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To assess the effect of rural-to-urban migration on nutrition transition and overweight/obesity risk among women in Kenya.
Secondary analysis of data from nationally representative cross-sectional samples. Outcome variables were women’s BMI and nutrition transition. Nutrition transition was based on fifteen different household food groups and was adjusted for socio-economic and demographic characteristics. Stepwise backward multiple ordinal regression analysis was applied.
Kenya Demographic and Health Survey 2014.
Rural non-migrant, rural-to-urban migrant and urban non-migrant women aged 15–49 years (n 6171).
Crude data analysis showed rural-to-urban migration to be associated with overweight/obesity risk and nutrition transition. After adjustment for household wealth, no significant differences between rural non-migrants and rural-to-urban migrants for overweight/obesity risk and household consumption of several food groups characteristic of nutrition transition (animal-source, fats and sweets) were observed. Regardless of wealth, migrants were less likely to consume main staples and legumes, and more likely to consume fruits and vegetables. Identified predictive factors of overweight/obesity among migrant women were age, duration of residence in urban area, marital status and household wealth.
Our analysis showed that nutrition transition and overweight/obesity risk among rural-to-urban migrants is apparent with increasing wealth in urban areas. Several predictive factors were identified characterising migrant women being at risk for overweight/obesity. Future research is needed which investigates in depth the association between rural-to-urban migration and wealth to address inequalities in diet and overweight/obesity in Kenya.
Introduction: Variation in image ordering exists across Alberta emergency departments (EDs). Evidence-based, pocket-sized knowledge dissemination tools were developed for two conditions (acute asthma [AA] and benign headache [BHA]) for which imaging (chest x-ray [CXR] and computed tomography [CT], respectively) has limited utility. This study explored tool acceptability among ED patients and emergency physicians (EPs). Methods: Tool feedback was provided by EPs, via online survey, and adult patients with AA and BHA via in-person survey. EPs qualitative interviews further explored communication tools. Preliminary descriptive analyses of survey responses and content analysis of interview data were conducted. Results: Overall, 55 EPs (55/192; 29%) and 38 consecutive patients participated in the AA study; 73 EPs (73/192; 38%) and 160 patients participated in the BHA study. In both studies, approximately 50% of EPs felt comfortable using the tool; however, they suggested including radiation risk details and imaging indications and removing references to imaging variation and health system cost. In the BHA study, EPs opposed the four Choosing Wisely® campaign questions fearing they would increase imaging expectations. In both conditions, most patients ( >90%) understood the content and 68% felt the information applied to them. Less than half (AA:45%; BHA: 38%) agreed that they now knew more about when a patient should have imaging workup done. Following tool review, 71% of AA and 50% of BHA patients stated they would discuss their imaging needs with their ED care provider today or during a future presentation. Both patient groups suggested including: additional imaging details (i.e., indications, risk, clinical utility), removing imaging overuse references, and including instructions that encourage patients to ask their EP questions. EP interviews (n = 12) identified preferences for personalized and interactive tools. Tensions were perceived around ED time pressure as well as remuneration schemes that fail to prioritize patient conversation. Tool centralization, easy access, and connection with outpatient support were also key themes. Conclusion: Both patients and EPs provided valuable information on how to improve ED knowledge dissemination tools, using two chronic conditions to demonstrate how these changes would improve tool utility. Implementing these recommendations, and considering preferences of EPs and patients, may improve future tool uptake and impact.
