Ecology of emergency care in lower-tier healthcare providers in Ghana: an empirical data-driven Bayesian network analytical approach

The healthcare landscape in Ghana is primarily composed of lower-tier providers, which serve as the initial  point of contact for most medical emergencies. This study aimed to assess the emergency care preparedness and readiness of primary healthcare providers using a robust evaluation approach. A multicentre retrospective cross-sectional study was conducted on  460 healthcare facilities  using the standardised Health Facilities Emergency Preparedness Assessment Tool (HeFEPAT). Data were analysed via Bayesian Belief network. Emergency preparedness was associated with facility location, type, ownership, and in-charge personnel. Over 70% of facilities lacked specialised emergency/critical care personnel. Although 65% of in-charges reported protocol knowledge, only 7.8% could execute cardiopulmonary resuscitation. 90% of facilities lacked onsite defibrillators, and over 80% had no cerebrovascular accident medications. Road traffic accident protocols were largely unavailable, with an  estimated 53% probability of  lacking such protocols. Private-owned facilities were more likely to lack protocols for road traffic accidents (76% vs 20% probability) and general acute care (62% vs 32%) compared to government-owned facilities. Significant gaps in emergency preparedness were identified across the studied health facilities, indicating limited capacity to manage critical situations effectively. Urgent investments in emergency medicine training, essential resources, and evidence-based protocols are needed. Standardised emergency preparedness assessments should be implemented for accreditation and quality improvement. Further research can inform the development of national guidelines and targeted interventions to strengthen emergency response capacities.

Socio-demographic effects on role assignment and associated occupational health and safety issues in artisanal and small-scale gold mining in Amansie Central District, Ghana

The study employed the binary logistic regression model, Chi-square, and likelihood ratio test to explore the nexus between socio-demographic characteristics and role assignment as well as Occupational Health and Safety (OHS) issues in artisanal and small-scale gold mining (ASGM) undertakings in the Amansie Central District of Ghana. Simple random sampling was employed to sample 250 respondents from three (3) different mining sites. The results revealed that socio-demographic variables such as age, gender, and work experience significantly impacted the type of role assumed by individuals in ASGM undertakings. For the socio-demographic effects on OHS issues, male respondents especially those in the age group between 18 and 35 with less work experience and education had a higher risk of recording injuries/accidents. Other risk factors such as types of role, reasons for ASGM, awareness of OHS hazards, awareness of Personal Protective Equipment (PPE), usage of PPE, arrest for not using PPE, cost of PPE, and frequency of buying PPE had a statistically significant influence on the occurrence of injuries/accidents. It is recommended that the Government implement initiatives to ensure that workers in ASGM operations in Ghana are provided with training, education, resources, and support services to ensure their safety and well-being, taking into account their socio-demographic characteristics. Also, the government and related stakeholders create more jobs through sustainable mining with long-term potential in local districts to address goals 1 (No poverty) and 2 (zero hunger) of the sustainable development goals.

Urban Sprawl On Microclimate In The Ga East Municipality Of Ghana

Climatic elements such as temperature and rainfall provide great and unquantifiable benefits to human health. However, rapid urban sprawl has the tendency to undermine these health consequences. The relationship between urban sprawl and microclimate in the Ga East Municipality has been assessed to present the extent of sprawl that inhibit temperature and rainfall in recent times. Methodologically, satellite imagery and meteorological data (minimum and maximum temperature and rainfall) from 1990 to 2020 were used. The results indicate that rapid urban sprawl in recent times has significantly undermined the local climate through land use and land cover changes. There was strong statistical relationships between temperature and built-up areas (p < 0.05), grass/shrub cover (p < 0.04) and all vegetation cover (p < 0.03). There was also strong statistical relationship between rainfall and built-up areas (p < 0.03), grass/shrub cover (p < 0.04) and all vegetation (p < 0.02). Thus, expansion in built up areas and reduced grass/shrub cover led to increases in temperature, rainfall and surface water run off while reduction in all vegetation led to increase in both temperature and rainfall. These changes in climate brought about by urban sprawl will affect crop production, increase cataclysmic floods as well as growth of some harmful insects. There is the need for the amalgamation of urban growth and climate change into spatial planning through an all-embracing approach.

