High red blood cell folate is associated with an increased risk of diabetes death among a hypertensive cohort.

The relationship between folate and diabetes remains inconclusive, possibly because of folate measured differentially between studies. Interference from mandatory folic acid fortification (FAF) has also been blamed. With both folate intake and circulating concentration measured, we assessed the relationship between folate and the risk of diabetes death in a hypertensive cohort established before FAF. We hypothesized that the association between folate and diabetes death is measurement dependent. We analyzed the data of 3133 hypertensive adults aged ≥19 years who participated in the Third National Health and Nutrition Examination Survey (1991-1994) and were followed up through December 31, 2010. Hazard ratios of diabetes death were estimated for participants with high (4th quarter) folate compared with those with moderate (2nd and 3rd quarters) or low (1st quarter) concentrations of folate. Dietary folate intake, total folate intake (including folate from supplements), serum, and red blood cell (RBC) folate were measured. After 42,025 person-years of follow-up, 165 diabetes deaths were recorded, and a dose-response positive association was observed between diabetes death and RBC folate. The adjusted hazard ratios of diabetes death were 1.00 (reference), 1.42 (95% CI. 1.20-1.68), and 2.21 (1.73-2.82), respectively, for hypertensive adults with low, moderate, and high RBC folate. No association was detected between diabetes death and serum folate concentration, folate intake, or either dietary intake or total intake. With minimized interference from FAF, neither dietary nor serum folate was associated with diabetes death, but elevated RBC folate was associated with a high risk of diabetes deaths among hypertensive patients.

Occupational health hazards among healthcare providers and ancillary staff in Ghana: a scoping review.

OBJECTIVE: The strict implementation of occupational health and safety policy curbs exposure to occupational hazards. However, empirical evidence is lacking in the Ghanaian context. This review primarily aimed to explore exposure to occupational hazards among healthcare providers and ancillary staff in Ghana. DESIGN: A scoping review was conducted based on Arksey and O'Malley's methodological framework and Levac et al's methodological enhancement. DATA SOURCES: Searches were conducted of the PubMed, MEDLINE, CINAHL, Embase, PsycINFO and Scopus databases, as well as Google Scholar and websites of tertiary institutions in Ghana, for publications from 1 January 2010 to 30 November 2021. ELIGIBILITY CRITERIA: Quantitative studies that were published in the English language and focused on occupational exposure to biological and/or non-biological hazards among healthcare professionals in Ghana were included. DATA EXTRACTION AND SYNTHESIS: Two independent reviewers extracted the data based on the type of occupational exposure and descriptive characteristics of the studies. The data are presented in tables and graphs. A narrative summary of review findings was prepared based on the review research questions. RESULTS: Our systematic search strategy retrieved 507 publications; however, only 43 met the inclusion criteria. A little over one-quarter were unpublished theses/dissertations. The included studies were related to biological, psychosocial, ergonomic and other non-biological hazards. 55.8% of the studies were related to exposure to biological hazards and related preventive measures. In general, health workers were reported to use and comply with control and preventive measures; however, knowledge of control and preventive measures was suboptimal. CONCLUSION: Work is needed to address the issue of occupational health hazard exposure in Ghana's health system. More research is needed to understand the extent of these exposures and their effects on the health system.

Ensuring Food Safety for Americans: The Role of Local Health Departments.

