"These are just finishing our medicines": older persons' perceptions and experiences of access to healthcare in public and private health facilities in Uganda.

BACKGROUND: There is limited research on the experiences of access to medicines for non-communicable diseases (NCDs) in health facilities among older persons in Uganda. This paper explores the perspectives of older persons and healthcare providers concerning older persons' access to essential medicines in Uganda. METHODS: It is based on qualitative data from three districts of Hoima, Kiboga, and Busia in Uganda. Data collection methods included seven (07) focus group discussions (FGDs) and eighteen (18) in-depth interviews with older persons. Nine (9) key informant interviews with healthcare providers were conducted. Deductive and inductive thematic analysis (using Health Access Livelihood Framework) was used to analyze the barriers and facilitators of access to healthcare using QSR International NVivo software. RESULTS: The key facilitators and barriers to access to healthcare included both health system and individual-level factors. The facilitators of access to essential medicines included family or social support, earning some income or Social Assistance Grants for Empowerment (SAGE) money, and knowing a healthcare provider at a health facility. The health system barriers included the unavailability of specialized personnel, equipment, and essential medicines for non-communicable diseases, frequent stock-outs, financial challenges, long waiting times, high costs for medicines for NCDs, and long distances to health facilities. CONCLUSION: Access to essential medicines for NCDs is a critical challenge for older persons in Uganda. The Ministry of Health should make essential drugs for NCDS to be readily available and train geriatricians to provide specialized healthcare for older persons to reduce health inequities in old age. Social support systems need to be strengthened to enable older persons to access healthcare.

On the limited consensus of mountain pine beetle impacts on wildfire.

Context: The mountain pine beetle (MPB; Dendroctonus ponderosae) is a native bark beetle whose outbreaks leads to widespread conifer forest mortality. Of particular concern to forest and wildfire managers is the influence of MPB outbreaks on wildfire via spatial legacies left in impacted forest stands. There is, however, limited consensus in the literature regarding how MPB outbreaks affect wildfire across western North America. Objectives: This meta-analysis aims to (1) summarize available evidence regarding MPB-wildfire interactions, and (2) identify environmental and methodological indicators associated with various wildfire responses (i.e., amplified, neutral, or dampened) post-outbreak. Methods: We include peer-reviewed publications focusing on MPB outbreaks and subsequent wildfire activity in forests across western Canada and the USA between 2000 and 2021. A classification scheme was used to examine attributes of each publication to assess which indicators contribute most to their associated wildfire response. Results: We found that spatial scale, forest fuels, and weather are main drivers of variation in wildfire response post-outbreak. Metrics of forest fuels and inclusion of weather data on a stand-scale are related to amplified fire responses, whereas dampened responses correspond to landscape-scale analyses. Furthermore, red-stage stands are associated with amplified fire response, whereas other stages are associated with dampened response-supporting current conceptual models of the importance of outbreak stage on wildfire. Conclusions: Advancing our understanding regarding drivers of wildfire responses post-MPB outbreak is key to developing accurate, and comparative research studies. These findings provide crucial information for wildfire, and forest management agencies, especially in forests newly exposed to this disturbance interaction under climate change. Supplementary Information: The online version contains supplementary material available at 10.1007/s10980-023-01720-z.

Return to play after treating acute muscle injuries in elite football players with radial extracorporeal shock wave therapy.

BACKGROUND: To compare lay-off times achieved by treating acute muscle injuries in elite football players with a multimodal therapy approach that includes a specific protocol of almost daily radial extracorporeal shock wave therapy (rESWT) with corresponding data reported in the literature. METHODS: We performed a retrospective analysis of treatments and recovery times of muscle injuries suffered by the players of an elite football team competing in the first/second German Bundesliga during one of the previous seasons. RESULTS: A total of 20 acute muscle injuries were diagnosed and treated in the aforementioned season, of which eight (40%) were diagnosed as Type 1a/muscular tightness injuries, five (25%) as Type 2b/muscle strain injuries, four (20%) as Type 3a/partial muscle tear injuries and three (15%) as contusions. All injuries were treated with the previously mentioned multimodal therapy approach. Compared with data reported by Ekstrand et al. (Br J Sports Med 47:769-774, 2013), lay-off times (median/mean) were shortened by 54% and 58%, respectively, in the case of Type 1a injuries, by 50% and 55%, respectively, in the case of Type 2b injuries as well as by 8% and 21%, respectively, in the case of Type 3a injuries. No adverse reactions were observed. CONCLUSIONS: Overall, the multimodal therapy approach investigated in this study is a safe and effective treatment approach for treating Type 1a and 2b acute muscle injuries amongst elite football players and may help to prevent more severe, structural muscle injuries.