Estimating the magnitude and risk associated with heat exposure among Ghanaian mining workers

Many occupational settings located outdoors in direct sun, such as open cut mining, pose a health, safety, and productivity risk to workers because of their increased exposure to heat. This issue is exacerbated by climate change effects, the physical nature of the work, the requirement to work extended shifts and the need to wear protective clothing which restricts evaporative cooling. Though Ghana has a rapidly expanding mining sector with a large workforce, there appears to be no study that has assessed the magnitude and risk of heat exposure on mining workers and its potential impact on this workforce. Questionnaires and temperature data loggers were used to assess the risk and extent of heat exposure in the working and living environments of Ghanaian miners. The variation in heat exposure risk factors across workers' gender, education level, workload, work hours, physical work exertion and proximity to heat sources is significant (p<0.05). Mining workers are vulnerable to the hazards of heat exposure which can endanger their health and safety, productive capacity, social well-being, adaptive capacity and resilience. An evaluation of indoor and outdoor Wet Bulb Globe Temperature (WBGT) in the working and living environment showed that mining workers can be exposed to relatively high thermal load, thus raising their heat stress risk. Adequate adaptation policies and heat exposure management for workers are imperative to reduce heat stress risk, and improve productive capacity and the social health of mining workers.

Construct validity of the Suboptimal Health Status Questionnaire-25 in a Ghanaian population

Background

The Suboptimal Health Status Questionnaire-25 (SHS-Q-25) developed to measure Suboptimal Health Status has been used worldwide, but its construct validity has only been tested in the Chinese population. Applying Structural Equation Modelling, we investigate aspects of the construct validity of the SHS-Q-25 to determine the interactions between SHS subscales in a Ghanaian population.

Methods

The study involved healthy Ghanaian participants (n = 263; aged 20–80 years; 63% female), who responded to the SHSQ-25. In an exploratory factor and parallel analysis, the study extracted a new domain structure and compared to the established five-domain structure of SHSQ-25. A confirmatory factor analysis (CFA) was conducted and the fit of the model further discussed. Invariance analysis was carried out to establish the consistency of the instrument across multi-groups.

Results

The extracted domains were reliable with Cronbach’s \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\alpha$$\end{document}α of 0.846, 0.820 and 0.864 respectively, for fatigue, immune-cardiovascular and cognitive. The CFA revealed that the model fit indices were excellent \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\left( {{\text{RMSEA}} = 0.049~ < ~0.08,\,{\text{CFI}} = 0.903 > 0.9,\,{\text{GFI}} = 0.880 < 0.9,\,{\text{TLI}} = 0.907 > 0.9} \right)$$\end{document}RMSEA=0.049<0.08,CFI=0.903>0.9,GFI=0.880<0.9,TLI=0.907>0.9. The fit indices for the three-domain model were statistically superior to the five-domain model. There were, however, issues of insufficient discriminant validity as some average variance extracts were smaller than the corresponding maximum shared variance. The three-domain model was invariant for all constrained aspects of the structural model across age, which is an important risk factor for most chronic diseases.

Conclusion

The validity tests suggest that the SHS-Q25 can measure SHS in a Ghanaian population. It can be recommended as a screening tool to early detect chronic diseases especially in developing countries where access to facilities is diminished.

Construct validity and invariance assessment of the social impacts of occupational heat stress scale (SIOHSS) among Ghanaian mining workers

Heat exposure studies over the last decade have shown little attention in assessing and reporting the psychometric properties of the various scales used to measure impacts of occupational heat stress on workers. A descriptive cross-sectional survey including 320 small- and large-scale mining workers was employed to assess the construct validity of the social impacts of occupational heat stress scale (SIOHSS) in the Western Region of Ghana in 2017. A confirmatory factor analysis (CFA) and invariance analysis were carried out using AMOS version 25 and statistical product and service solutions (SPSS) version 26 to examine the model fit and establish consistency correspondingly across multiple groups (gender, age, working hours, type of mining and workplace setting). Empirically, our results depicted that effects on health and safety, behavioural, productivity and social well-being were each found to be reliable, with Cronbach's α of 0.722, 0.807, 0.852 and 0.900 respectively. Though there were issues of insufficient discriminant validity as some average variance extract (AVE) were smaller than the corresponding maximum shared variance (MSV), the CFA showed good model fit indices (CFI = 0.856, GFI = 0.890, TLI = 0.863, SRMR = 0.08, RMSEA = 0.08). Also, the model was variant for all constrained aspects of the structural model indicating a requirement for an adaptation of the instrument across groups. The good to moderate internal consistency and construct validity of the SIOHSS is adequate evidence for the confidence required for its reliability and accuracy in measuring the social impacts of occupational heat stress on workers.

