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  • image/svg+xml art designer at PLoS, modified by Wikipedia users Nina, Beao, JakobVoss, and AnonMoos Open Access logo, converted into svg, designed by PLoS. This version with transparent background. http://commons.wikimedia.org/wiki/File:Open_Access_logo_PLoS_white.svg art designer at PLoS, modified by Wikipedia users Nina, Beao, JakobVoss, and AnonMoos http://www.plos.org/
    Authors: Haldenby, S.; Bronowski, C.; Nelson, C.; Kenny, J.; +14 Authors

    Background:\ud Campylobacter jejuni is the most common bacterial cause of human infectious intestinal disease.\ud \ud Methods:\ud We genome sequenced 601 human C. jejuni isolates, obtained from two large prospective studies of infectious intestinal disease (IID1 [isolates from 1993–1996; n = 293] and IID2 [isolates from 2008–2009; n = 93]), the INTEGRATE project [isolates from 2016–2017; n = 52] and the ENIGMA project [isolates from 2017; n = 163].\ud \ud Results:\ud There was a significant increase in the prevalence of the T86I mutation conferring resistance to fluoroquinolone between each of the three later studies (IID2, INTEGRATE and ENIGMA) and IID1. Although the distribution of major multilocus sequence types (STs) was similar between the studies, there were changes in both the abundance of minority STs associated with the T86I mutation, and the abundance of clones within single STs associated with the T86I mutation.\ud \ud Discussion:\ud Four population-based studies of community diarrhoea over a 25 year period revealed an increase over time in the prevalence of the T86I amongst isolates of C. jejuni associated with human gastrointestinal disease in the UK. Although associated with many STs, much of the increase is due to the expansion of clones associated with the resistance mutation.

    image/svg+xml art designer at PLoS, modified by Wikipedia users Nina, Beao, JakobVoss, and AnonMoos Open Access logo, converted into svg, designed by PLoS. This version with transparent background. http://commons.wikimedia.org/wiki/File:Open_Access_logo_PLoS_white.svg art designer at PLoS, modified by Wikipedia users Nina, Beao, JakobVoss, and AnonMoos http://www.plos.org/ Europe PubMed Centra...arrow_drop_down
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    image/svg+xml art designer at PLoS, modified by Wikipedia users Nina, Beao, JakobVoss, and AnonMoos Open Access logo, converted into svg, designed by PLoS. This version with transparent background. http://commons.wikimedia.org/wiki/File:Open_Access_logo_PLoS_white.svg art designer at PLoS, modified by Wikipedia users Nina, Beao, JakobVoss, and AnonMoos http://www.plos.org/
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    PLoS ONE
    Article . 2020 . Peer-reviewed
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    DOAJ; PLoS ONE
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      image/svg+xml art designer at PLoS, modified by Wikipedia users Nina, Beao, JakobVoss, and AnonMoos Open Access logo, converted into svg, designed by PLoS. This version with transparent background. http://commons.wikimedia.org/wiki/File:Open_Access_logo_PLoS_white.svg art designer at PLoS, modified by Wikipedia users Nina, Beao, JakobVoss, and AnonMoos http://www.plos.org/ Europe PubMed Centra...arrow_drop_down
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      image/svg+xml art designer at PLoS, modified by Wikipedia users Nina, Beao, JakobVoss, and AnonMoos Open Access logo, converted into svg, designed by PLoS. This version with transparent background. http://commons.wikimedia.org/wiki/File:Open_Access_logo_PLoS_white.svg art designer at PLoS, modified by Wikipedia users Nina, Beao, JakobVoss, and AnonMoos http://www.plos.org/
      PLoS ONE
      Article . 2020 . Peer-reviewed
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      image/svg+xml art designer at PLoS, modified by Wikipedia users Nina, Beao, JakobVoss, and AnonMoos Open Access logo, converted into svg, designed by PLoS. This version with transparent background. http://commons.wikimedia.org/wiki/File:Open_Access_logo_PLoS_white.svg art designer at PLoS, modified by Wikipedia users Nina, Beao, JakobVoss, and AnonMoos http://www.plos.org/
      image/svg+xml art designer at PLoS, modified by Wikipedia users Nina, Beao, JakobVoss, and AnonMoos Open Access logo, converted into svg, designed by PLoS. This version with transparent background. http://commons.wikimedia.org/wiki/File:Open_Access_logo_PLoS_white.svg art designer at PLoS, modified by Wikipedia users Nina, Beao, JakobVoss, and AnonMoos http://www.plos.org/
      DOAJ; PLoS ONE
      Article . 2020
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  • image/svg+xml art designer at PLoS, modified by Wikipedia users Nina, Beao, JakobVoss, and AnonMoos Open Access logo, converted into svg, designed by PLoS. This version with transparent background. http://commons.wikimedia.org/wiki/File:Open_Access_logo_PLoS_white.svg art designer at PLoS, modified by Wikipedia users Nina, Beao, JakobVoss, and AnonMoos http://www.plos.org/
    Authors: Johanna Riha; Alex Karabarinde; Gerald Ssenyomo; Steven Allender; +5 Authors

