Reversible and irreversible cardiovascular risk factors.
\\n\\n
More than half of the publishers listed alongside IntechOpen (18 out of 30) are Social Science and Humanities publishers. IntechOpen is an exception to this as a leader in not only Open Access content but Open Access content across all scientific disciplines, including Physical Sciences, Engineering and Technology, Health Sciences, Life Science, and Social Sciences and Humanities.
\\n\\nOur breakdown of titles published demonstrates this with 47% PET, 31% HS, 18% LS, and 4% SSH books published.
\\n\\n“Even though ItechOpen has shown the potential of sci-tech books using an OA approach,” other publishers “have shown little interest in OA books.”
\\n\\nAdditionally, each book published by IntechOpen contains original content and research findings.
\\n\\nWe are honored to be among such prestigious publishers and we hope to continue to spearhead that growth in our quest to promote Open Access as a true pioneer in OA book publishing.
\\n\\n\\n\\n
\\n"}]',published:!0,mainMedia:{caption:"IntechOpen Maintains",originalUrl:"/media/original/113"}},components:[{type:"htmlEditorComponent",content:'
Simba Information has released its Open Access Book Publishing 2020 - 2024 report and has again identified IntechOpen as the world’s largest Open Access book publisher by title count.
\n\nSimba Information is a leading provider for market intelligence and forecasts in the media and publishing industry. The report, published every year, provides an overview and financial outlook for the global professional e-book publishing market.
\n\nIntechOpen, De Gruyter, and Frontiers are the largest OA book publishers by title count, with IntechOpen coming in at first place with 5,101 OA books published, a good 1,782 titles ahead of the nearest competitor.
\n\nSince the first Open Access Book Publishing report published in 2016, IntechOpen has held the top stop each year.
\n\n\n\nMore than half of the publishers listed alongside IntechOpen (18 out of 30) are Social Science and Humanities publishers. IntechOpen is an exception to this as a leader in not only Open Access content but Open Access content across all scientific disciplines, including Physical Sciences, Engineering and Technology, Health Sciences, Life Science, and Social Sciences and Humanities.
\n\nOur breakdown of titles published demonstrates this with 47% PET, 31% HS, 18% LS, and 4% SSH books published.
\n\n“Even though ItechOpen has shown the potential of sci-tech books using an OA approach,” other publishers “have shown little interest in OA books.”
\n\nAdditionally, each book published by IntechOpen contains original content and research findings.
\n\nWe are honored to be among such prestigious publishers and we hope to continue to spearhead that growth in our quest to promote Open Access as a true pioneer in OA book publishing.
\n\n\n\n
\n'}],latestNews:[{slug:"intechopen-supports-asapbio-s-new-initiative-publish-your-reviews-20220729",title:"IntechOpen Supports ASAPbio’s New Initiative Publish Your Reviews"},{slug:"webinar-introduction-to-open-science-wednesday-18-may-1-pm-cest-20220518",title:"Webinar: Introduction to Open Science | Wednesday 18 May, 1 PM CEST"},{slug:"step-in-the-right-direction-intechopen-launches-a-portfolio-of-open-science-journals-20220414",title:"Step in the Right Direction: IntechOpen Launches a Portfolio of Open Science Journals"},{slug:"let-s-meet-at-london-book-fair-5-7-april-2022-olympia-london-20220321",title:"Let’s meet at London Book Fair, 5-7 April 2022, Olympia London"},{slug:"50-books-published-as-part-of-intechopen-and-knowledge-unlatched-ku-collaboration-20220316",title:"50 Books published as part of IntechOpen and Knowledge Unlatched (KU) Collaboration"},{slug:"intechopen-joins-the-united-nations-sustainable-development-goals-publishers-compact-20221702",title:"IntechOpen joins the United Nations Sustainable Development Goals Publishers Compact"},{slug:"intechopen-signs-exclusive-representation-agreement-with-lsr-libros-servicios-y-representaciones-s-a-de-c-v-20211123",title:"IntechOpen Signs Exclusive Representation Agreement with LSR Libros Servicios y Representaciones