Physical Activity Levels, Perceived Barriers to Exercise and Development of Secondary Conditions in Community Dwelling Persons with Spinal Cord Injury / Niveles de Actividad física, Barreras Percibidas para Ejercitar, y Desarrollo de Condiciones Secundarias en Personas con Lesión de la Médula Espinal que Viven en sus Comunidades

ABSTRACT Objective: To determine physical activity levels of community dwelling persons with spinal cord injury (SCI) who received inpatient rehabilitation at the Sir John Golding Rehabilitation Centre (SJGRC). This study also explored the perceived barriers to exercise and the development of secondary health complications. Methods: A non-experimental cross-sectional analysis of relationships was done. Participants were recruited from the SJGRC discharge files. Three questionnaires (The Physical Activity and Disability Scale, Spinal Cord Injury Secondary Conditions Scale and the Barriers to Exercise and Disability Scale) were administered via a telephone interview. Results: Only 58.3% of patients were engaged in some form of exercise and of that amount only 6% engaged in vigorous exercise. The main secondary conditions affecting both persons with paraplegia and quadriplegia were spasticity, chronic, muscle and joint pain. There were no significant differences between persons having paraplegia and quadriplegia in relation to physical activity levels, development of secondary conditions or barriers to exercise. Most persons were interested in an exercise programme but the most common barriers to exercise were cost and not knowing where they could go to exercise. Conclusion: Regardless of injury level, persons with spinal cord injury living in their communities in Jamaica are not engaged in adequate levels of exercise to confer health benefits and aid with healthy ageing. Barriers like cost, availability and accessibility of facilities must be addressed if this situation is to improve.

RESUMEN Objetivo: Determinar los niveles de actividad física de las personas con lesión de la médula espinal (LME) que viven en sus comunidades -es decir, en sus casas en vez de asilos o instituciones asistenciales-y que recibieron rehabilitación hospitalaria en el Centro de Rehabilitación Sir John Golding (SJGRC, en inglés). Este estudio también exploró las barreras percibidas para hacer ejercicios, y el desarrollo de complicaciones secundarias de salud. Métodos: Se realizó un análisis transversal no experimental de las relaciones. Los participantes fueron reclutados a partir de los archivos de altas del Centro SJGRC. Se aplicaron tres cuestionarios mediante entrevista telefónica (Escala de Actividad Física y Discapacidad, Escala de Condiciones Secundarias de la Lesión Medular, y Escala de Discapacidad y Barreras al Ejercicio). Resultados: Sólo el 58.3% de los pacientes se hallaban participando en alguna forma de ejercicio, y de este número sólo el 6% practicaba ejercicios fuertes. Las condiciones secundarias principales que afectaban a ambas personas con paraplejia y cuadriplejia eran la espasticidad, y el dolor muscular y articular crónico. No había diferencias significativas entre las personas que tenían paraplejia y cuadriplejia en lo referente a los niveles de actividad física, el desarrollo de condiciones secundarias o las barreras al ejercicio. La mayoría de las personas estaban interesadas en un programa de ejercicios, pero las barreras más comunes eran el costo y el no saber dónde ir a hacerlos. Conclusión: Independientemente del nivel de la lesión, las personas con lesión medular que viven en sus comunidades en Jamaica no participan en niveles adecuados de ejercicio que brinden beneficios de salud y ayuden a un envejecimiento saludable. Las barreras como el costo, la disponibilidad y la accesibilidad de las instalaciones deben ser abordadas, si se quiere mejorar esta situación.

Does Exposure To Household and Ambient Air Pollution Pose a Risk To Cardiovascular Health? - A Cross-Sectional Study in Nepal

Over half the world’s population is exposed daily to very high levels of household air pollutants arising from burning biomass fuels; however the effects of these pollutants on cardiovascular health have not been fully established. This study aimed to compare the relationship between household indoor and outdoor air pollution with cardiovascular health in biomass and non-biomass exposed group. To compare the relationship between household indoor and outdoor air pollution with cardiovascular health in biomass and non-biomass exposed group. This cross-sectional study compared parameters of cardiovascular health in populations exposed to household indoor pollutants from biomass burning and non-biomass respectively among adults in Nepal. Data using an interviewer administered questionnaire including chest pain, blood pressure measurements and real-time measurements of household and ambient airborne particulate (PM2.5) concentrations were collected. Rural dwellers cooking with biomass fuels reported significantly more chest pain on exertion compared with non-biomass fuel users. 24-hour direct PM2.5 and CO measurements were not associated with changes in blood pressure as was the case for other measures of airborne particulate exposure except outdoor PM2.5 with men in non-biomass using households. Ambient temperature and seasonality was negatively associated with increase in blood pressure. The prevalence of both systolic (21% vs. 6%, p<0.001) and diastolic (32% vs. 7%, p<0.001) hypertension was higher amongst non-biomass fuel users compared with biomass users. There was no association between 24-hour real-time airborne pollutants data from biomass smoke and cardiovascular health effects but significantly more chest pain on exertion was found in those exposed to smoke from biomass fuel burning. Urban dwellers in Nepal were found to have higher blood pressure compared to rural dwellers, which was associated with their higher BMI levels and seasonality.