Construct Validity of the Suboptimal Health Status Questionnaire-25 in a Ghanaian Population.. [DOI: 10.21203/rs.3.rs-33104/v3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

Background: The Suboptimal Health Status Questionnaire-25 (SHS-Q-25) developed to measure suboptimal health status has been used worldwide, but its construct validity has only been tested in the Chinese population. In this article, we investigate aspects of the construct validity of the SHS-Q-25 to determine the interactions between SHS subscales in a Ghanaian population. Methods: The study involved healthy Ghanaian participants (n = 263; aged 20-80 years; 63% female), who responded to the SHSQ-25. In an exploratory factor and parallel analysis, the study extracted a new domain structure and compared to the established five-domain structure of SHSQ-25. A confirmatory factor analysis (CFA) was conducted and the fit of the model further discussed. Invariance analysis was carried out to establish the consistency of the instrument across multi-groups. Results: The extracted domains were reliable with Cronbach’s of 0.861, 0.821 and 0.853 respectively, for fatigue, immune-cardiovascular and cognitive, confirming the construct validity of the SHSQ-25 instrument. The CFA revealed that the model fit indices were excellent but the fit indices for the three-domain model were statistically superior to the five-domain model. There were, however, issues of insufficient discriminant validity as some average variance extracts (AVE) were smaller than the corresponding maximum shared variance (MSV). The three-domain model was invariant for all constrained aspects of the structural model across age, which is an important risk factor for most chronic diseases. Conclusion: The validity tests provide evidence to endorse the credibility of the tool and suggest that the SHS-Q25 can measure SHS in a Ghanaian population. It can be recommended as a screening tool to early detect possible for chronic diseases especially in developing countries where the access to facilities is diminished.

Construct Validity of the Suboptimal Health Status Questionnaire-25 in a Ghanaian Population.. [DOI: 10.21203/rs.3.rs-33104/v2]

Background: The Suboptimal Health Status Questionnaire-25 (SHS-Q-25) developed to measure suboptimal health status has been used worldwide, but its construct validity has only been tested in the Chinese population. In this article, we investigate aspects of the construct validity of the SHS-Q-25 to determine the interactions between SHS subscales in a Ghanaian population.Methods: The study involved healthy Ghanaian participants (n = 263; aged 20-80 years; 63% female), who responded to the SHSQ-25. In an exploratory factor and parallel analysis, the study extracted a new domain structure and compared to the established five-domain structure of SHSQ-25. A confirmatory factor analysis (CFA) was conducted and the fit of the model further discussed. Invariance analysis was carried out to establish the consistency of the instrument across multi-groups. Results: The extracted domains were reliable with Cronbach’s B of 0.861, 0.821 and 0.853 respectively, for fatigue, immune-cardiovascular and cognitive, confirming the construct validity of the SHSQ-25 instrument. The CFA revealed that the model fit indices were excellent a The fit indices for the three-domain model were statistically superior to the five-domain model. There were, however, issues of insufficient discriminant validity as some average variance extracts (AVE) were smaller than the corresponding maximum shared variance (MSV). The three-domain model was invariant for all constrained aspects of the structural model across age, which is an important risk factor for most chronic diseases.Conclusion: The validity tests provide evidence to endorse the credibility of the tool and suggest that the SHS-Q25 can measure SHS in a Ghanaian population. It can be recommended as a screening tool to early detect possible for chronic diseases especially in developing countries where the access to facilities is diminished.

Barriers to occupational heat stress risk adaptation of mining workers in Ghana

Increasing temperature and climate warming impacts are aggravating the vulnerability of workers to occupational heat stress. Adaptation and social protection strategies have become crucial to enhance workers' health, safety, productive capacity and social lives. However, the effective implementation of work-related heat stress adaptation mechanisms appears to be receiving little attention. This study assessed the barriers to occupational heat stress adaptation and social protection strategies of mining workers in Ghana. Based on a mixed methods approach, focus group discussions and questionnaires were used to elicit data from 320 mining workers. Workers' adaptation strategies (water intake, wearing loose and light-coloured clothing, participating in training programmes, taking regular breaks, use of mechanical equipment, use of cooling systems and housing designs) varied significantly across the type of mining activity (p < .001). Workers' social protection measures were adequate. The disparities in workers' social protection measures significantly differed across the type of mining activity (p < .001). Barriers of workers to the implementation of relevant adaptation strategies (inadequate knowledge of coping and adaptive behaviour, lack of regular training on adaptation measures, lack of specific heat-related policy regulations, lack of management commitment and the lack of access to innovative technology and equipment) also differed across the type of mining activity (p < .001). Adaptation policy options and recommendations centred on overcoming the barriers that constrain the adaptive capacity of workers and employers have the potential to reduce workers' vulnerability to occupational heat stress.

