Showing papers by "University of the Witwatersrand published in 2009"
TL;DR: In this paper, the efficacy of cetuximab plus irinotecan, fluorouracil, and leucovorin (FOLFIRI) as first-line treatment for metastatic colorectal cancer was investigated.
Abstract: Background We investigated the efficacy of cetuximab plus irinotecan, fluorouracil, and leucovorin (FOLFIRI) as first-line treatment for metastatic colorectal cancer and sought associations between the mutation status of the KRAS gene in tumors and clinical response to cetuximab. Methods We randomly assigned patients with epidermal growth factor receptor–positive colorectal cancer with unresectable metastases to receive FOLFIRI either alone or in combination with cetuximab. The primary end point was progression-free survival. Results A total of 599 patients received cetuximab plus FOLFIRI, and 599 received FOLFIRI alone. The hazard ratio for progression-free survival in the cetuximab–FOLFIRI group as compared with the FOLFIRI group was 0.85 (95% confidence interval [CI], 0.72 to 0.99; P=0.048). There was no significant difference in the overall survival between the two treatment groups (hazard ratio, 0.93; 95% CI, 0.81 to 1.07; P=0.31). There was a significant interaction between treatment group and KRAS ...
3,504 citations
TL;DR: Pivotal facets of primary health care are not in place and there is a substantial human resources crisis facing the health sector, so the new government needs to address these factors if health is to be improved and the Millennium Development Goals achieved in South Africa.
1,344 citations
TL;DR: The launching of a national initiative to establish sites of service excellence in urban and rural settings throughout South Africa to trial, assess, and implement integrated care interventions for chronic infectious and non-communicable diseases is urged.
1,019 citations
Columbia University1, University of Miami2, University of North Carolina at Chapel Hill3, SUNY Downstate Medical Center4, University College London5, Cambridge University Hospitals NHS Foundation Trust6, University of California, San Francisco7, University of California, Los Angeles8, University of Alabama at Birmingham9, Rio de Janeiro State University10, University of Guadalajara11, University of Düsseldorf12, New York University13, University of Barcelona14, Shanghai Jiao Tong University15, University of Lisbon16, Stellenbosch University17, Guy's and St Thomas' NHS Foundation Trust18, Oregon Health & Science University19, University of Padua20, University of Leeds21, North Shore-LIJ Health System22, Northwestern University23, Medical University of South Carolina24, University of Birmingham25, Sun Yat-sen University26, Lille University of Science and Technology27, Charité28, Rutgers University29, Federal University of São Paulo30, University of Debrecen31, Imperial College London32, Emory University33, University of Liège34, University of Pittsburgh35, University of Paris36, University of the Witwatersrand37, California State University, Long Beach38, Royal Melbourne Hospital39, University of Texas Southwestern Medical Center40, Autonomous University of Barcelona41, Pennsylvania State University42, Johns Hopkins University43, University of Szeged44, Duke University45, University of Colorado Denver46, Harvard University47, University of Cape Town48, University of Malaya49, Peking Union Medical College50
TL;DR: Although most patients in both treatment groups experienced clinical improvement, the study did not meet its primary objective of showing that MMF was superior to IVC as induction treatment for lupus nephritis.
Abstract: Recent studies have suggested that mycophenolate mofetil (MMF) may offer advantages over intravenous cyclophosphamide (IVC) for the treatment of lupus nephritis, but these therapies have not been compared in an international randomized, controlled trial. Here, we report the comparison of MMF and IVC as induction treatment for active lupus nephritis in a multinational, two-phase (induction and maintenance) study. We randomly assigned 370 patients with classes III through V lupus nephritis to open-label MMF (target dosage 3 g/d) or IVC (0.5 to 1.0 g/m(2) in monthly pulses) in a 24-wk induction study. Both groups received prednisone, tapered from a maximum starting dosage of 60 mg/d. The primary end point was a prespecified decrease in urine protein/creatinine ratio and stabilization or improvement in serum creatinine. Secondary end points included complete renal remission, systemic disease activity and damage, and safety. Overall, we did not detect a significantly different response rate between the two groups: 104 (56.2%) of 185 patients responded to MMF compared with 98 (53.0%) of 185 to IVC. Secondary end points were also similar between treatment groups. There were nine deaths in the MMF group and five in the IVC group. We did not detect significant differences between the MMF and IVC groups with regard to rates of adverse events, serious adverse events, or infections. Although most patients in both treatment groups experienced clinical improvement, the study did not meet its primary objective of showing that MMF was superior to IVC as induction treatment for lupus nephritis.