    Editors’ Summary Background Cardiometabolic diseases—cardiovascular diseases that affect the heart and/or the blood vessels and metabolic diseases that affect the cellular chemical reactions needed to sustain life—are a growing global health concern. In sub-Saharan Africa, for example, the prevalence (the proportion of a population that has a given disease) of adults with diabetes (a life-shortening metabolic disease that affects how the body handles sugars) is currently 3.8%. By 2030, it is estimated that the prevalence of diabetes among adults in this region will have risen to 4.6%. Similarly, in 2004, around 1.2 million deaths in sub-Saharan Africa were attributed to coronary heart disease, heart failure, stroke, and other cardiovascular diseases. By 2030, the number of deaths in this region attributable to cardiovascular disease is expected to double. Globally, cardiovascular disease and diabetes are now responsible for around 17.3 million and 1.3 million annual deaths, respectively, together accounting for about one-third of all deaths. Why Was This Study Done? Experts believe that increased consumption of saturated fats, sugar, and salt and reduced physical activity are partly responsible for the increasing global prevalence of cardiometabolic diseases. These lifestyle changes, they suggest, are related to urbanization—urban expansion into the countryside and migration from rural to urban areas. If this is true, the prevalence of unhealthy lifestyles should increase as rural areas adopt urban characteristics. Sub-Saharan Africa is the least urbanized region in the world, with about 60% of the population living in rural areas. However, rural settlements across the subcontinent are increasingly adopting urban characteristics. It is important to know whether urbanization is affecting the health of rural residents in sub-Saharan Africa to improve estimates of the future burden of cardiometabolic diseases in the region and to provide insights into ways to limit this burden. In this cross-sectional study (an investigation that studies participants at a single time point), the researchers examine the distribution of urban characteristics across rural communities in Uganda and the association of these characteristics with lifestyle risk factors for cardiometabolic diseases. What Did the Researchers Do and Find? For their study, the researchers used data collected in 2011 by the General Population Cohort study, a study initiated in 1989 to describe HIV infection trends among people living in 25 villages in rural southwestern Uganda that collects health-related and other information annually from its participants. The researchers quantified the “urbanicity” of the 25 villages using a multi-component scale that included information such as village size and economic activity. They then used statistical models to examine associations between urbanicity and lifestyle risk factors such as body mass index (BMI, a measure of obesity) and self-reported fruit and vegetable consumption for more than 7,000 study participants living in those villages. None of the villages had paved roads or running water. However, urbanicity varied markedly across the villages, largely because of differences in economic activity, civil infrastructure, and the availability of educational and healthcare services. Notably, increasing urbanicity was associated with an increase in lifestyle risk factors for cardiovascular diseases. So, for example, people living in villages with the highest urbanicity scores were nearly 20% more likely to be physically inactive and to eat less fruits and vegetables and nearly 50% more likely to have a high BMI than people living in villages with the lowest urbanicity scores. What Do These Findings Mean? These findings indicate that, across rural communities in Uganda, even a small increase in urbanicity is associated with a higher prevalence of potentially modifiable lifestyle risk factors for cardiometabolic diseases. These findings suggest, therefore, that simply classifying settlements as either rural or urban may not be adequate to capture the information needed to target strategies for cardiometabolic disease management and control in rural areas as they become more urbanized. Because this study was cross-sectional, it is not possible to say how long a rural population needs to experience a more urban environment before its risk of cardiometabolic diseases increases. Longitudinal studies are needed to obtain this information. Moreover, studies of other countries in sub-Saharan Africa are needed to show that these findings are generalizable across the region. However, based on these findings, and given that more than 553 million people live in rural areas across sub-Saharan Africa, it seems likely that increasing urbanization will have a substantial impact on the future health of populations throughout sub-Saharan Africa. Additional Information Please access these websites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.1001683. This study is further discussed in a PLOS Medicine Perspective by Fahad Razak and Lisa Berkman The American Heart Association provides information on all aspects of cardiovascular disease and diabetes; its website includes personal stories about heart attacks, stroke, and diabetes The US Centers for Disease Control and Prevention has information on heart disease, stroke, and diabetes (in English and Spanish) The UK National Health Service Choices website provides information about cardiovascular disease and diabetes (including some personal stories) The World Health Organization’s Global Noncommunicable Disease Network (NCDnet) aims to help low- and middle-income countries reduce illness and death caused by cardiometabolic and other non-communicable diseases The World Heart Federation has recently produced a report entitled “Urbanization and Cardiovascular Disease” Wikipedia has a page on urbanization (note that Wikipedia is a free online encyclopedia that anyone can edit; available in several languages) Background Urban living is associated with unhealthy lifestyles that can increase the risk of cardiometabolic diseases. In sub-Saharan Africa (SSA), where the majority of people live in rural areas, it is still unclear if there is a corresponding increase in unhealthy lifestyles as rural areas adopt urban characteristics. This study examines the distribution of urban characteristics across rural communities in Uganda and their associations with lifestyle risk factors for chronic diseases. Methods and Findings Using data collected in 2011, we examined cross-sectional associations between urbanicity and lifestyle risk factors in rural communities in Uganda, with 7,340 participants aged 13 y and above across 25 villages. Urbanicity was defined according to a multi-component scale, and Poisson regression models were used to examine associations between urbanicity and lifestyle risk factors by quartile of urbanicity. Despite all of the villages not having paved roads and running water, there was marked variation in levels of urbanicity across the villages, largely attributable to differences in economic activity, civil infrastructure, and availability of educational and healthcare services. In regression models, after adjustment for clustering and potential confounders including socioeconomic status, increasing urbanicity was associated with an increase in lifestyle risk factors such as physical inactivity (risk ratio [RR]: 1.19; 95% CI: 1.14, 1.24), low fruit and vegetable consumption (RR: 1.17; 95% CI: 1.10, 1.23), and high body mass index (RR: 1.48; 95% CI: 1.24, 1.77). Conclusions This study indicates that even across rural communities in SSA, increasing urbanicity is associated with a higher prevalence of lifestyle risk factors for cardiometabolic diseases. This finding highlights the need to consider the health impact of urbanization in rural areas across SSA. Please see later in the article for the Editors' Summary Johanna Riha and colleagues evaluate the association of lifestyle risk factors with elements of urbanicity, such as having a public telephone, a primary school, or a hospital, among individuals living in rural settings in Uganda. Please see later in the article for the Editors' Summary

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    Europe PubMed Central
    Article . 2014 . Peer-reviewed
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    PLoS Medicine
    Article . 2014 . Peer-reviewed
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    PLoS Medicine
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    PLoS Medicine
    Article . 2014
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      image/svg+xml art designer at PLoS, modified by Wikipedia users Nina, Beao, JakobVoss, and AnonMoos Open Access logo, converted into svg, designed by PLoS. This version with transparent background. http://commons.wikimedia.org/wiki/File:Open_Access_logo_PLoS_white.svg art designer at PLoS, modified by Wikipedia users Nina, Beao, JakobVoss, and AnonMoos http://www.plos.org/ Europe PubMed Centra...arrow_drop_down
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      Europe PubMed Central
      Article . 2014 . Peer-reviewed
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      PLoS Medicine
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  • image/svg+xml art designer at PLoS, modified by Wikipedia users Nina, Beao, JakobVoss, and AnonMoos Open Access logo, converted into svg, designed by PLoS. This version with transparent background. http://commons.wikimedia.org/wiki/File:Open_Access_logo_PLoS_white.svg art designer at PLoS, modified by Wikipedia users Nina, Beao, JakobVoss, and AnonMoos http://www.plos.org/
    Authors: Biran, Adam; Schmidt, Wolf-Peter; Varadharajan, Kiruba Sankar; Rajaraman, Divya; +5 Authors

