Detecting and Managing Childhood Onset Hypertension in Africa: A Call to Action

PURPOSE OF REVIEW

To review recent evidence on childhood hypertension across Africa, identifying knowledge gaps, challenges and priorities, and highlight clinical perspectives in managing primary hypertension.

RECENT FINDINGS

Only 15 of the 54 African countries reported on absolute blood pressure (BP) measures, elevated BP, pre- and/or hypertension. The reported hypertension prevalence ranged between 0.0 and 38.9%, while elevated BP and/or pre-hypertnesion ranged from 2.7 to 50.5%. Childhood BP nomograms are lacking across Africa and the rates of hypertension were based on guidelines developed in countries with the lowest to no number of children from African ancestry. The recent studies across Africa also showed little to no detail when reporting BP specific methodology. No recent data informing the use or effectiveness of antihypertensive agents in children and adolesents are available. Childhood hypertension is on the rise, while data from Africa remains vastly under-represented. Collaborative research, resources, and policies need to be strengthened in addressing the growing public health concern of childhood onset hypertension on this continent.

A comparison of paediatric hypertension clinical practice guidelines and their ability to predict adult hypertension in an African birth cohort

It remains unclear which paediatric hypertension clinical practice guideline (CPG) should be applied in an African population. We, therefore, aimed to compare commonly used CPG (2017 AAP, 2016 ESH, 2004 Fourth Report) developed in high-income countries for use in South African children at four paediatric ages (children: 5 years, 8 years; adolescents: 13 years, 17 years) to determine which best predicts elevated blood pressure (BP) in adulthood (22 years, 28 years). Moreover, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for each specific paediatric CPG was calculated across the age points. The 2017 AAP definition identified more children and adolescents with hypertension when compared to the 2004 Fourth Report and 2016 ESH guidelines. In computed hazards ratios, ages 8 years to 17 years, all three paediatric CPG significantly predicted the risk of elevated BP in young adulthood (p ≤ 0.032). However, sensitivity to predict elevated BP at age 22 years for all CPG was generally low (17.0%-33.0%) with higher specificity (87.4%-93.1%). Sensitivity increased at age 28 years (51.4%-70.1%), while specificity decreased (52.8%-65.1%). Both PPV and NPV at both adult age points varied widely (17.9%-79.9% and 29.3%-92.5% respectively). The performance of these paediatric CPG in terms of AUC were not optimal at both adult age points, however, the 2017 AAP definition at age 17 years met an acceptable level of performance (AUC = 0.71). Our results, therefore, highlight the need for more research to examine if an African-specific CPG would better identify high-risk children to minimise their trajectory towards adult hypertension.

Effects of seeking compensation on the psychological health and recovery of injured patients: the role of stress vulnerability and injury-related disability

BACKGROUND

Seeking compensation has been shown to have an adverse effect on the psychological health and recovery of injured patients, however, this effect requires clarification.

METHODS

A total of 2019 adults sustaining a traffic injury were recruited. Of these, 709 (35.1%) lodged a compensation claim. Interviews occurred at 1-, 6- and 12-month post-injury. Outcomes were psychological distress (posttraumatic stress (PTS) and depressive symptoms) and health-related functioning (HrF) (quality of life measured by EQ-5D-3L and disability by WHODAS) over 12-months post-injury. Covariates included individual stress vulnerability (preinjury, injury-related factors).

RESULTS

Compared with non-compensation participants, compensation groups had higher stress vulnerability (more severe injuries and negative reactions) and poorer baseline outcomes (psychological health and HrF). After adjustment, we found an effect of compensation on HrF [β-0.09 (-0.11 to -0.07), p < 0.001] and PTS [β = 0.36 (0.16 to 0.56), p = 0.0003], but not on depression [β = -0.07 (-0.42 to 0.28), p = 0.7]. Both groups improved over time. Vulnerable individuals (β = 1.23, p < 0.001) and those with poorer baseline outcomes (PTS: β = 0.06, p = 0.002; HrF: β = -1.07, p < 0.001) were more likely to lodge a claim. In turn, higher stress vulnerability, poor baseline outcomes and claiming compensation were associated with long-term psychological distress and HrF. Nevertheless, concurrent HrF in the model fully accounted for the compensation effect on psychological distress (β = -0.14, p = 0.27), but not vice versa.

CONCLUSIONS

This study provides convincing evidence that seeking compensation is not necessarily harmful to psychological health. The person's stress vulnerability and injury-related disability emerge as major risk factors of long-term psychological distress, requiring a whole-systems approach to address the problem.