Anthropogenic impacts on the decreasing sediment loads of nine major rivers in China, 1954-2015.

Over the past 60 years, because of the combined impacts of human activities and climate change, the sediment load of the nine major rivers (the Yellow, Yangtze, Pearl, Songhuajiang, Liaohe, Haihe, Huaihe, Qiantangjiang, and Minjiang rivers) in China has dropped by 85%, which had caused serious environmental problems such as reservoir siltation and estuary erosion. However, quantitatively evaluating the impact of different human activities on this decline is still an unsolved and complex problem. Based on a big new data set from 27 gauge stations and 469 meteorological stations, we established five methods to assess sediment loss of China's nine major rivers. During 1954-2015, the sediment load into the marginal seas via these nine rivers was characterized by a marked decline, from 1.95 Gt/yr (1954-1968) to 1.40 Gt/yr (1969-1985), 890 Mt/yr (1986-1998), 450 Mt/yr (1999-2003), and 310 Mt/yr (2004-2015), reflecting an 85% decrease between 1954-1968 and 2004-2015. The cumulative sediment load into the marginal seas was ~71.0 Gt, constituting ~7% of the global sediment load. The Yellow River, Yangtze River, Pearl River, and other six major rivers contributed 40.9 (58%), 22.9 (32%), 4.1 (6%), and 2.96 Gt (4%), respectively. We estimate that ~53.0 Gt of terrestrial sediment has been retained on the mainland China because of human activities, with reservoir trapping, water resource utilization, and water-soil conservation measures accounting for 45.5%, 29%, and 25.5% of the total, respectively. The contribution of climatic factors was assessed to be secondary. This drastic reduction in river sediment load could lead to a series of negative effects on deltas: decreased sediment delivery, coastal erosion, aggravated reaction to storm disasters, and most importantly, loss of new land for human use. In addition, the large amounts of sediment trapping by reservoirs over long periods will cause siltation that could reduce reservoir water storage capacity.

Randomised controlled feasibility trial of standard wound management versus negative-pressure wound therapy in the treatment of adult patients having surgical incisions for hip fractures.

INTRODUCTION: Deep wound infection is a catastrophic complication after hip fracture surgery. However, current understanding of infection rates in this population is limited. Many technologies such as incisional negative-pressure wound therapy (NPWT) show promise in reducing the rate of infection. This trial is a feasibility study looking to establish a value estimated with a greater precision of the rate of deep infection after hip fracture treatment in patients treated with NPWT versus standard dressing following hip fracture surgery. METHODS AND ANALYSIS: A randomised controlled trial of 464 patients will be run across multiple centres. It is embedded in the World Hip Trauma Evaluation cohort study. Any patient over the age of 65 years having surgery for hip fracture is eligible unless they are being treated with percutaneous screw fixation. A web-based randomisation sequence will stratify patients by centre. Patients will be allocated to either NPWT or standard care on a 1:1 basis. The primary outcome measure is the Centre for Disease Control definition of deep infection at 30 days. Follow-up at 4 months will also assess deep infection and the core outcome dataset for hip fractures. This includes health-related quality of life (EQ-5D-5L), mobility, mortality and late complications such as further surgery. The primary analysis will be intention to treat. ETHICS AND DISSEMINATION: Oxford C Research Ethics Committee granted ethical approval on 28/04/2017, 17/SC/0207. The results of this study will be reported in a peer-reviewed publication and inform the design of a future full-scale trial. TRIAL REGISTRATION NUMBER: ISRCTN55305726.

Temperature fine-tunes Mediterranean Arabidopsis thaliana life-cycle phenology geographically.