    Summary Background Diarrhoea and respiratory infections are the two biggest causes of child death globally. Handwashing with soap could substantially reduce diarrhoea and respiratory infections, but prevalence of adequate handwashing is low. We tested whether a scalable village-level intervention based on emotional drivers of behaviour, rather than knowledge, could improve handwashing behaviour in rural India. Methods The study was done in Chittoor district in southern Andhra Pradesh, India, between May 24, 2011, and Sept 10, 2012. Eligible villages had a population of 700–2000 people, a state-run primary school for children aged 8–13 years, and a preschool for children younger than 5 years. 14 villages (clusters) were selected, stratified by population size ( vs >1200), and randomly assigned in a 1:1 ratio to intervention or control (no intervention). Clusters were enrolled by the study manager. Random allocation was done by the study statistician using a random number generator. The intervention included community and school-based events incorporating an animated film, skits, and public pledging ceremonies. Outcomes were measured by direct observation in 20–25 households per village at baseline and at three follow-up visits (6 weeks, 6 months, and 12 months after the intervention). Observers had no connection with the intervention and observers and participant households were told that the study was about domestic water use to reduce the risk of bias. No other masking was possible. The primary outcome was the proportion of handwashing with soap at key events (after defecation, after cleaning a child's bottom, before food preparation, and before eating) at all follow-up visits. The control villages received a shortened version of the intervention before the final follow-up round. Outcome data are presented as village-level means. Findings Handwashing with soap at key events was rare at baseline in both the intervention and control groups (1% [SD 1] vs 2% [1]). At 6 weeks' follow-up, handwashing with soap at key events was more common in the intervention group than in the control group (19% [SD 21] vs 4% [2]; difference 15%, p=0·005). At the 6-month follow-up visit, the proportion handwashing with soap was 37% (SD 7) in the intervention group versus 6% (3) in the control group (difference 31%; p=0·02). At the 12-month follow-up visit, after the control villages had received the shortened intervention, the proportion handwashing with soap was 29% (SD 9) in the intervention group and 29% (13) in the control group. Interpretation This study shows that substantial increases in handwashing with soap can be achieved using a scalable intervention based on emotional drivers. Funding Wellcome Trust, SHARE.

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    The Lancet Global Health
    Article . 2014 . Peer-reviewed
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      image/svg+xml art designer at PLoS, modified by Wikipedia users Nina, Beao, JakobVoss, and AnonMoos Open Access logo, converted into svg, designed by PLoS. This version with transparent background. http://commons.wikimedia.org/wiki/File:Open_Access_logo_PLoS_white.svg art designer at PLoS, modified by Wikipedia users Nina, Beao, JakobVoss, and AnonMoos http://www.plos.org/ CORE (RIOXX-UK Aggre...arrow_drop_down
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      The Lancet Global Health
      Article . 2014 . Peer-reviewed
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    Authors: Snowdon, Victoria K.; Lachlan, Neil J.; Hoy, Anna M.; Hadoke, Patrick W. F.; +22 Authors

    Background Chronic liver scarring from any cause leads to cirrhosis, portal hypertension, and a progressive decline in renal blood flow and renal function. Extreme renal vasoconstriction characterizes hepatorenal syndrome, a functional and potentially reversible form of acute kidney injury in patients with advanced cirrhosis, but current therapy with systemic vasoconstrictors is ineffective in a substantial proportion of patients and is limited by ischemic adverse events. Serelaxin (recombinant human relaxin-2) is a peptide molecule with anti-fibrotic and vasoprotective properties that binds to relaxin family peptide receptor-1 (RXFP1) and has been shown to increase renal perfusion in healthy human volunteers. We hypothesized that serelaxin could ameliorate renal vasoconstriction and renal dysfunction in patients with cirrhosis and portal hypertension. Methods and findings To establish preclinical proof of concept, we developed two independent rat models of cirrhosis that were characterized by progressive reduction in renal blood flow and glomerular filtration rate and showed evidence of renal endothelial dysfunction. We then set out to further explore and validate our hypothesis in a phase 2 randomized open-label parallel-group study in male and female patients with alcohol-related cirrhosis and portal hypertension. Forty patients were randomized 1:1 to treatment with serelaxin intravenous (i.v.) infusion (for 60 min at 80 μg/kg/d and then 60 min at 30 μg/kg/d) or terlipressin (single 2-mg i.v. bolus), and the regional hemodynamic effects were quantified by phase contrast magnetic resonance angiography at baseline and after 120 min. The primary endpoint was the change from baseline in total renal artery blood flow. Therapeutic targeting of renal vasoconstriction with serelaxin in the rat models increased kidney perfusion, oxygenation, and function through reduction in renal vascular resistance, reversal of endothelial dysfunction, and increased activation of the AKT/eNOS/NO signaling pathway in the kidney. In the randomized clinical study, infusion of serelaxin for 120 min increased total renal arterial blood flow by 65% (95% CI 40%, 95%; p < 0.001) from baseline. Administration of serelaxin was safe and well tolerated, with no detrimental effect on systemic blood pressure or hepatic perfusion. The clinical study’s main limitations were the relatively small sample size and stable, well-compensated population. Conclusions Our mechanistic findings in rat models and exploratory study in human cirrhosis suggest the therapeutic potential of selective renal vasodilation using serelaxin as a new treatment for renal dysfunction in cirrhosis, although further validation in patients with more advanced cirrhosis and renal dysfunction is required. Trial registration ClinicalTrials.gov NCT01640964 Author summary Why was this study done? Hepatorenal syndrome type 1 is a rapidly progressive, but potentially reversible, form of acute kidney injury occurring in patients with liver cirrhosis, characterized by severe renal vasoconstriction and a very poor prognosis. There is a significant unmet need for a widely approved, safe, and effective pharmacological treatment. Serelaxin, a recombinant form of the human peptide hormone relaxin-2, has been shown to increase renal perfusion in healthy human volunteers. We tested whether serelaxin could ameliorate renal vasoconstriction and renal dysfunction in cirrhosis. What did the researchers do and find? Administration of serelaxin improved renal blood flow, oxygenation, and function in two independent animal models of cirrhosis through reversal of endothelial dysfunction and increased activation of nitric oxide signaling in the kidney. In an exploratory phase 2 clinical trial in patients with cirrhosis and portal hypertension, serelaxin infusion induced a significant increase in renal blood flow and was safe and well tolerated, with no adverse effects on systemic blood pressure or hepatic perfusion. What do these findings mean? Our data indicate that selective targeting of renal vasoconstriction using serelaxin may modulate renal dysfunction in cirrhosis without affecting systemic blood pressure. Further studies in patients with more advanced cirrhosis and renal dysfunction are required to confirm whether there are beneficial effects on renal function and patient outcomes. In a Research Article, Jonathan Fallowfield and colleagues study serelaxin as a possible treatment for renal vasoconstriction in liver cirrhosis.

