Search

Abstract: Background: High-risk HPV (HR-HPV) are associated with the development of cervical cancer, the most common cancer in women in developing countries. Reliable diagnosis of HR-HPV infection combined with simple procedures to collect and store biological samples, could improve primary screening programs and vaccine strategies in these areas. Objective: To evaluate HR-HPV detection in conventional and dried samples. Study design: The presence of HR-HPV in 31 women in Republic of Congo (Central Africa) has been investigated by using standard cervical samples and dried cervical samples collected on filter paper and vaginal tampons. The detection of HPV DNA was performed in the Laboratory of virology in Lille (France) by using Hybrid capture 2 and HPV 16/18/45 Probe Set Test. Results: 22 standard samples were found positive for the detection of HR-HPV (71%). HPV 16/18/45 was displayed in 15 out of 22 samples positive for HR-HPV (68%). The correlations between HPV detection by using standard samples and samples dried on filter paper and dried tampons were 90.3% (kappa=0.77) and 80.6% (kappa=0.5) respectively. The sensitivity and the specificity of HPV detection reached 91% and 89%, respectively, with samples dried on filter paper and were 86% and 67%, respectively, for dried tampons compared with standard samples. Conclusion: Dried cervical samples and dried vaginal tampons can represent an alternative to conventional sampling to reduce barriers to large screening programs in developing countries and to facilitate storage and transport to reference centers. [Copyright &y& Elsevier]

The role of eHealth in conflict settings is increasingly important to address geographic, epidemiologic and clinical disparities. This study categorizes various forms of eHealth usage in conflict and aims to identify gaps in evidence to make recommendations for further research and practice. The analysis was carried out via a narrative hermeneutic review methodology. Articles that fulfilled the following screening criteria were reviewed: (1) describing an eHealth intervention in active conflict or ongoing insurgency, (2) an eHealth intervention targeting a conflict-affected population, (3) an e-learning platform for delivery in conflict settings and (4) non-interventional descriptive reviews relating to eHealth in conflict. Of the 489 papers eligible for screening, 46 merited final inclusion. Conflict settings described include Somalia, Sudan, Afghanistan, Syria, Iraq, Pakistan, Chechnya, Gaza and the Democratic Republic of Congo. Thirty-six studies described specific eHealth initiatives, while the remainder were more generic review papers exploring general principles. Analysis resulted in the elucidation of three final categories of current eHealth activity in conflict-affected settings: (1) eHealth for clinical management, (2) e-learning for healthcare in conflict and (3) eHealth for information management in conflict. Obvious disparities in the distribution of technological dividends from eHealth in conflict are demonstrated by this review. Conflict-affected populations are predominantly subject to ad hoc and voluntary initiatives delivered by diaspora and civil society organizations. While the deployment of eHealth technologies in conflict settings is increasingly normalized, there is a need for further clarification of global norms relating to practice in this context. [ABSTRACT FROM AUTHOR]

This paper analyses the effect of natural resource wealth on sustainable economic development in the top 8 resource-abundant sub-Saharan African countries according to the World Bank Wealth of Nations 2018 over the period 1981–2017. The study incorporates public debt as an explanatory variable in our analysis, which is an extension of previous natural resource-growth estimations, to throw more light on how natural resource abundance and debt overhang simultaneously affect economic growth in resource-abundant sub-Saharan African (SSA) countries. The NARDL bounds testing approach and asymmetric Granger causality tests are employed. Long-run asymmetric effect results show that an increase in natural resource rents significantly increases economic growth in Equatorial Guinea. However, an increase in natural resource rents in the Congo republic negatively affects economic growth, validating the resource curse hypothesis. No significant effect was found in other countries studied. In terms of asymmetric causality results, no bidirectional causality between natural resource rents and economic growth was noted. We, however, identified a weak unidirectional asymmetric causality relationship running from economic growth to resource rents in the Congo Republic and natural resource rents to economic growth in South Africa. The study, therefore, suggests the implementation of efficient public debt management policies and an improvement in the quality of institutions for effective management of public loans and resource revenues to stimulate economic development in these resource-rich countries. [ABSTRACT FROM AUTHOR]

African region represents the weak point of the world economy. Many African countries have still not finished the process of transforming their economy. Agriculture represents only a minor portion of their economies' performance - however it is still a key sector of the economy (especially considering the number of people working in agriculture or people representing the agricultural population). The agricultural sector in many sub-Saharan countries is extremely sensitive and its stability affects the stability of the whole region. A very good example representing sub-Saharan Africa is the Democratic Republic of Congo (DRC). It is a country with a lot of potential, but it is classified among the poorest countries in the world. Its economy is extremely weak (despite its significant share in total GDP formation value), and underdeveloped. The share of agriculture in total GDP formation is over 42.5%. The number of people living in rural areas represents over 45 million out of a total of 75 million. The number of people working in agriculture is over 60% of the total economically active population. The economy of the country is extremely poor and fragile, mainly because of political instability. The aim of this paper is firstly to specify the position of agriculture in the DRC economy, and also to specify the production and trade commodity structure in relation to other African countries. The paper's ambition is to identify the most perspective commodities (groups of commodities), both for production and also for trade, and to recommend such a production and trade profile which would allow the DRC the possibility of improving its competitiveness - not only in relation to other African countries, but also in relation to the global market. The production and trade commodity structures are analysed through the application of the BCG method and competitiveness analysis. In relation to these objectives, the paper provides the following conclusions. The position of agriculture in the DRC economy is stable one. Furthermore, agriculture probably represents the most stable part of the DRC economy. According to the portfolio and competitiveness analyses, the most important commodity items for the DRC are the following: Rice paddy, Maize, and Cassava. The most competitive trade items are particularly Coffee, Tea, and Cocoa, and Sugar Raw centrifugal. The most notable weakness of DRC agriculture is the production of Wheat, Beverages, Poultry Meat, and Fixed Vegetable Oils. [ABSTRACT FROM AUTHOR]

This paper proposes to analyze the effects of access to credit on the performance of SMEs in Congo. To this end, we used the theoretical model developed by Stiglitz and Weiss (1981). From an econometric point of view, we estimated a multiple linear regression model using the ordinary least square technique due to the absence of endogeneity. This application, as well as the statistical and econometric analyses that followed, were carried out using microeconomic data from the survey of very small, small, medium-sized enterprises and artisans in the Congo, which was carried out thanks to the multiple contributions of the managers of the National Institute of Statistics (INS). As a result, it was found that access to credit is neutral with respect to the performance of SMEs. This result led to an economic policy implication. [ABSTRACT FROM AUTHOR]