S.A. de C.V"},{slug:"intechopen-expands-partnership-with-research4life-20211110",title:"IntechOpen Expands Partnership with Research4Life"}]},book:{item:{type:"book",id:"9528",leadTitle:null,fullTitle:"Current Topics and Emerging Issues in Malaria Elimination",title:"Current Topics and Emerging Issues in Malaria Elimination",subtitle:null,reviewType:"peer-reviewed",abstract:"Malaria is one of the most important tropical diseases in the history of the world. This vector-borne disease has been a significant cause of morbidity and mortality in tropical countries of Africa, Asia, and Latin America. As such, this book provides updated information on epidemiological and public health research of malaria conducted in the last decade. Over four sections, chapters discuss such topics as diagnosis, epidemiology and surveillance, policy and prevention, and vector control and vaccines.",isbn:"978-1-83968-484-5",printIsbn:"978-1-83968-483-8",pdfIsbn:"978-1-83968-485-2",doi:"10.5772/intechopen.87323",price:139,priceEur:155,priceUsd:179,slug:"current-topics-and-emerging-issues-in-malaria-elimination",numberOfPages:334,isOpenForSubmission:!1,isInWos:null,isInBkci:!1,hash:"7f178329cc42e691efe226b32f14e2ea",bookSignature:"Alfonso J. Rodriguez-Morales",publishedDate:"July 21st 2021",coverURL:"https://cdn.intechopen.com/books/images_new/9528.jpg",numberOfDownloads:4537,numberOfWosCitations:0,numberOfCrossrefCitations:4,numberOfCrossrefCitationsByBook:1,numberOfDimensionsCitations:6,numberOfDimensionsCitationsByBook:1,hasAltmetrics:1,numberOfTotalCitations:10,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"September 8th 2020",dateEndSecondStepPublish:"October 6th 2020",dateEndThirdStepPublish:"December 5th 2020",dateEndFourthStepPublish:"February 23rd 2021",dateEndFifthStepPublish:"April 24th 2021",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"131400",title:"Prof.",name:"Alfonso J.",middleName:null,surname:"Rodriguez-Morales",slug:"alfonso-j.-rodriguez-morales",fullName:"Alfonso J. Rodriguez-Morales",profilePictureURL:"https://mts.intechopen.com/storage/users/131400/images/system/131400.png",biography:"Dr. Rodriguez-Morales is an expert in tropical and emerging diseases, particularly zoonotic and vector-borne diseases (especially arboviral diseases). He is the president of the Travel Medicine Committee of the Pan-American Infectious Diseases Association (API), as well as the president of the Colombian Association of Infectious Diseases (ACIN). He is a member of the Committee on Tropical Medicine, Zoonoses, and Travel Medicine of ACIN. He is a vice-president of the Latin American Society for Travel Medicine (SLAMVI) and a Member of the Council of the International Society for Infectious Diseases (ISID). Since 2014, he has been recognized as a Senior Researcher, at the Ministry of Science of Colombia. He is a professor at the Faculty of Medicine of the Fundacion Universitaria Autonoma de las Americas, in Pereira, Risaralda, Colombia. He is an External Professor, Master in Research on Tropical Medicine and International Health, Universitat de Barcelona, Spain. He is also a professor at the Master in Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima, Peru. In 2021 he has been awarded the “Raul Isturiz Award” Medal of the API. Also, in 2021, he was awarded with the “Jose Felix Patiño” Asclepius Staff Medal of the Colombian Medical College, due to his scientific contributions to COVID-19 during the pandemic. He is currently the Editor in Chief of the journal Travel Medicine and Infectious Diseases. His Scopus H index is 47 (Google Scholar H index, 68).",institutionString:"Institución Universitaria Visión de las Américas, Colombia",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"8",totalChapterViews:"0",totalEditedBooks:"11",institution:null}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"1129",title:"Epidemiology",slug:"epidemiology"}],chapters:[{id:"77221",title:"Introductory Chapter: Malaria Elimination - A Challenge with Multiple Emerging Ecosocial Challenges",doi:"10.5772/intechopen.98579",slug:"introductory-chapter-malaria-elimination-a-challenge-with-multiple-emerging-ecosocial-challenges",totalDownloads:253,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:1,abstract:null,signatures:"Alfonso J. Rodriguez-Morales, Jaime A. Cardona-Ospina, D. Katterine Bonilla-Aldana, Luis Andrés Salas-Matta, Wilmer E. Villamil-Gómez, Juan Pablo Escalera-Antezana, Lucia E. Alvarado-Arnez, Carlos Franco-Paredes, Juan-Carlos Navarro, Tomas Orduna and José A. Suárez",downloadPdfUrl:"/chapter/pdf-download/77221",previewPdfUrl:"/chapter/pdf-preview/77221",authors:[{id:"131400",title:"Prof.",name:"Alfonso J.",surname:"Rodriguez-Morales",slug:"alfonso-j.