(1) Background: Several agencies in the United States play a primary role in ensuring food safety, yet foodborne illnesses result in about 3000 deaths and cost more than USD 15.6 billion each year. The study objectives included analyzing local health departments' (LHDs) level of engagement in food safety and other related services, and LHDs' characteristics associated with those services. (2) Methods: We used data from 1496 LHDs that participated in the 2019 National Profile of Local Health Departments Survey, administered to all 2459 LHDs in the United States. Logistic regression analyses were performed to model multiple dichotomous variables. (3) Results: An estimated 78.9% of LHDs performed food safety inspections, 78.3% provided food safety education, 40.7% provided food processing inspections, and 48.4% engaged in policy and advocacy. The odds for LHDs to directly provide preventive nutrition services were 20 times higher if the LHDs had one or more nutritionists on staff (Adjusted Odds Ratio or AOR = 20.0; Confidence Interval, CI = 12.4−32.2) compared with LHDs with no nutritionists. Other LHD characteristics significantly associated with the provision of nutrition services (p < 0.05) included population size, state governance (rather than local), and LHD having at least one registered, licensed, practical, or vocational nurse. The odds of providing food processing services were lower for locally governed than state-governed LHDs (AOR = 0.5; CI = 0.4−0.7). The odds of performing food safety inspections varied by LHD's population size, whether a nutritionist was on staff, whether it was state-governed (vs. locally), and whether it completed a community health assessment (CHA) within 5 years. (4) Conclusions: LHDs play a critical role in ensuring safe food for Americans, yet variations exist in their performance based on their specific characteristics. Adequate funding and a competent workforce are essential for LHDs to utilize evidence-based practices and engage in policymaking and advocacy concerning food safety.

Identifying occupational health hazards among healthcare providers and ancillary staff in Ghana: a scoping review protocol.

INTRODUCTION: The formation, modification and implementation of occupational health and safety policy for the Ghana healthcare industry hinge on data and reviews on occupational exposures. However, there is no synthesised review to speak to the issues of these occupational exposures. A scoping review on occupational exposures among the health workforce in Ghana will provide a broad overview of exposures, and can guide and assist in making decisions on occupational health issues relating to healthcare workers. METHODS AND ANALYSIS: Arksey and O'Malley's scoping review methodology framework will guide the conduct of this scoping review. Primary research studies, government documents and other information on occupational exposures among healthcare workers published in the English language will be retrieved from databases including PubMed, CINAHL, Embase, MEDLINE, Scopus, PsycINFO and Google scholar. A systematic search strategy will be employed to identify articles from 1 January 2010 until 30 November 2021. Also, grey literature sources in Ghana including government and tertiary institutions websites will be searched. A reference list of key studies and other available non-electronic materials will also be screened to identify relevant studies for inclusion. The review will consider studies that address prevalence, knowledge and predisposing factors of occupational exposures along with the use of occupational hazards control/preventive measures. After removal of duplicates, and title and abstract screening, relevant articles will be subjected to full-text analysis. The screening processes will be conducted independently by two reviewers. Data will then be extracted and presented in tabular form with a narrative to aid easy comprehension. ETHICS AND DISSEMINATION: This scoping review does not require ethical approval. The findings will be disseminated through publications, conference presentations and stakeholder meetings.

Social ecological factors affecting substance abuse in Ghana (West Africa) using photovoice.

INTRODUCTION: Substance abuse is an important public health issue affecting West Africa; however, there is currently a dearth of literature on the actions needed to address it. The aim of this study was to assess the risks and protective factors of substance abuse in Ghana, West Africa, using the photovoice method. METHODS: This study recruited and trained 10 participants in recovery from substance abuse and undergoing treatment in the greater Accra region of Ghana on the photovoice methodology. Each participant received a disposable camera to take pictures that represented the risk and protective factors pertinent to substance abuse in their communities. They were also given the opportunity to provide narratives of the pictures using pre-identified themes and the different levels of the social-ecological model and participatory action research (PAR). RESULTS: Participants identified at the individual level: ignorance; interpersonal level: family and peer pressure; organizational level: lack of regulation; community level: media, availability of drugs, cost of drugs, urbanization, slum communities and cultural factors; and policy level: lack of regulations and their enforcement. Education and beliefs were cited at the individual level; family at the interpersonal level; religion at the organizational level; organizing youth, media and narcotics anonymous at the community level; and nothing at the policy level. CONCLUSION: This is an exploratory study that will add to the limited body of knowledge in the scientific literature with respect to substance abuse in the country and also help develop interventions to address the respective needs of several communities in Ghana.

The effect of power outages on in-facility mortality in healthcare facilities: Evidence from Ghana.