This paper focuses on enforcement issues with regard to deepsea mineral mining in terms of unilateral and multilateral structures. It begins by exploring early forays into mineral mining, namely in the Democratic Republic of the Congo, and the necessity of the extractives industries generally. Next, this comment analyzes unilateral policy regimes, specifically through the lens of United States courts and through differing mining regulatory regimes between countries, and how unilateral regulatory change is likely an ineffective mechanism for enforcing standards for the industry. Finally, this comment looks at international structures that currently govern deep-sea mineral mining and how multilateral regulatory regimes may provide an effective enforcement mechanism in the future. This comment addresses, among other things, (1) the origins of deep-sea mineral mining regulation under the International Seabed Authority; (2) domestic regulation of deep-sea mineral mining; (3) the environmental concerns associated with deep-sea mining; (4) how unilateral changes to regulatory regimes may create externalities that undermine enforcement efforts; and (5) dynamics of international norms and its effects on deep-sea mineral mining. It also explores potential solutions for industry regulations and how to systematize such regulations. It concludes that while the impacts of deep-sea mining are not thoroughly understood, there exist both domestic and international solutions to account for future unknown risk and possible incentive structures that can effectively direct countries toward compliance with international norms. Though this comment takes the position that unilateral policy efforts with regard to deep-sea mineral mining seem unlikely to be effective, it nonetheless recommends that the United States pass new legislation raising liability limits for deep-sea mining organizations similar in manner to the Oil Pollution Act of 1990. This comment further recommends that any international law-based changes include creating new international agreements, or amendments to existing agreements, to emplace incentive structures necessary for compelling compliance with international norms, which would grant the International Tribunal for the Law of the Sea (ITLOS) adjudicative authority and the World Trade Organization (WTO) the authority to provide specific, enforceable trade-based remedies for deep-sea mineral mining infractions. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to explore Congolese refugees and asylum seekers' survival strategies in South Africa, the focus of this paper will be on the role of the social worker. The paper is part of the study that was conducted on Congolese refugees and asylum seekers in South Africa post-war or conflicts. The study employed a qualitative research method and a descriptive case study of 10 female Congolese refugees living in Yeoville, Johannesburg South Africa. The participants have lived in South African for less than five years and there were 30–40 years of age. Data were collected by means of one-on-one in-depth interviews in the form of semi-structured interviews. Purposive sampling and snowball sampling techniques were used in the selection of participants. Thematic content analysis was used in analyzing the data collected. The paper provides recommendations on what role can social workers play can in mental wellbeing interventions. This study also contributes to a better understanding of mental wellbeing issues of Congolese refugees and asylum seekers. Ethical approval for this research study was obtained from the Department of Social Work Human Research Ethics Committee (Non-medical) of the University of Witwatersrand. [ABSTRACT FROM AUTHOR]

Conservation groups are always challenged with assigning limited resources to interventions they assume will have the most effective impact in addressing threats to their conservation targets. These decisions are often made based on experience and perceived outcomes, rather than evidence. In the past decade, multiple public awareness and proactive law enforcement activities have been initiated in the Congo Republic to address the illegal wildlife trade. This paper presents the challenges faced and lessons learned in shifting from experience to evidence‐based program evaluation related to the effectiveness of billboards in informing and inspiring local populations to support positive conservation behavior with regard to great apes. RESEARCH HIGHLIGHTS: Critical assumptions on public knowledge of wildlife laws influenced design of campaign, these assumptions were later proven inaccurate through campaign survey questionnaire resultsLinking falling rates of confiscations of chimpanzees to public awareness campaign through evidence‐based process is far more challenging than expectedRobust survey methods in public awareness campaigns is critical to attaining evidence to validate the effectiveness of these campaigns [ABSTRACT FROM AUTHOR]

Refugees and other displaced persons are exposed to many risk factors for unhealthy alcohol and other drug (AOD) use and concomitant mental health problems. Evidence-based services for AOD use and mental health comorbidities are rarely available in humanitarian settings. In high income countries, screening, brief intervention and referral to treatment (SBIRT) systems can provide appropriate care for AOD use but have rarely been used in low- and middle-income countries and to our knowledge never tested in a humanitarian setting. This paper describes the protocol for a randomised controlled trial to compare the effectiveness of an SBIRT system featuring the Common Elements Treatment Approach (CETA) to treatment as usual in reducing unhealthy AOD use and mental health comorbidities among refugees from the Democratic Republic of the Congo and host community members in an integrated settlement in northern Zambia. The trial is an individually randomised, single-blind, parallel design with outcomes assessed at 6-months (primary) and 12-months post-baseline. Participants are Congolese refugees and Zambians in the host community, 15 years of age or older with unhealthy alcohol use. Outcomes are: unhealthy alcohol use (primary), other drug use, depression, anxiety and traumatic stress. The trial will explore SBIRT acceptability, appropriateness, cost-effectiveness, feasibility, and reach. [ABSTRACT FROM AUTHOR]

This paper assesses the economy-wide impact of an agricultural project cultivating oil palms in specific rural areas of the Republic of Congo, an African country with a limited agricultural tradition and dominated by the mineral oil extraction sector. The project expects that all palm oil extracted will be used for domestic food consumption (direct human consumption or food processing). This paper illustrates a methodological framework to perform an impact analysis at local (rural) and supra-local (nationwide) levels and presents some preliminary results. Assessment is carried out by constructing and applying a multi-regional input-output model. The relevant economy-wide impacts are then computed using appropriate multipliers. Results provide evidence of a significant positive impact of the project in terms of both wealth and employment, though they also demonstrate how much the strong dominance of the oil economy within the country may limit cross-sector and cross-region effects. [ABSTRACT FROM AUTHOR]

