The COVID-19 pandemic reveals an unprecedented rise in hunger: The South African Government was ill-prepared to meet the challenge.

Recent research has shown increasing household food and nutrition insecurity in South Africa, indicating weaknesses in the national food system due to historical and current socioeconomic inequalities. The lack of inclusive governance and collaboration among actors and institutions to develop long-term strategies increase the problem. Such weaknesses intensify the government's ill-preparedness to provide food relief during disasters. We drew upon two rounds of the longitudinal University of Johannesburg and the Human Sciences Research Council's COVID-19 Democracy Survey to illustrate how ill-preparedness has resulted in increased hunger. The rollout of food relief was slow because the state ignored established non-governmental food relief structures. Delayed tender processes and corruption have worsened local distribution and access to food relief, increasing households' hunger. Individuals reported higher experiences of hunger above pre-COVID-19 figures of 11% attaining highs of 42% in 2020. We argue that COVID-19 has emphasised the South African food system's inequalities, particularly the state's inability to ensure integration, inclusiveness and rapidly provide emergency food relief. We focused on individual and households' experiences of hunger and economic circumstances. Challenges were evident where access to food was provided in-kind or through financial aid. The pandemic food relief interventions and the lack of food price controls were serious challenges. The state and stakeholders must prevent high transitory food insecurity levels from resulting in chronic food insecurity. The state's practices and challenges during lockdown must be examined to ensure this situation does not reoccur. Some essential foods require subsidisation and price regulation to ensure long-term access for the poor. To ensure zero hunger and increased food security, these elements of the NDP must be re-examined. Research is required on vulnerabilities in the system, ways to overcome these and the understanding of factors contributing to system-wide resilience, including at individual and household levels.

Exposure to air pollution and tobacco smoking and their combined effects on depression in six low- and middle-income countries.

BackgroundLittle is known about the joint mental health effects of air pollution and tobacco smoking in low- and middle-income countries.AimsTo investigate the effects of exposure to ambient fine particulate matter pollution (PM2.5) and smoking and their combined (interactive) effects on depression.MethodMultilevel logistic regression analysis of baseline data of a prospective cohort study (n = 41 785). The 3-year average concentrations of PM2.5 were estimated using US National Aeronautics and Space Administration satellite data, and depression was diagnosed using a standardised questionnaire. Three-level logistic regression models were applied to examine the associations with depression.ResultsThe odds ratio (OR) for depression was 1.09 (95% C11.01-1.17) per 10 µg/m3 increase in ambient PM2.5, and the association remained after adjusting for potential confounding factors (adjusted OR = 1.10, 95% CI 1.02-1.19). Tobacco smoking (smoking status, frequency, duration and amount) was also significantly associated with depression. There appeared to be a synergistic interaction between ambient PM2.5 and smoking on depression in the additive model, but the interaction was not statistically significant in the multiplicative model.ConclusionsOur study suggests that exposure to ambient PM2.5 may increase the risk of depression, and smoking may enhance this effect.

Noncontact mapping of small pulmonary artery potentials preceding ectopy from the right ventricular outflow tract.

Idiopathic right ventricular tachycardia typically originates from the right ventricular outflow tract (RVOT). However, it also may originate from above the pulmonic valve. We describe a patient with a 2-year history of symptoms of palpitations associated with premature ventricular contractions (PVCs) in whom radiofrequency catheter ablation at the PVC exit site in the lateral RVOT failed despite the presence of several favorable criteria. However, using a multiple electrode array catheter, we demonstrated above the pulmonic valve clear evidence of low-amplitude preceding electrical activity ("blue ghost") that swept 3 cm inferolaterally over 20 ms to the previously identified lateral RVOT exit. Catheter mapping even at 128x gain demonstrated only very-low-amplitude potentials at this site, and pacing was unable to capture the ventricle from this region. However, ablation at this site immediately terminated the arrhythmia, and the patient has remained PVC-free after 1 year. This case supports the existence of previously hypothesized myocardial sleeves above the pulmonary valve that may be responsible for RVOT tachycardia and shows that they can be detected using noncontact mapping.