The World Bank estimates that at least 25 countries in the Sub-Saharan region of Africa experience chronic power outages. However, the implications of power shortages are often discussed within the context of industrial and economic disruptions, with little attention given to the health impact. Using a nationally representative data of healthcare facilities from the 2012 Ghana Access, Bottlenecks, Cost and Equity (ABCE) Health Facility Survey, this study aims to assess the impact of power outages on in-healthcare facility mortality in Ghana, a country that has experienced worsening energy crises in the last few decades. Findings revealed a positive association between the frequency of power outages and in-facility mortality, with the risk for mortality estimated to increase by 43% for each day the power was out for over 2 h. Further, when compared to an urban healthcare facility experiencing the same frequency of power outages, the risk of mortality was found to be lower in the rural facility. These findings call for a concerted effort among all stakeholders to ensure the availability of consistent power supply in healthcare facilities, in order to provide the necessary environment for the successful provision of healthcare for the citizens of Ghana.

Serum folate levels and fatality among diabetic adults: A 15-y follow-up study of a national cohort.

OBJECTIVE: Folate is involved in carbohydrate metabolism, a process that can have clinical implications regarding diabetes management. The aim of this study was to assess the relationship between serum folate and fatality among adults with diabetes. METHODS: A retrospective cohort study was conducted with 532 adults with diabetes who participated in Phase II of NHANES III (National Health and Nutrition Examination Survey III; 1991-1994). This study served as baseline and was linked to the National Death Index database for a 15-y (1991-2006) follow-up study. Estimates of hazard ratios (HRs) for all-cause and cancer-related deaths, cardiovascular disease (CVD), and diabetes for individuals with different serum folate levels were obtained from Cox proportional hazards regression. RESULTS: The mean age of adults with diabetes and detected serum folate at baseline was 63.2 y (SD 13.8 y). During follow-up, diabetes was listed as a contributor for 138 of 299 deaths. For all-cause deaths, the fatality rate of the upper quartile (74.30/1000 person-years [PY]) was almost twofold higher than the lower quartile (41.75/1000 PY) of serum folate levels. After adjusting for several covariates, including serum vitamin B12, cotinine, homocysteine and CVD history at baseline; the HRs for all-cause fatalities were 1.00 (reference), 1.62 (95% confidence interval [CI], 1.06-2.47) and 1.76 (95% CI, 1.09-2.83) among adults with diabetes in the lower, intermediate, and upper quartiles of serum folate levels, respectively. CONCLUSION: Results indicate that high serum folate concentrations are associated with an increased fatality risk among adults with diabetes. Further studies are warranted to determine the mechanism(s) of this phenomenon.

Body mass index and death rate of colorectal cancer among a national cohort of U.S. adults.

Substantial evidence suggests that increasing adiposity is associated with an increased death rate of colorectal cancer, but no studies were conducted among national representative populations in the United States. The current study examined the death rate across BMI levels in 7,016 adults who participated in the National Health and Nutrition Examination Survey in 1971-1975. BMI categories were defined as normal (18.5-24.9 kg/m(2)), overweight (25-29.9), and obese (≥30). A total of 519 cancer deaths were identified during a 17-yr follow-up with 118,998 person-years. No significantly increased death rates of total cancers, lung, breast, and prostate cancer were observed among participants with an increased BMI. However, colorectal cancer death rates were 0.39, 0.68, and 0.96/1,000 person-years, respectively, for normal weight, overweight, and obese (P value for log-rank trend test < 0.001), and the corresponding adjusted hazard ratios [95% confidence intervals (CI)] were 1.00 (reference), 1.25 (95% CI = 0.72-2.19), and 2.04 (1.08-3.83), respectively. No gender difference of the association was identified. The authors conclude that a significantly increased death rate of colorectal cancer was associated with excess body weight. The current study is an addition to the expanding body of literature indicating an increased risk of colorectal cancer development among the obese.

HIV and hepatocellular and esophageal carcinomas related to consumption of mycotoxin-prone foods in sub-Saharan Africa.