This paper builds on the growing literature on the political resource curse by highlighting the potential impacts of risitarianing global commodity prices on good governance and peace-building in the Democratic Republic of Congo (DRC). It confirms the existence of the connection between natural resource dependence, armed conflict and weak governance, particularly in Sub-Saharan Africa. By focusing on the Democratic Republic of Congo, the paper contributes to the ongoing resource curse literature by highlighting the role of various mineral resources, the geographical distribution of such resources as well as the role of international state and non-state actors. The paper argues that the recent shift in the global terms of trade in favour of hard commodities due to the growing demand of China and India will present significant challenges for governance and peace-building as state and non-state actors attempt to gain control over lucrative natural resource rents. [ABSTRACT FROM AUTHOR]

This paper examined the causal relationship between financial development and energy consumption for a panel of nine African countries for the time period running from 1971 to 2014. In particular, the paper applied the bootstrap panel causality Granger causality test. The bootstrap panel Granger approach was adopted by the study because it allows both cross-sectional dependence and heterogeneity across countries. The results from the bootstrap panel Granger causality test indicate the presence of a unidirectional causality running from energy consumption to financial development for Congo Republic, Nigeria, Senegal and Zambia but not vice versa. However, for the rest of the sample countries, the two variables have no causal influence on each other. These results suggest that energy consumption promotes financial development in Congo Republic, Nigeria, Senegal and Zambia. [ABSTRACT FROM AUTHOR]

We conducted a systematic review of the scientific literature between 1996 and 2013 on rape in war-ridden Eastern Democratic Republic of Congo (DRC) in order to better understand the interest of the scientific community in describing the magnitude and characteristics of the problem. The literature search was conducted in French and English using several databases (Pubmed, PsycInfo, Sapphire, BDSP, Embase, Rero, and Web of Science) with the key words “rape and DRC” combined with several Medical Subject Headings concepts. Our systematic review yielded 2,087 references, among which only 27 are original studies, that is 20 are based on population surveys and the remaining 7 are original data based on case studies and reviews. Ten studies provided prevalence rates of rape victims, 18 provided specific information on the profile of the victims, 10 reported that most of the perpetrators of rape were military personnel, 14 referred to the negligence of the government in protecting victims, and 10 reported a lack of competent health-care facilities. The awareness of rape in conflict-ridden DRC is still limited as reported in the scientific literature: Published scientific papers are scarce. Yet more research would probably help mobilize local authorities and the international community against this basic human rights violation. [ABSTRACT FROM AUTHOR]

Background: The use of medicinal plants is integral to global healthcare systems, with Sub-Saharan Africa maintaining a robust tradition of herbal medicine alongside Western-oriented healthcare. As migrant communities tend to continue traditional herbal practices after migration, documenting this use is vital to develop culturally sensitive healthcare. This study investigates plant usage and perspectives in the context of sexual and reproductive health among the Congolese community in Belgium, particularly in the Matongé quarter of Brussels. Our research questions were: (1) What is the current knowledge of medicinal plants among the Congolese community in Belgium in the context of sexual health, and what are the applications and commonly employed administration methods of these plants? (2) What role does herbal medicine play in the context of sexual health for people of Congolese descent in Belgium and how this is influenced by perceptions of sexuality? and (3) Is there a gender bias in the use of medicinal plants, and if so, can this be related to perceived gender norms? Methods: We conducted 22 semi-structured interviews with people of Congolese descent currently living in Belgium. Participants were selected using both snowball sampling and purposive sampling. Plant use in the context of sexual health was recorded through freelisting. Data on narratives, ideas, and perceptions of this plant use in the context of sexual health were collected. Interview transcripts were analyzed using thematic analysis. Results: We identified 17 plant species used for sexual health. Three overarching themes emerged from our data. Plants were used with a notable gender bias favoring male sexual potency enhancement. Men used these plants for both remedying potency issues and enhancing sexual prowess. In contrast, knowledge about plants for female sexual health was limited. Gender norms reinforced the importance of male sexual potency, while stigmatizing open discussions of female sexuality. Conclusions: The use of medicinal plants for sexual health raises health, social, and conservation concerns, underscoring the need for further research in this area. This study contributes to understanding medicinal plant use within the Congolese community in Belgium and highlights the necessity for future research on herbal practices for female sexual health in this context. [ABSTRACT FROM AUTHOR]

The livelihood strategies of indigenous communities in the Congo Basin are inseparable from the forests, following their use of forest ecosystem goods and services (FEGS). Climate change is expected to exert impacts on the forest and its ability to provide FEGS. Thus, human livelihoods that depend on these FEGS are intricately vulnerable to climate impacts. Using the livelihood strategies of the two main forest indigenous groups; the Bantus and Pygmies, of the high forest zone of southern Cameroon; this paper examines the nature and pattern of their vulnerability to different climate risks as well as highlights how place of settlement in the forest contributes to the vulnerability of people in forest systems. Forests provide different capitals as FEGS and make direct and indirect contributions to livelihoods which are exploited differently by the two indigenous groups. The results show that vulnerability of forest communities is structured by lifestyle, culture and the livelihood strategies employed which are largely shaped by the place of settlement in the forest. The Pygmies living within the forests are engaged in nomadic gathering and foraging of non-timber forest resources. The Bantus prefer forest margins and are mostly preoccupied with sedentary farming, using the forest as additional livelihood opportunity. The contrasting lifestyles have implications on their vulnerability and adaptation to climate impacts which need to be taken into considerations in planning and implementation of national climate change adaptation strategies. [ABSTRACT FROM AUTHOR]

Abstract Among the rural Punu of Congo-Brazzaville, possession trance is an essential part of the mainly female celebrations dedicated to the bayisi or water spirits. It is a privileged medium through which these spirits reveal their wishes and conditions their willingness to assure the community's well-being. On the human side, in order to be possessed an 'opening of the mind' is requested and needs to be activated through collective song-dance performances that recall the flowing motions of the spirits' water world and convey the longing for this maternal universe. As a critique of the predominant use of the term 'agency' in reference to autonomy and resistance, this paper adheres to a context-based view that relies on the way the actors experience the phenomenon. In line with the Punu reality this paper considers receptivity, in its ambivalent link to suffering, as the main source of the power these possessions grant to women. [ABSTRACT FROM AUTHOR]

An index of economic vulnerability is developed and used with a more conventional measure of income poverty to explore vulnerability and chronic poverty in isolated rural communities. The method is applied to data from remote rural fishing-farming communities in Congo. The analysis highlights the high vulnerability of full-time fisherfolk and identifies mobility as a key factor increasing vulnerability. In line with other recent economic research, our work also shows that households can remain highly vulnerable even when their incomes lie well above the average local income. These different results are consistent with the more specialised literature on small-scale fisheries, confirming the robustness of the analysis proposed in this paper. [ABSTRACT FROM AUTHOR]