Salmonella enterica serovar Wangata (S. Wangata) is an important cause of endemic salmonellosis in Australia, with human infections occurring from undefined sources. This investigation sought to examine possible environmental and zoonotic sources for human infections with S. Wangata in north-eastern New South Wales (NSW), Australia. The investigation adopted a One Health approach and was comprised of three complimentary components: a case–control study examining human risk factors; environmental and animal sampling; and genomic analysis of human, animal and environmental isolates. Forty-eight human S. Wangata cases were interviewed during a 6-month period from November 2016 to April 2017, together with 55 Salmonella Typhimurium (S. Typhimurium) controls and 130 neighbourhood controls. Indirect contact with bats/flying foxes (S. Typhimurium controls (adjusted odds ratio (aOR) 2.63, 95% confidence interval (CI) 1.06–6.48)) (neighbourhood controls (aOR 8.33, 95% CI 2.58–26.83)), wild frogs (aOR 3.65, 95% CI 1.32–10.07) and wild birds (aOR 6.93, 95% CI 2.29–21.00) were statistically associated with illness in multivariable analyses. S. Wangata was detected in dog faeces, wildlife scats and a compost specimen collected from the outdoor environments of cases’ residences. In addition, S. Wangata was detected in the faeces of wild birds and sea turtles in the investigation area. Genomic analysis revealed that S. Wangata isolates were relatively clonal. Our findings suggest that S. Wangata is present in the environment and may have a reservoir in wildlife populations in north-eastern NSW. Further investigation is required to better understand the occurrence of Salmonella in wildlife groups and to identify possible transmission pathways for human infections.
Methods have been developed for autopsy tissue analysis using a proton-induced X-ray emission (PIXE) system optimized for thin sample analysis. The system uses 2 MeV protons, thus limiting sample thickness to several milligrams per square centimeter. Calibration was accomplished with standard solutions spotted onto Nuclepore filters, which were subsequently irradiated in a uniform proton flux. X-ray yields measured with a Si (Li) detector were corrected for proton energy loss in the filter matrix as well as X-ray attenuation. Corrections for proton energy loss were determined from empirical parameters relating proton energy to X-ray cross sections. Typical filter thickness and penetration of the sample solution into the filter matrix were measured allowing calculation of proton energy attenuation and X-ray absorption corrections. The method was used in routine analyses for sixteen elements in seven types of human tissue. Accuracy was evaluated with standard reference materials and atomic absorption analyses.
The objective of this study was to investigate the impact of the most commonly cited factors that may have influenced infants’ gut microbiota profiles at one year of age: mode of delivery, breastfeeding duration and antibiotic exposure. Barcoded V3/V4 amplicons of bacterial 16S-rRNA gene were prepared from the stool samples of 52 healthy 1-year-old Australian children and sequenced using the Illumina MiSeq platform. Following the quality checks, the data were processed using the Quantitative Insights Into Microbial Ecology pipeline and analysed using the Calypso package for microbiome data analysis. The stool microbiota profiles of children still breastfed were significantly different from that of children weaned earlier (P<0.05), independent of the age of solid food introduction. Among children still breastfed, Veillonella spp. abundance was higher. Children no longer breastfed possessed a more ‘mature’ microbiota, with notable increases of Firmicutes. The microbiota profiles of the children could not be differentiated by delivery mode or antibiotic exposure. Further analysis based on children’s feeding patterns found children who were breastfed alongside solid food had significantly different microbiota profiles compared to that of children who were receiving both breastmilk and formula milk alongside solid food. This study provided evidence that breastfeeding continues to influence gut microbial community even at late infancy when these children are also consuming table foods. At this age, any impacts from mode of delivery or antibiotic exposure did not appear to be discernible imprints on the microbial community profiles of these healthy children.
To examine the feasibility of using social media to assess the consumer nutrition environment by comparing sentiment expressed in Yelp reviews with information obtained from a direct observation audit instrument for grocery stores.
Trained raters used the Nutrition Environment Measures Survey in Stores (NEMS-S) in 100 grocery stores from July 2015 to March 2016. Yelp reviews were available for sixty-nine of these stores and were retrieved in February 2017 using the Yelp Application Program Interface. A sentiment analysis was conducted to quantify the perceptions of the consumer nutrition environment in the review text. Pearson correlation coefficients (ρ) were used to compare NEMS-S scores with Yelp review text on food availability, quality, price and shopping experience.
Detroit, Michigan, USA.
Yelp reviews contained more comments about food availability and the overall shopping experience than food price and food quality. Negative sentiment about food prices in Yelp review text and the number of dollar signs on Yelp were positively correlated with observed food prices in stores (ρ=0·413 and 0·462, respectively). Stores with greater food availability were rated as more expensive on Yelp. Other aspects of the food store environment (e.g. overall quality and shopping experience) were captured only in Yelp.