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    Authors: Xiaolei Liu; Meng Huang; Bin Fan; Edward S. Buckler; +1 Authors

    False positives in a Genome-Wide Association Study (GWAS) can be effectively controlled by a fixed effect and random effect Mixed Linear Model (MLM) that incorporates population structure and kinship among individuals to adjust association tests on markers; however, the adjustment also compromises true positives. The modified MLM method, Multiple Loci Linear Mixed Model (MLMM), incorporates multiple markers simultaneously as covariates in a stepwise MLM to partially remove the confounding between testing markers and kinship. To completely eliminate the confounding, we divided MLMM into two parts: Fixed Effect Model (FEM) and a Random Effect Model (REM) and use them iteratively. FEM contains testing markers, one at a time, and multiple associated markers as covariates to control false positives. To avoid model over-fitting problem in FEM, the associated markers are estimated in REM by using them to define kinship. The P values of testing markers and the associated markers are unified at each iteration. We named the new method as Fixed and random model Circulating Probability Unification (FarmCPU). Both real and simulated data analyses demonstrated that FarmCPU improves statistical power compared to current methods. Additional benefits include an efficient computing time that is linear to both number of individuals and number of markers. Now, a dataset with half million individuals and half million markers can be analyzed within three days. Author Summary Genome-Wide Association Studies (GWAS) can reveal genetic-phenotypic relationships, but have limitations. To control false positives, population structure and kinship are incorporated in a fixed and random effect Mixed Linear Model (MLM). However, because of the confounding between population structure, kinship, and quantitative trait nucleotides (QTNs), MLM leads to false negatives, missing some potentially important discoveries. Here, we present a new method, Fixed and random model Circulating Probability Unification (FarmCPU). FarmCPU performs marker tests with associated markers as covariates in a fixed effect model and optimization on the associated covariate markers in a random effect model separately. This process enables efficient computation, removes the confounding, prevents model over-fitting, and controls false positives simultaneously. FarmCPU controls false positives as well as MLM with reductions in both false negatives and computing times. Researchers will not only be able to analyze big data, but will also have greater success with fewer mistakes when mapping genes of interest.

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    PLoS Genetics
    Article . 2016 . Peer-reviewed
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    PLoS Genetics
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    Authors: Robert Heyderman; Nicola Desmond; Deborah Nyirenda;

    Radio is an effective source of health information in many resource poor countries. In Malawi, 53% of households own radios however few radio programmes in Malawi focus on health issues in the context of medical research. An interactive health-talk radio programme ‘ Umoyo nkukambirana’ was introduced by Malawi-Liverpool-Wellcome Trust Clinical Research Programme on a national radio station. The aim was to increase awareness of health and medical research, and improve engagement between researchers, healthcare workers and the public. The content and presentation were developed through participatory community consultations. Focus Group Discussions were conducted with established Radio Listening Clubs whilst quantitative data was collected using toll free FrontlineSMS to explore national response. A total of 277 to 695 SMS (Median: 477) were received per theme. The majority of SMS were received from men (64%) and mainly from rural areas (54%). The programme improved knowledge of medical research, health and dispelled misconceptions. This study suggests that the radio may be an effective means of increasing the exposure of men to health information in resource poor settings.

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    Public Understanding of Science; OpenAPC Global Initiative
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      Public Understanding of Science; OpenAPC Global Initiative
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    Authors: Manikandan, Srinivasan; Mahendra M, Reddy; Sonali, Sarkar; Vikas, Menon;

    Abstract Background The burden of common mental disorders (CMDs) which includes depression, anxiety, and stress-related disorders are on the rise in India. Women in rural areas form one of the high-risk groups with respect to CMDs due to their compromised status of living. Objective The aim of the study was to estimate the prevalence of depression, anxiety, and stress, and the predictors to depression among women in rural Puducherry. Methods A community-based, cross-sectional study was performed in 2016, among women aged 18 to 59 years, residing in the rural area of Puducherry. Prevalence of CMDs was determined using the Depression Anxiety Stress Scale (DASS)-21. Using a systematic random sampling method, women were interviewed in their houses. The socio-demographic characteristics along with risk factors for depression were captured using a semi-structured proforma. A multivariable logistic regression model was used to determine the predictors of depression. Results A total of 301 women were surveyed and their mean age (SD) was 34.9 (10.2) years. The prevalence of depression, anxiety, and stress was found to be 15% (95% CI: 11.3–19.3), 10.6% (95% CI: 7.5–14.5), and 5% (95% CI: 3–8), respectively. Multivariable analysis identified that lesser education and living separately/divorced to be significant predictors for depression in these women. Conclusion About one in six adult women living in a rural area was found to be depressed, which is considerably high. This emphasizes the need for screening among women for common mental disorders in primary care settings, especially in rural areas so that early diagnoses happen and thus reduce the impact due to mental disability.

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    Journal of Neurosciences in Rural Practice
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    Authors: Strauss, Soeren; Woodgate, Philip J.W.; Sami, Saber A.; Heinke, Dietmar;

    AbstractWe present an extension of a neurobiologically inspired robotics model, termed CoRLEGO (Choice reaching with a LEGO arm robot). CoRLEGO models experimental evidence from choice reaching tasks (CRT). In a CRT participants are asked to rapidly reach and touch an item presented on the screen. These experiments show that non-target items can divert the reaching movement away from the ideal trajectory to the target item. This is seen as evidence attentional selection of reaching targets can leak into the motor system. Using competitive target selection and topological representations of motor parameters (dynamic neural fields) CoRLEGO is able to mimic this leakage effect. Furthermore if the reaching target is determined by its colour oddity (i.e. a green square among red squares or vice versa), the reaching trajectories become straighter with repetitions of the target colour (colour streaks). This colour priming effect can also be modelled with CoRLEGO. The paper also presents an extension of CoRLEGO. This extension mimics findings that transcranial direct current stimulation (tDCS) over the motor cortex modulates the colour priming effect (Woodgate et al., 2015). The results with the new CoRLEGO suggest that feedback connections from the motor system to the brain’s attentional system (parietal cortex) guide visual attention to extract movement-relevant information (i.e. colour) from visual stimuli. This paper adds to growing evidence that there is a close interaction between the motor system and the attention system. This evidence contradicts the traditional conceptualization of the motor system as the endpoint of a serial chain of processing stages. At the end of the paper we discuss CoRLEGO’s predictions and also lessons for neurobiologically inspired robotics emerging from this work.