The objectives of this study were (1) to examine the prevalence of diabetes and hypertension among church personnel in North-Eastern Democratic Republic of Congo, and (2) to identify socio-demographic factors and health behaviors that are associated with these outcomes. Data for this study were obtained from a sample of 670 pastors and their wives, and other church workers in North-Eastern Congo in 2014/2015. Pearson chi square and binary logistic regression analyses were conducted with diabetes status and hypertension as outcome variables. A little over one in ten respondents (11.3 %; n = 76) were diabetic. Of the 76 respondents with diabetes, 49, or approximately two-thirds (64 %) were aged 50 and over. Of the respondents aged 70 and above, 85.5 % were found to be hypertensive. Adjusting for all other predictors, respondents who were older, market women/homemakers, and those who used vehicles as opposed to walking or biking as their means of transport were more likely to be diabetic. Also, respondents who were older or overweight were more likely to have hypertension. The paper discusses the results and their implication for public health policy on diabetes prevention, particularly among older individuals who are religious workers in Africa. [ABSTRACT FROM AUTHOR]

Though benefiting from a high potential, agriculture in Democratic Republic of Congo only reaches low performances and yields. In South-Kivu, small scale family farms are frequently scattered due to inheritance systems that give a share to all children. So, land becomes a scarce resource in a densely populated area. The socioeconomic and political elites benefit from this situation and accumulate land resources, while the churches are the heirs of former colonial concessions. Unfortunately, the land belonging to the large landowners is not valorized; it is often hired to small-scale farmers with less than 0.5 ha. These farmers use low quantities of inputs and are oriented towards subsistence agriculture. To valorize the high agricultural potential of this area, the solution is perhaps not a land reform and the distribution of plots to small-scale farmers, but to make agriculture more profitable and a wealth producer for the whole community. To do so, the archdiocese certainly has a role to play. The vision of religious authorities is that the priests should be real entrepreneurs and support all local initiatives which could be profitable for large groups of citizens. During workshops organized in 2021, people in charge of the parishes reported the agricultural activities which are already organized and the new opportunities they identified, proving that a bottomup peasant movement could enhance rural development. Future agricultural practices should lead to sustainable agriculture, with high yields and better income for the farmers. [ABSTRACT FROM AUTHOR]

Background. Acute generalised peritonitis (AGP) is a common and serious digestive surgery pathology. Undernutrition exacerbates patient condition and compromises their postoperative prognosis. Early enteral nutrition is recommended to reduce postoperative complications, but its availability and cost are problematic in low-income countries. The objective of this study was to evaluate the impact of providing early enteral feeding (EEF) to postoperative patients with intestinal perforation AGP using a locally prepared protein-energy food ration in two hospitals in Bukavu, a city of South Kivu, in the eastern part of the Democratic Republic of Congo. Methods. A prospective, randomised controlled trial with two groups of patients was conducted to investigate the effects of EEF with a local mixture versus enteral feeding after peristalsis had returned (control group) in patients who underwent laparotomy for AGP caused by ileal perforation. The local mixture consisted of soybean, maize, white rice, and pineapple. The trial included 66 patients with ileal perforation peritonitis. Results. The results comparing early enteral fed and nonfed patients showed significant differences in peristalsis recovery time (2.1 (0.6) days vs. 3.8 (1.2) days, p < 0.0001) and length of hospital stay (25.5 (14.9) days vs. 39.4 (25.3) days, p = 0.0046). Bivariate analyses indicated a significant early enteral feeding (EEF) reduced of 9.1% (vs. 36.4%, p = 0.0082) in parietal infections and 3.4% (28.1%, p = 0.009) in fistulas (p = 0.009) when EEF was included. In addition, EEF significantly reduced reintervention rates by 9.1% (p = 0.0003) and eliminated evisceration rates. EEF was also shown to reduce the incidence of malnutrition by 63.6% (p < 0.0001). Multivariate analysis showed that enteral nutrition significantly reduced the time to recovery of peristalsis (p = 0.0278) with an ORa of 0.3 and a 95% CI of 0.1-0.9. Moreover, EEF reduced malnutrition (p = 0.0039) with an ORa of 0.1 and a 95% CI of 0-0.4. Conclusion. EEF with locally sourced protein-energy rations can enhance a patient's nutritional status and facilitate postoperative recovery. This procedure is advantageous and involved early enteral nutrition using locally manufactured rations, especially for those operated on for acute generalised peritonitis in the Democratic Republic of Congo. [ABSTRACT FROM AUTHOR]

The paper explores the role of convenient shopping in establishing a sense of comfort for Europeans in a colonial environment. So far, there has been little investigation into how Belgian retailers tried to gain a firm foothold in the Congo, how they presented themselves and promoted their wares. This paper examines the activities of the colonial department of Delhaize Frères & Cie ‘Le Lion’, Belgium's first and largest food multiple. It examines how this large grocery chain tried to establish itself in the Congo, what motivations it had to extend its business to the colony, what audience it wished to reach, what products and services it had to offer and what sales and marketing strategies were used. It appears that convenient shopping was one of the key selling points Delhaize's advertising, while also characterising its products as indispensable for Europeans' comfort, moral respectability and homely warmth in a so-called primitive, backward environment. [ABSTRACT FROM AUTHOR]

Populations in post-conflict settings often have increased healthcare needs, residing in settings where basic services needed to maintain good health may be non-existent or hard to access. Therefore, there is a need for better identification and reallocation of resources as part of the post-conflict health rehabilitation effort. Assets can be described as the collective resources that individuals and communities have at their disposal, which protect against adverse health outcomes and promote health status. This study applies an asset-based approach to explore the most optimal design of health services and to identify the resource constraints for basic health service delivery to the most vulnerable communities in eastern Congo. We implemented the asset mapping in two phases. Firstly, we combined a qualitative survey with community walks to identify the assets already present in the communities. Secondly, we conducted group discussions to map out assets that are the core of asset-based community development (ABCD) practice. We finally documented all assets in a Community Asset Spreadsheet. Overall, 210 assets were identified as available and potentially valuable resources for the communities in eastern Congo. Among them, 57 were related to local associations, 23 to land and physical environments, 43 to local institutions, 46 to individuals, 35 to economy and exchange, and only 6 to culture, history, and stories. Drawing upon the findings of the qualitative survey, community walks, and group discussions, we concluded that an important number of resources are in place for basic health service delivery. By activating existing and potential resources, the most vulnerable populations in eastern Congo might have the required resources for basic health service delivery. Our findings support the use of an asset-mapping research method as appropriate for identifying existing and potential resources for basic health services in a post-conflict setting. [ABSTRACT FROM AUTHOR]

