


Asunto(s)
/diagnóstico , /terapia , Hospitales de Distrito/estadística & datos numéricos , /genética , Adulto , Causas de Muerte , Comorbilidad , Estudios Transversales , Manejo de la Enfermedad , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Mortalidad Hospitalaria , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Terapia por Inhalación de Oxígeno , Alta del Paciente , Derivación y Consulta , Respiración Artificial , Sudáfrica/epidemiología , Evaluación de Síntomas , Factores de Tiempo , Resultado del Tratamiento
5.
BMC Infect Dis ; 21(1): 60, 2021 Jan 13.
Artículo en Inglés | MEDLINE | ID: mdl-33435861

RESUMEN

BACKGROUND: Little evidence exists to comprehensively estimate adolescent viral suppression after initiation on antiretroviral therapy in sub-Saharan Africa. This study examines adolescent progression along the HIV care cascade to viral suppression for adolescents initiated on antiretroviral therapy in South Africa. METHODS: All adolescents ever initiated on antiretroviral therapy (n=1080) by 2015 in a health district of the Eastern Cape, South Africa, were interviewed in 2014-2015. Clinical records were extracted from 52 healthcare facilities through January 2018 (including records in multiple facilities). Mortality and loss to follow-up rates were corrected for transfers. Predictors of progression through the HIV care cascade were tested using sequential multivariable logistic regressions. Predicted probabilities for the effects of significant predictors were estimated by sex and mode of infection. RESULTS: Corrected mortality and loss to follow-up rates were 3.3 and 16.9%, respectively. Among adolescents with clinical records, 92.3% had ≥1 viral load, but only 51.1% of viral loads were from the past 12 months. Adolescents on ART for ≥2 years (AOR 3.42 [95%CI 2.14-5.47], p< 0.001) and who experienced decentralised care (AOR 1.39 [95%CI 1.06-1.83], p=0.018) were more likely to have a recent viral load. The average effect of decentralised care on recent viral load was greater for female (AOR 2.39 [95%CI 1.29-4.43], p=0.006) and sexually infected adolescents (AOR 3.48 [95%CI 1.04-11.65], p=0.043). Of the total cohort, 47.5% were recorded as fully virally suppressed at most recent test. Only 23.2% were recorded as fully virally suppressed within the past 12 months. Younger adolescents (AOR 1.39 [95%CI 1.06-1.82], p=0.017) and those on ART for ≥2 years (AOR 1.70 [95%CI 1.12-2.58], p=0.013) were more likely to be fully viral suppressed. CONCLUSIONS: Viral load recording and viral suppression rates remain low for ART-initiated adolescents in South Africa. Improved outcomes for this population require stronger engagement in care and viral load monitoring.


Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , VIH-1/genética , Adolescente , Niño , Continuidad de la Atención al Paciente , Femenino , Estudios de Seguimiento , Infecciones por VIH/mortalidad , Infecciones por VIH/virología , Humanos , Modelos Logísticos , Estudios Longitudinales , Masculino , ARN Viral/genética , Estudios Retrospectivos , Sudáfrica/epidemiología , Respuesta Virológica Sostenida , Carga Viral/efectos de los fármacos , Adulto Joven
6.
BMC Infect Dis ; 21(1): 61, 2021 Jan 13.
Artículo en Inglés | MEDLINE | ID: mdl-33435863

RESUMEN

BACKGROUND: To effectively reduce vertical HIV transmission requires a reduction of HIV prevalence and incidence among pregnant women and a full understanding of its epidemiology. The study aimed to determine the prevalence of HIV among women attending antenatal care and further determine spousal support during antenatal care attendance in rural areas in Eastern Cape province, South Africa. METHODS: A Cross-sectional study of women attending antenatal care in four Primary Care facilities was conducted using an interviewer-administered questionnaire which collected information on socio-demographic characteristics and medical history. Binomial logistic regression analyses were used to determine factors associated with HIV and to estimate the prevalence ratio (PR). The 95% confidence interval (95%CI) is used for precision of estimates; p≤0.05 for statistical significance. RESULTS: A total of 343 participants were included in the final analysis. The antenatal HIV prevalence was 38.2% (95%CI: 33.2-43.9). For 75% of the women, the HIV diagnosis was made 141 days before the date of the interview (median=77 days, interquartile range=42-141 days). Participants between the age of 30 to 39 years were 50% more likely to be HIV positive compared to those who were between the age of 20 to 29, these differences were statistically significant (PR=1.5; p-value=0.001). Furthermore, self-employed women were 30% less likely to be HIV positive when compared to unemployed participants, this was also statistically significant (PR=0.7; p-value< 0.0001). CONCLUSION: Despite a 100% antenatal HIV testing rate, the antenatal HIV prevalence remains high in this population, coupled with no spousal attendance in antenatal care. It is important to move beyond awareness about the HIV status to actionable strategies of reducing the HIV incident cases. It is therefore important to remain vigilant and monitor mother-to-child transmission that could be associated with this increased prevalence.