Construct Validity of the Suboptimal Health Status Questionnaire-25 in a Ghanaian Population.. [DOI: 10.21203/rs.3.rs-33104/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

BackgroundThe Suboptimal Health Status Questionnaire-25 (SHS-Q-25) developed to measure suboptimal health status has been used worldwide, but its construct validity has only been tested in the Chinese population. In this article, we investigate aspects of the construct validity of the SHS-Q-25 to determine the interactions between SHS subscales in a Ghanaian population.MethodsThe study involved healthy Ghanaian participants (n = 263; aged 20-80 years; 63% female), who responded to the SHSQ-25. In an exploratory factor and parallel analysis, the study extracted a new domain structure and compared to the established five-domain structure of SHSQ-25. A confirmatory factor analysis (CFA) was conducted and the fit of the model further discussed. Invariance analysis was carried out to establish the consistency of the instrument across multi-groups.ResultsThe extracted domains were reliable with Cronbach’s B of 0.861, 0.821 and 0.853 respectively, for fatigue, immune-cardiovascular and cognitive, confirming the construct validity of the SHSQ-25 instrument. The CFA revealed that the model fit indices were excellent a The fit indices for the three-domain model were statistically superior to the five-domain model. There were, however, issues of insufficient discriminant validity as some average variance extracts (AVE) were smaller than the corresponding maximum shared variance (MSV). The three-domain model was invariant for all constrained aspects of the structural model across age, which is an important risk factor for most chronic diseases.ConclusionThe validity tests provide evidence to endorse the credibility of the tool and suggest that the SHS-Q25 is robust tool for measuring SHS in a different population.

Evaluation of heat stress impacts and adaptations: perspectives from smallholder rural farmers in Bawku East of Northern Ghana

Across the tropical developing countries, smallholder farmers are confronted with various climate related risks that hinge on agricultural activities. Climate change is predicted to impact smallholder farmers and their livelihood, especially within and beyond this century. Several studies have examined the impact of drought and rainfall on smallholder farmers as climate change impact assessment. However, there is limited information on impacts and coping strategies of poor farmers to heat exposure at household and farm level in tropical developing countries. As global temperature is predicted to increase with robust impacts on farmers in African region due to poverty and low adaptive capacity, this study evaluates how farmers in Bawku East of Northern Ghana experience the impacts of heat stress and how they cope with it both at the household level and on the field of cultivation. Using household survey and focus group discussion, the authors elicited impacts and responses of heat exposure from 308 resident farmers in three selected farming communities in Bawku East to gauge their vulnerability to heat exposure. Even though farmers have various impacts and coping strategies to heat exposure, these are ineffective to prevent them from heat related morbidity and mortality at both household and farm level. The study recommends the need for government led intervention to assist farmers in their effort to cope with heat stress as global temperatures will exacerbate heat stress impacts on small holder farmers especially in African region.

An assessment of house-hold solid waste management in a large Ghanaian district

The importance of waste management cannot be overemphasized. Improper waste management and disposal has rippling effect on the environment and human health. The aim of this study is to assess solid waste management among household in a large Ghanaians district. Multi-stage sampling technique comprising a cluster, simple random sampling, and systematic sampling techniques were used to select 600 respondents for the study. Data was analyzed using (SPSS) version 23.0. Results indicates that communal waste collection bins were far from households as confirmed by the majority (57.3%) of the respondents. The majority (56.5%) of the households walked a distance of 11-15 min before reaching the refuse site. The study found that the number of waste collection point in the community were few (1-3 collection bins) as confirmed by majority (92.2%) of the respondents. The distance from the center of the community to the final waste disposal site covered 1-2 h journey. There was a significant relationship between the number of waste disposal sites in the community and the average distance (in kilometers one way) from the city center to a disposing site. In conclusion, the study found that communal waste collection bins were far from households; number of waste collection point in the community were few. This indicates that the distance from the center of the community to the final waste disposal site covered 1-2 h journey. Based on the major findings of the study, we recommend that district assembly should provide waste collection bins to every household to ensure that residents do not dispose their housrhold waste indiscriminately. District by-laws should be strengthened to ensure proper household waste disposal at all districts in Ghana.

The nexus between social impacts and adaptation strategies of workers to occupational heat stress: a conceptual framework

Adverse effects of occupational heat stress in the context of the changing climate on working populations are subtle but considerably harmful. However, social dimensions and impacts of climate change-related occupational heat concerns on workers' safety and health, productivity and well-being are often overlooked or relegated as minor issues in social impact analyses of occupational heat exposure due to climate change. This paper offers a conceptual framework based on an appraisal and synthesis of the literature on social impacts of climate change-related occupational heat exposure on workers' safety and health, productivity and social welfare and the quest to localise and achieve sustainable development goals. A sustained global, national, institutional and individual collaborative involvement and financial support for research, improved adaptation and social protection strategies, predominantly in the developing world, where a large number of people work outdoors, can reduce heat exposure and boost the resilience and adaptive capacity of workers to facilitate efforts to achieve sustainable development goals.