909 citations
Book•
[...]
TL;DR: Foreword, Sonia Nieto Preface Acknowledgments 1. Turning to Literacy 2. Orientations to literacy 3. Language and Power 4. Reading Texts Critically 5. Diversity, Difference and Disparity 6. Access, Gate-Keeping and Desire
Abstract: Foreword, Sonia Nieto Preface Acknowledgments 1. Turning to Literacy 2. Orientations to Literacy 3. Language and Power 4. Reading Texts Critically 5. Diversity, Difference and Disparity 6. Access, Gate-Keeping and Desire 7. Critical Text Production: Writing and Design 8. Redesign, Social Action and Possibilities for Transformation 9. The Future of Critical Literacy References Index
682 citations
TL;DR: This review will delve into the various internally and externally stimuli-responsive polymers and the drug delivery systems that exploit them.
Abstract: Interest in stimuli-responsive polymers is steadily gaining increasing momentum especially in the fields of controlled and self-regulated drug delivery. Delivery systems based on these polymers are developed to closely resemble the normal physiological process of the diseased state ensuring optimum drug release according to the physiological need. Also termed 'environmental-sensitive' or 'smart', these polymers experience rapid changes in their microstructure from a hydrophilic to a hydrophobic state triggered by small changes in the environment. The changes are reversible; therefore, the polymer is capable of returning to its initial state as soon as the trigger is removed. Stimuli may occur internally (e.g. a change in pH in certain organs or diseased states, a change in temperature or the presence of specific enzymes or antigens). External stimuli include magnetic or electric fields, light, ultrasound, etc. This review will delve into the various internally and externally stimuli-responsive polymers and the drug delivery systems that exploit them.
550 citations
TL;DR: Early ART resulted in less AIDS progression/death with no increase in adverse events or loss of virologic response compared to deferred ART, and these results support the early initiation of ART in patients presenting with acute AIDS-related OIs, absent major contraindications.
Abstract: Background: Optimal timing of ART initiation for individuals presenting with AIDS-related OIs has not been defined. Methods and Findings: A5164 was a randomized strategy trial of ‘‘early ART’’ - given within 14 days of starting acute OI treatment versus ‘‘deferred ART’’ - given after acute OI treatment is completed. Randomization was stratified by presenting OI and entry CD4 count. The primary week 48 endpoint was 3-level ordered categorical variable: 1. Death/AIDS progression; 2. No progression with incomplete viral suppression (ie HIV viral load (VL) $50 copies/ml); 3. No progression with optimal viral suppression (ie HIV VL ,50 copies/ml). Secondary endpoints included: AIDS progression/death; plasma HIV RNA and CD4 responses and safety parameters including IRIS. 282 subjects were evaluable; 141 per arm. Entry OIs included Pneumocytis jirovecii pneumonia 63%, cryptococcal meningitis 12%, and bacterial infections 12%. The early and deferred arms started ART a median of 12 and 45 days after start of OI treatment, respectively. The difference in the primary endpoint did not reach statistical significance: AIDS progression/death was seen in 20 (14%) vs. 34 (24%); whereas no progression but with incomplete viral suppression was seen in 54 (38%) vs. 44 (31%); and no progression with optimal viral suppression in 67 (48%) vs 63 (45%) in the early vs. deferred arm, respectively (p=0.22). However, the early ART arm had fewer AIDS progression/deaths (OR=0.51; 95% CI=0.27–0.94) and a longer time to AIDS progression/death (stratified HR=0.53; 95% CI=0.30–0.92). The early ART had shorter time to achieving a CD4 count above 50 cells/mL (p,0.001) and no increase in adverse events. Conclusions: Early ART resulted in less AIDS progression/death with no increase in adverse events or loss of virologic response compared to deferred ART. These results support the early initiation of ART in patients presenting with acute AIDS-related OIs, absent major contraindications. Trial Registration: ClinicalTrials.gov NCT00055120
497 citations
TL;DR: Thirteen additional pieces of incised ochre recovered from c.