Abstract: This paper discusses the discourses on climate change adaptation and mitigation that are currently at the forefront in the Congo Basin. On mitigation, the forests have enormous opportunities to contribute to the reducing emissions from deforestation and forest degradation (REDD+) mechanism. But the forest itself and its multiple dependent societies and sectors need to adapt to potential climate risks. Hence, actors are debating the design of climate change policy in the forest sector. Theoretically, we combine the agency-focus of frame analysis and discourse theory to analyze how different agents hold frames on climate change adaptation and mitigation policies in the region. This paper draws upon interviews with 103 different actors from government, international organizations, non-governmental organizations, research institutions and private sector in three countries: Cameroon, Central African Republic (CAR) and Democratic Republic of Congo (DRC). Three discourses were found on policy response to climate change in the forest sector: mitigation policy only, separated policy on adaptation and mitigation, and an integrated policy on adaptation and mitigation. The various frames articulated around each discourse by the coalitions include elements of: costs and benefits, scale of operation, effectiveness, financial resources and implementation mechanisms. Overall, the mitigation discourse, through its mix of actors, resources and interests seems to be stronger than the adaptation discourse. The paper finally outlines a number of implications of the discourses for policy design. [Copyright &y& Elsevier]

ABSTRACT The stratigraphic, paleogeographic and tectonic evolution of the intracratonic Congo Basin in Central Africa has been revised on the basis of an integrated interpretation of gravity, magnetic and reflection seismic data, together with a literature review of papers sometimes old and difficult to access, map compilation and partial reexamination of outcrop and core samples stored in the Royal Museum for Central Africa (RMCA). The Congo Basin has a long and complex evolution starting in the Neoproterozoic and governed by the interplay of tectonic and climatic factors, in a variety of depositional environments.This multidisciplinary study involving 2D gravity and magnetic modeling as additional constraints for the interpretation of seismic profiles appears to be a powerful tool to investigate sedimentary basins where seismic data alone may be difficult to interpret. The tectonic deformations detected in the Congo Basin after the 1970-1984 hydrocarbon exploration campaign in the Democratic Republic of Congo (DRC) have been attributed to crustal contraction and basement uplift at the center of the basin, following a transpressional inversion of earlier graben structures. Two-dimensional gravity and magnetic models run along key seismic lines suggest the presence of evaporite sequences in some of the deeper units of the stratigraphic succession, in the lateral continuity with those observed in the Mbandaka and Gilson exploration wells. The poorly defined seismic facies that led to the previous basement uplift interpretation of the crystalline basement is shown to correspond to salt-rich formations that have been tectonically de-stabilized. These features may be related to vertical salt-tectonics connected to the near/far-field effects of the late Pan-African and the Permo-Triassic compressive tectonic events that affected this African part of Gondwana. [ABSTRACT FROM AUTHOR]

This paper examines the vulnerability of the Congo Basin's forests through a GIS platform, taking into consideration the variables of population growth, road density, logging concession, and forest fragmentation. The assessment indicates that the forests will continue to shrink towards the interior over the next 50 years. Current contiguous forests will fragment into three large blocks, including one on the west side of the Congo River and two in the Democratic Republic of Congo, while a large number of small forest patches will retain in the periphery of the large blocks. The study shows that integrated GIS assessment of the driving forces of tropical deforestation can shed light on the future forest distribution and provide a tool to address the broader implications of social and economic development for tropical deforestation. [ABSTRACT FROM AUTHOR]

Sexual violence in the conflict in eastern Democratic Republic of Congo is predominantly understood and represented as a "native" phenomenon – a direct consequence of the economic civil war – unrelated to colonial violence. This article offers a historicized perspective on Congo's enduring conflict in which sexual violence continues to ruin lives. I argue that sexual violence does not follow but structures colonialism as part of a continuum of violence. Drawing on extensive archival research, I analyze patterns of everyday gender-based violence in the Congo Free State (1885–1908) and identify the fusion of terror and pleasure as key aspects of a capitalist and patriarchal gender order. Staging an encounter between historical and contemporary dynamics of sexual violence in Congo, this article addresses and reconceptualizes contemporary sexual violence in relation to past colonial violence. [ABSTRACT FROM AUTHOR]

Introduction: Adolescence is a period of psychological and somatic growth and development. Pregnancy and childbirth during this period expose women to medical and cognitive risks. The aim of this study was to determine the prevalence, indications, evolution and factors associated with the risk of caesarean section among adolescent and adult women. Methods: This was a cross-sectional, analytical study conducted at Lubao General Referral Hospital. Data covered the period from 2018 to 2022. Epi Info 7.2.4 and Jamovi 2.3.21 software were used for data analysis. The p-value and Odd ratio were used to determine the association between the variables. Results: Caesarean sections accounted for 15.3% of deliveries (375 out of 2444). The prevalence of caesarean sections was 78.0% (64 out of 82 deliveries) among adolescent women and 13.2% (311 out of 2362 deliveries) among adult women. The risk of caesarean section was 23.44 times higher among adolescents (OR 23.44; [IC95% 13.71-40.09]; p-0.0000). Fetal macrosomia and acute fetal distress were the main indications in both groups. Bone dystocia was found only among adolescents. Occupation (OR 39.04 [CI95% 5.34-285.27]; p=0.0000), being single (OR 43.26 [CI95% 9.54-196.10]; p=0.0000), mechanical dystocia (OR 2.08 [CI95% 1.11-3.87]; p=0.0190) and parity = three (p=0.0000) were associated with the indication for caesarean section among the adolescents studied. Maternal and early neonatal outcome were not associated with maternal age. Conclusion: Adolescents present a very high risk of caesarean section. Raising parents' awareness of the risks of early marriage, educating girls in favour of sex education in schools, churches and youth clubs, and combating sexual exploitation and abuse and even sexual violence are all solutions that should be considered. [ABSTRACT FROM AUTHOR]

