South African Brain Research Institute

Background Adverse childhood experiences (ACEs), including abuse, neglect and household challenges, have been linked to various mental health outcomes, including psychosis and bipolar symptoms. Research indicates a 57–80% increased risk of psychosis among individuals exposed to ACEs. Aim This study examines the relationship between ACEs and psychotic/bipolar symptoms in Kenyan adolescents, assessing resilience as a potential moderator or mediator. Method This cross-sectional study was conducted in Nairobi and Kiambu counties, Kenya. A total of 1972 youth, aged 14–25 years, were recruited and completed questionnaires focusing on ACEs (Trauma and Distress Scale), psychosis/bipolar symptoms (Washington Early Recognition Center Affectivity and Psychosis screen) and resilience (Adult Resilience Measure +16). Descriptive statistics, Pearson correlation and multiple linear regression were used to assess the relationships between ACEs and psychosis/bipolar symptoms. SPSS Process macro was employed to examine the moderating/mediating role of resilience. Results Emotional abuse and physical abuse were significantly associated with higher psychosis and bipolar symptoms ( P < 0.001). Emotional neglect negatively impacted bipolar symptoms ( P = 0.042). Resilience moderated the relationship between sexual abuse and psychosis, but not bipolar symptoms. Mediation analysis showed that resilience partially mediated the relationships between sexual abuse and both psychosis and bipolar symptoms. Conclusions ACEs, particularly emotional and physical abuse, are significant predictors of psychosis and bipolar symptoms in Kenyan youth. Resilience may play a key role in moderating and mediating these relationships, particularly in cases of sexual abuse. Developing resilience-focused interventions could help mitigate the long-term effects of ACEs on mental health.

Global dementia cases are rising, particularly in low- and middle-income countries with limited health-care access and scarce resources, calling for preventive strategies that align with local capital and cultural practices. The Africa-FINGERS project, an adaptation of the Finnish FINGER trial, pioneers a culturally relevant, multidomain approach to dementia risk reduction for African settings. This Perspective article explores the efficacy of multimodal lifestyle interventions in reducing risks associated with cognitive decline, addressing the unique challenges involvedand examining opportunities for implementing such programmes in Africa. Drawing on preliminary insights from ongoing implementation efforts in Africa and lessons from the WorldWide FINGERS global network, we describe a standardized, evidence-based precision brain health model that aims to dynamically and equitably optimize protective factors for brain health in Africa. This model is tailored to accommodate the diverse cultural, socioeconomic and logistical contexts of Africa, emphasizing culturally adapted, scalable and resource-sensitive solutions for sustainable implementation. Building on thesuccessful execution of regional lifestyle-based interventions for other non-communicable diseases, we highlight the potential of the Africa-FINGERS programme to improve brain health and mitigate dementia risks across diverse global settings.

Concurrent wasting and stunting (WaSt) is a condition where both wasting and stunting exist in a child at the same time. This study aimed to assess the prevalence of WaSt and to identify potential associated factors in Ethiopia. A total of 33,650 children aged between 0 and 59 months were included in the analysis from the four waves of the Ethiopian Demographic and Health Survey. A mixed‐effects logistic regression model was used to identify the determinants of WaSt. The prevalence of WaSt was found to be 4.7% (95% confidence interval [CI]: (4.5–4.9)), with respectively 2.5% (95% CI: 2.1–3.1) and 4.9% (95% CI: 4.7–5.2) among children in urban and rural settings. Children: (i) in the age group 12–23 months (adjusted odds ratio [AOR]: 4.16, 95% CI: (3.20–5.42)) and 24–59 months (AOR: 3.08, 95% CI: (2.28–4.17)); (ii) who were perceived by their mothers to be smaller than normal at birth (AOR: 1.98, 95% CI: (1.57–2.50)); (iii) had diarrhoea (AOR: 1.38, 95% CI: (1.11–1.71)); and (iv) fever in the past 2 weeks (AOR: 1.38, 95% CI: (1.10–1.71)) reported higher odds of WaSt. Being a female child (AOR: 0.57, 95% CI: (0.48–0.69)), having received measles vaccination (AOR: 0.71, 95% CI: (0.55–0.89)), having a mother with a normal body mass index (18.5–24.9 kg/m2) (AOR: 0.57, 95% CI: (0.48–0.68)), having a wealthier household (AOR: 0.67, 95% CI: (0.50–0.90)), and living in rural setting (AOR: 0.49, 95% CI: (0.32–0.74)) were associated with reduced odds of WaSt. The prevalence of WaSt was high, with approximately 1 in 20 Ethiopian children suffering from the condition and needing a prompt response to minimize the poor health and developmental outcomes. Children perceived by their mother to be smaller than normal at birth, older children, and babies with diarrhoea and fever had higher odds of WaSt.

Macular pigment (MP) confers potent antioxidant and anti-inflammatory effects at the macula; however, its optical density in the eye is not routinely measured in clinical practice. This study explored a range of surrogate biomarkers including anthropometric, clinical, and plasma measures that may be associated with lower MP optical density (MPOD). Two thousand five hundred ninety-four subjects completed a full MP assessment as part of wave 1 of The Irish Longitudinal Study of Aging. Macular pigment optical density was measured using customized heterochromatic flicker photometry. Clinical (blood pressure), plasma (lipoproteins, inflammatory markers), and anthropometric (waist, hip, height, weight) biomarkers were measured for each participant. Mean (standard deviation) MPOD for the study group was 0.223 (0.161), with a range of 0 to 1.08. One-way ANOVA revealed that MPOD was significantly lower among participants with low plasma high-density lipoprotein (HDL; P = .04), raised plasma triglyceride-to-HDL ratio (P = .003), and raised total cholesterol-to-HDL ratio (P = .03). Subjects with an elevated waist circumference (WC) had a significantly lower MPOD (mean, 0.216 [0.159]) compared with those with an ideal WC (mean, 0.229 [0.162]; P = .03). Significant correlates of MPOD on mixed linear model analysis included education, smoking status, and WC. Higher abdominal fat is associated with lower MPOD in this representative sample of older Irish adults. Although altered lipoprotein profiles (low HDL, raised triglyceride-to-HDL ratio, raised total cholesterol-to-HDL ratio) may affect the transport, uptake, and stabilization of carotenoids in the retina, these plasma biomarkers were not predictive of low MPOD after adjustment for abdominal circumference. Although WC emerged as a viable anthropometric predictor of lower MPOD, its effect size seems to be small.