473 citations
TL;DR: In this article, the authors present a revised model for the opening of the South Atlantic Ocean founded on a remapping of the continent-ocean boundaries and Aptian salt basins, the chronology of magmatic activity in and around the ocean basin and on the timing and character of associated intraplate deformation in Africa and South America.
Abstract: SUMMARY We present a revised model for the opening of the South Atlantic Ocean founded on a remapping of the continent–ocean boundaries and Aptian salt basins, the chronology of magmatic activity in and around the ocean basin and on the timing and character of associated intraplate deformation in Africa and South America. The new plate tectonic model is internally consistent and consistent with globally balanced plate motion solutions. The model includes realistic scenarios for intraplate deformation, pre-drift extension and seafloor spreading. Within the model, Aptian salt basins preserved in the South American (Brazilian) and African (Angola, Congo, Gabon) continental shelves are reunited in their original positions as parts of a single syn-rift basin in near subtropical latitudes (10 ◦ S–27 ◦ S). The basin was dissected at around 112 Ma (Aptian–Albian boundary) when the model suggests that seafloor spreading commenced north of the Walvis Ridge–Rio Grande Rise.
411 citations
TL;DR: Compound adhesives made from red ochre mixed with plant gum were used in the Middle Stone Age of South Africa and this ability suggests overlap between the cognitive abilities of modern people and people in the MSA.
Abstract: Compound adhesives made from red ochre mixed with plant gum were used in the Middle Stone Age (MSA), South Africa. Replications reported here suggest that early artisans did not merely color their glues red; they deliberately effected physical transformations involving chemical changes from acidic to less acidic pH, dehydration of the adhesive near wood fires, and changes to mechanical workability and electrostatic forces. Some of the steps required for making compound adhesive seem impossible without multitasking and abstract thought. This ability suggests overlap between the cognitive abilities of modern people and people in the MSA. Our multidisciplinary analysis provides a new way to recognize complex cognition in the MSA without necessarily invoking the concept of symbolism.
365 citations
TL;DR: The type of vision, leadership, and priority actions needed to achieve such a change in the health trajectory of the country, and even meet the MDGs are discussed.
TL;DR: Luminescence from quartz is commonly used in retrospective dosimetry, in particular for the dating of archaeological materials and sediments from the Quaternary period as discussed by the authors, which is related to the interaction of natural radiation with mineral grains, by the activation of and subsequent trapping of electrons at defects within the quartz lattice.
TL;DR: Programs that promote widespread HIV testing and discussion of HIV/AIDS, as well as education regarding and universal access to ARVs, may reduce HIV/ AIDS-related stigma and discrimination.
TL;DR: The results of this study highlight the importance of standardized longitudinal insecticide resistance monitoring and the urgent need for studies to monitor the impact of this resistance on malaria vector control activities.
Abstract: Background
Insecticide resistance in malaria vectors is a growing concern in many countries which requires immediate attention because of the limited chemical arsenal available for vector control The current extent and distribution of this resistance in many parts of the continent is unknown and yet such information is essential for the planning of effective malaria control interventions
Journal Article•
TL;DR: The already inadequate health systems of Africa, especially sub-Saharan Africa, have been badly damaged by the migration of their health professionals and there is a need for concerted political will and funding support to allow them to do what is necessary.
Abstract: The already inadequate health systems of Africa, especially sub-Saharan Africa, have been badly damaged by the migration of their health professionals. There are 57 countries with a critical shortage of healthcare workers, a deficit of 2.4 million doctors and nurses. Africa has 2.3 healthcare workers per 1000 population, compared with the Americas, which have 24.8 healthcare workers per 1000 population. Only 1.3% of the world's health workers care for people who experience 25% of the global disease burden. The consequences for some countries resulting from loss of health workers are increasingly recognized and are now being widely aired in the public media. The health services of a continent already facing daunting challenges to the delivery of minimum standards of health care are now also being potentially overwhelmed by HIV/AIDS. There is a need for concerted political will and funding support that will allow them to do what is necessary. It may well be asked why special measures should be necessary to influence the migration of health professionals rather than engineers or football players or any other category. The answer must surely be that no other category of worker is so essential to the well-being of the population of every nation.
TL;DR: It is estimated that 11,500 infants' lives could be saved by effective implementation of basic neonatal care at 95% coverage and similar coverage of dual-therapy prevention of mother-to-child transmission with appropriate feeding choices could save 37,200 children's lives in South Africa per year in 2015 compared with 2008.