Scale-up of a decentralized HIV treatment programme in rural KwaZulu-Natal, South Africa: does rapid expansion affect patient outcomes?

Objective:To describe the scale-up of a decentralized HIV treatment programme delivered through the primary health care system in rural KwaZulu-Natal, South Africa, and to assess trends in baseline characteristics and outcomes in the study population Methods The programme started delivery of antiretroviral therapy (ART) in October 2004. Information on all patients initiated on ART was captured in the programme database and follow-up status was updated monthly. All adult patients (≥ 16 years) who initiated ART between October 2004 and September 2008 were included and stratified into 6-month groups. Clinical and sociodemographic characteristics were compared between the groups. Retention in care, mortality, loss to follow-up and virological outcomes were assessed at 12 months post-ART initiation.Findings A total of 5719 adults initiated on ART were included (67.9% female). Median baseline CD4+ lymphocyte count was 116 cells/µl (interquartile range, IQR: 53­173). There was an increase in the proportion of women who initiated ART while pregnant but no change in other baseline characteristics over time. Overall retention in care at 12 months was 84.0% (95% confidence interval, CI: 82.6­85.3); 10.9% died (95% CI: 9.8­12.0); 3.7% were lost to follow-up (95% CI: 3.0­4.4). Mortality was highest in the first 3 months after ART initiation: 30.1 deaths per 100 person­years (95% CI: 26.3­34.5). At 12 months 23.0% had a detectable viral load (> 25 copies/ml) (95% CI: 19.5­25.5).Conclusion Outcomes were not affected by rapid expansion of this decentralized HIV treatment programme. The relatively high rates of detectable viral load highlight the need for further efforts to improve the quality of services

Invasive Salmonellosis in Malawi

The incidence of invasive salmonellosis has increased among children and HIV-infected adults in Malawi. This has been associated with the emergence of drug resistance in the non-typhoidal Salmonella serovars Enteritidis and Typhimurium. In contrast; S. Typhi isolates have remained fully sensitive to commonly used antibiotics and the estimated incidence of typhoid fever; although still present; has fallen slightly among both adults and children. Infection with S. Typhi is not closely associated with underlying immuno- suppression but it is possible that the non-typhoidal Salmonellae have adapted to the person-person human transmission niche in this frequently immunosuppressed population. The huge burden of invasive salmonellosis in Malawi; the high associated mortality; and the recent emergence of drug resistance emphasise the need for a better understanding of the epidemiology and the need for vaccine development

Prevalence of risk factors in breast cancer patients at the University Hospital of the West Indies

The records of 120 consecutive patients diagnosed with carcinoma of the breast were examined between July 1996 and June 1999 in order to estimate the prevalence of established risk factors for this disease. Early menarche was present in 5.5 percent of patients, while 36 subjects (30 percent) were mulliparous and 6 (5 percent) had a first live birth after age 30 years. Four subjects had a previous biopsy with histological features of atypical hyperplasia. Fifteen subjects (12.5 percent) had one or more affected first degree relatives. Fifty-four percent of subjects possessed none of the risk factors examined in this study while 36 percent had a single risk factor and 10 percent possessed two risk factors. There was no significant clustering of risk factors in the group of patients aged thirty-five years or less. Larger studies should be encouraged to identify the risk factors which operate in our population and the degree to which published predictive variables are applicable.

La dracunculose au Cameroun en 1991

La dracunculose; qui sevit dans le Departement du Mayo-Sava (Province de l'Extreme-Nord) au Cameroun; a vu son incidence reduite de la moitie entre 1990 et 1991 passant de 778 a 394 cas grace aux mesures prises dans la cadre du programme national d'eridication