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    Authors: Paul Mee; Ryan G. Wagner; Francesc Xavier Gómez-Olivé; Chodziwadziwa W. Kabudula; +5 Authors

    Background In 2011 there were 5.5 million HIV infected people in South Africa and 71% of those requiring antiretroviral therapy (ART) received it. The effective integration of traditional medical practitioners and biomedical providers in HIV prevention and care has been demonstrated. However concerns remain that the use of traditional treatments for HIV-related disease may lead to pharmacokinetic interactions between herbal remedies and ART drugs and delay ART initiation. Here we analyse the changing prevalence and determinants of traditional healthcare use amongst those dying of HIV-related disease, pulmonary tuberculosis and other causes in a rural South African community between 2003 and 2011. ART was made available in this area in the latter part of this period. Methods Data was collected during household visits and verbal autopsy interviews. InterVA-4 was used to assign causes of death. Spatial analyses of the distribution of traditional healthcare use were performed. Logistic regression models were developed to test associations of determinants with traditional healthcare use. Results There were 5929 deaths in the study population of which 47.7% were caused by HIV-related disease or pulmonary tuberculosis (HIV/AIDS and TB). Traditional healthcare use declined for all deaths, with higher levels throughout for those dying of HIV/AIDS and TB than for those dying of other causes. In 2003-2005, sole use of biomedical treatment was reported for 18.2% of HIV/AIDS and TB deaths and 27.2% of other deaths, by 2008–2011 the figures were 49.9% and 45.3% respectively. In bivariate analyses, higher traditional healthcare use was associated with Mozambican origin, lower education levels, death in 2003–2005 compared to the later time periods, longer illness duration and moderate increases in prior household mortality. In the multivariate model only country of origin, time period and illness duration remained associated. Conclusions There were large decreases in reported traditional healthcare use and increases in the sole use of biomedical treatment amongst those dying of HIV/AIDS and TB. No associations between socio-economic position, age or gender and the likelihood of traditional healthcare use were seen. Further qualitative and quantitative studies are needed to assess whether these figures reflect trends in healthcare use amongst the entire population and the reasons for the temporal changes identified. Electronic supplementary material The online version of this article (doi:10.1186/1472-6882-14-504) contains supplementary material, which is available to authorized users.

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    BMC Complementary and Alternative Medicine
    Other literature type . Article . 2014 . Peer-reviewed
    License: Springer TDM
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      BMC Complementary and Alternative Medicine
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    Authors: Becker, Daniel J.; Czirják, Gábor Á.; Volokhov, Dmitriy V.; Bentz, Alexandra B.; +10 Authors

    S1. Site coordinates and livestock density; S2. Stable isotopes of bats and prey; S3. Multivariate analysis of immune function; S4. Livestock biomass and isotopic distance; S5. Sensitivity to holding time

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    Authors: Haldenby, S.; Bronowski, C.; Nelson, C.; Kenny, J.; +14 Authors

    Background:\ud Campylobacter jejuni is the most common bacterial cause of human infectious intestinal disease.\ud \ud Methods:\ud We genome sequenced 601 human C. jejuni isolates, obtained from two large prospective studies of infectious intestinal disease (IID1 [isolates from 1993–1996; n = 293] and IID2 [isolates from 2008–2009; n = 93]), the INTEGRATE project [isolates from 2016–2017; n = 52] and the ENIGMA project [isolates from 2017; n = 163].\ud \ud Results:\ud There was a significant increase in the prevalence of the T86I mutation conferring resistance to fluoroquinolone between each of the three later studies (IID2, INTEGRATE and ENIGMA) and IID1. Although the distribution of major multilocus sequence types (STs) was similar between the studies, there were changes in both the abundance of minority STs associated with the T86I mutation, and the abundance of clones within single STs associated with the T86I mutation.\ud \ud Discussion:\ud Four population-based studies of community diarrhoea over a 25 year period revealed an increase over time in the prevalence of the T86I amongst isolates of C. jejuni associated with human gastrointestinal disease in the UK. Although associated with many STs, much of the increase is due to the expansion of clones associated with the resistance mutation.

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    PLoS ONE
    Article . 2020 . Peer-reviewed
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    DOAJ; PLoS ONE
    Article . 2020
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      DOAJ; PLoS ONE
      Article . 2020
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    Authors: Johanna Riha; Alex Karabarinde; Gerald Ssenyomo; Steven Allender; +5 Authors