While Yelp cannot replace in-person audits for collecting detailed information on the availability, quality and cost of specific food items, Yelp holds promise as a cost-effective means to gather information on the overall cost, quality and experience of food stores, which may be relevant for nutrition outcomes.
Background: Atrial fibrillation (AF) is associated with increased risk of ischemic stroke. In Canada, the contemporary burden of AF-related stroke is incompletely characterized. Our objective was to determine temporal trends in hospital admissions and in-hospital mortality for AF-related stroke in Canada from 2007 to 2015. Methods: We conducted a retrospective cohort study using Canadian national administrative data to identify admissions to hospital for stroke with comorbid AF between 2007 and 2015. We analyzed temporal trends in age- and sex-standardized proportion of admissions with comorbid AF and associated in-hospital mortality. Results: There were 222,100 admissions to hospital for ischemic (182,990) or hemorrhagic (39,110) stroke. The age-sex adjusted proportion of ischemic stroke admissions with comorbid AF increased from 16.2% to 20.5% (p for trend = 0.02) between 2007 and 2015, and was stable among hemorrhagic stroke. In-hospital mortality for ischemic stroke with comorbid AF decreased from 21.6% to 15.0% (p for trend = 0.001). Conclusions: Rates of hospital admission for ischemic stroke with comorbid AF have increased, while associated in-hospital mortality has decreased. These results identify AF as an important continued focus for stroke prevention. Our findings provide insight into current trends and highlight the need for continued focus on AF-related stroke.
Introduction: The effectiveness of intravenous alteplase is highly time dependent, and very short door-to-needle times (DNT) of 30 minutes or less have been reported in single centre hospitals, but never in an entire population. QuICR (Quality Improvement and Clinical Research) Alberta Stroke Program aimed to reduce DNT to a median of 30 minutes across the Canadian province of Alberta. Methods: We used the Improvement Collaborative Methodology from early 2015 to September 2016 with participation from all 17 Stroke Centres in Alberta. This methodology included 4 face-to-face workshops, site visits, webinars, data collection, data feedback, intensive process mapping, and process improvements. We compared data in the pre-intervention period from 2009-2014 (collected during the Alberta Provincial Stroke Strategy) to data in the post-intervention period from March 2016-February 2017 (collected during the QuICR DTN Collaborative). Data from January 2015-February 2016 were excluded, as improvements were being implemented during this time. Results: There were a total of 2,322 treated cases in the pre- and post-intervention periods. The results show that the median DNT dropped from 68 minutes (n=1846) in the pre-intervention period to 36 minutes (n=476) in the post-intervention period (p<0.001). There were reductions in DNT across all hospital types: median DNT dropped from 63 to 32 minutes in Urban Tertiary Centres (p<0.001), from 73 to 32 minutes in Community with 24/7 neurology (p<0.001), from 85 to 62 minutes in Community with limited/no neurology (p<0.001), and from 74 to 52.5 minutes in rural centres (p<0.001). Conclusion: There were 21.5 to 41 minute reductions in median DNT across all hospital types including smaller rural and community hospitals. A targeted multi-site improvement collaborative can be an effective intervention to reduce DNT across an entire population.