Asunto(s)
Infecciones por VIH/epidemiología , VIH/aislamiento & purificación , Pobreza , Complicaciones Infecciosas del Embarazo/epidemiología , Atención Prenatal , Atención Primaria de Salud , Servicios de Salud Rural , Adolescente , Adulto , Estudios Transversales , Femenino , Infecciones por VIH/virología , Humanos , Incidencia , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Embarazo , Complicaciones Infecciosas del Embarazo/virología , Prevalencia , Pruebas Serológicas , Sudáfrica/epidemiología , Adulto Joven
7.
Ecotoxicol Environ Saf ; 211: 111961, 2021 Mar 15.
Artículo en Inglés | MEDLINE | ID: mdl-33513524

RESUMEN

Contaminated agricultural soil with potentially toxic elements (PTEs) poses a threat to food safety and can adversely affect human health. This study evaluates the potential health risk caused by PTEs contamination in cultivated soils and the possible related health effect. Sixty-four (64) soil samples from cultivated soils before crop cultivation and post-crop were harvested and twenty-four (24) soil samples from a natural game reserve park were collected and. The PTEs were analysed using the inductively coupled plasma-mass spectrometry (ICP-MS) for the following elements As, Cd, Cr, Cu, Ni, Pb, Zn, Mn, Al, and Fe. The contamination factor (CF), pollution load index (PLI), hazard quotient (HQ), and hazard index (HI) was calculated to assess the human health risks for the different pathways to the exposed population. A carcinogenic probabilistic risk model based on the mathematical derivation and PTEs transmission pathways is presented. The mean concentrations of the PTEs in the cultivated soil varied in order of Al > Fe > Mn > Cr > Ni > Zn > Cu > Pb > As > Cd. Cr and Ni concentrations in all the cultivated soils were found to be higher than the Canadian guidelines and the Finnish permissible threshold guidelines for agricultural. The CF in the soil indicates extreme contamination suggestion an ecotoxicological effect. The PLI value also suggests that the soils have undergone some form of deterioration, particularly with Cr and Ni. The ingestion seems to be the major pathway followed by dermal to children. The HQ and HI values for the children were > 1 indicating an adverse health effect for the children residing around the cultivated fields. The simulated results indicate that the percentage of the affected humans that may be consuming crop derived from the contaminated soil increases by a factor of 2 as the contamination factor increases. The transmission compartments can be used as an effective measure in which mitigation can be effectively used.


Asunto(s)
Exposición a Riesgos Ambientales/estadística & datos numéricos , Contaminación Ambiental/estadística & datos numéricos , Metales Pesados/análisis , Neoplasias/epidemiología , Contaminantes del Suelo/análisis , Agricultura , Canadá , Carcinógenos/análisis , Ecotoxicología , Monitoreo del Ambiente/métodos , Contaminación Ambiental/análisis , Inocuidad de los Alimentos , Humanos , Medición de Riesgo/métodos , Ríos , Suelo/química , Sudáfrica/epidemiología
8.
Int J Equity Health ; 20(1): 21, 2021 01 07.
Artículo en Inglés | MEDLINE | ID: mdl-33413442