    Editors’ Summary Background Cardiometabolic diseases—cardiovascular diseases that affect the heart and/or the blood vessels and metabolic diseases that affect the cellular chemical reactions needed to sustain life—are a growing global health concern. In sub-Saharan Africa, for example, the prevalence (the proportion of a population that has a given disease) of adults with diabetes (a life-shortening metabolic disease that affects how the body handles sugars) is currently 3.8%. By 2030, it is estimated that the prevalence of diabetes among adults in this region will have risen to 4.6%. Similarly, in 2004, around 1.2 million deaths in sub-Saharan Africa were attributed to coronary heart disease, heart failure, stroke, and other cardiovascular diseases. By 2030, the number of deaths in this region attributable to cardiovascular disease is expected to double. Globally, cardiovascular disease and diabetes are now responsible for around 17.3 million and 1.3 million annual deaths, respectively, together accounting for about one-third of all deaths. Why Was This Study Done? Experts believe that increased consumption of saturated fats, sugar, and salt and reduced physical activity are partly responsible for the increasing global prevalence of cardiometabolic diseases. These lifestyle changes, they suggest, are related to urbanization—urban expansion into the countryside and migration from rural to urban areas. If this is true, the prevalence of unhealthy lifestyles should increase as rural areas adopt urban characteristics. Sub-Saharan Africa is the least urbanized region in the world, with about 60% of the population living in rural areas. However, rural settlements across the subcontinent are increasingly adopting urban characteristics. It is important to know whether urbanization is affecting the health of rural residents in sub-Saharan Africa to improve estimates of the future burden of cardiometabolic diseases in the region and to provide insights into ways to limit this burden. In this cross-sectional study (an investigation that studies participants at a single time point), the researchers examine the distribution of urban characteristics across rural communities in Uganda and the association of these characteristics with lifestyle risk factors for cardiometabolic diseases. What Did the Researchers Do and Find? For their study, the researchers used data collected in 2011 by the General Population Cohort study, a study initiated in 1989 to describe HIV infection trends among people living in 25 villages in rural southwestern Uganda that collects health-related and other information annually from its participants. The researchers quantified the “urbanicity” of the 25 villages using a multi-component scale that included information such as village size and economic activity. They then used statistical models to examine associations between urbanicity and lifestyle risk factors such as body mass index (BMI, a measure of obesity) and self-reported fruit and vegetable consumption for more than 7,000 study participants living in those villages. None of the villages had paved roads or running water. However, urbanicity varied markedly across the villages, largely because of differences in economic activity, civil infrastructure, and the availability of educational and healthcare services. Notably, increasing urbanicity was associated with an increase in lifestyle risk factors for cardiovascular diseases. So, for example, people living in villages with the highest urbanicity scores were nearly 20% more likely to be physically inactive and to eat less fruits and vegetables and nearly 50% more likely to have a high BMI than people living in villages with the lowest urbanicity scores. What Do These Findings Mean? These findings indicate that, across rural communities in Uganda, even a small increase in urbanicity is associated with a higher prevalence of potentially modifiable lifestyle risk factors for cardiometabolic diseases. These findings suggest, therefore, that simply classifying settlements as either rural or urban may not be adequate to capture the information needed to target strategies for cardiometabolic disease management and control in rural areas as they become more urbanized. Because this study was cross-sectional, it is not possible to say how long a rural population needs to experience a more urban environment before its risk of cardiometabolic diseases increases. Longitudinal studies are needed to obtain this information. Moreover, studies of other countries in sub-Saharan Africa are needed to show that these findings are generalizable across the region. However, based on these findings, and given that more than 553 million people live in rural areas across sub-Saharan Africa, it seems likely that increasing urbanization will have a substantial impact on the future health of populations throughout sub-Saharan Africa. Additional Information Please access these websites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.1001683. This study is further discussed in a PLOS Medicine Perspective by Fahad Razak and Lisa Berkman The American Heart Association provides information on all aspects of cardiovascular disease and diabetes; its website includes personal stories about heart attacks, stroke, and diabetes The US Centers for Disease Control and Prevention has information on heart disease, stroke, and diabetes (in English and Spanish) The UK National Health Service Choices website provides information about cardiovascular disease and diabetes (including some personal stories) The World Health Organization’s Global Noncommunicable Disease Network (NCDnet) aims to help low- and middle-income countries reduce illness and death caused by cardiometabolic and other non-communicable diseases The World Heart Federation has recently produced a report entitled “Urbanization and Cardiovascular Disease” Wikipedia has a page on urbanization (note that Wikipedia is a free online encyclopedia that anyone can edit; available in several languages) Background Urban living is associated with unhealthy lifestyles that can increase the risk of cardiometabolic diseases. In sub-Saharan Africa (SSA), where the majority of people live in rural areas, it is still unclear if there is a corresponding increase in unhealthy lifestyles as rural areas adopt urban characteristics. This study examines the distribution of urban characteristics across rural communities in Uganda and their associations with lifestyle risk factors for chronic diseases. Methods and Findings Using data collected in 2011, we examined cross-sectional associations between urbanicity and lifestyle risk factors in rural communities in Uganda, with 7,340 participants aged 13 y and above across 25 villages. Urbanicity was defined according to a multi-component scale, and Poisson regression models were used to examine associations between urbanicity and lifestyle risk factors by quartile of urbanicity. Despite all of the villages not having paved roads and running water, there was marked variation in levels of urbanicity across the villages, largely attributable to differences in economic activity, civil infrastructure, and availability of educational and healthcare services. In regression models, after adjustment for clustering and potential confounders including socioeconomic status, increasing urbanicity was associated with an increase in lifestyle risk factors such as physical inactivity (risk ratio [RR]: 1.19; 95% CI: 1.14, 1.24), low fruit and vegetable consumption (RR: 1.17; 95% CI: 1.10, 1.23), and high body mass index (RR: 1.48; 95% CI: 1.24, 1.77). Conclusions This study indicates that even across rural communities in SSA, increasing urbanicity is associated with a higher prevalence of lifestyle risk factors for cardiometabolic diseases. This finding highlights the need to consider the health impact of urbanization in rural areas across SSA. Please see later in the article for the Editors' Summary Johanna Riha and colleagues evaluate the association of lifestyle risk factors with elements of urbanicity, such as having a public telephone, a primary school, or a hospital, among individuals living in rural settings in Uganda. Please see later in the article for the Editors' Summary

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    Europe PubMed Central
    Article . 2014 . Peer-reviewed
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    Authors: Biran, Adam; Schmidt, Wolf-Peter; Varadharajan, Kiruba Sankar; Rajaraman, Divya; +5 Authors

    Summary Background Diarrhoea and respiratory infections are the two biggest causes of child death globally. Handwashing with soap could substantially reduce diarrhoea and respiratory infections, but prevalence of adequate handwashing is low. We tested whether a scalable village-level intervention based on emotional drivers of behaviour, rather than knowledge, could improve handwashing behaviour in rural India. Methods The study was done in Chittoor district in southern Andhra Pradesh, India, between May 24, 2011, and Sept 10, 2012. Eligible villages had a population of 700–2000 people, a state-run primary school for children aged 8–13 years, and a preschool for children younger than 5 years. 14 villages (clusters) were selected, stratified by population size ( vs >1200), and randomly assigned in a 1:1 ratio to intervention or control (no intervention). Clusters were enrolled by the study manager. Random allocation was done by the study statistician using a random number generator. The intervention included community and school-based events incorporating an animated film, skits, and public pledging ceremonies. Outcomes were measured by direct observation in 20–25 households per village at baseline and at three follow-up visits (6 weeks, 6 months, and 12 months after the intervention). Observers had no connection with the intervention and observers and participant households were told that the study was about domestic water use to reduce the risk of bias. No other masking was possible. The primary outcome was the proportion of handwashing with soap at key events (after defecation, after cleaning a child's bottom, before food preparation, and before eating) at all follow-up visits. The control villages received a shortened version of the intervention before the final follow-up round. Outcome data are presented as village-level means. Findings Handwashing with soap at key events was rare at baseline in both the intervention and control groups (1% [SD 1] vs 2% [1]). At 6 weeks' follow-up, handwashing with soap at key events was more common in the intervention group than in the control group (19% [SD 21] vs 4% [2]; difference 15%, p=0·005). At the 6-month follow-up visit, the proportion handwashing with soap was 37% (SD 7) in the intervention group versus 6% (3) in the control group (difference 31%; p=0·02). At the 12-month follow-up visit, after the control villages had received the shortened intervention, the proportion handwashing with soap was 29% (SD 9) in the intervention group and 29% (13) in the control group. Interpretation This study shows that substantial increases in handwashing with soap can be achieved using a scalable intervention based on emotional drivers. Funding Wellcome Trust, SHARE.