BACKGROUND: Promotion of the HIV epidemic by aflatoxin is postulated but not yet established. Sub-Saharan populations commonly consume food contaminated by mycotoxins, particularly aflatoxins (predominantly found in peanut, maize, rice, and cassava) and fumonisins, which occur primarily in maize. Aflatoxin promotes hepatocellular cancer, and fumonisin may promote esophageal cancer. OBJECTIVES: This analysis was undertaken to test the hypotheses that consumption of mycotoxin-prone staple foods is 1) related to the incidence of HIV infection in Africa and 2) related to "signature" cancer rates confirming exposure to aflatoxins and fumonisins. DESIGN: World Health Organization data for causes of death and the Food and Agriculture Organization per capita consumption data for commodities in sub-Saharan Africa were used. Per capita Gross Domestic Product and the percentage of Muslims (%Muslim) were the socioeconomic data sets exploited. Relations between causes of mortality, consumption of mycotoxin-prone foods, and socioeconomic variables were evaluated. Models for HIV transmission as a function of maize consumption and %Muslim were estimated. RESULTS: HIV and esophageal cancer deaths were significantly related to maize but were inversely related to %Muslim and rice consumption. HIV infections were minimized (74 compared with 435/100,000 people; odds ratio: 2.41; 95% CI: 1.73, 3.24; P < or = 0.0001) by the combination of low maize consumption and above-median % Muslim. Hepatocellular cancer deaths were positively related to rice but negatively related to maize consumption. CONCLUSIONS: HIV transmission frequency is positively associated with maize consumption in Africa. The relation between cancer and food suggests that fumonisin contamination rather than aflatoxin is the most likely factor in maize promoting HIV. Changes to the quality of maize may avoid up to 1,000,000 transmissions of HIV annually.

Aflatoxin B1 albumin adducts in plasma and aflatoxin M1 in urine are associated with plasma concentrations of vitamins A and E.

BACKGROUND: Although aflatoxin exposure has been associated with micronutrient deficiency in animals, there are few investigations on the effects of aflatoxin exposure on micronutrient metabolism in humans. OBJECTIVE: To examine the relationship between aflatoxin B1 (AFB1) albumin adducts (AF-ALB) in plasma and the aflatoxin M1 (AFM1) metabolite in urine and plasma concentrations of retinol (vitamin A) and alpha-tocopherol (vitamin E) in Ghanaians. METHODS: A cross-sectional study of 147 adult participants was conducted. Blood and urine samples were tested for aflatoxin and vitamins A and E levels. RESULTS: Multivariable analysis showed that participants with high AF-ALB (>or=0.80 pmol/mg albumin) had increased odds of having vitamin A deficiency compared to those with lower AF-ALB [Odds Ratio (OR)=2.61; CI=1.03-6.58; p=0.04]. Participants with high AF-ALB also showed increased odds of having vitamin E deficiency but this was not statistically significant (OR=2.4; CI=0.96-6.05; p=0.06). Conversely, those with higher AFM1 values had a statistically nonsignificant reduced odds of having vitamin A deficiency (OR=0.31; CI=0.09-1.02; p=0.05) and a statistically significant reduced odds of having vitamin E deficiency (OR=0.31; CI=0.10-0.97; p=0.04). Participants with high AF-ALB or high AFM1 (>or=437.95 pg/dL creatinine) were almost 6 times more likely to be hepatitis B virus surface antigen (HBsAg)-positive (OR=5.88; CI=1.71-20.14; p=0.005) and (OR=5.84; CI=1.15-29.54; p=0.03) respectively. CONCLUSIONS: These data indicate that aflatoxin may modify plasma micronutrient status. Thus, preventing aflatoxin exposure may reduce vitamin A and E deficiencies.

PAH exposure in a Ghanaian population at high risk for aflatoxicosis.