-rodriguez-morales",fullName:"Alfonso J. Rodriguez-Morales"},{id:"421599",title:"Dr.",name:"Jaime A.",surname:"Cardona-Ospina",slug:"jaime-a.-cardona-ospina",fullName:"Jaime A. Cardona-Ospina"},{id:"421600",title:"Dr.",name:"D.",surname:"Katterine-Bonilla-Aldana",slug:"d.-katterine-bonilla-aldana",fullName:"D. Katterine-Bonilla-Aldana"},{id:"421601",title:"Dr.",name:"Luis Andrés",surname:"Salas-Matta",slug:"luis-andres-salas-matta",fullName:"Luis Andrés Salas-Matta"},{id:"421602",title:"Dr.",name:"Wilmer E.",surname:"Villamil-Gómez",slug:"wilmer-e.-villamil-gomez",fullName:"Wilmer E. Villamil-Gómez"},{id:"421603",title:"Dr.",name:"Juan Pablo",surname:"Escalera-Antezana",slug:"juan-pablo-escalera-antezana",fullName:"Juan Pablo Escalera-Antezana"},{id:"421604",title:"Dr.",name:"Lucia E.",surname:"Alvarado-Arnez",slug:"lucia-e.-alvarado-arnez",fullName:"Lucia E. Alvarado-Arnez"},{id:"421605",title:"Dr.",name:"Carlos",surname:"Franco-Paredes",slug:"carlos-franco-paredes",fullName:"Carlos Franco-Paredes"},{id:"421606",title:"Dr.",name:"Juan-Carlos",surname:"Navarro",slug:"juan-carlos-navarro",fullName:"Juan-Carlos Navarro"},{id:"421607",title:"Dr.",name:"Tomas",surname:"Orduna",slug:"tomas-orduna",fullName:"Tomas Orduna"},{id:"421608",title:"Dr.",name:"José A.",surname:"Suárez",slug:"jose-a.-suarez",fullName:"José A. Suárez"}],corrections:null},{id:"75673",title:"Point-of-Care Strategies Applied to Malaria Diagnosis",doi:"10.5772/intechopen.96721",slug:"point-of-care-strategies-applied-to-malaria-diagnosis",totalDownloads:419,totalCrossrefCites:0,totalDimensionsCites:1,hasAltmetrics:0,abstract:"Rapid and specific diagnosis of malaria remains one of the main strategies to fight the disease. The diagnosis is made primarily by the simple and low-cost thick drop technique, considered the gold standard test. However, the requirement for good quality microscopes and well-trained personnel often lead to inaccurate diagnosis, especially in cases of mixed infections or low parasitemia. Although PCR-based tests can help in these situations, this technique requires large and sensitive equipments, being unsuitable for point of care (POC) settings. A myriad of POC diagnostic tests have being developed in the last years, relying on molecular methods but also on novel strategies. New platforms, miniaturization techniques, and multiplexing possibilities promise great potential to improve disease diagnostics through fast and accurate detection of cases, even at remote places. Here, we will address the main POC strategies developed for the diagnosis of malaria, highlighting their strengths and weakness as POC applications.",signatures:"Alexandre Dias Tavares Costa, Anna Caroline Campos Aguiar, Angelina Moraes Silva and Dhelio Batista Pereira",downloadPdfUrl:"/chapter/pdf-download/75673",previewPdfUrl:"/chapter/pdf-preview/75673",authors:[{id:"333225",title:"Ph.D.",name:"Alexandre",surname:"Costa",slug:"alexandre-costa",fullName:"Alexandre Costa"},{id:"344447",title:"Dr.",name:"Anna Caroline Campos",surname:"Aguiar",slug:"anna-caroline-campos-aguiar",fullName:"Anna Caroline Campos Aguiar"},{id:"344456",title:"Dr.",name:"Dhelio Batista",surname:"Pereira",slug:"dhelio-batista-pereira",fullName:"Dhelio Batista Pereira"},{id:"344457",title:"MSc.",name:"Angelina Moraes",surname:"Silva",slug:"angelina-moraes-silva",fullName:"Angelina Moraes Silva"}],corrections:null},{id:"75545",title:"Prompt and Accurate Diagnosis, A Veritable Tool in Malaria Elimination Efforts",doi:"10.5772/intechopen.96582",slug:"prompt-and-accurate-diagnosis-a-veritable-tool-in-malaria-elimination-efforts",totalDownloads:212,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"The