To understand how adaptive evolution in life-cycle phenology operates in plants, we need to unravel the effects of geographic variation in putative agents of natural selection on life-cycle phenology by considering all key developmental transitions and their co-variation patterns. We address this goal by quantifying the temperature-driven and geographically varying relationship between seed dormancy and flowering time in the annual Arabidopsis thaliana across the Iberian Peninsula. We used data on genetic variation in two major life-cycle traits, seed dormancy (DSDS50) and flowering time (FT), in a collection of 300 A. thaliana accessions from the Iberian Peninsula. The geographically varying relationship between life-cycle traits and minimum temperature, a major driver of variation in DSDS50 and FT, was explored with geographically weighted regressions (GWR). The environmentally varying correlation between DSDS50 and FT was analysed by means of sliding window analysis across a minimum temperature gradient. Maximum local adjustments between minimum temperature and life-cycle traits were obtained in the southwest Iberian Peninsula, an area with the highest minimum temperatures. In contrast, in off-southwest locations, the effects of minimum temperature on DSDS50 were rather constant across the region, whereas those of minimum temperature on FT were more variable, with peaks of strong local adjustments of GWR models in central and northwest Spain. Sliding window analysis identified a minimum temperature turning point in the relationship between DSDS50 and FT around a minimum temperature of 7.2 °C. Above this minimum temperature turning point, the variation in the FT/DSDS50 ratio became rapidly constrained and the negative correlation between FT and DSDS50 did not increase any further with increasing minimum temperatures. The southwest Iberian Peninsula emerges as an area where variation in life-cycle phenology appears to be restricted by the duration and severity of the hot summer drought. The temperature-driven varying relationship between DSDS50 and FT detected environmental boundaries for the co-evolution between FT and DSDS50 in A. thaliana. In the context of global warming, we conclude that A. thaliana phenology from the southwest Iberian Peninsula, determined by early flowering and deep seed dormancy, might become the most common life-cycle phenotype for this annual plant in the region.

A systematic review of alternative splinting versus complete plaster casts for the management of childhood buckle fractures of the wrist.

Paediatric wrist-buckle fractures are common distal radius fractures with inherent stability. Traditional management with complete plaster-cast immobilization necessitates follow-up visits, time off school/work and hospital treatment costs. Treatment with alternative splinting, negating the need for follow-up visits and saving time and money, has been proposed. However, concerns with regard to complications, primarily pain, have been raised; hence, the topic remains controversial. A systematic review was performed with eight randomized-controlled trials analysed. Alternative splinting was superior to casting in terms of function, cost and convenience, but with no significantly worse pain or fracture complication level. The evidence endorses the use alternative splinting over casting in paediatric wrist-buckle fractures.

Has Uganda experienced any stalled fertility transitions? Reflecting on the last four decades (1973-2011).

BACKGROUND: Persistent high fertility is associated with mother and child mortality. While most regions in the world have experienced declines in fertility rates, there are conflicting views as to whether Uganda has entered a period of fertility transition. There are limited data available that explicitly detail the fertility trends and patterns in Uganda over the last four decades, from 1973 to 2011. Total fertility rate (TFR) is number of live births that a woman would have throughout her reproductive years if she were subject to the prevailing age specific fertility patterns. The current TFR for Uganda stands at 6.2 children born per woman, which is one of the highest in the region. This study therefore sought to examine whether there has been a fertility stall in Uganda using all existing Demographic Health Survey data, to provide estimates for the current fertility levels and trends in Uganda, and finally to examine the demographic and socioeconomic factors responsible for fertility levels in Uganda. This is a secondary analysis of data from five consecutive Ugandan Demographic Health Surveys (UDHS); 1988/1989, 1995, 2000/2001, 2006 and 2011. Using pooled data to estimate for fertility levels, patterns and trends, we applied a recently developed fertility estimation approach. A Poisson regression model was also used to analyze fertility differentials over the study period. RESULTS: Over the studied period, fertility trends and levels fluctuated from highs of 8.8 to lows of 5.7, with no specific lag over the study period. These findings suggest Uganda is at the pre-transitional stage, with indications of imminent fertility rate reductions in forthcoming years. Marital status remained a strong predictor for number of children born, even after controlling for other variables. CONCLUSIONS: This study suggests there is no evidence of a fertility stall in Uganda, but demonstrates an onset of fertility transition in the country. If this trend continues, Uganda will experience a low fertility rate in the future-a finding pertinent for policy makers, especially as the continent and the country focus on harnessing the demographic dividend.