RESUMEN

BACKGROUND: The coronavirus disease 2019 (COVID-19) has resulted in an enormous dislocation of society especially in South Africa. The South African government has imposed a number of measures aimed at controlling the pandemic, chief being a nationwide lockdown. This has resulted in income loss for individuals and firms, with vulnerable populations (low earners, those in informal and precarious employment, etc.) more likely to be adversely affected through job losses and the resulting income loss. Income loss will likely result in reduced ability to access healthcare and a nutritious diet, thus adversely affecting health outcomes. Given the foregoing, we hypothesize that the economic dislocation caused by the coronavirus will disproportionately affect the health of the poor. METHODS: Using the fifth wave of the National Income Dynamics Study (NIDS) dataset conducted in 2017 and the first wave of the NIDS-Coronavirus Rapid Mobile Survey (NIDS-CRAM) dataset conducted in May/June 2020, this paper estimated income-related health inequalities in South Africa before and during the COVID-19 pandemic. Health was a dichotomized self-assessed health measure, with fair and poor health categorized as "poor" health, while excellent, very good and good health were categorized as "better" health. Household per capita income was used as the ranking variable. Concentration curves and indices were used to depict the income-related health inequalities. Furthermore, we decomposed the COVID-19 era income-related health inequality in order to ascertain the significant predictors of such inequality. RESULTS: The results indicate that poor health was pro-poor in the pre-COVID-19 and COVID-19 periods, with the latter six times the value of the former. Being African (relative to white), per capita household income and household experience of hunger significantly predicted income-related health inequalities in the COVID-19 era (contributing 130%, 46% and 9% respectively to the inequalities), while being in paid employment had a nontrivial but statistically insignificant contribution (13%) to health inequality. CONCLUSIONS: Given the significance and magnitude of race, hunger, income and employment in determining socioeconomic inequalities in poor health, addressing racial disparities and hunger, income inequality and unemployment will likely mitigate income-related health inequalities in South Africa during the COVID-19 pandemic.


Asunto(s)
Disparidades en el Estado de Salud , Renta/estadística & datos numéricos , Adulto , Femenino , Humanos , Masculino , Sudáfrica/epidemiología
9.
BMC Med Res Methodol ; 21(1): 15, 2021 01 11.
Artículo en Inglés | MEDLINE | ID: mdl-33423669

RESUMEN

BACKGROUND: The rising burden of the ongoing COVID-19 epidemic in South Africa has motivated the application of modeling strategies to predict the COVID-19 cases and deaths. Reliable and accurate short and long-term forecasts of COVID-19 cases and deaths, both at the national and provincial level, are a key aspect of the strategy to handle the COVID-19 epidemic in the country. METHODS: In this paper we apply the previously validated approach of phenomenological models, fitting several non-linear growth curves (Richards, 3 and 4 parameter logistic, Weibull and Gompertz), to produce short term forecasts of COVID-19 cases and deaths at the national level as well as the provincial level. Using publicly available daily reported cumulative case and death data up until 22 June 2020, we report 5, 10, 15, 20, 25 and 30-day ahead forecasts of cumulative cases and deaths. All predictions are compared to the actual observed values in the forecasting period. RESULTS: We observed that all models for cases provided accurate and similar short-term forecasts for a period of 5 days ahead at the national level, and that the three and four parameter logistic growth models provided more accurate forecasts than that obtained from the Richards model 10 days ahead. However, beyond 10 days all models underestimated the cumulative cases. Our forecasts across the models predict an additional 23,551-26,702 cases in 5 days and an additional 47,449-57,358 cases in 10 days. While the three parameter logistic growth model provided the most accurate forecasts of cumulative deaths within the 10 day period, the Gompertz model was able to better capture the changes in cumulative deaths beyond this period. Our forecasts across the models predict an additional 145-437 COVID-19 deaths in 5 days and an additional 243-947 deaths in 10 days. CONCLUSIONS: By comparing both the predictions of deaths and cases to the observed data in the forecasting period, we found that this modeling approach provides reliable and accurate forecasts for a maximum period of 10 days ahead.