Perceptions of climate change and occupational heat stress risks and adaptation strategies of mining workers in Ghana

Heavy physical workload for long hours coupled with increasing workplace heat exposure due to rising temperatures stemming from climate change, especially where there are inadequate prevention and control policies, adversely affect workers' health and safety, productive capacity and social well-being. However, variations in workers' concerns and awareness of occupational heat stress and climate change risks impede the effectiveness of heat stress management. A mixed method approach was used to assess climate change perceptions and occupational heat stress risks and adaptation strategies of Ghanaian mining workers. Questionnaires and focus group discussions were used to collect data from 320 respondents. Quantitative and qualitative approaches were used for data analysis. Workers' climate change risk perception, as confirmed by trends in climate data, was reasonable, but concerns about climate change effects and workplace heat exposure risks varied significantly across types of mining activity (p < 0.001). Workers experienced heat-related morbidities, but the variation in heat-related morbidity experiences across the type of mining activity was not significant. However, the type of heat-related morbidities experienced by workers differed across the type of mining activity (p < 0.001). Workers' awareness of occupational heat stress prevention and control was adequate. The disparities in workers' awareness and use of the prevention and control measures significantly differed across the type of mining activity (p < 0.001). Occupational heat stress prevention activities should focus on workers, and a concerted effort must be made to promote workers' adaptive capacity and inform policy decisions.

Climate change and occupational heat stress risks and adaptation strategies of mining workers: Perspectives of supervisors and other stakeholders in Ghana

Increasing air temperatures as a result of climate change are worsening the impact of heat exposure on working populations, including mining workers, who are at risk of suffering heat-related illnesses, injury and death. However, inadequate awareness of climate change-related occupational heat stress risks and adaptation strategies have been shown to render occupational heat stress management ineffective. A concurrent mixed-methods approach was used to assess the perceptions of climate change and occupational heat stress risks and adaptation strategies of mining workers among supervisory personnel and other stakeholders in Ghana. Questionnaires and interviews were used to elicit data from 19 respondents. Data were processed and interpreted using descriptive statistics, chi-square and Fisher's exact tests, and thematic analysis. Supervisors' climate change risks perception was adequate, and their concern about workplace heat exposure risks was moderate. Mining workers' occupational heat stress risks experiences were linked to heat-related illness and minor injuries. Mining workers' adaptation strategies included water intake, use of cooling mechanisms, work-break practices, and clothing use. The related differences in job experience in the distribution of climate change risk perception and occupational heat stress risk experiences, and the difference in educational attainment in the distribution of adaptation strategies of occupational heat stress were significant (p < 0.05). Hence, an effective workplace heat management policy requires adequate understanding of occupational heat stress risks and adaptation policies and continued education and training for mining workers.

Social impacts of occupational heat stress and adaptation strategies of workers: A narrative synthesis of the literature

Dimensions of risks and impacts of occupational heat stress due to climate change on workers' health and safety, productivity, and social well-being are significantly deleterious. Aside from empirical evidence, no systematic review exists for policy development and decision making in managing occupation heat stress impacts and adaptation strategies of workers. This study sought to synthesise evidence on the social impacts of occupational heat stress and adaptation strategies of workers. From a review of existing literature, eight categories were obtained from 25 studies and grouped into three syntheses: (1) awareness of occupational heat stress, (2) social impacts of occupational heat stress and (3) workers' adaptation to occupational heat stress due to changing climate. Awareness of occupational heat stress among workers varied and their social impacts were related to workers' health and safety, productivity and social well-being. Sustainable adaptation to occupation heat stress due to climate change hinges on financial resource availability. Adequate investment and research are required to develop and implement policies to combat the threat of rising temperature and climate change to enhance workers' adaptive capacity, boost resilience and foster sustainable development.

A Review of Heat Stress Policies in the Context of Climate Change and Its Impacts on Outdoor Workers

Record-breaking summer heat events are increasing in frequency in Zimbabwe and 2016 was a particularly hot year with the country experiencing its worst heat wave event in decades. Currently, Zimbabwe has no coordinated public health response to deal with heat wave events and no specific data on heat-related morbidity and mortality. The country has no legislation for protecting workers against environmental heat exposure, particularly those most vulnerable who are employed in the informal sector. These workers are also at risk due to their outdoor work environments. The article outlines the state of climate and heat stresses in Zimbabwe, as benchmarked against other African countries and France. It further summarizes outdoor workers' susceptibility to heat exposure and the need for the Zimbabwean Government to develop policies to ensure the health and safety of an increasing population of outdoor workers in Zimbabwe.