A systematic review of the evidence for single stage and two stage revision of infected knee replacement.

BACKGROUND: Periprosthetic infection about the knee is a devastating complication that may affect between 1% and 5% of knee replacement. With over 79 000 knee replacements being implanted each year in the UK, periprosthetic infection (PJI) is set to become an important burden of disease and cost to the healthcare economy. One of the important controversies in treatment of PJI is whether a single stage revision operation is superior to a two-stage procedure. This study sought to systematically evaluate the published evidence to determine which technique had lowest reinfection rates. METHODS: A systematic review of the literature was undertaken using the MEDLINE and EMBASE databases with the aim to identify existing studies that present the outcomes of each surgical technique. Reinfection rate was the primary outcome measure. Studies of specific subsets of patients such as resistant organisms were excluded. RESULTS: 63 studies were identified that met the inclusion criteria. The majority of which (58) were reports of two-stage revision. Reinfection rated varied between 0% and 41% in two-stage studies, and 0% and 11% in single stage studies. No clinical trials were identified and the majority of studies were observational studies. CONCLUSIONS: Evidence for both one-stage and two-stage revision is largely of low quality. The evidence basis for two-stage revision is significantly larger, and further work into direct comparison between the two techniques should be undertaken as a priority.

Socio-economic impacts on flooding: a 4000-year history of the Yellow River, China.

We analyze 4000-year flood history of the lower Yellow River and the history of agricultural development in the middle river by investigating historical writings and quantitative time series data of environmental changes in the river basin. Flood dynamics are characterized by positive feedback loops, critical thresholds of natural processes, and abrupt transitions caused by socio-economic factors. Technological and organizational innovations were dominant driving forces of the flood history. The popularization of iron plows and embarkment of the lower river in the 4th century BC initiated a positive feedback loop on levee breaches. The strength of the feedback loop was enhanced by farming of coarse-sediment producing areas, steep hillslope cultivation, and a new river management paradigm, and finally pushed the flood frequency to its climax in the seventeenth century. The co-evolution of river dynamics and Chinese society is remarkable, especially farming and soil erosion in the middle river, and central authority and river management in the lower river.

Fluvial landscapes of the Harappan civilization.

The collapse of the Bronze Age Harappan, one of the earliest urban civilizations, remains an enigma. Urbanism flourished in the western region of the Indo-Gangetic Plain for approximately 600 y, but since approximately 3,900 y ago, the total settled area and settlement sizes declined, many sites were abandoned, and a significant shift in site numbers and density towards the east is recorded. We report morphologic and chronologic evidence indicating that fluvial landscapes in Harappan territory became remarkably stable during the late Holocene as aridification intensified in the region after approximately 5,000 BP. Upstream on the alluvial plain, the large Himalayan rivers in Punjab stopped incising, while downstream, sedimentation slowed on the distinctive mega-fluvial ridge, which the Indus built in Sindh. This fluvial quiescence suggests a gradual decrease in flood intensity that probably stimulated intensive agriculture initially and encouraged urbanization around 4,500 BP. However, further decline in monsoon precipitation led to conditions adverse to both inundation- and rain-based farming. Contrary to earlier assumptions that a large glacier-fed Himalayan river, identified by some with the mythical Sarasvati, watered the Harappan heartland on the interfluve between the Indus and Ganges basins, we show that only monsoonal-fed rivers were active there during the Holocene. As the monsoon weakened, monsoonal rivers gradually dried or became seasonal, affecting habitability along their courses. Hydroclimatic stress increased the vulnerability of agricultural production supporting Harappan urbanism, leading to settlement downsizing, diversification of crops, and a drastic increase in settlements in the moister monsoon regions of the upper Punjab, Haryana, and Uttar Pradesh.