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    The Lancet Global Health
    Article . 2014 . Peer-reviewed
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      The Lancet Global Health
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    Authors: Snowdon, Victoria K.; Lachlan, Neil J.; Hoy, Anna M.; Hadoke, Patrick W. F.; +22 Authors

    Background Chronic liver scarring from any cause leads to cirrhosis, portal hypertension, and a progressive decline in renal blood flow and renal function. Extreme renal vasoconstriction characterizes hepatorenal syndrome, a functional and potentially reversible form of acute kidney injury in patients with advanced cirrhosis, but current therapy with systemic vasoconstrictors is ineffective in a substantial proportion of patients and is limited by ischemic adverse events. Serelaxin (recombinant human relaxin-2) is a peptide molecule with anti-fibrotic and vasoprotective properties that binds to relaxin family peptide receptor-1 (RXFP1) and has been shown to increase renal perfusion in healthy human volunteers. We hypothesized that serelaxin could ameliorate renal vasoconstriction and renal dysfunction in patients with cirrhosis and portal hypertension. Methods and findings To establish preclinical proof of concept, we developed two independent rat models of cirrhosis that were characterized by progressive reduction in renal blood flow and glomerular filtration rate and showed evidence of renal endothelial dysfunction. We then set out to further explore and validate our hypothesis in a phase 2 randomized open-label parallel-group study in male and female patients with alcohol-related cirrhosis and portal hypertension. Forty patients were randomized 1:1 to treatment with serelaxin intravenous (i.v.) infusion (for 60 min at 80 μg/kg/d and then 60 min at 30 μg/kg/d) or terlipressin (single 2-mg i.v. bolus), and the regional hemodynamic effects were quantified by phase contrast magnetic resonance angiography at baseline and after 120 min. The primary endpoint was the change from baseline in total renal artery blood flow. Therapeutic targeting of renal vasoconstriction with serelaxin in the rat models increased kidney perfusion, oxygenation, and function through reduction in renal vascular resistance, reversal of endothelial dysfunction, and increased activation of the AKT/eNOS/NO signaling pathway in the kidney. In the randomized clinical study, infusion of serelaxin for 120 min increased total renal arterial blood flow by 65% (95% CI 40%, 95%; p < 0.001) from baseline. Administration of serelaxin was safe and well tolerated, with no detrimental effect on systemic blood pressure or hepatic perfusion. The clinical study’s main limitations were the relatively small sample size and stable, well-compensated population. Conclusions Our mechanistic findings in rat models and exploratory study in human cirrhosis suggest the therapeutic potential of selective renal vasodilation using serelaxin as a new treatment for renal dysfunction in cirrhosis, although further validation in patients with more advanced cirrhosis and renal dysfunction is required. Trial registration ClinicalTrials.gov NCT01640964 Author summary Why was this study done? Hepatorenal syndrome type 1 is a rapidly progressive, but potentially reversible, form of acute kidney injury occurring in patients with liver cirrhosis, characterized by severe renal vasoconstriction and a very poor prognosis. There is a significant unmet need for a widely approved, safe, and effective pharmacological treatment. Serelaxin, a recombinant form of the human peptide hormone relaxin-2, has been shown to increase renal perfusion in healthy human volunteers. We tested whether serelaxin could ameliorate renal vasoconstriction and renal dysfunction in cirrhosis. What did the researchers do and find? Administration of serelaxin improved renal blood flow, oxygenation, and function in two independent animal models of cirrhosis through reversal of endothelial dysfunction and increased activation of nitric oxide signaling in the kidney. In an exploratory phase 2 clinical trial in patients with cirrhosis and portal hypertension, serelaxin infusion induced a significant increase in renal blood flow and was safe and well tolerated, with no adverse effects on systemic blood pressure or hepatic perfusion. What do these findings mean? Our data indicate that selective targeting of renal vasoconstriction using serelaxin may modulate renal dysfunction in cirrhosis without affecting systemic blood pressure. Further studies in patients with more advanced cirrhosis and renal dysfunction are required to confirm whether there are beneficial effects on renal function and patient outcomes. In a Research Article, Jonathan Fallowfield and colleagues study serelaxin as a possible treatment for renal vasoconstriction in liver cirrhosis.

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    Authors: Xiaolei Liu; Meng Huang; Bin Fan; Edward S. Buckler; +1 Authors

    False positives in a Genome-Wide Association Study (GWAS) can be effectively controlled by a fixed effect and random effect Mixed Linear Model (MLM) that incorporates population structure and kinship among individuals to adjust association tests on markers; however, the adjustment also compromises true positives. The modified MLM method, Multiple Loci Linear Mixed Model (MLMM), incorporates multiple markers simultaneously as covariates in a stepwise MLM to partially remove the confounding between testing markers and kinship. To completely eliminate the confounding, we divided MLMM into two parts: Fixed Effect Model (FEM) and a Random Effect Model (REM) and use them iteratively. FEM contains testing markers, one at a time, and multiple associated markers as covariates to control false positives. To avoid model over-fitting problem in FEM, the associated markers are estimated in REM by using them to define kinship. The P values of testing markers and the associated markers are unified at each iteration. We named the new method as Fixed and random model Circulating Probability Unification (FarmCPU). Both real and simulated data analyses demonstrated that FarmCPU improves statistical power compared to current methods. Additional benefits include an efficient computing time that is linear to both number of individuals and number of markers. Now, a dataset with half million individuals and half million markers can be analyzed within three days. Author Summary Genome-Wide Association Studies (GWAS) can reveal genetic-phenotypic relationships, but have limitations. To control false positives, population structure and kinship are incorporated in a fixed and random effect Mixed Linear Model (MLM). However, because of the confounding between population structure, kinship, and quantitative trait nucleotides (QTNs), MLM leads to false negatives, missing some potentially important discoveries. Here, we present a new method, Fixed and random model Circulating Probability Unification (FarmCPU). FarmCPU performs marker tests with associated markers as covariates in a fixed effect model and optimization on the associated covariate markers in a random effect model separately. This process enables efficient computation, removes the confounding, prevents model over-fitting, and controls false positives simultaneously. FarmCPU controls false positives as well as MLM with reductions in both false negatives and computing times. Researchers will not only be able to analyze big data, but will also have greater success with fewer mistakes when mapping genes of interest.

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    PLoS Genetics
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      PLoS Genetics
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    Authors: Robert Heyderman; Nicola Desmond; Deborah Nyirenda;

    Radio is an effective source of health information in many resource poor countries. In Malawi, 53% of households own radios however few radio programmes in Malawi focus on health issues in the context of medical research. An interactive health-talk radio programme ‘ Umoyo nkukambirana’ was introduced by Malawi-Liverpool-Wellcome Trust Clinical Research Programme on a national radio station. The aim was to increase awareness of health and medical research, and improve engagement between researchers, healthcare workers and the public. The content and presentation were developed through participatory community consultations. Focus Group Discussions were conducted with established Radio Listening Clubs whilst quantitative data was collected using toll free FrontlineSMS to explore national response. A total of 277 to 695 SMS (Median: 477) were received per theme. The majority of SMS were received from men (64%) and mainly from rural areas (54%). The programme improved knowledge of medical research, health and dispelled misconceptions. This study suggests that the radio may be an effective means of increasing the exposure of men to health information in resource poor settings.