It was postulated that a population in sub-Saharan Africa, known to be at high risk for aflatoxicosis due to frequent ingestion of aflatoxin (AF)-contaminated foods could also be exposed to polycyclic aromatic hydrocarbons (PAHs) from a variety of environmental sources. Previously, participants in this population were shown to be highly exposed to AFs, and this exposure was significantly reduced by intervention with NovaSil clay (NS). Objectives of this study were 1) to assess PAH exposure in participants from the AF study using urinary biomarker 1-hydroxypyrene (1-OHP); 2) examine the effect of NS clay and placebo (cellulose) treatment on 1-OHP levels; and 3) determine potential association(s) between AF and PAH exposures. A clinical trial was conducted in 177 Ghanaians who received either NS capsules as high dose or low dose, or placebo (cellulose) for a period of 3 months. At the start and end of the study, urine samples were analyzed for 1-OHP. Of the 279 total samples, 98.9% had detectable levels of 1-OHP. Median 1-OHP excretion in nonsmokers was 0.64 micromol/mol creatinine at baseline and 0.69 micromol/mol creatinine after 3 months. Samples collected at both time points did not show significant differences between placebo and NS-treated groups. There was no linear correlation between 1-OHP and AF-albumin adduct levels. Results show that this population is highly exposed to PAHs (and AFs), that NS and cellulose treatment had no statistically significant effect on 1-OHP levels, and that this urinary biomarker was not linearly related with AF exposure.

Determinants of aflatoxin levels in Ghanaians: sociodemographic factors, knowledge of aflatoxin and food handling and consumption practices.

Aflatoxins are among the most potent of carcinogens found in staple foods such as groundnuts, maize and other oil seeds. This study was conducted to measure the levels of aflatoxin B(1) (AFB(1)) albumin adducts in blood and aflatoxin M(1) (AFM(1)) metabolite in urine of people in a heavy peanut and maize consuming region of Ghana and to examine the association between aflatoxin levels and several socio-demographic factors and food handling and consumption practices. A cross-sectional study was conducted in four villages in the Ejura Sekyedumase district of Ghana. A socio-demographic survey was administered to 162 participants. Blood samples were collected from 140 and urine samples from 91 of the participants and AFB(1) albumin-adduct levels in blood and AFM(1) levels in urine were measured. High AFB(1) albumin-adduct levels were found in the plasma (mean+/-SD=0.89+/-0.46pmol/mg albumin; range=0.12-3.00pmol/mg; median=0.80pmol/mg) and high AFM(1) levels in the urine (mean+/-SD=1,800.14+/-2602.01pg/mg creatinine; range=non-detectable to 11,562.36pg/mg; median=472.67pg/mg) of most of the participants. There was a statistically significant correlation (r=0.35; p=0.007) between AFB(1)-albumin adduct levels in plasma and AFM(1) levels in urine. Several socio-demographic factors, namely, educational level, ethnic group, the village in which participants lived, number of individuals in the household, and number of children in the household attending secondary school, were found to be significantly associated with AFB(1) albumin-adduct levels by bivariate analysis. By multivariate analyses, ethnic group (p=0.04), the village in which participants live (p=0.02), and the number of individuals in the household (p=0.01), were significant predictors of high AFB(1) albumin-adducts. These findings indicate strongly that there is need for specifically targeted post-harvest and food handling and preparation interventions designed to reduce aflatoxin exposure among the different ethnic groups in this region of Ghana.

Chronic toxicological evaluation of dietary NovaSil clay in Sprague-Dawley rats.

NovaSil (NS) clay, a common anti-caking agent in animal feeds, has been shown to sorb aflatoxins in the GI tract and diminish their bioavailability and adverse effects in short-term animal studies. Based on this evidence, it is hypothesized that clay-based enterosorption of aflatoxins may be a useful strategy for the prevention of aflatoxicosis in human populations. However, the potential toxicity of long-term dietary exposure to NS has not been determined. In this research, 5-6-week-old male and female Sprague-Dawley rats were fed rations containing 0, 0.25, 0.5, 1.0, or 2.0% (w/w) levels of NS for 28 weeks. Analysis of the NS showed negligible levels of dioxin and furan contaminants. Total feed consumption, cumulative feed consumption, body weight, total body weight gain, feed conversion efficiency, cumulative feed conversion efficiency, and relative organ weights were unaffected in either sex at the doses tested. No NS-dependent differences in relative organ weights or gross or histopathological changes were observed. Analysis of hematological parameters, clinical chemistry, and selected vitamin and mineral levels revealed isolated significant differences between some treatments and control groups (mean corpuscular hemoglobin, serum Ca, serum vitamin A, and serum Fe). However, the differences observed in each case were not dose-dependent. These results suggest that dietary inclusion of NS at levels as high as 2.0% (w/w) does not result in overt toxicity. These findings (as well as others) support the use of NS clay for dietary intervention studies in human populations at high risk for aflatoxicosis.