Outcomes after traffic injury: mental health comorbidity and relationship with pain interference

BACKGROUND

Mental health symptoms, like depressive mood (DM) and post-traumatic stress (PTS), and pain interference (PI) with daily functioning often co-occur following traffic injury and their comorbidity can complicate recovery. This study aimed to map the course and overlapping trajectories of mental health symptoms, and associations with PI in a traffic injury population.

METHODS

In total, 2019 adults sustaining minor-to-moderate traffic injury were recruited within 28 days post-injury and assessed using phone interviews at 1, 6 and 12-months post-injury. Trajectories of DM, PTS and PI were established and relationships between DM, PTS and PI trajectories were explored using dual trajectory modelling. Bio-psychosocial predictors (e.g. pre-injury health, catastrophizing, acute distress, quality of life, social support) of mental health trajectories were investigated.

RESULTS

Up to five typical post-trauma trajectories were identified for DM, PTS and PI. Most people were in a resilient mental health trajectory (over 60%, DM or PTS), or in a chronic PI trajectory (almost 60%) 12 months post-injury. While recovery/resilient mental health trajectories were strongly interrelated (73.4% joint probability and > 94% conditional probabilities), DM/PTS comorbidity in chronic trajectories was not straightforward, suggesting a possibly asymmetric relationship. That is, persistent DM was more likely associated with persistent PTS (90.4%), than vice versa (31.9%), with a 22.5% probability that persistent PTS was associated with none or milder depression (i.e. following a recovery/resilient DM trajectory). An asymmetrical relationship was also found between mental health and PI. The majority of those with persistent PI were likely to be in a recovery/resilient DM/PTS trajectory (almost 70%), but those in a non-resilient DM/PTS trajectory showed a high risk of persistent PI. Predictors of non-resilient mental health trajectories included poorer pre-injury health and social support, and shared factors like acute psychological distress and pain catastrophizing.

CONCLUSIONS

Strong interrelations were confirmed between mental health symptoms and PI following traffic injury. However, persistent DM was more strongly linked to persistent PTS, than vice versa. Persistent PI was only linked with persistent DM/PTS in vulnerable subgroups. Early psychiatric/psychological interventions should target elevated psychological distress and negative appraisals in vulnerable individuals, to reduce long-term mental health morbidity/comorbidity and PI.

TRIAL REGISTRATION

ACTRN12613000889752.

Diaphragmotomy to aid exposure during hepatobiliary surgery: a multi-centre retrospective review of 31 dogs

OBJECTIVES

To report surgical technique, intra- and post-operative complications, and short- and long-term outcome following canine hepatobiliary surgery in which exposure of intra-abdominal hepatobiliary lesions was aided by diaphragmotomy.

MATERIALS AND METHODS

Clinical records from four multi-disciplinary UK-based small animal referral hospitals were retrospectively reviewed for dogs in which diaphragmotomy was performed between January 2014 and May 2019. Signalment, diagnosis, surgery performed, diaphragmotomy technique, management of diaphragmotomy and pneumothorax, intra- and post-operative complications, short-term outcome and long-term outcome were recorded.

RESULTS

Thirty-one cases were identified. The most common hepatobiliary surgeries performed alongside diaphragmotomy were single hepatic lobectomy (14/31) and cholecystectomy (11/31). The most common diagnoses were hepatocellular carcinoma (10/31), gall bladder mucocoele (7/31) and hepatic nodular hyperplasia (4/31). Peri-operative mortality rate was 9.7% (3/31 cases) though none of these deaths were considered attributable to diaphragmotomy. Post-operative complications were encountered in 67.9% (19/28) cases that survived the peri-operative period, of which 25.0% (7/28) suffered complications that were considered attributable or likely attributable to diaphragmotomy. These seven complications resolved following non-surgical intervention. Follow-up was available for 26 of 28 patients that survived to discharge at a median of 4-months (range 10 days to 24 months) following surgery and revealed no evidence of complications related to diaphragmotomy.

CLINICAL SIGNIFICANCE

Diaphragmotomy appears safe and increases abdominal exposure of hepatobiliary lesions. The benefit of improved exposure must be carefully weighed up against the risks inherent in inducing pneumothorax.