TL;DR: The experience of poor households attempting to access chronic care in a rural area of South Africa is described, finding that productive patient-provider interactions not only facilitated appropriate treatment action but enabled patients to justify their need for financial assistance to family and neighbours, and so access care.
Abstract: There is an increasing burden of chronic illness in low and middle income countries, driven by TB/HIV, as well as non-communicable diseases. Few health systems are organized to meet the needs of chronically ill patients, and patients' perspectives on the difficulties of accessing care need to be better understood, particularly in poor resourced settings, to achieve this end. This paper describes the experience of poor households attempting to access chronic care in a rural area of South Africa. A household survey (n = 1446 individuals) was combined with qualitative longitudinal research that followed 30 case study households over 10 months. Illness narratives and diaries provided descriptive textual data of household interactions with the health system. In the survey 74% of reported health problems were 'chronic', 48% of which had no treatment action taken in the previous month. Amongst the case study households, of the 34 cases of chronic illness, only 21 (62%) cases had an allopathic diagnosis and only 12 (35%) were receiving regular treatment. Livelihoods exhausted from previous illness and death, low income, and limited social networks, prevented consultation with monthly expenditure for repeated consultations as high as 60% of income. Interrupted drug supplies, insufficient clinical services at the clinic level necessitating referral, and a lack of ambulances further hampered access to care. Poor provider-patient interaction led to inadequate understanding of illness, inappropriate treatment action, 'healer shopping', and at times a break down in cooperation, with the patient 'giving up' on the public health system. However, productive patient-provider interactions not only facilitated appropriate treatment action but enabled patients to justify their need for financial assistance to family and neighbours, and so access care. In addition, patients and their families with understanding of a disease became a community resource drawn on to assist others. In strengthening the public sector it is important not only to improve drug supply chains, ambulance services, referral systems and clinical capacity at public clinics, and to address the financial constraints faced by the socially disadvantaged, but also to think through how providers can engage with patients in a way that strengthens the therapeutic alliance.
Goddard Space Flight Center1, University of Maryland, Baltimore County2, Russian Academy of Sciences3, Leibniz Institute of Marine Sciences4, Pacific Marine Environmental Laboratory5, University of Hamburg6, National Institute of Water and Atmospheric Research7, Plymouth Marine Laboratory8, University of the Witwatersrand9, Polish Academy of Sciences10, Woods Hole Oceanographic Institution11, Bigelow Laboratory For Ocean Sciences12, University of California, Santa Barbara13, Arctic and Antarctic Research Institute14, Vikram Sarabhai Space Centre15, University of Bari16, University of Cape Town17
TL;DR: The current status of the Maritime Aerosol Network (MAN), which has been developed as a component of the AERONET, is presented in this paper. But the authors do not provide a detailed analysis of the data collected.
Abstract: The paper presents the current status of the Maritime Aerosol Network (MAN), which has been developed as a component of the Aerosol Robotic Network (AERONET). MAN deploys Microtops handheld Sun photometers and utilizes the calibration procedure and data processing (Version 2) traceable to AERONET. A web site dedicated to the MAN activity is described. A brief historical perspective is given to aerosol optical depth (AOD) measurements over the oceans. A short summary of the existing data, collected on board ships of opportunity during the NASA Sensor Intercomparison and Merger for Biological and Interdisciplinary Oceanic Studies (SIMBIOS) Project is presented. Globally averaged oceanic aerosol optical depth (derived from island-based AERONET measurements) at 500 nm is similar to 0.11 and Angstrom parameter (computed within spectral range 440-870 nm) is calculated to be similar to 0.6. First results from the cruises contributing to the Maritime Aerosol Network are shown. MAN ship-based aerosol optical depth compares well to simultaneous island and near-coastal AERONET site AOD.
TL;DR: Micromorphological analysis of sediments from the Middle Stone Age site of Sibudu Cave, KwaZulu-Natal, South Africa, provides a high-resolution sequence and evidence of site formation processes of predominantly anthropogenic deposits.