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    Public Understanding of Science; OpenAPC Global Initiative
    Article . Conference object . 2016 . Peer-reviewed
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    Public Understanding of Science
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      Public Understanding of Science; OpenAPC Global Initiative
      Article . Conference object . 2016 . Peer-reviewed
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    Authors: Manikandan, Srinivasan; Mahendra M, Reddy; Sonali, Sarkar; Vikas, Menon;

    Abstract Background The burden of common mental disorders (CMDs) which includes depression, anxiety, and stress-related disorders are on the rise in India. Women in rural areas form one of the high-risk groups with respect to CMDs due to their compromised status of living. Objective The aim of the study was to estimate the prevalence of depression, anxiety, and stress, and the predictors to depression among women in rural Puducherry. Methods A community-based, cross-sectional study was performed in 2016, among women aged 18 to 59 years, residing in the rural area of Puducherry. Prevalence of CMDs was determined using the Depression Anxiety Stress Scale (DASS)-21. Using a systematic random sampling method, women were interviewed in their houses. The socio-demographic characteristics along with risk factors for depression were captured using a semi-structured proforma. A multivariable logistic regression model was used to determine the predictors of depression. Results A total of 301 women were surveyed and their mean age (SD) was 34.9 (10.2) years. The prevalence of depression, anxiety, and stress was found to be 15% (95% CI: 11.3–19.3), 10.6% (95% CI: 7.5–14.5), and 5% (95% CI: 3–8), respectively. Multivariable analysis identified that lesser education and living separately/divorced to be significant predictors for depression in these women. Conclusion About one in six adult women living in a rural area was found to be depressed, which is considerably high. This emphasizes the need for screening among women for common mental disorders in primary care settings, especially in rural areas so that early diagnoses happen and thus reduce the impact due to mental disability.

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    Journal of Neurosciences in Rural Practice
    Article . 2020 . Peer-reviewed
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    Journal of Neurosciences in Rural Practice
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      Journal of Neurosciences in Rural Practice
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    Authors: Strauss, Soeren; Woodgate, Philip J.W.; Sami, Saber A.; Heinke, Dietmar;

    AbstractWe present an extension of a neurobiologically inspired robotics model, termed CoRLEGO (Choice reaching with a LEGO arm robot). CoRLEGO models experimental evidence from choice reaching tasks (CRT). In a CRT participants are asked to rapidly reach and touch an item presented on the screen. These experiments show that non-target items can divert the reaching movement away from the ideal trajectory to the target item. This is seen as evidence attentional selection of reaching targets can leak into the motor system. Using competitive target selection and topological representations of motor parameters (dynamic neural fields) CoRLEGO is able to mimic this leakage effect. Furthermore if the reaching target is determined by its colour oddity (i.e. a green square among red squares or vice versa), the reaching trajectories become straighter with repetitions of the target colour (colour streaks). This colour priming effect can also be modelled with CoRLEGO. The paper also presents an extension of CoRLEGO. This extension mimics findings that transcranial direct current stimulation (tDCS) over the motor cortex modulates the colour priming effect (Woodgate et al., 2015). The results with the new CoRLEGO suggest that feedback connections from the motor system to the brain’s attentional system (parietal cortex) guide visual attention to extract movement-relevant information (i.e. colour) from visual stimuli. This paper adds to growing evidence that there is a close interaction between the motor system and the attention system. This evidence contradicts the traditional conceptualization of the motor system as the endpoint of a serial chain of processing stages. At the end of the paper we discuss CoRLEGO’s predictions and also lessons for neurobiologically inspired robotics emerging from this work.

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    Authors: Paul Mee; Ryan G. Wagner; Francesc Xavier Gómez-Olivé; Chodziwadziwa W. Kabudula; +5 Authors

    Background In 2011 there were 5.5 million HIV infected people in South Africa and 71% of those requiring antiretroviral therapy (ART) received it. The effective integration of traditional medical practitioners and biomedical providers in HIV prevention and care has been demonstrated. However concerns remain that the use of traditional treatments for HIV-related disease may lead to pharmacokinetic interactions between herbal remedies and ART drugs and delay ART initiation. Here we analyse the changing prevalence and determinants of traditional healthcare use amongst those dying of HIV-related disease, pulmonary tuberculosis and other causes in a rural South African community between 2003 and 2011. ART was made available in this area in the latter part of this period. Methods Data was collected during household visits and verbal autopsy interviews. InterVA-4 was used to assign causes of death. Spatial analyses of the distribution of traditional healthcare use were performed. Logistic regression models were developed to test associations of determinants with traditional healthcare use. Results There were 5929 deaths in the study population of which 47.7% were caused by HIV-related disease or pulmonary tuberculosis (HIV/AIDS and TB). Traditional healthcare use declined for all deaths, with higher levels throughout for those dying of HIV/AIDS and TB than for those dying of other causes. In 2003-2005, sole use of biomedical treatment was reported for 18.2% of HIV/AIDS and TB deaths and 27.2% of other deaths, by 2008–2011 the figures were 49.9% and 45.3% respectively. In bivariate analyses, higher traditional healthcare use was associated with Mozambican origin, lower education levels, death in 2003–2005 compared to the later time periods, longer illness duration and moderate increases in prior household mortality. In the multivariate model only country of origin, time period and illness duration remained associated. Conclusions There were large decreases in reported traditional healthcare use and increases in the sole use of biomedical treatment amongst those dying of HIV/AIDS and TB. No associations between socio-economic position, age or gender and the likelihood of traditional healthcare use were seen. Further qualitative and quantitative studies are needed to assess whether these figures reflect trends in healthcare use amongst the entire population and the reasons for the temporal changes identified. Electronic supplementary material The online version of this article (doi:10.1186/1472-6882-14-504) contains supplementary material, which is available to authorized users.

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    BMC Complementary and Alternative Medicine
    Other literature type . Article . 2014 . Peer-reviewed
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      BMC Complementary and Alternative Medicine
      Other literature type . Article . 2014 . Peer-reviewed
      License: Springer TDM
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    Authors: Becker, Daniel J.; Czirják, Gábor Á.; Volokhov, Dmitriy V.; Bentz, Alexandra B.; +10 Authors

    S1. Site coordinates and livestock density; S2. Stable isotopes of bats and prey; S3. Multivariate analysis of immune function; S4. Livestock biomass and isotopic distance; S5. Sensitivity to holding time

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