Development of a transient thrust stand with sub-millisecond resolution

A transient thrust stand has been developed to offer 0.1 ms time-resolved force measurements up to 22 N. The system uses a predictor-based subspace system identification (PBSID) algorithm to obtain a high order state space model of the thrust stand. The state space model defines high-frequency vibration modes within the thrust stand. The high-frequency vibration modes are necessary to provide the time response of 0.1 ms. Thruster forces are then estimated using an augmented Kalman filter (AKF) to combine sensor traces from four accelerometers, a velocity sensor, and a displacement transducer. Fusing low-frequency displacement data with high-frequency acceleration measurements provides accurate force data from 0 kHz to 10 kHz. Combining the AKF with the PBSID state space model inherently attenuates external noise sources such as pumps. The transient thrust stand uses a torsional configuration to minimize influence from external vibrations and achieve high force resolution independent of thruster weight. Results demonstrated that the system was capable of obtaining dynamic thrust profiles with less than 5% error and a time resolution of 0.1 ms. To date, no thrust stand is capable of measuring up to 22 N forces with a time response of 10 kHz.

An Infant with Neonatal Abstinence Syndrome in the Setting of Hydranencephaly

An infant of 37 weeks' gestation was born with signs and symptoms of neonatal abstinence syndrome (NAS). Upon further investigation, he was found to have congenital hydranencephaly, a condition in which the forebrain is absent. In this case report, we explore the mechanisms of NAS and hydranencephaly, and why an infant without a forebrain can still experience NAS symptoms.

Daytime sleepiness and its relationships to fatigue and autonomic dysfunction in adults with spinal cord injury

OBJECTIVE

To determine the extent of daytime sleepiness in adults with spinal cord injury (SCI) and investigate the contribution of fatigue and autonomic function to sleepiness status.

METHODS

Participants included 45 adults with SCI attending outpatient services or living in the community and 44 able-bodied controls. The Oxford Sleep Resistance Test (OSLER) was used to assess daytime sleepiness, while eye blink rate duration (electrooculography) and the Iowa Fatigue Scale assessed fatigue. Heart rate variability (HRV) was used to assess autonomic function. Survival analysis (Kaplan Meier) was used to estimate the rate of loss in participation in the OSLER task, as a measure of daytime sleepiness. Repeated measures ANOVA was used to determine HRV differences between groups. Regression analysis was used to establish factors that contributed to daytime sleepiness.

RESULTS

Participants with high lesions ("T3 and above") had significantly increased daytime sleepiness. OSLER results revealed only 33% of those with high lesions remained awake during the task. Those with high lesions also had significantly reduced sympathetic activity while no differences in parasympathetic activity were found between groups. Lesion completeness had no effect. Standardized variation in heart rate, slow eye blinks, low frequency HRV and self-reported fatigue contributed to daytime sleepiness.

CONCLUSION

Neurological lesions at "T3 or above" have an increased risk of daytime sleepiness, impacting on independence in daily functional tasks and work performance. Autonomic imbalance alters cardiovascular control, affecting health and wellbeing. The interaction of these factors requires further investigation.

Understanding the drivers of improved pig weaning weight by investigation of colostrum intake, sow lactation feed intake, or lactation diet specification

Modern sows have low feed intake (FI) during lactation. The main aim of this study was to understand interactions between and separate effects of FI and nutrient density on litter weaning weight (WW). Key drivers of colostrum intake (CIn), piglet survival, WW, and colostrum yield (CY) were also investigated. Sows ( = 82) were offered a High (15.8 MJ/kg DE; 1.3% total lysine) or Normal (15.2 MJ/kg DE; 1.28% total lysine) specification lactation diet at either a High (feed allowance increased by 0.5 kg/d after farrowing until intake reached 10 kg/d) or Low (feed allowance was increased by 0.3 kg/d after farrowing until intake reached 7.5 kg/d) feeding level (2 × 2 factorial design). A subset of sows ( = 18) were observed during farrowing to collect data on factors affecting CIn. No interactions were found between diet specification and feeding level. Sows on the Low feeding level lost 10.6 kg more BW during lactation than those on the High feeding level ( < 0.001). Sows offered the High specification diet lost 6.4 kg more BW than those on the Normal specification diet ( = 0.018). Diet specification had no effect on ADFI. Between birth and weaning, litters of sows offered the High feeding level grew 326 g/d faster ( < 0.001) and were heavier at 28 d (114 kg; < 0.001) compared with those of sows offered the Low feeding level (104 kg). Although litters from sows offered the High specification diet had WW similar to that of litters from sows offered the Normal specification diets, their ADG was 190 g/d greater ( = 0.018) between birth and weaning. A regression analysis was completed using data from 192 sows and indicated that FI and lysine intake throughout lactation and DE and lysine intake from 14 to 28 d of lactation were the main drivers of litter WW. Lactation efficiency was 0.65 from 0 to 7 d and decreased to 0.42 from 21 to 28 d. Variation in CIn was mainly explained by 24-h weight, birth weight, and the duration of farrowing. Colostrum yield was significantly correlated ( = 0.004; pseudo = 54.5%) with litter birth weight. Piglet WW was positively correlated with 3-wk weight ( < 0.001) but negatively correlated with sow parity ( = 0.035), number born alive ( = 0.045), and being female ( < 0001). Out of 45 variables, preweaning piglet survival was positively correlated ( = 0.008) with only 24- to 48-h weight gain. In conclusion, lactation FI and DE and lysine intake in the second half of lactation were the main drivers of litter WW.