Profiling of cardio-metabolic risk factors and medication utilisation among Type II diabetes patients in Ghana: a prospective cohort study

BACKGROUND

Type II diabetes mellitus (T2DM) is complicated by multiple cardio-metabolic risk factors. Controlling these factors requires lifestyle modifications alongside utilisation of anti-diabetic medications. Different glucose lowering [(biguanides (BIGs), sulfonylureas (SUAs), thiazolidinediones (TNZ)], lipid lowering (statins), and anti-hypertensive medicines [angiotensin converting enzyme inhibitors (ACEIs), calcium channel blockers (CCBs), angiotensin II receptor blockers (ARBs) and central acting drugs (CADs)] have been approved for controlling hyperglycaemia, dyslipidaemia and hypertension respectively. Here, we examined factors that characterise T2DM and explored the response to medication therapy among T2DM patients.

METHODS

This prospective cohort study recruited 241 T2DM patients reporting at a clinic in Ghana, from January through to August, 2016. Each patient's demographic, medications and anthropometric data was obtained while information on medication adherence was captured using Morisky adherence scale-8 (MMAS-8). Fasting blood samples were collected for biochemical analysis.

RESULTS

The mean age of participants was 57.82 years for baseline and six-month follow-up. Physical activity differed at baseline and follow up (p < 0.05) but not body mass index (BMI). BIG alone, or in combination with SUA and TNZ did not improve glycaemic status at follow up (p > 0.05). Many participants using either ACEI or ARB were able to control their blood pressures. Among dyslipidaemia patients under statin treatment, there was an improved lipid profile at follow-up.

CONCLUSIONS

Statin medications are effective for reducing dyslipidaemia in T2DM patients. However, control of modifiable risk factors, particularly blood glucose and to a lesser degree blood pressure is suboptimal. Addressing these will require concomitant interventions including education on medication adherence and correct dietary plans, lifestyle modifications and physical activity.

Emerging issues in public health: a perspective on Ghana's healthcare expenditure, policies and outcomes

Ghana's healthcare expenditure has increased over the past two decades. Increased healthcare expenditures are required to enhance the acquisition of better hospital resources that may improve healthcare. This study presents an overview of healthcare expenditures and health outcomes (i.e. infant mortality, under-5 mortality and life expectancy) from 1995 to 2014 in Ghana. Infant and under-5 mortalities have declined by 50 and 25%, respectively, as of 2014, while life expectancy has increased from 60.7 to 64.8 years. Private spending on health, especially out-of-pocket payments, declined but is higher than the World Health Organization's recommended financial threshold. Non-communicable diseases (NCDs) are rising with healthcare costs leading to catastrophically high healthcare expenditures in the future. While government's investments on healthcare have yielded positive results, the improvement in the health outcomes cannot be attributed to increased health expenditure alone. Therefore, this paper outlines policies on maternal health, national health insurance and healthcare reforms that have influenced health outcomes. In parallel, the paper highlights challenges of the Ghana health system of which the major ones are (1) inadequate financial investments in health and (2) limited health workforce and facilities. These challenges can be ameliorated by (1) establishing new health institutions and expanding existed ones; (2) providing incentives to discourage the exodus of health workers; (3) introduction of the concept of predictive, preventive and personalized medicine (PPPM) for treating NCDs; and (4) alternative insurance schemes for vulnerable groups. This, coupled with the will of the government to curb misappropriation of funds, will be important to achieving better health outcomes.

Heat exposure on farmers in northeast Ghana

Environmental health hazards faced by farmers, such as exposure to extreme heat stress, are a growing concern due to global climate change, particularly in tropical developing countries. In such environments, farmers are considered to be a population at risk of environmental heat exposure. The situation is exacerbated due to their farming methods that involve the use of primitive equipment and hard manual labour conducted in full sunshine under hot and humid conditions. However, there is inadequate information about the extent of heat exposure to such farmers, both at the household and farm levels. This paper presents results from a study assessing environmental heat exposure on rural smallholder farmers in Bawku East, Northern Ghana. From January to December 2013, Lascar USB temperature and humidity sensors and a calibrated Questemp heat stress monitor were deployed to farms and homes of rural farmers at Pusiga in Bawku East to capture farmers' exposure to heat stress in both their living and working environments as they executed regular farming routines. The Lascar sensors have the capability to frequently, accurately and securely measure temperature and humidity over long periods. The Questemp heat stress monitor was placed in the same vicinity and showed strong correlations to Lascar sensors in terms of derived values of wet-bulb globe temperature (WBGT). The WBGT in the working environment of farmers peaked at 33.0 to 38.1 °C during the middle of the day in the rainy season from March to October and dropped to 14.0-23.7 °C in the early morning during this season. A maximum hourly WBGT of 28.9-37.5 °C (March-October) was recorded in the living environment of farmers, demonstrating little relief from heat exposure during the day. With these levels of heat stress, exposed farmers conducting physically demanding outdoor work risk suffering serious health consequences. The sustainability of manual farming practices is also under threat by such high levels of heat exposure.