Value of magnetic resonance arthrography in post-traumatic anterior shoulder instability prior to arthroscopy: a prospective evaluation of MRA versus arthroscopy.

PURPOSE: This prospective study was designed to evaluate the value of magnetic resonance arthrography (MRA) after traumatic anterior shoulder instability prior to arthroscopy. METHODS: Patients included had two or more shoulder dislocations, at least the first being traumatic. MRA images were scored for Hill Sachs lesions, superior labral anterior posterior (SLAP) lesions, rotator cuff tears, glenohumeral ligament (GHL) lesions and Bankart lesions. Consequently, a standardized shoulder arthroscopy was performed. Five surgeons were involved in the study, initially blinded to the MRA results. MRA and arthroscopic findings were compared. Interobserver agreement was calculated by using Cohen's Kappa coefficients (κ). RESULTS: Eighteen patients (13 male, 5 female) were included (mean age 26.1 years). Hill Sachs lesions demonstrated fair agreement (κ = 0.33) whereas for SLAP lesions moderate agreement was calculated (κ = 0.43). On MRA, four partial thickness rotator cuff lesions were seen, not being stated by arthroscopy. GHL lesions were described on MRA in 15 patients; only two patients turned out to have GHL lesions at arthroscopy. Two arthroscopically diagnosed Bankart lesions which needed surgical treatment were not detected by MRA (moderate agreement, κ = 0.47). CONCLUSIONS: In patients with post-traumatic anterior glenohumeral instability MRA shows many lesions that can not be confirmed by arthroscopy and therefore do not have therapeutical consequences. On the other hand some labral lesions which do need surgical treatment are not detected on MRA. At least from this study, it can be concluded that MRA has limited value prior to the arthroscopic treatment of post-traumatic shoulder instability.

Sediment flux and the Anthropocene.

Data and computer simulations are reviewed to help better define the timing and magnitude of human influence on sediment flux--the Anthropocene epoch. Impacts on the Earth surface processes are not spatially or temporally homogeneous. Human influences on this sediment flux have a secondary effect on floodplain and delta-plain functions and sediment dispersal into the coastal ocean. Human impact on sediment production began 3000 years ago but accelerated more widely 1000 years ago. By the sixteenth century, societies were already engineering their environment. Early twentieth century mechanization has led to global signals of increased sediment flux in most large rivers. By the 1950s, this sediment disturbance signal reversed for many rivers owing to the proliferation of dams, and sediment load reduction below pristine conditions is the dominant signal today. A delta subsidence signal began in the 1930s and is now a dominant signal in terms of sea level for many coastal environments, overwhelming even the global warming imprint on sea level. Humans have engineered how most water and sediment are discharged into the coastal ocean. Hyperpycnal flow events have become more common for some rivers, and less common for other rivers. Bottom trawling is now widespread, suggesting that even continental shelves have received a significant but as yet quantified Anthropocene impact. The Anthropocene attains the level of a geological climate event, such as that seen in the transition between the Pleistocene and the Holocene.

Assessing the effect of natural controls and land use change on sediment yield in a major Andean River: the Magdalena drainage basin, Colombia.

The Magdalena River, a major fluvial system draining most of the Colombian Andes, is a world-class river, in the top 10 in terms of sediment load (approximately 150 MT/yr). In this study, we explore the major natural factors and anthropogenic influences behind the patterns in sediment yield on the Magdalena basin and reconstruct the spatial and temporal pattern of deforestation and agricultural intensification across the basin to test the relationships between land use change and trends in sediment yield. Our results show that sediment yield for the whole Magdalena catchment can be explained by natural variables, including runoff and maximum water discharge. These two estimators explain 58% of variance in sediment yield. Temporal analyses of sediment discharges and land use show that the extent of erosion within the catchment has increased over the last 10 to 20 years. Many anthropogenic influences, including a forest decrease by 40% in a 20-year period, an agriculture and pasture increase by 65%, poor soil conservation and mining practices, and increasing rates of urbanization, may have accounted for the overall increasing trends in sediment yield on a regional scale.

Impact of humans on the flux of terrestrial sediment to the global coastal ocean.