Introduction: Unnecessary care is an increasingly commonly used term in medicine. Previous survey research suggests that definitions of unnecessary care vary within and among professional and patient groups. This research explores how emergency physicians and administrators understand the term unnecessary care. Methods: Site chiefs and emergency physicians in an Alberta region were recruited through email and online surveys respectively for a qualitative study. One hour one-on-one in-depth interviews explored understandings of unnecessary care within the emergency department (ED) context. Interview transcripts underwent thematic analysis. Results: Five physicians and seven site chiefs completed interviews. Two key themes emerged. First, interviewees conceptualized unnecessary care as inappropriate or non-urgent presentations. This patient-centric view raised non-urgent ED presentations as a health system problem with complex components, including: lack of public knowledge of healthcare resources, shrinking comfort and scope of community providers and patient willingness to utilize other resources. Despite concerns over non-urgent visits, interviewees expressed that these patients still need to be seen, assessed and managed. The second conceptualization focused on over-investigation (and to lesser extent, treatment). This physician-centric conceptualization identified issues around: variation in physician risk tolerance, established decision rules with the allowable miss rates, patient expectation for testing or physician feeling that the patient was owed something or that patient would not accept their diagnosis/treatment without testing. Additionally, interviewees described patient characteristics that may initiate more aggressive investigation (e.g., patient reliability, follow-up care access, etc.). An overarching concern about the connection between unnecessary care and wasted resources was identified. Additionally, interviewees emphasized that patient conversations are outside the scope of unnecessary care despite their possible implications for limited time resources. Conclusion: A range of concepts surrounding unnecessary care in the ED were identified. Further exploring nuances of these conceptualizations may inform and improve the effectiveness of campaigns seeking to improve efficiency in practice and reduce inappropriate care. Additionally, this work provides an impetus for developing clearer concepts of care within the ED.
Broiler breeders conduct their breeding programs only in optimal environments, claiming that because farmers are instructed to provide the broilers with optimal management, genotype by environment interactions (GxE) are not important for the broiler industry. However, with the rapid development of the poultry industry worldwide, high-performance broiler stocks are now being imported to developing countries where environmental control, mainly the mitigation of hot climates, is not feasible. Moreover, results from several studies suggest that due to the increase in genetic potential for rapid growth rate, resulting from successful breeding programs, broilers are becoming more sensitive to rather small environmental deviations from optimal conditions (Leenstra and Cahaner, 1991; Cahaner and Leenstra, 1992; Cahaner et al., 1993; Settar et al., 1999; Yunis et al, 1999). Hence, also in developed countries, many broilers will be, or are already being reared under suboptimal hot environments.
A combination of better management and genetic selection for good health and fertility would provide a more effective long term solution for economic loss due to diseases and poor fertility. This would also help to address public concerns about the use of medical treatment in milk production. A balance in the genetic improvement of health and fertility together with milk production could be achieved through their inclusion in national genetic selection indices, for which genetic parameters are needed. One of the main objectives of this study was to estimate genetic parameters for various disease and fertility traits in the UK dairy cattle population, using records from a national recording scheme run by Livestock Services UK Ltd. Genetic analysis of traits recorded as present or absent (binary traits; e.g. diseases) requires the use of non-linear threshold models, because linear models require normality assumptions (e.g., Gianola 1982). The other objective of this study was to estimate genetic parameters for binary disease and fertility traits based on threshold animal models and to compare results with those from linear animal models.
The Middle East respiratory syndrome coronavirus (MERS-CoV) is caused by a novel coronavirus discovered in 2012. Since then, 1806 cases, including 564 deaths, have been reported by the Kingdom of Saudi Arabia (KSA) and affected countries as of 1 June 2016. Previous literature attributed increases in MERS-CoV transmission to camel breeding season as camels are likely the reservoir for the virus. However, this literature review and subsequent analysis indicate a lack of seasonality. A retrospective, epidemiological cluster analysis was conducted to investigate increases in MERS-CoV transmission and reports of household and nosocomial clusters. Cases were verified and associations between cases were substantiated through an extensive literature review and the Armed Forces Health Surveillance Branch's Tiered Source Classification System. A total of 51 clusters were identified, primarily nosocomial (80·4%) and most occurred in KSA (45·1%). Clusters corresponded temporally with the majority of periods of greatest incidence, suggesting a strong correlation between nosocomial transmission and notable increases in cases.
Although a robust literature has linked stable, high levels of fear across childhood to increased risk for anxiety problems, less is known about alternative pathways to anxiety. We tested two putatively normative developmental pathways of early fearfulness for their distinct associations with behavioral (anxiety-related behaviors and symptoms) and biological (diurnal cortisol) markers of anxiety risk in middle childhood in a community-based sample (n = 107). Steeper increases in fear from 6 to 36 months predicted more parent-reported anxiety symptoms at age 8 years. In addition, children who exhibited steep increases in fear during infancy were overrepresented among children with diagnoses of separation anxiety disorder at age 8 years. Finally, we showed that steeper increases in fearfulness in infancy predicted flatter slopes of diurnal cortisol at age 8 years for girls. Thus, differences in stranger fear across infancy may indicate varying degrees of risk for anxious behaviors in later childhood.