In this paper, we discuss acculturation stress and social capital experienced by Congolese young refugees in regional Australia. Seventy percent of Australia's humanitarian entrants are young people; many settle in regional areas. However, the perspectives of young refugees in regional areas have received little attention. Qualitative in-depth interviewing and photo elicitation methods were conducted with sixteen Congolese young people. Findings revealed that these young people experienced unique acculturation stress including language problems, a lack of employment opportunities and difficulties accessing further education, impacting on their integration into Australian society. However, they relied on a range of social support from their friends, family, their ethnic community and the wider regional community to cope with these issues. This social support helped to strengthen their social capital and enhance their wellbeing. [ABSTRACT FROM AUTHOR]

Co-occurring intimate partner violence (IPV) and child abuse occur at staggering levels in eastern Democratic Republic of Congo (DRC), yet little is known about the relationship between these forms of violence and a feminst-grounded conceptualization of family functioning nor how best to programmatically address these multiple forms of violence in the home. Analysis of cross-sectional baseline data from 203 adult couple dyads participating in a randomized controlled trial was undertaken to (1) understand the correlation of family functioning and violence in the home in North Kivu, DRC; (2) unpack potential shared correlates of violence in the home and family functioning, such as attitudes and behaviors; and (3) describe programmatic implications for delivering violence prevention programming that seeks to address multiple forms of violence in the home. Findings suggest over half of all families reported experiencing IPV against women or use of child abuse by any caregiver. Moderate levels of family functioning were also reported, although women reported lower levels. In adjusted models, a one-point change in family functioning score was associated with a 0.12 reduction in odds of co-occurring experience of IPV and use of child abuse for women, and a 0.03 reduction in odds of co-occurring perpetration for men. A focus on improving family functioning as a primary outcome, alongside explicit targeting of harmful gender norms and skills-based approaches, may be a promising avenue to integrate approaches from different violence prevention fields while maintaining a strong dedication to intersectional feminist-grounded approaches that allows for separate, but at times combined, approaches to reducing IPV and child abuse in the home. [ABSTRACT FROM AUTHOR]

An integrated approach to reduce intimate partner violence and improve mental health in humanitarian settings requires coordination across health and protection services. We developed and tested the Nguvu intervention, which combined evidence-based interventions for psychological distress and intimate partner violence among Congolese refugee women in Nyarugusu refugee camp (Tanzania). We conducted 29 semi-structured interviews with Nguvu participants and stakeholders to explore the relevance, acceptability, feasibility, and impact of this intervention. Participants reported that the intervention aligned with needs and filled a gap in programming, yet further adaptations may improve the fit of the intervention. The Nguvu intervention was acceptable to participants, including group discussion of sensitive topics. Confidentiality was highly regarded among staff and participants, which improved safety and acceptability. It was feasible to train non-specialist refugee workers to deliver the intervention with adequate supervision. Facilitators noted contextual challenges that made it difficult to implement the intervention: limited infrastructure, competing priorities, and population mobility. The intervention was perceived to improve awareness of the association between violence and mental health, reduce self-blame, and build skills to improve wellbeing. Recommended adaptations reveal promising, yet challenging future directions for addressing social determinants of mental health and implementing multi-sectoral programmes in complex humanitarian settings. [ABSTRACT FROM AUTHOR]

The role of nature in potentially improving people's health – including immigrant women, who are particularly prone to health challenges – has been highlighted. Success in this public health arena requires an adequate understanding of the target group's current practices and preferences. However, knowledge in this field is lacking, and is nearly non-existent in the Norwegian context. The present study therefore aims to explore practices regarding interactions with nature among immigrant women in Norway. Data were gathered through individual interviews with 14 immigrant women from Iran (2), Poland (2), Palestine, Afghanistan, Congo, Kenya, Thailand, Russia, Portugal, Latvia, Colombia, and Bulgaria. The qualitative content analysis revealed a relatively comprehensive and mixed use of natural environments, which took place in three distinct types of locales: 1) local natural environments, e.g. neighboring wooded areas, sites by the water, playing fields, and school yards; 2) domestic natural environments, e.g. indoor and garden plants; and 3) distant natural environments, e.g. mountains and fjords requiring driving and often overnight visit. Nature outings often included passive recreational pursuits, such as eating a meal and enjoying the scenery, with a few close friends or family members. Walking emerged as a common local nature-based physical activity. Study findings also portray a complex 'image of nature' among the women, reflecting their valuing of both more managed and more pristine nature. Findings therefore suggest that future public health practices targeting immigrant women may apply a broad definition of 'interaction with nature', incorporating various geographical locales as well as types of nature. [ABSTRACT FROM AUTHOR]

Elder abuse and neglect (EAN) are serious health and human rights issues. Less is known about EAN in refugee communities. University researchers and leaders of a refugee services nonprofit partnered to conduct an exploratory community engaged study on EAN risks in two refugee communities in North Carolina. A convenience sample of 17 Nepali-speaking Bhutanese and 13 Congolese self-identified older adults filled short surveys and participated in Focus Group Discussions (FGDs). Descriptive survey findings showed EAN risk, isolation, economic insecurity, and family dependency, more among Congolese. FGDs yielded no reports of EAN, but showed dependence on family, and difficulties with language, transportation, and economic insecurity in both groups. These factors indicate individual and contextual vulnerabilities for EAN in these communities. An EAN awareness event was conducted for participants by a family violence nonprofit. Refugee older adults need culturally appropriate coordinated services including EAN information, English classes, job skills, income, and transportation. [ABSTRACT FROM AUTHOR]