Asunto(s)
/epidemiología , /mortalidad , Humanos , Modelos Logísticos , Modelos Estadísticos , Sudáfrica/epidemiología
10.
Epidemiol Serv Saude ; 30(1): e2020513, 2021.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-33440403

RESUMEN

OBJECTIVE: To describe lockdown-type containment measures and COVID-19 incidence in South Africa, Germany, Brazil, Spain, United States, Italy and New Zealand. METHODS: This is a descriptive ecological study with data on daily incidence of confirmed COVID-19 cases from February 22 to August 31 2020, as well as information on lockdown measures implemented by the governments of each country. RESULTS: Daily COVID-19 incidence (cases per 1 million inhabitants) decreased within three weeks after lockdown started in the countries that implemented it: South Africa (3.7 to 1.7), Germany (37.5 to 33.7) Spain (176.3 to 82.0), Italy (92.0 to 52.1) and New Zealand (7.5 to 1.7). As for Brazil and the United States, which did not implement lockdown, there was no considerable decrease. CONCLUSION: After lockdown implementation, there was a considerable decrease in the number of confirmed cases.


Asunto(s)
/prevención & control , Pandemias , Cuarentena/métodos , Brasil/epidemiología , Alemania/epidemiología , Humanos , Incidencia , Italia/epidemiología , Sudáfrica/epidemiología , España/epidemiología , Estados Unidos/epidemiología
11.
Health Res Policy Syst ; 19(1): 2, 2021 Jan 06.
Artículo en Inglés | MEDLINE | ID: mdl-33407574

RESUMEN

BACKGROUND: In September 2016, South Africa (SA) began implementing the universal-test-and-treat (UTT) policy in hopes of attaining the UNAIDS 90-90-90 targets by 2020. The SA National Department of Health provided a further directive to initiate antiretroviral therapy (ART) on the day of HIV diagnosis in September 2017. We conducted a qualitative study to determine the progress in implementing UTT and examine health providers' perspectives on the implementation of the same-day initiation (SDI) policy, six months after the policy change. METHODS: We conducted in-depth interviews with three professional nurses, and four HIV lay counsellors of five primary health clinics in the Gauteng province, between October and December 2017. In September 2018, we also conducted a focus group discussion with ten professional nurses/clinic managers from ten clinic facilities. The interviews and focus groups covered the adoption and implementation of UTT and SDI policies. Interviews were conducted in English, Sotho or Zulu and audio-recorded with participant consent. Audio-recordings were transcribed verbatim, translated to English and analysed thematically using NVivo 11. RESULTS: The data indicates inconsistencies across facilities and incongruities between counsellor and nursing provider perspectives regarding the SDI policy implementation. While nurses highlighted the clinical benefits of early ART initiation, they expressed concerns that immediate ART may be overwhelming for some patients, who may be unprepared and likely to disengage from care soon after the initial acceptance of ART. Accordingly, the SDI implementation was slow due to limited patient demand, provider ambivalence to the policy implementations, as well as challenges with infrastructure and human resources. The process for assessing patient readiness was poorly defined by health providers across facilities, inconsistent and counsellor dependent. Providers were also unclear on how to ensure that patients who defer treatment return for ongoing counselling. CONCLUSIONS: Our results highlight important gaps in the drive to achieve the ART initiation target and demonstrate the need for further engagement with health care providers around the implementation of same-day ART initiation, particularly with regards to infrastructural/capacity needs and the management of patient readiness for lifelong ART on the day of HIV diagnosis. Additionally, there is a need for improved promotion of the SDI provision both in health care settings and in media communications to increase patient demand for early and lifelong ART.


Asunto(s)
Antirretrovirales/uso terapéutico , Actitud del Personal de Salud , Infecciones por VIH/tratamiento farmacológico , Política de Salud , Adulto , Femenino , Grupos Focales , Infecciones por VIH/epidemiología , Humanos , Entrevistas como Asunto , Masculino , Sudáfrica/epidemiología
12.
Artículo en Inglés | MEDLINE | ID: mdl-33466227