The past few years have been a period of unprecedented political upheaval for the Maghreb. While each country had, of course, experienced dramatic moments before – Ben Ali's ousting of Bourguiba, Algeria's Black October riots, the Casablanca bombings and Mauritania's 2005 and 2008 coups d’état to name but some – nothing of the breadth, depth or duration of the Arab Spring, a protest that began in a provincial city in one of North Africa's quieter corners and quickly engulfed the entire region. Presidents of decades’ standing – latter-day imperators – were swept from office on waves of public discontent while their counterparts elsewhere nervously and hurriedly tried to calm the mob.
In several places, these protests are still being played out: in the law courts of Egypt; on the bloody battlefields of Libya; and in the leaking tubs carrying migrants to Europe. And, even where the winds of change seem to have died down, the political and social landscape is different from before, sometimes markedly so. Algeria has dispensed with its nineteen-year-long state of emergency. King Mohammed VI is now obliged – constitutionally, at least – to consult his prime minister more frequently and widely. Mauritania has a new youth movement. Tunisia has become a democracy.
And herein lies one of the defining paradoxes of the Arab Spring; its ubiquity and singularity. Nearly all of the region's countries have been directly affected, have experienced some domestic manifestation of this transnational phenomenon. Anti-government rallies were staged everywhere throughout early 2011. Umbrella bodies mushroomed better to co-ordinate, direct and motivate protestors. Public squares were occupied, government buildings targeted, symbols of the regime attacked, yet, despite making similar demands in largely the same ways over much the same period, the outcomes of these protests varied hugely. These transnational forces were given local faces. Domestic factors and concerns helped generate unique results.
Regional specialists were repeatedly confounded – initially at least – by this interplay of generalities and specificities. They compounded their collective failure to anticipate the start of the Arab Spring first by being too conservative and then too ambitious. They misdiagnosed what would become of Ben Ali's regime and the speed of its collapse. They then overcompensated and predicted sweeping changes everywhere all at once: Algeria was to be next, Bouteflika's days were definitely numbered.
The Maghreb's political development continues to confound expectations. Few specialists anticipated the start of the Arab Spring. Fewer still thought it would begin in Tunisia, long regarded as one of the region's most stable and prosperous countries. Then, when the demonstrations did break out, most assumed Ben Ali would easily deal with them. Not only had he overcome similar challenges in the past, but he had the support of a large, well-funded and experienced security apparatus. Their shock at his downfall less than a month later was compounded by the simultaneous outbreak of copycat protests elsewhere and Libya's descent into civil war. Many now issued millennial predictions about what would happen next. Unrest would sweep the region. None of its leaders would be spared. Algeria was especially vulnerable.
Yet many of these forecasts have proved to be just as inaccurate as the conservative assumptions that preceded them. While the Arab Spring has undoubtedly wrought many significant changes to the Maghreb, its impact has not been as great as was predicted. In large parts of the region, political life has continued very much as before. Morocco's monarchy has not surrendered any of its core powers let alone become fully constitutional. Mauritania is still governed by the general and coup d’état leader, Mohamed Ould Abdel Aziz. And Algeria's 2014 presidential election was won comfortably by the long-serving, aging and seriously ill incumbent, Abdelaziz Bouteflika.
A critical mistake made by many commentators was to overemphasise Tunisia's similarity to its near neighbours. They deduced that, if comparable circumstances to those which had led to Ben Ali's fall could be found throughout the rest of the region, then its other leaders were likely to suffer the same fate. Their suppositions and hypotheses were given additional weight and credibility by the outbreak of equally decisive protests in other parts of the Middle East. Hosni Mubarak's demise was widely seen as both a sign and a prelude, as evidence of the region's hunger and readiness for change, and the continued power of this transnational impulse and movement to enact it. Soon, the whole region would succumb to its transformational energy.