Prevention of zearalenone-induced hyperestrogenism in prepubertal mice.

Previous methods for the control of zearalenone (ZEN)-induced hyperestrogenism in animals have proven largely ineffective. The main objective in this study was to identify an enterosorbent that decreases the dietary bioavailability, and subsequent estrogenic effects, of ZEN. Initial in vitro screenings in aqueous solution (4 microg ZEN/ml) indicated that an activated carbon (AC) was the most efficient sorbent (99%), followed by a combination of 2 parts AC plus 3 parts HEC (hectorite) (69%), cetylpyridinium-exchanged low-pH montmorillonite (CP-LPHM) clay (58%), hexadecyltrimethylammonium-exchanged low-pH montmorillonite (HDTMA-LPHM) clay (54%), and HEC alone (28%). Results from the adult hydra bioassay suggested that the addition of either AC or HEC effectively decreased the effects of ZEN on Hydra attenuata without toxicity, as was observed with the use of either CP-LPHM or HDTMA-LPHM. Based on these results, AC, HEC, and 2AC:3HEC were evaluated in prepubertal mice. At a dietary inclusion level of 0.8% (w/w), AC alone significantly protected mice against the estrogenic effects induced by 35 mg ZEN/kg feed. Inclusion of 1.2% HEC with the 0.8% AC showed no additional protection; whereas 1.2% HEC alone failed to decrease the estrogenic effects. Ground flaxseed (25% w/w) in the diet also elicited protection, but to a lesser extent. Preliminary studies suggested that three similar carbons failed to decrease ZEN bioavailability. These findings suggest that the AC used in this study may be efficacious as an enterosorbent in animals consuming ZEN-contaminated diets. However, further studies are needed to evaluate the binding specificity, as well as the safety of chronic exposure.

Toxicological evaluation and metal bioavailability in pregnant rats following exposure to clay minerals in the diet.

Silicate clays are frequently added to animal feeds to bind and reduce the bioavailability of mycotoxins in the gastrointestinal tract. However, the bioavailability of trace metals in these clay feed additives has not been thoroughly investigated. Clays that act nonselectively may interact with nutrients, minerals, and other feedborne chemicals to pose significant hidden risks. In this study, a calcium montmorillonite clay (Novasil Plus, NSP) commonly used as an enterosorbent for aflatoxins and a sodium montmorillonite clay (Swy-2) (Source Clay Minerals Repository, Columbia, MO) were examined. Clays were supplemented in the balanced diet of Sprague-Dawley rats during pregnancy at a level of 2% (w/w). Evaluations of toxicity were performed on gestation d 16 and included maternal body weights, maternal feed intakes, litter weights, and embryonic resorptions. Liver, kidneys, tibia, brain, uterus, pooled placentas, and pooled embryonic mass were collected and weighed. Tissues were lyophilized and neutron activation analysis (NAA) was performed. Elements considered by NAA included Al, Ba, Br, Ca, Ce, Co, Cr, Cs, Cu, Dy, Eu, Fe, Hf, K, La, Lu, Mg, Mn, Na, Nd, Ni, Rb, S, Sb, Sc, Se, Sm, Sr, Ta, Tb, Te, Th, Ti, Tl, U, V, Yb, Zn, and Zr. Inductively coupled plasma-mass spectroscopy further confirmed that Al was below detection limits (<0.5 ppm) in the brain. Animals supplemented with either NSP or Swy-2 were similar to controls with respect to toxicity evaluations and metal analysis, with the exception of decreased brain Rb following clay supplementation. Overall, the results of this study suggest that neither NSP nor Swy-2, at relatively high dietary concentrations, influences mineral uptake or utilization in the pregnant rat.