The objective of this study was to investigate the association between dietary diversity, child growth and child developmental outcomes. This was a prospective cohort study. Developmental outcomes were assessed by communication, fine motor, gross motor, personal social, problem solving and combined developmental scores measured by the Extended Ages and Stages Questionnaire (EASQ) at a 6‐month follow‐up visit. Height and weight were measured at baseline and a 6‐month follow‐up. Baseline minimum dietary diversity (MDD) for children 6–23 months old was defined by consumption of five or more of the following food groups: (1) breast milk; (2) grains, roots and tubers; (3) legumes and nuts; (4) dairy products; (5) flesh foods; (6) eggs; (7) vitamin A‐rich fruits and vegetables and (8) other fruits and vegetables. Participants were 117 children 6–23 months of age. Linear growth faltering was defined as a significant decline (p < 0.05) in length‐for‐age Z‐scores (LAZ) between baseline and follow‐up. Regression models were performed. The study was conducted in rural eastern Democratic Republic of the Congo (DRC). MDD was positively associated with change in LAZ (coefficient: 0.87 [95% confidence interval [CI]: 0.33, 1.40]), and a reduced odds of stunting (LAZ < −2) (odds ratio: 0.21 [95% CI: 0.07, 0.61]). MDD was also associated with a significantly higher combined EASQ‐Z‐scores (coefficient: 0.34 [95% CI: 0.003, 0.68], higher communication EASQ‐Z‐scores [0.50 {95% CI: 0.14, 0.85}], and higher personal social EASQ‐Z‐scores [0.46 {95% CI: 0.11, 0.82}]). This study provides further evidence demonstrating the need for interventions to improve dietary diversity among young children. Key messages: Dietary diversity was low among young children in our study setting in rural eastern Democratic Republic of the Congo.Low dietary diversity was associated with linear growth faltering and lower child developmental outcomes.This study provides further evidence demonstrating the need for interventions to improve dietary diversity among young children to improve child health. [ABSTRACT FROM AUTHOR]

Social workers can promote resiliency among refugee families by referring them to evidence-based programs to reduce the stressors of resettlement. The purpose of this study was to complete a structured adaptation process with the SafeCare® program for implementation in a refugee resettlement community. Participants included 21 members of an adaptation team made up of administrators, supervisors, and family service providers from three community agencies and community health workers. Quantitative findings suggested that content, process, and literacy-related adaptations were necessary to ensure cultural relevance of program materials. Qualitative feedback suggested the adaptation approach was a meaningful process that engaged community members and resulted in an acceptable and feasible curriculum for delivery in the refugee resettlement community, which will be further tested in a forthcoming implementation trial. The multi-pronged, community-engaged approach to SafeCare adaptation is presented as a potential framework for other programs that could benefit refugee children and their families. [ABSTRACT FROM AUTHOR]

Background: Poor data quality is limiting the use of data sourced from routine health information systems (RHIS), especially in low- and middle-income countries. An important component of this data quality issue comes from missing values, where health facilities, for a variety of reasons, fail to report to the central system. Methods: Using data from the health management information system in the Democratic Republic of the Congo and the advent of COVID-19 pandemic as an illustrative case study, we implemented seven commonly used imputation methods and evaluated their performance in terms of minimizing bias in imputed values and parameter estimates generated through subsequent analytical techniques, namely segmented regression, which is widely used in interrupted time series studies, and pre–post-comparisons through paired Wilcoxon rank-sum tests. We also examined the performance of these imputation methods under different missing mechanisms and tested their stability to changes in the data. Results: For regression analyses, there were no substantial differences found in the coefficient estimates generated from all methods except mean imputation and exclusion and interpolation when the data contained less than 20% missing values. However, as the missing proportion grew, k-NN started to produce biased estimates. Machine learning algorithms, i.e. missForest and k-NN, were also found to lack robustness to small changes in the data or consecutive missingness. On the other hand, multiple imputation methods generated the overall most unbiased estimates and were the most robust to all changes in data. They also produced smaller standard errors than single imputations. For pre–post-comparisons, all methods produced p values less than 0.01, regardless of the amount of missingness introduced, suggesting low sensitivity of Wilcoxon rank-sum tests to the imputation method used. Conclusions: We recommend the use of multiple imputation in addressing missing values in RHIS datasets and appropriate handling of data structure to minimize imputation standard errors. In cases where necessary computing resources are unavailable for multiple imputation, one may consider seasonal decomposition as the next best method. Mean imputation and exclusion and interpolation, however, always produced biased and misleading results in the subsequent analyses, and thus, their use in the handling of missing values should be discouraged. [ABSTRACT FROM AUTHOR]

Abstract: Aims: Atherosclerosis is now accepted as a chronic vascular inflammatory disorder that is present in a variety of conditions such as obesity, physical inactivity, hypertension, type 2 diabetes, metabolic syndrome/insulin resistance and renal impairment. In this paper, we determine the cardiometabolic causes and consequences of elevated erythrocyte sedimentation rate (ESR) among healthy bank employees from Brazzaville, Central Africa. We also aimed at determining the optimal cut-points for ESR associated with higher cardiometabolic risk using ROC analysis. Materials and methods: This cross-sectional survey used data from participants examined from 1 to 30 December, 2008. A simple random of 126 bank employees, 42±9 years old, completed an interviewer administered questionnaire and had anthropometric, QTc, cardiac index and blood pressure measurements performed by trained nurses using standardized procedures. Fasting glucose, lipids, ESR and creatinine were measured using a venous blood sample. Cardiometabolic risk was defined by obesity, physical inactivity, low energy expenditure, long QTc, dyslipidaemia, hypertension, metabolic syndrome, type 2 diabetes, coronary heart disease (CHD) and decline of estimated glomerular filtration rate (EGFR). Results: The population was defined by epidemic rates of physical inactivity, hypertension, obesity, excessive alcohol intake and CHD. This higher cardiometabolic risk and the ESR values were more frequent in females than males. There was a significant (P <0.05) association between age (r =0.292), QTc (r =0.245), BMI (r =0.263), waist (r =0.520), body fat mass (r =0.534), systolic blood pressure (r =0.244), diastolic blood pressure (r =0.279), total cholesterol (r =0.318), LDL-cholesterol (r =0.281), eGFR (r =−0.311), and ESR at second hour. Abdominal fat distribution, reduced energy expenditure, decline in body total water, total obesity, hypertension, type 2 diabetes, metabolic syndrome and CHD were significantly associated with elevated ESR. ESR≥13mm at first hour and ESR≥30mm at second hour was identified as significant and optimal cut-points to detect hypertension, type 2 diabetes and metabolic syndrome. Conclusions: Aging, female sex, physical inactivity, low energy expenditure, reduced body total water and obesities are considered as the causes of elevated ESR. Dyslipidaemia, hypertension, type 2 diabetes, renal function decline and coronary heart disease are the consequences of elevated ESR. Weight loss, exercise, appropriate diet, and pharmacological means are needed to control the emergence of Western diseases among these African employees. [Copyright &y& Elsevier]