Review of Climate Change Adaptation and Social Protection Policies of Ghana

Smallholder farming has become a significant livelihood coping strategy of the population in Ghana. However, in the last decade the upsurge of climate change and the effect of heat stress vulnerability on smallholder farmers in Northern Ghana are alarming. This article investigates the chances of using social protection and climate change adaptation policies towards the management of risks associated with heat stress emanating from climate change. It reviews salient literature on heat stress, social protection, and climate change policies and develops a model upon which both domestic and international interest in climate and social protection policies of Ghana and Sub-Sahara Africa can reduce or aggravate heat stress impacts on smallholder farmers both at their working environment and at household level. It exemplifies the efficacy of the strength of social protection and climate change adaptation policies in Ghana and its impacts on vulnerable rural smallholder farmers and how such situation is replicated in many parts of Africa. It outlines further measures that can be undertaken by governments and international donor agencies to revamp the destitution of smallholder farmers to climate change and heat stress in African region.

Synthesis of quaternary carbon centers via hydroformylation

The application of hydroformylation to the synthesis of quaternary carbon centers is reported. The synthesis of the highly substituted carbon is achieved by applying a catalytic amount of 1. Ligand 1 serves as a catalytic directing group by covalently and reversibly binding to both the substrate and catalyst. The intramolecular nature of the directing group strategy accelerates the hydroformylation reaction such that the reaction is performed at mild temperatures (35-55 degrees C) and with excellent regioselectivity (b:l > 94:6).

Cotransduction of nondividing cells using lentiviral vectors

Diseases such as AIDS and cancers may require the introduction of multiple genes into either stem cells or nondividing cells, among others, for therapeutic purposes. Such genes may act at different points of the disease pathway, or may constitute a regulatory loop to bypass or rectify the defective gene or pathway underpinning the disease. Ideally, the therapeutic genes must be transduced together in diverse combinations, and the introduction should occur without constraints. Since lentiviral vectors can transduce both dividing and nondividing cells, they are ideal vehicles to investigate combinatorial gene transfer into diverse cells. In this study, we demonstrate that by using two independent lentiviral vectors, pseudotyped with the protein g of vesicular stomatitis virus, up to four genes can be introduced simultaneously into single dividing and nondividing cells. Up to 45% and 73% of dividing and nondividing cells, respectively, could be transduced with two lentiviral vectors. The efficiency of cotransducing a single cell was the product of the individual transduction efficiencies and suggested the absence of viral interference. Multiple and combinatorial gene transduction using lentiviral vectors may prove useful in gene therapy.

Inhibition of HIV replication by dominant negative mutants of Sam68, a functional homolog of HIV-1 Rev

The HIV-1 Rev protein facilitates the nuclear export of mRNA containing the Rev response element (RRE) through binding to the export receptor CRM-1. Here we show that a cellular nuclear protein, Sam68 (Src-associated protein in mitosis), specifically interacts with RRE and can partially substitute for as well as synergize with Rev in RRE-mediated gene expression and virus replication. Differential sensitivity to leptomycin B, an inhibitor of CRM-1, indicates that the export pathways mediated by Rev and Sam68 are distinct. C-terminally deleted mutants of Sam68 inhibited the transactivation of RRE-mediated expression by both wild-type Sam68 and Rev. They were retained in the cytoplasm and impeded the nuclear localization of Rev in co-expressed cells. These mutants also inhibited wild-type HIV-1 replication to the same extent as the RevM10 mutant, and may be useful as anti-viral agents in the treatment of AIDS.