RESUMEN

Healthcare workers (HCWs) are at increased risk of infection by the virulent severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Though data exist on the positivity rate of the SARS-CoV-2 reverse transcription polymerase chain reaction (RT-PCR) test as well as COVID-19-related deaths amongst HCWs in South Africa, the overall infection rate remains underestimated by these indicators. It is also unclear whether the humoral immune response after SARS-CoV-2 infection offers durable protection against reinfection. This study will assess the SARS-CoV-2 seroprevalence amongst HCWs in the Eastern Cape (EC) and examine the longitudinal changes (rate of decay) in the antibody levels after infection in this cohort. Using a multi-stage cluster sampling of healthcare workers in selected health facilities in the EC, a cross-sectional study of 2250 participants will be recruited. In order to assess the community infection rate, 750 antenatal women in the same settings will be recruited. Relevant demographic and clinical characteristics will be obtained by a self-administered questionnaire. A chemiluminescent microparticle immunoassay (CMIA) will be used for the qualitative detection of IgG antibodies against SARS-CoV-2 nucleocapsid protein. A nested cohort study will be conducted by performing eight-weekly antibody assays (X2) from 201 participants who tested positive for both SARS-CoV-2 RT-PCR and serology. Logistic regression models will be fitted to identify the independent risk factors for SARS-CoV-2 infection. The cumulative SARS-CoV-2 infection rate and infection fatality rate among the frontline HCWs will be estimated. In addition, the study will highlight the overall effectiveness of infection prevention and control measures (IPC) per exposure sites/wards at the selected health facilities. Findings will inform the South African Department of Health's policies on how to protect HCWs better as the country prepares for the second wave of the SARS-CoV pandemic.


Asunto(s)
/diagnóstico , Personal de Salud , Exposición Profesional/estadística & datos numéricos , Proyectos de Investigación , Estudios de Cohortes , Estudios Transversales , Femenino , Humanos , Embarazo , Estudios Seroepidemiológicos , Sudáfrica/epidemiología
14.
Artículo en Inglés | MEDLINE | ID: mdl-33466566

RESUMEN

Recent studies have suggested the common co-occurrence of hypertension and diabetes in South Africa. Given that hypertension and diabetes are known to share common socio-demographic, anthropometric and lifestyle risk factors, the aim of this study was to jointly model the shared and disease-specific geographical variation of hypertension and diabetes. The current analysis used the Study on Global Ageing and Adult Health (SAGE) South Africa Wave 2 (2014/15) data collected from 2761 participants. Of the 2761 adults (median age = 56 years), 641 (23.2%) had high blood pressure on measurement and 338 (12.3%) reported being diagnosed with diabetes. The shared component has distinct spatial patterns with higher values of odds in the eastern districts of Kwa-Zulu Natal and central Gauteng province. The shared component may represent unmeasured health behavior characteristics or the social determinants of health in our population. Our study further showed how a shared component (latent and unmeasured health behavior characteristics or the social determinants of health) is distributed across South Africa among the older adult population. Further research using similar shared joint models may focus on extending these models for multiple diseases with ecological factors and also incorporating sampling weights in the spatial analyses.


Asunto(s)
Diabetes Mellitus , Hipertensión , Adulto , Anciano , Diabetes Mellitus/epidemiología , Femenino , Geografía Médica , Humanos , Hipertensión/epidemiología , Masculino , Persona de Mediana Edad , Prevalencia , Factores de Riesgo , Determinantes Sociales de la Salud , Sudáfrica/epidemiología , Organización Mundial de la Salud
16.
Artículo en Inglés | MEDLINE | ID: mdl-33401502

RESUMEN

BACKGROUND: The study aimed to investigate the association of Body Roundness Index (BRI), A Body Shape Index (ABSI), and Conicity Index with nutritional status and cardiovascular risk factors in South African rural young adults. METHODS: The study included a total of 624 young adults aged 21-30 years from the Ellisras rural area. Anthropometric indices, blood pressure (BP), and biochemical measurements were measured. RESULTS: BRI was significantly correlated with insulin (0.252 males, females 0.255), homeostatic model assessment (HOMA)-ß (0.250 males, females 0.245), and TG (0.310 males, females 0.216). Conicity Index was significantly associated with pulse rate (PR) (ß 0.099, 95% confidence interval (CI) 0.017, 0.143, p < 0.013; ß 0.081, 95% CI 0.000 0.130, p < 0.048), insulin (ß 0.149, 95% CI 0.286 0.908, p < 0.001; ß 0.110, 95% CI 0.123 0.757, p < 0.007). Conicity Index is associated with insulin resistance (IR) (odds ratio (OR) 7.761, 95% CI 5.783 96.442, p < 0.001; OR 4.646, 95% CI 2.792 74.331, p < 0.007), underweight (OR 0.023, 95% CI 0.251 0.433, p < 0.001; OR 0.031, 95% CI 0.411 0.612, p < 0.001), and obesity (OR 1.058, 95% CI 271.5 4.119, p < 0.001; OR 1.271, 95% CI 0.672 1.099, p < 0.001). CONCLUSION: Conicity Index was positively associated with insulin resistance, hypertension and dyslipidaemia. Further investigation of these indices and their association with nutritional status and cardiovascular diseases (CVDs) could assist in efforts to prevent CVD in the rural South African population.