Abstract: The sustainability of fast-growing tropical Eucalyptus plantations is of concern in a context of rising fertilizer costs, since large amounts of nutrients are removed with biomass every 6–7 years from highly weathered soils. A better understanding of the dynamics of tree requirements is required to match fertilization regimes to the availability of each nutrient in the soil. The nutrition of Eucalyptus plantations has been intensively investigated and many studies have focused on specific fluxes in the biogeochemical cycles of nutrients. However, studies dealing with complete cycles are scarce for the Tropics. The objective of this paper was to compare these cycles for Eucalyptus plantations in Congo and Brazil, with contrasting climates, soil properties, and management practices. The main features were similar in the two situations. Most nutrient fluxes were driven by crown establishment the two first years after planting and total biomass production thereafter. These forests were characterized by huge nutrient requirements: 155, 10, 52, 55 and 23kgha−1 of N, P, K, Ca and Mg the first year after planting at the Brazilian study site, respectively. High growth rates the first months after planting were essential to take advantage of the large amounts of nutrients released into the soil solutions by organic matter mineralization after harvesting. This study highlighted the predominant role of biological and biochemical cycles over the geochemical cycle of nutrients in tropical Eucalyptus plantations and indicated the prime importance of carefully managing organic matter in these soils. Limited nutrient losses through deep drainage after clear-cutting in the sandy soils of the two study sites showed the remarkable efficiency of Eucalyptus trees in keeping limited nutrient pools within the ecosystem, even after major disturbances. Nutrient input–output budgets suggested that Eucalyptus plantations take advantage of soil fertility inherited from previous land uses and that long-term sustainability will require an increase in the inputs of certain nutrients. [Copyright &y& Elsevier]

Copyright of Africa Spectrum is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background Rifampicin (RIF) resistance is highly correlated with isoniazid (INH) resistance and used as proxy for multidrug-resistant tuberculosis (MDR-TB). Using MTBDR plus as a comparator, we evaluated the predictive value of Xpert MTB/RIF (Xpert)–detected RIF resistance for MDR-TB in eastern Democratic Republic of the Congo (DRC). Methods We conducted a cross-sectional study involving data from new or retreatment pulmonary adult TB cases evaluated between July 2013 and December 2016. Separate, paired sputa for smear microscopy and MTBDR plus were collected. Xpert testing was performed subject to the availability of Xpert cartridges on sample remnants after microscopy. Results Among 353 patients, 193 (54.7%) were previously treated and 224 (63.5%) were MTBDR plus TB positive. Of the 224, 43 (19.2%) were RIF monoresistant, 11 (4.9%) were INH monoresistant, 53 (23.7%) had MDR-TB, and 117 (52.2%) were RIF and INH susceptible. Overall, among the 96 samples detected by MTBDR plus as RIF resistant, 53 (55.2%) had MDR-TB. Xpert testing was performed in 179 (50.7%) specimens; among these, 163 (91.1%) were TB positive and 73 (44.8%) RIF resistant. Only 45/73 (61.6%) Xpert-identified RIF-resistant isolates had concomitant MTBDR plus -detected INH resistance. Xpert had a sensitivity of 100.0% (95% CI, 92.1–100.0) for detecting RIF resistance but a positive-predictive value of only 61.6% (95% CI, 49.5–72.8) for MDR-TB. The most frequent mutations associated with RIF and INH resistance were S531L and S315T1, respectively. Conclusions In this high-risk MDR-TB study population, Xpert had low positive-predictive value for the presence of MDR-TB. Comprehensive resistance testing for both INH and RIF should be performed in this setting. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Small Business & Entrepreneurship is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Vertical disease control programmes have enormous potential to benefit or weaken health systems, and it is critical to understand how programmes' design and implementation impact the health systems and communities in which they operate. We use the Develop-Distort Dilemma (DDD) framework to understand how the Global Polio Eradication Initiative (GPEI) distorted or developed local health systems. We include document review and 176 interviews with respondents at the global level and across seven focus countries (Afghanistan, Bangladesh, Democratic Republic of Congo, Ethiopia, India, Indonesia and Nigeria). We use DDD domains, contextual factors and transition planning to analyse interactions between the broader context, local health systems and the GPEI to identify changes. Our analysis confirms earlier research including improved health worker, laboratory and surveillance capacity, monitoring and accountability, and efforts to reach vulnerable populations, whereas distortions include shifting attention from routine health services and distorting local payment and incentives structures. New findings highlight how global-level governance structures evolved and affected national actors; issues of country ownership, including for data systems, where the polio programme is not indigenously financed; how expectations of success have affected implementation at programme and community level; and unresolved tensions around transition planning. The decoupling of polio eradication from routine immunization, in particular, plays an outsize role in these issues as it removed attention from system strengthening. In addition to drawing lessons from the GPEI experience for other efforts, we also reflect on the use of the DDD framework for assessing programmes and their system-level impacts. Future eradication efforts should be approached carefully, and new initiatives of any kind should leverage the existing health system while considering equity, inclusion and transition from the start. [ABSTRACT FROM AUTHOR]

Background: Temporal discounting, the tendency of individuals to discount future costs and benefits relative to the present, is often associated with greater engagement in risky behaviors. Incentives such as conditional cash transfers (CCTs) have the potential to counter the effects of high discount rates on health behaviors.Methods: With data from a randomized trial of a CCT intervention among 434 HIV-positive pregnant women in the Democratic Republic of Congo, we used binomial models to assess interactions between discount rates (measured using a delay-discounting task) and the intervention. The analysis focused on two outcomes: 1) retention in HIV care, and 2) uptake of prevention of mother-to-child transmission (PMTCT) services.Results: The effect of high discount rates on retention was small, and we did not observe evidence of interaction between high discount rates and CCT on retention. However, our findings suggest that CCT may mitigate the negative effect of high discount rates on uptake of PMTCT services (interaction contrast (IC): 0.18, 95% CI: - 0.09, 0.44).Conclusions: Our findings provide evidence to support the continued use of small, frequent incentives, to motivate improved uptake of PMTCT services, especially among women exhibiting high rates of temporal discounting.Trial Registration: Clinicaltrials.gov number NCT01838005 , April 23, 2013. [ABSTRACT FROM AUTHOR]