Catalysis by Syrian hamster 3-hydroxy-3-methylglutaryl-coenzyme A reductase. Proposed roles of histidine 865, glutamate 558, and aspartate 766

We employed the overexpressed catalytic domains of wild-type Syrian hamster 3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMG-CoA reductase, EC 1.1.1.34) and of mutant enzymes E558Q, H865Q, and D766N to investigate the roles of Glu558, His865, and Asp786 in catalysis. Five reactions were studied: reductive deacylation of HMG-CoA or of mevaldyl-CoA to mevalonate, reduction of mevaldehyde to mevalonate, oxidation of mevaldyl-CoA to HMG-CoA, and oxidative acylation of mevaldehyde to HMG-CoA. While only the wild-type enzyme catalyzed all five reactions, mutant enzymes E558Q and H865Q catalyzed other reactions at significant rates. Mutant enzyme D766N, although apparently structurally similar to the wild-type enzyme, was inactive for all five reactions. While an ineffective catalyst for the overall reaction, mutant enzyme H865Q catalyzed the reduction of mevaldehyde to mevalonate at about the wild-type rate. Coenzyme A, which stimulated mevaldehyde reduction by the wild-type enzyme, inhibited mutant enzyme H865Q, apparently due to an impaired ability to protonate the coenzyme A thioanion, CoAS-. Based on these data, we infer that Glu558, His865, and Asp766 function in catalysis at the indicated stage of the overall reaction, [formula: see text] and we propose a revised mechanism for catalysis by mammalian HMG-CoA reductases.

The active site of hamster 3-hydroxy-3-methylglutaryl-CoA reductase resides at the subunit interface and incorporates catalytically essential acidic residues from separate polypeptides

We employed site-directed mutagenesis based on sequence comparisons and characterization of purified mutant enzymes to identify Glu558 and Asp766 of Syrian hamster 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase (EC 1.1.1.34) as essential for catalysis. Mutant enzymes E558D, E558Q, and D766N had wild-type Km values for (S)-HMG-CoA and NADPH, but exhibited less than 0.5% of the wild-type catalytic activity. The inactive mutant polypeptides E558Q and D766N nevertheless can associate to generate an active enzyme. In vitro, 6% of the wild-type activity was observed when mutant polypeptides E558D and D766N were mixed in the absence of chaotropic agents. When mutant polypeptides E558Q and D766N were co-expressed in Escherichia coli, the resulting purified enzyme had 25% of wild-type activity. Hamster HMG-CoA reductase thus is a two-site, dimeric enzyme whose subunits associate to form an active site in which each monomer contributes at least one residue (e.g. Glu558 from one monomer and Asp766 from the other). The wild-type enzyme behaves as a dimer during size exclusion chromatography and has one HMG-CoA binding site per monomer. Syrian hamster HMG-CoA reductase thus appears to be a homodimer with two active sites which are located at the subunit interface.

Syrian hamster 3-hydroxy-3-methylglutaryl-coenzyme A reductase expressed in Escherichia coli: production of homogeneous protein

When overexpressed in Escherichia coli, the catalytic domain of Syrian hamster 3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMG-CoA reductase, EC 1.1.1.34) is catalytically active, but exhibits major heterogeneity. This heterogeneity reflects deletion of about 60 aminoacyl residues from the C-terminus, presumably a result of proteolytic cleavage or premature termination of translation. With the intent of separating the intact and truncated proteins via immunoaffinity chromatography, we constructed the expression phagemid pKFT7-21. This construct encodes the catalytic domain of Syrian hamster HMG-CoA reductase with the C-terminal extension Glu-Glu-Phe, an epitope recognized by a specific antibody. Following overexpression, the modified catalytic domain RcatEEF had high catalytic activity and exhibited no heterogeneity. It therefore was possible to purify RcatEEF to over 95% homogeneity without resorting to immunoaffinity chromatography. The yield of homogeneous protein averaged 20-25 mg per liter of cells with a final specific activity of up to 40 mumol NADPH oxidized per minute per milligram. The EEF modification thus should prove useful for the purification of the catalytic domains of other eukaryotic HMG-CoA reductases which exhibit heterogeneity.

[Management of rejection following heart transplantation using oral steroid medication]

After 47 orthotopic heart transplantations with long-term immunosuppression (cyclosporin A, 3-10 mg/kg; azathioprine, 1-2 mg/kg; prednisolone 0.1 mg/kg) there were 306 episodes of acute rejection. In 44 of these (14.8%) the oral prednisolone dosage was increased, from a mean of 10.8 +/- 2.95 mg/d to 36.6 +/- 7.2 mg/d, followed by stepwise reduction to the original maintenance dose. Compared with the customary intravenous bolus administration (1.0 g/d for three days: success rate 89%), the oral schedule was successful in 33 of the 44 episodes of rejection (75%). It is concluded that in selected patients acute rejection episodes after heart transplantation can be successful treated by an increase in the oral dose of steroids without changing the dosage of the other two immunosuppressive drugs.