Characterisation of the transcriptome of male and female wild-type guppy brains with RNA-Seq and consequences of exposure to the pharmaceutical pollutant, 17α-ethinyl estradiol

Waterways are increasingly being contaminated by chemical compounds that can disrupt the endocrinology of organisms. One such compound is 17α-ethinyl estradiol (EE2), a synthetic estrogen used in the contraceptive pill. Despite considerable research interest in the effects of EE2 on reproduction and gene expression, surprisingly, only a few studies have capitalised on technologies, such as next-generation sequencing (NGS), to uncover the molecular pathways related to EE2 exposure. Accordingly, using high-throughput sequencing technologies, the aim of our study was to explore the effects of EE2 on brain transcriptome in wild-type male and female guppy (Poecilia reticulata). We conducted two sets of experiments, where fish were exposed to EE2 (measured concentrations: 8ng/L and 38ng/L) in a flow-through system for 21days. The effects on the brain transcriptome on both males and females were assessed using Illumina sequencing (MiSeq and HiSeq) platform followed by bioinformatics analysis (edgeR, DESeq2). Here, we report that exposure to EE2 caused both up- and downregulation of specific transcript abundances, and affected transcript abundance in a sex-specific manner. Specifically, we found 773 transcripts, of which 60 were male-specific, 61 female-specific and 285 treatment-specific. EE2 affected expression of 165 transcripts in males, with 88 downregulated and 77 upregulated, while in females, 120 transcripts were affected with 62 downregulated and 58 upregulated. Finally, RT-qPCR validation demonstrated that expression of transcripts related to transposable elements, neuroserpin and heat shock protein were significantly affected by EE2-exposure. Our study is the first to report brain transcriptome libraries for guppies exposed to EE2. Not only does our study provide a valuable resource, it offers insights into the mechanisms underlying the feminizing effects on the brains of organisms exposed to environmentally realistic concentrations of EE2.

The psychological impact of traffic injuries sustained in a road crash by bicyclists: A prospective study

OBJECTIVE

The objective of this study was to investigate the psychological impact of traffic injuries in bicyclists (cyclists) in comparison to car occupants who also sustained traffic injuries. Factors predictive of elevated psychological distress were also investigated.

METHODS

An inception cohort prospective design was used. Participants included cyclists aged ≥17 years (mean age 41.7 years) who sustained a physical injury (n = 238) assessed within 28 days of the crash, following medical examination by a registered health care practitioner. Injury included musculoskeletal and soft tissue injuries and minor/moderate traumatic brain injury (TBI), excluding severe TBI, spinal cord injury, and severe multiple fractures. Assessment also occurred 6 months postinjury. Telephone-administered interviews assessed a suite of measures including sociodemographic, preinjury health and injury factors. Psychological impact was measured by pain catastrophization, trauma-related distress, and general psychological distress. The psychological health of the cyclists was compared to that of the car occupants (n = 234; mean age 43.1 years). A mixed model repeated measures analysis, adjusted for confounding factors, was used to determine differences between groups and regression analyses were used to determine contributors to psychological health in the cyclists 6 months postinjury.

RESULTS

Cyclists had significantly better psychological health (e.g., lower pain catastrophizing, lower rates of probable posttraumatic stress disorder [PTSD], and lower general distress levels) compared to car occupants at baseline and 6 months postinjury. Factors predictive of cyclists' psychological distress included younger age, greater perceived danger of death, poorer preinjury health, and greater amount of time in hospital after the injury.

CONCLUSIONS

These data provide insight into how cyclists perceive and adjust to their traffic injuries compared to drivers and passengers who sustain traffic injuries, as well as direction for preventing the development of severe psychological injury. Future research should examine the utility of predictors of psychological health to improve recovery.

IgE-mediated food allergy--diagnosis and management in New Zealand children

AIM

To summarise the diagnosis and management of IgE-mediated food allergy (FA) in New Zealand children.

METHOD

A review of the scientific literature and subsequent consensus development.

RESULTS

FA is a common problem in New Zealand children with management necessitating accurate diagnosis, appropriate risk management, and reassessment over time.

CONCLUSION

This paper highlights the importance of a structured approach to diagnosis and management of FA in New Zealand children, guided by appropriately skilled health professionals.