Here we provide global estimates of the seasonal flux of sediment, on a river-by-river basis, under modern and prehuman conditions. Humans have simultaneously increased the sediment transport by global rivers through soil erosion (by 2.3 +/- 0.6 billion metric tons per year), yet reduced the flux of sediment reaching the world's coasts (by 1.4 +/- 0.3 billion metric tons per year) because of retention within reservoirs. Over 100 billion metric tons of sediment and 1 to 3 billion metric tons of carbon are now sequestered in reservoirs constructed largely within the past 50 years. African and Asian rivers carry a greatly reduced sediment load; Indonesian rivers deliver much more sediment to coastal areas.

The effect of hyperglycemia on experimental retinal ischemia.

OBJECTIVE: To determine the effect of hyperglycemia and intraocular glucose delivery on ischemic retinal injury. METHODS: Experimental diabetes was induced in age- and sex-matched Wistar rats by an injection of streptozocin. The functional and structural retinal injury in these rats after a period of pressure-induced retinal ischemia was compared with the injury in appropriate controls and with rats made hyperglycemic by an injection of systemic glucose. The effect of high intraocular pressure-induced ischemia with the use of several different isotonic substrates in the elevated reservoir (isotonic sodium chloride solution, glucose, 2-deoxyglucose, and lactate) was also determined. Electroretinography, reverse transcriptase polymerase chain reaction, and histologic examination were used to assess the retinal injury. RESULTS: Streptozocin-induced diabetes, glucose injection-induced preexisting hyperglycemia, and intraocular glucose delivery during ischemia markedly reduced the functional and structural ischemic retinal injury. Neither postischemic hyperglycemia nor the intraocular delivery of lactate significantly affected the ischemic injury; however, the intraocular delivery of 2-deoxyglucose significantly exacerbated the retinal injury. CONCLUSION: Preexisting hyperglycemia and the intraocular delivery of glucose markedly attenuate ischemic retinal injury. Clinical Relevance These findings highlight fundamental differences in energy metabolism between brain and retina, have important implications for the pathophysiology of diabetic retinopathy, and may lead to novel therapeutic strategies for ischemic retinopathies.

Has the HIV/AIDS epidemic changed sexual behaviour of high risk groups in Uganda?

BACKGROUND: Uganda, was the first country in sub-Saharan Africa to reverse its HIV/AIDS epidemic. Long distance drivers, prostitutes and barmaids have been identified as the groups that engage in risky sex, which promotes HIV transmission in Uganda and other countries across the continent. This paper investigates whether and why there were changes of sexual behaviour and practices among five risky groups in Uganda as a consequence of HIV/AIDS epidemic. METHODOLOGY: The paper is based on data generated from a survey on 'resistance to sexual behaviour change in the African AIDS epidemic', which was conducted in the districts of Kabale, Kampala and Lira in 1999. For purposes of this paper, only data from the focus group discussions with high-risk groups have been analysed. These include commercial sex workers, street children, long haul truck drivers, bar maids and adolescents in three towns of Uganda (Kabale, Kampala, Lira). RESULTS: Results indicate that despite the HIV/AIDS epidemic, these groups had only changed their sexual behaviour a little, and they reported to be continuing with multiple sexual partners for a variety of reasons. The adolescents and street children were under peer pressure and a lot of sexual urge; commercial sex workers and bar maids attributed their risky behaviour to the need to survive due to the existing poverty; and the truck drivers reflected on the need for female company to reduce their stress while on the long lonely travels across Africa. Nevertheless, they are all aware and perceive people with multiple sexual partners as being highly vulnerable to contracting HIV and they all reported to have adopted condom use as an HIV preventive strategy. They also observed that married people were at a high risk of contracting HIV due to non-use of condoms in marital relationships and unfaithfulness of spouses. CONCLUSIONS Females engage in high-risk sexual relations as a means of economic survival, and perceive their acts as a strategy to improve their socio-economic well being. On the contrary, men in these high-risk categories do such acts out of pleasure and as avenues for attaining fulfilled sexual lives. The search for money among women and the constant desire for men to have sexual pleasure, which are greatly facilitated by their financial status are the forces behind reckless sexual behaviour among high-risk groups.