Abstract: Micromorphological analysis of sediments from the Middle Stone Age site of Sibudu Cave, KwaZulu-Natal, South Africa, provides a high-resolution sequence and evidence of site formation processes of predominantly anthropogenic deposits. This methodology allows for a detailed interpretation of individual anthropogenic activi- ties, including the construction of hearths and bedding and the maintenance of occupational surfaces through the sweep out of hearths and the repeated burning of bedding. This analysis also provides a context for evaluating other studies at the site relating to magnetic susceptibility, paleobotany, paleozoology, anthracology, and studies of ochre.
TL;DR: The data suggest the development of a very limited number of neutralizing antibody specificities during the early stages of HIV-1 subtype C infection, with temporal fluctuations in specificities as escape occurs.
Abstract: We previously showed that HIV-1 subtype C viruses elicit potent but highly type-specific neutralizing antibodies (nAb) within the first year of infection. In order to determine the specificity and evolution of these autologous nAbs, we examined neutralization escape in four individuals whose responses against the earliest envelope differed in magnitude and potency. Neutralization escape occurred in all participants, with later viruses showing decreased sensitivity to contemporaneous sera, although they retained sensitivity to new nAb responses. Early nAb responses were very restricted, occurring sequentially and targeting only two regions of the envelope. In V1V2, limited amino acid changes often involving indels or glycans, mediated partial or complete escape, with nAbs targeting the V1V2 region directly in 2 cases. The alpha-2 helix of C3 was also a nAb target, with neutralization escape associated with changes to positively charged residues. In one individual, relatively high titers of anti-C3 nAbs were required to drive genetic escape, taking up to 7 weeks for the resistant variant to predominate. Thereafter titers waned but were still measurable. Development of this single anti-C3 nAb specificity was associated with a 7-fold drop in HIV-1 viral load and a 4-fold rebound as the escape mutation emerged. Overall, our data suggest the development of a very limited number of neutralizing antibody specificities during the early stages of HIV-1 subtype C infection, with temporal fluctuations in specificities as escape occurs. While the mechanism of neutralization escape appears to vary between individuals, the involvement of limited regions suggests there might be common vulnerabilities in the HIV-1 subtype C transmitted envelope.
TL;DR: The adsorption capabilities for the removal of parts per billion levels (ppb) of hexavalent chromium by three adsorbents namely functionalized multi-walled carbon nanotubes (MWCNTs), functionalized and non-functionalized MWCNTs were investigated as a function of contact time, initial solution pH, initial Cr(VI) concentrations and the presence of competing anions.
TL;DR: Tuberculosis risk is significantly reduced by IPT in HAART-treated adults in a high-incidence operational setting in South Africa and calls for the implementation of IPt in conjunction with the roll-out of HAART are strengthened.
Abstract: Background
The World Health Organization recommends isoniazid preventive therapy (IPT) for preventing tuberculosis in HIV-infected adults, although few countries have instituted this policy. Both IPT and highly active antiretroviral therapy (HAART) used separately result in reductions in tuberculosis risk. There is less information on the combined effect of IPT and HAART. We assessed the effect of IPT, HAART or both IPT and HAART on tuberculosis incidence in HIV-infected adults in South Africa.
TL;DR: DST-NRF Centre of Excellence for Invasion Biology, the University of Pretoria, EU FP6 MACIS species targeted project (Minimisation of and Adaptation to Climate change: Impacts on biodiversity, contract No. 044399) and EU FP 6 ECOCHANGE integrated project (Challenges in assessing and forecasting biodiversity and ecosystem changes in Europe).
Abstract: DST-NRF Centre of Excellence for Invasion Biology, the University of Pretoria, EU FP6 MACIS species targeted project (Minimisation of and Adaptation to Climate change: Impacts on biodiversity, contract No.: 044399) and EU FP6 ECOCHANGE integrated project (Challenges in assessing and forecasting biodiversity and ecosystem changes in Europe).
TL;DR: A comparison of the plant diversity and palaeoenvironmetal patterns of mediterranean-climate regions provide insights regarding the "remarkable environmental conditions" of the Cape that have generated the high diversification and low extinction rates necessary to produce such a rich flora.
University of Barcelona1, University of London2, Medicines and Healthcare Products Regulatory Agency3, University of Newcastle4, Charité5, Korle Bu Teaching Hospital6, Bernhard Nocht Institute for Tropical Medicine7, University of Tübingen8, Albert Schweitzer Hospital9, College of Health Sciences, Bahrain10, Eduardo Mondlane University11, University of Liverpool12, Ministry of Health (Ghana)13, University of the Witwatersrand14, Centers for Disease Control and Prevention15
TL;DR: IPTi with sulfadoxine-pyrimethamine was safe and efficacious across a range of malaria transmission settings, suggesting that this intervention is a useful contribution to malaria control.