Asunto(s)
Antropometría , Enfermedades Cardiovasculares , Población Rural , Adulto , Antropometría/métodos , Índice de Masa Corporal , Enfermedades Cardiovasculares/epidemiología , Femenino , Humanos , Masculino , Estado Nutricional , Población Rural/estadística & datos numéricos , Sudáfrica/epidemiología , Adulto Joven
17.
Curr Opin Pulm Med ; 27(2): 79-87, 2021 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-33417344

RESUMEN

PURPOSE OF REVIEW: Mineworkers in South Africa experience a triple burden of disease due to their distinct work experience. Silicosis increases their risk of tuberculosis (TB), exacerbated by the HIV epidemic. Work-related factors are likely to increase transmission, severity, and post infection sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Understanding these relationships is important to control the impact of the epidemic. RECENT FINDINGS: SARS-CoV-2 infection rates among mineworkers exceed the population rates in the provinces in which those mines are located. Migrant work, living in crowded hostels, working in narrow poorly ventilated shafts mainly underground constitute important factors that increase transmission risk. Mineworkers continue to experience high levels of silica exposure. The prevalences of silicosis, HIV and pulmonary TB, remain high. Interstitial lung disease, pulmonary TB, and HIV have all been associated with poorer outcomes of SARS-CoV-2 infections. Mineworkers with post infection respiratory sequelae are likely to lose their jobs or lose income, due to the physically demanding nature of underground minework. SUMMARY: Further research into the unique work-related risk factors in mining that influence the COVID-19 epidemic is crucial for optimizing current interventions. Reducing SARS-CoV-2 infection transmission, health monitoring of infected and vulnerable workers, and following up of postinfection outcomes is essential to protect the respiratory health of miners.


Asunto(s)
/epidemiología , Mineros , Enfermedades Profesionales/epidemiología , Infecciones por VIH/epidemiología , Humanos , Enfermedades Pulmonares Intersticiales/epidemiología , Prevalencia , Infecciones del Sistema Respiratorio/complicaciones , Factores de Riesgo , Silicosis/epidemiología , Sudáfrica/epidemiología , Tuberculosis/epidemiología
18.
BMC Infect Dis ; 21(1): 5, 2021 Jan 04.
Artículo en Inglés | MEDLINE | ID: mdl-33446115