Differential effects of self-efficacy and perceived control on intention to perform skin cancer-related health behaviours

Previous research using the Theory of Planned Behaviour (TPB) for predicting skin cancer-related health behaviours has not adequately incorporated empirical advances in the conceptualization of the perceived behavioural control (PBC) component of the theory. This study examined the role of self-efficacy and controllability for predicting sunscreen and sunbed use intentions. Five hundred and ninety young adults completed a questionnaire on beliefs and intentions regarding sunscreen and sunbed use. Analysis using confirmatory factor analysis and multiple regression supported a conceptual distinction between two PBC subcomponents: controllability and self-efficacy. While self-efficacy--but not controllability--emerged as a significant predictor of intentions to use sunscreen, the opposite pattern was observed for the prediction of intentions to use sunbeds, whereby lower controllability beliefs were associated with higher intentions. Campaigns aimed at influencing health behaviours should consider the differential effects of the components of perceived control.

Body Consciousness Moderates the Effect of Message Framing on Intentions to Use Sunscreen

The objective of this study was to investigate the impact of messages differing in focus (health vs appearance) and frame (gain vs loss) on intentions for sunscreen use and sunbed use, and the potential moderating role of body consciousness. Questionnaire data from 390 young adults were analysed using factorial ANOVA. Results showed a significant interaction between message frame and body consciousness, such that gain-framed health or appearance messages had the strongest effect on sunscreen use intentions for those high in body consciousness, compared to those low in body consciousness. We conclude that message framing effects on precautionary sun behaviour intentions are moderated by body consciousness.

Effects of mental fatigue on 8-13Hz brain activity in people with spinal cord injury

Brain computer interfaces (BCIs) can be implemented into assistive technologies to provide 'hands-free' control for the severely disabled. BCIs utilise voluntary changes in one's brain activity as a control mechanism to control devices in the person's immediate environment. Performance of BCIs could be adversely affected by negative physiological conditions such as fatigue and altered electrophysiology commonly seen in spinal cord injury (SCI). This study examined the effects of mental fatigue from an increase in cognitive demand on the brain activity of those with SCI. Results show a trend of increased alpha (8-13Hz) activity in able-bodied controls after completing a set of cognitive tasks. Conversely, the SCI group showed a decrease in alpha activity due to mental fatigue. Results suggest that the brain activity of SCI persons are altered in its mechanism to adjust to mental fatigue. These altered brain conditions need to be addressed when using BCIs in clinical populations such as SCI. The findings have implications for the improvement of BCI technology.

Proteinuria as a predictor of renal functional outcome after revascularization in atherosclerotic renovascular disease (ARVD)

BACKGROUND

Renal revascularization is performed in 16% of newly diagnosed patients with atherosclerotic renovascular disease (ARVD). Although there may be some improvement in hypertension control as a result of intervention, renal functional outcomes are known to vary. Pre-existing renal parenchymal injury, as manifested by proteinuria, is associated with poor functional outcome in conservatively managed ARVD patients, but this association has not been investigated in patients undergoing revascularization.

METHODS

Retrospective case note review of 83 ARVD patients who underwent renal revascularization in four centres within a renal network between 1998 and 2003 was undertaken. Amongst other parameters, baseline proteinuria was correlated with renal functional outcome post revascularization. Renal functional outcome was determined over a mean follow up of 22 months by rate of change of estimated glomerular filtration rate (eGFR) over time.

RESULTS

Univariate analysis showed that proteinuria >0.6 g/day was the only significant predictor of poor outcome after revascularization. The relationship persisted with multivariate analysis, and linear regression showed a correlation between baseline proteinuria and decline in eGFR with time (r(2) = 0.058, P = 0.039).

CONCLUSION

This study confirms that prior renal parenchymal injury, here reflected by proteinuria at baseline, is a major arbiter of renal functional outcome after renal revascularization in ARVD.

Increase in regularity and decrease in variability seen in electroencephalography (EEG) signals from alert to fatigue during a driving simulated task

Driver fatigue is a prevalent problem and a major risk for road safety accounting for approximately 20-40% of all motor vehicle accidents. One strategy to prevent fatigue related accidents is through the use of countermeasure devices. Research on countermeasure devices has focused on methods that detect physiological changes from fatigue, with the fast temporal resolution from brain signals, using the electroencephalogram (EEG) held as a promising technique. This paper presents the results of nonlinear analysis using sample entropy and second-order difference plots quantified by central tendency measure (CTM) on alert and fatigue EEG signals from a driving simulated task. Results show that both sample entropy and second-order difference plots significantly increases the regularity and decreases the variability of EEG signals from an alert to a fatigue state.