TL;DR: To understand the ways in which iron balance can be disturbed, it is necessary to have an understanding of how losses from the body are matched by the absorption of iron in different dietary settings as well as the limits of this regulatory control.
Abstract: There are two major disturbances of iron balance: iron deficiency and iron overload. Iron-deficiency anemia is a major problem in developing countries and affects between 500 million and 600 million people worldwide. While iron overload is much less prevalent, it has a number of major pathologic sequelae and there have been recent suggestions that even modest increases in the body's iron stores may have pathologic associations. To understand the ways in which iron balance can be disturbed, it is necessary to have an understanding of how losses from the body are matched by the absorption of iron in different dietary settings as well as the limits of this regulatory control.
TL;DR: In this article, the Malani Igneous Suite (MIS) was used to reconstruct the Indian subcontinent between the dispersal of the Mesoproterozoic supercontinent Rodinia and the assembly of Gondwana.
TL;DR: Investigation of the in vitro pharmacological interactions between essential oils and conventional antimicrobials when used in combination to find alternatives to conventional antimicrobial therapy.
Abstract: Aims: Due to the emergence of multi-drug resistance, alternatives to conventional antimicrobial therapy are needed. This study aims to investigate the in vitro pharmacological interactions between essential oils (considered valuable as natural therapeutic treatments) and conventional antimicrobials (ciprofloxacin/amphotericin B) when used in combination.
Methods and Results: Interactions of the essential oils (Melaleuca alternifolia, Thymus vulgaris, Mentha piperita and Rosmarinus officinalis) when combined with ciprofloxacin against Staphylococcus aureus indicate mainly antagonistic profiles. When tested against Klebsiella pneumoniae the isobolograms show antagonistic, synergistic and additive interactions depending on the combined ratio. The R. officinalis/ciprofloxacin combination against K. pneumoniae displayed the most favourable synergistic pattern. The interactions of M. alternifolia (tea tree), T. vulgaris (thyme), M. piperita (peppermint) and R. officinalis (rosemary) essential oils with amphotericin B indicate mainly antagonistic profiles when tested against Candida albicans.
Conclusion: While a number of interactions show complete antagonism, others show varied (synergistic, additive and/or antagonistic) interactions, thus the efficacy is dependent on the ratio in which the two components co-exist.
Significance and Impact of the Study: The predominant antagonistic interactions noted here, suggests that some natural therapies containing essential oils should be used with caution when combined with antibiotics.
TL;DR: There was strong concordance between recognized local clustering of cases and outbreak declaration in specific towns, and this synergy may allow mutual validation of the two systems in confirming outbreaks demanding additional resources and cluster identification at local level to better target resources.
Abstract: Mpumalanga Province, South Africa is a low malaria transmission area that is subject to malaria epidemics. SaTScan methodology was used by the malaria control programme to detect local malaria clusters to assist disease control planning. The third season for case cluster identification overlapped with the first season of implementing an outbreak identification and response system in the area. SaTScan™ software using the Kulldorf method of retrospective space-time permutation and the Bernoulli purely spatial model was used to identify malaria clusters using definitively confirmed individual cases in seven towns over three malaria seasons. Following passive case reporting at health facilities during the 2002 to 2005 seasons, active case detection was carried out in the communities, this assisted with determining the probable source of infection. The distribution and statistical significance of the clusters were explored by means of Monte Carlo replication of data sets under the null hypothesis with replications greater than 999 to ensure adequate power for defining clusters. SaTScan detected five space-clusters and two space-time clusters during the study period. There was strong concordance between recognized local clustering of cases and outbreak declaration in specific towns. Both Albertsnek and Thambokulu reported malaria outbreaks in the same season as space-time clusters. This synergy may allow mutual validation of the two systems in confirming outbreaks demanding additional resources and cluster identification at local level to better target resources. Exploring the clustering of cases assisted with the planning of public health activities, including mobilizing health workers and resources. Where appropriate additional indoor residual spraying, focal larviciding and health promotion activities, were all also carried out.