RESUMEN

BACKGROUND: Dolutegravir (DTG)-based antiretroviral therapy (ART) is highly effective and well-tolerated in adults and is rapidly being adopted globally. We describe the design of the ODYSSEY trial which evaluates the efficacy and safety of DTG-based ART compared with standard-of-care in children and adolescents. The ODYSSEY trial includes nested pharmacokinetic (PK) sub-studies which evaluated pragmatic World Health Organization (WHO) weight-band-based DTG dosing and opened recruitment to children < 14 kg while dosing was in development. METHODS: ODYSSEY (Once-daily DTG based ART in Young people vS. Standard thErapY) is an open-label, randomised, non-inferiority, basket trial comparing the efficacy and safety of DTG + 2 nucleos(t) ides (NRTIs) versus standard-of-care (SOC) in HIV-infected children < 18 years starting first-line ART (ODYSSEY A) or switching to second-line ART (ODYSSEY B). The primary endpoint is clinical or virological failure by 96 weeks. RESULTS: Between September 2016 and June 2018, 707 children weighing ≥14 kg were enrolled; including 311 ART-naïve children and 396 children starting second-line. 47% of children were enrolled in Uganda, 21% Zimbabwe, 20% South Africa, 9% Thailand, 4% Europe. 362 (51%) participants were male; median age [range] at enrolment was 12.2 years [2.9-18.0]. 82 (12%) children weighed 14 to < 20 kg, 135 (19%) 20 to < 25 kg, 206 (29%) 25 to < 35 kg, 284 (40%) ≥35 kg. 128 (18%) had WHO stage 3 and 60 (8%) WHO stage 4 disease. Challenges encountered include: (i) running the trial across high- to low-income countries with differing frequencies of standard-of-care viral load monitoring; (ii) evaluating pragmatic DTG dosing in PK sub-studies alongside FDA- and EMA-approved dosing and subsequently transitioning participants to new recommended doses; (iii) delays in dosing information for children weighing 3 to < 14 kg and rapid recruitment of ART-naïve older/heavier children, which led to capping recruitment of participants weighing ≥35 kg in ODYSSEY A and extending recruitment (above 700) to allow for ≥60 additional children weighing between 3 to < 14 kg with associated PK; (iv) a safety alert associated with DTG use during pregnancy, which required a review of the safety plan for adolescent girls. CONCLUSIONS: By employing a basket design, to include ART-naïve and -experienced children, and nested PK sub-studies, the ODYSSEY trial efficiently evaluates multiple scientific questions regarding dosing and effectiveness of DTG-based ART in children. TRIAL REGISTRATION: NCT, NCT02259127 , registered 7th October 2014; EUDRACT, 2014-002632-14, registered 18th June 2014 ( https://www.clinicaltrialsregister.eu/ctr-search/trial/2014-002632-14/ES ); ISRCTN, ISRCTN91737921 , registered 4th October 2014.


Asunto(s)
Infecciones por VIH/tratamiento farmacológico , Inhibidores de Integrasa VIH/administración & dosificación , Inhibidores de Integrasa VIH/efectos adversos , VIH-1/genética , Compuestos Heterocíclicos con 3 Anillos/administración & dosificación , Compuestos Heterocíclicos con 3 Anillos/efectos adversos , Oxazinas/administración & dosificación , Oxazinas/efectos adversos , Piperazinas/administración & dosificación , Piperazinas/efectos adversos , Piridonas/administración & dosificación , Piridonas/efectos adversos , Adolescente , Peso Corporal , Niño , Preescolar , Estudios de Cohortes , Cálculo de Dosificación de Drogas , Europa (Continente)/epidemiología , Femenino , Infecciones por VIH/epidemiología , Infecciones por VIH/virología , Humanos , Masculino , ARN Viral/genética , Sudáfrica/epidemiología , Tailandia/epidemiología , Resultado del Tratamiento , Uganda/epidemiología , Carga Viral/efectos de los fármacos , Organización Mundial de la Salud , Zimbabwe/epidemiología
19.
PLoS One ; 16(1): e0245546, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33481848

RESUMEN

Amidst the rapid global spread of Covid-19, many governments enforced country-wide lockdowns, with likely severe well-being consequences. In this regard, South Africa is an extreme case suffering from low levels of well-being, but at the same time enforcing very strict lockdown regulations. In this study, we analyse the causal effect of a lockdown and consequently, the determinants of happiness during the aforementioned. A difference-in-difference approach is used to make causal inferences on the lockdown effect on happiness, and an OLS estimation investigates the determinants of happiness after lockdown. The results show that the lockdown had a significant and negative impact on happiness. In analysing the determinants of happiness after lockdown, we found that stay-at-home orders have positively impacted happiness during this period. On the other hand, other lockdown regulations such as a ban on alcohol sales, a fear of becoming unemployed and a greater reliance on social media have negative effects, culminating in a net loss in happiness. Interestingly, Covid-19, proxied by new deaths per day, had an inverted U-shape relationship with happiness. Seemingly people were, at the onset of Covid-19 positive and optimistic about the low fatality rates and the high recovery rates. However, as the pandemic progressed, they became more concerned, and this relationship changed and became negative, with peoples' happiness decreasing as the number of new deaths increased.


Asunto(s)
/epidemiología , Control de Enfermedades Transmisibles/métodos , Consumo de Bebidas Alcohólicas/epidemiología , Consumo de Bebidas Alcohólicas/prevención & control , Control de Enfermedades Transmisibles/organización & administración , Femenino , Felicidad , Humanos , Masculino , Sudáfrica/epidemiología
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