The case report by Hirvioja et al. raises some interesting points [1]. Unfortunately, the title is somewhat misleading because it suggests that it was nitrous oxide alone that caused the death and ignores the likelihood, from the data presented, that the death was probably due to the other substances found in the patient's blood as well as the nitrous oxide [1]. As far as I am aware, there is no case in the literature where nitrous oxide alone has caused sudden death during misuse, except when the subject has been asphyxiated because of oxygen lack [2]. I would like to congratulate the authors for not confusing abuse with use, something not always done with enough precision [3]. Indeed, some authors have given the impression that recreational use automatically means abuse [4]. Their paper also highlights the point that pure nitrous oxide abuse is extremely rare and that those who do abuse it do so as part of their polydrug abuse [1, 4]. It is also important to note that although the recreational use of nitrous oxide seems currently to be an increase, the history of the use of nitrous oxide since the late 17th century has been punctuated by cycles of increased and decreased popularity. Furthermore, and in all this time, it has never yet caused the severe problem as found with other drugs such as morphine, heroin, cocaine or the benzodiazepines [4]. However, the statement that ‘Nitrous oxide… is used as an anaesthetic…. during small dental procedures and labour’ is simply wrong. For these indications, nitrous oxide is used at concentrations well below those that could produce unconsciousness and anaesthesia and while the patient is conscious and fully responsive and definitely not anaesthetized [5].

Aim: To determine the prevalence and causes of visual impairment, cataract surgical coverage and barriers to cataract surgery amongst people in the northern eThekwini district of KwaZuluNatal Province, South Africa.Method: Thirty-three clusters of 50 subjects ≥ 50 years old were randomly selected. Consenting subjects underwent enumeration to establish a demographic profile and thereafter a clinical examination. Visual acuity (VA) was measured with a Tumbling ‘E’ chart; participants having a VA < 6/18 were retested with a pinhole. If no improvement in VA occurred, subjects underwent clinical examination, including a dilated fundus exam where necessary, to determine the cause of visual impairment.Results: Of the 1650 subjects selected, 1542 (93.5%) were examined. The overall prevalence of blindness was 1.9%. The age- and gender-adjusted prevalence of blindness was 2.1%, severe visual impairment (SVI) 1.2%, and moderate visual impairment (MVI) 3.9%. Untreated cataract was the major cause of blindness (55.2%) and SVI (53.3%), and uncorrected refractive error was the major cause of MVI (49.1%). The cataract surgical coverage rate was 70% at visual acuity < 3/60 level; 51% at visual acuity < 6/60 level; and 38% at visual acuity < 6/18 level. Poor awareness of cataract surgical intervention was the main reason that participants with untreated cataracts had not used existing cataract services.Conclusion: The prevalence of blindness in the study region was lower (by 1.98%) than World Health Organization estimates of 9% for the Africa-E sub-region (within which South Africa falls). There is no permanent cataract service in this region; the lower cataract surgical coverage rates indicate that a permanent eye care centre could significantly alleviate avoidable blindness, particularly that caused by cataract.

To the Editor: The work by Murakawa et al. [1] gives further support for the actions of nitrous oxide on influencing dopamine (DA) activity [2]. Opioids can also influence mesolimbic DA, with mu-receptor activation and kappa attenuation of DA release in the nucleus accumbens (NA) [3]. Compelling evidence has accumulated that psychotropic analgesic nitrous oxide (PAN) is the first gaseous member of the opioid family [4,5]. These facts have been used to propose that PAN is able to modulate the mesolimbic DA system through its agonistic activity at mu and kappa receptors [6]. Murakawa et al. [1] give some further evidence for these two opposing opioid effects of PAN on DA. In both the hippocampus and cerebellum, their data show a more rapid swing from stimulation to attenuation of DA release in less than 2 h after exposure, while in the midbrain this biphasic effect is only seen after 4 h [1]. Unfortunately, they did not specifically measure DA levels in the DA, which is the site believed to be directly involved in addictive processes [3]. It would seem that PAN has the unique property among opioids to modulate DA levels in the NA in opposite directions by activating both mu and kappa receptors [6]. It would seem that PAN has similar actions in other brain areas [1]. This bidirectional modulation would explain the insignificant addictive potential of PAN despite the fact that medical professionals may misuse it mainly during their student years [4]. Based on evidence presented elsewhere [4], we take issue with Murakawa et al. [1] when they state that the gas "has been abused in social settings." Although these authors [1] suggest that nausea and vomiting, as well as the psychotropic effects of the gas, are mediated by DA, a more comprehensive explanation is that PAN acts through both its opioid and dopaminergic effects. M. A. Gillman, BDS, DSc F. J. Lichtigfeld, MBBch, BSc, FF(Psych) South African Brain Research Institute, Waverley 2090, Johannesburg, South Africa