These assumptions were not without foundation. The countries of the Maghreb do share a great deal in common. And their likenesses are accentuated by the region's exceptionalism. Indeed, the Maghreb is defined by separation and similarity.
Mauritania presents a quite different explanatory challenge from Morocco. For, unlike its near neighbour, Nouakchott seems to offer a near textbook exposition of Levitsky and Way's ideas and arguments, starting with their foundational observation that not all political transitions ‘lead to democracy’. The country's 2005 turn towards more liberal and open government proved to be short-lived and, over the course of the next couple of years, it steadily regressed into authoritarianism, albeit of a more competitive form. That the self-installed Military Council for Justice and Democracy (Le Conseil Militaire pour la Justice et la Démocratie, CMJD) felt obliged to launch this experiment at all was mainly due to the political and economic pressure Western governments were beginning to put on them for having ousted their long-time ally, President Maayouya Ould Sidi Ahmed Taya. Anxious to avoid the imposition of any further sanctions, the CMJD quickly sought to mollify the West. On this occasion, therefore, the threat of further Western pressure succeeded in altering the regime's behaviour, in making it democratise, in creating the political opening.
Yet the speed with which this opportunity passed continues to raise difficult questions about the true extent of the West's support for this democratic turn and leverage over the regime. Western governments may have been pleasantly surprised by the course of events but their optimism has proved insufficient to sustain the country's experiment with democracy. This, by extension, generates doubts about how much influence they actually have over Nouakchott because they have failed to discipline subsequent governments into respecting and consolidating these earlier reforms. Why, if they have been able to make the regime democratise once, have they not done so again? Is this failure due to disinterest, incompetence or inability?
Then there were the causes of the West's ire, of the irritation and anger which prompted the regime to make these changes. While Western governments welcomed Nouakchott's democratic turn, their pleasure stemmed, at least in part, from their surprise. They did not expect it to respond in this way. Nor, crucially, did they demand that it do so. On the contrary, the regime took the initiative by introducing reforms calculated to appeal to Western sensibilities and prevent the imposition of any further sanctions.
Algeria is perplexing. Like Tunisia, it has defied expectations. Yet it has done so in very different ways. For, unlike its near neighbour, it has not succumbed to dramatic or fundamental political change. Certainly, it was affected by the Arab Spring. Its protests were sufficiently large, frequent and angry to frighten the regime into making several noteworthy concessions. Opposition parties were promised more media coverage. A new job-creation scheme was launched. And most significant of all, the nineteen-year-long state of emergency was lifted. Yet the regime did not fall. President Abdelaziz Bouteflika not only survived but went on to win an unprecedented fourth term in office. Algeria is puzzling, therefore, not for how it has changed but the reasons why it has remained the same.
Paradoxically, some of the main factors that were initially highlighted as likely reasons why Algeria would soon follow Tunisia down the path of decisive unrest were quickly recast as impediments to its political transformation. Commenting on the growing expectations of specialists that Bouteflika's regime would be one of the next to fall, James Gelvin notes the high level of expert emphasis placed on Algeria as a trendsetter. The country, so the argument ran, had been here before. In the late 1980s it had been one of the very few Arab states to form part of the so-called Third Wave of democratisation that had been triggered by the end of the Cold War. In June 1990 and December 1991 it had held free and fair multiparty elections which had been won by the opposition Islamic Salvation Front (Front Islamique du Salut, FIS). By the time the Arab Spring began, therefore, Algeria had already experimented with democracy. Its citizens had demanded and won greater political freedoms once before. Moreover, they had done so in a way similar to that in which Tunisians had during the Arab Spring. They had experience of pressuring their government into introducing democratic reforms.
Furthermore, Algerians bore many of the same burdens in 2011 that had prompted them to act before and which had driven their neighbours to oust Ben Ali. Conditions in the country, therefore, appeared propitious to decisive unrest. Gelvin argues that four factors in particular encouraged this perception.