Noncommunicable Disease (NCD) strategic plans in low- and lower-middle income Sub-Saharan Africa: framing and policy response.

BACKGROUND: Global efforts to address NCDs focus primarily on 4-by-4 interventions - interventions to prevent and treat four groups of conditions affecting mainly older adults (some cardiovascular disease and cancers, type 2 diabetes, chronic respiratory disease) and four associated risk factors (alcohol, tobacco, poor diets, and physical inactivity). However, the NCD burden in Sub-Saharan Africa (SSA) is composed of a more diverse set of conditions, driven by a more complex group of risks, and impacting all segments of the population. OBJECTIVE: To document the NCD priorities identified by NCD strategic plans, to characterize the proposed policy response, and to assess the alignment between the two. METHODS: Using a two-part conceptual framework, we undertook a descriptive study to characterize the framing and overall policy response of strategic plans from 24 low- and lower-middle-income countries across SSA. RESULTS: The national situation assessments that ground strategic plans emphasize a diversity of conditions that range in terms of severity and frequency. These assessments also highlight a wide diversity of factors that shape this burden. Most include discussions of a broad range of behavioral, structural, genetic, and infectious risk factors. Plans endorse a more narrow response to this diverse burden, with a focus on primary and secondary prevention that is generally convergent with the objectives established in global policy documents. CONCLUSIONS: Broadly, we observe that plans developed by countries in SSA recognize the heterogeneity of the NCD burden in this region. However, they emphasize interventions that are consistent with global strategies focused on preventing a narrower set of cardiometabolic risk factors and their associated diseases. In comparison, relatively few countries detail plans to prevent, treat, and palliate the full scope of the needs they identify. There is a need for increased support for bottom-up planning efforts to address local priorities.

Impact of Planting Date on Melanaphis sacchari (Hemiptera: Aphididae) Population Dynamics and Grain Sorghum Yield.

The sugarcane aphid, Melanaphis sacchari (Zehntner) (Hemiptera: Aphididae), has become a major pest of grain sorghum, Sorghum bicolor (L.) Moench, in the United States in recent years. Feeding by large densities of sugarcane aphids causes severe damage, which can lead to a total loss of yield in extreme cases. Our objective was to determine the effect of grain sorghum planting date on sugarcane aphid population dynamics and their potential to reduce yields. We conducted field experiments from 2015 to 2017 in which an aphid-susceptible grain sorghum hybrid was planted at four different dates, which encompassed the typical range of planting dates used in Arkansas production systems. Plots were either protected from sugarcane aphid feeding using foliar insecticide sprays, or left untreated to allow natural populations of sugarcane aphids to colonize and reproduce freely. Planting date impacted both the magnitude and severity of sugarcane aphid infestations, with the highest population densities (and subsequent reductions in sorghum yield) generally occurring on plots that were planted in May or June. Sugarcane aphid feeding reduced yields in the untreated plots in two of the four planting date categories we tested. Earlier planting generally resulted in less sugarcane aphid damage and improved yields compared with later planting dates. While the effect of planting date on sugarcane aphid populations is likely to vary by region, sorghum producers should consider grain sorghum planting date as a potential cultural tactic to reduce the impact of sugarcane aphid.

The use of nonthrust manipulation in an adolescent for the treatment of thoracic pain and rib dysfunction: a case report.

STUDY DESIGN: Case report. BACKGROUND: Back pain is a common presentation of patients in the orthopedic physical therapy setting. In an athletic environment, back pain can limit an athlete's ability to perform running, cutting, and throwing. This case report describes the use of a spinal nonthrust manipulation in conjunction with therapeutic exercise for the management of thoracic and rib pain in an adolescent athlete. CASE DESCRIPTION: A 16-year-old male presented to the outpatient clinic without physician referral. His chief complaint was right-sided thoracic and rib pain during running, jumping, cutting, and kicking that began 1 month before the initial physical therapy visit. He had no previous episodes of pain or associated injuries. A screening examination for serious underlying pathology was negative. After physical examination, it was determined that manual therapy was indicated. A thoracic nonthrust manipulation was applied to the painful area (the right-side thoracic facet joints of segments 5-7). OUTCOMES: Immediately after the thoracic nonthrust manipulation, the patient experienced a decrease in tenderness to palpation of the thoracic erector spinae musculature and the associated intercostal spaces of ribs 6 through 8 (a decrease of 1-2 points on the pain scale), an increase in thoracic side-bending active range of motion recorded at T3 and T9, and improved chest expansion, which had been limited by pain before treatment. DISCUSSION: This case report demonstrates the use of a spinal nonthrust manipulation that seems to have helped an adolescent return to pain-free sports activity, with an immediate decrease in pain after 1 visit. Follow-up telephone calls were made 1 month and 9 months after treatment, in which no return of symptoms was reported.