concept of malaria elimination is to get rid of local transmission of malaria parasites in a defined geographical area. Among the measures required for malaria elimination is prompt and accurate diagnosis. Malaria diagnostic tools currently in use: clinical diagnosis, Malaria Rapid Diagnostic Tests (mRDT) and molecular diagnosis, have limitations. Clinical diagnosis can be used as first step in making prompt malaria diagnosis, but cannot confirm cases. Malaria RDTs satisfies the need for prompt diagnosis but has low accuracy in confirming cases. Accuracy of microscopy depends on making good blood films, and accurate film interpretation. Molecular diagnosis required for species-specific diagnosis of malaria parasites, and determination of genes that confers drug resistance to Plasmodium species is not available for routine use. As part of elimination efforts, there is development of mRDT kits that utilize urine or saliva instead of blood specimen, microscopy digital image recognition and different technologies for molecular diagnosis. So far, none of these diagnostic tools has satisfied the need for prompt and accurate diagnosis. It is therefore recommended that more than one diagnostic tool is needed for malaria elimination to be achieved in a given area. This will ensure early detection and treatment of cases, as well as prevent the re-establishment of transmission.",signatures:"Chukwudi Michael Egbuche",downloadPdfUrl:"/chapter/pdf-download/75545",previewPdfUrl:"/chapter/pdf-preview/75545",authors:[{id:"332819",title:"Dr.",name:"Chukwudi Michael",surname:"Egbuche",slug:"chukwudi-michael-egbuche",fullName:"Chukwudi Michael Egbuche"}],corrections:null},{id:"76766",title:"Malaria Elimination: The Role and Value of Sero-Surveillance",doi:"10.5772/intechopen.97131",slug:"malaria-elimination-the-role-and-value-of-sero-surveillance",totalDownloads:313,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:1,abstract:"As countries move from intense malaria transmission to low transmission there will be a demand for more sensitive tools and approaches in tracking malaria transmission dynamics. Surveillance tools that are sensitive in tracking real time infectious bites as well as infectious reservoir will be preferred to counting number of cases in the hospital or parasite prevalence. The acquisition and maintenance of anti-malarial antibodies is a direct function of parasite exposure, seroprevalence rates has been used as an efficient tool in assessing malaria endemicity and confirming malaria elimination. Plasmodium antibodies are explicit biomarkers that can be utilised to track parasite exposure over more extensive time spans than microscopy, rapid diagnostic testing or molecular testing and the conventional entomological inoculation rate. Seroprevalence studies can therefore help monitor the impact of malaria control interventions, especially when the parasite occurrence is low. As a result, antibody responses to Anopheles salivary proteins or Plasmodium species may potentially offer reliable information of recent or past exposure; recognise short-term or gradual changes in exposure to Plasmodium infection or to estimate individual-level exposure to infection. This book chapter will present about four studies we have conducted across eastern and western Africa on the efficiency of salivary gland proteins and antimalarial antibodies in tracking malaria transmission intensity. We hope that these could be used as surveillance tools in malaria elimination efforts.",signatures:"Kingsley Badu, Amma Aboagyewa Larbi and Kwadwo Boampong",downloadPdfUrl:"/chapter/pdf-download/76766",previewPdfUrl:"/chapter/pdf-preview/76766",authors:[{id:"331951",title:"Dr.",name:"Kingsley",surname:"Badu",slug:"kingsley-badu",fullName:"Kingsley Badu"},{id:"346313",title:"Dr.",name:"Kwadwo",surname:"Boampong",slug:"kwadwo-boampong",fullName:"Kwadwo Boampong"},{id:"346314",title:"Dr.",name:"Amma Aboagyewa",surname:"Larbi",slug:"amma-aboagyewa-larbi",fullName:"Amma Aboagyewa Larbi"}],corrections:null},{id:"75830",title:"The Role of Adaptive Surveillance as a Core Intervention to Achieve Malaria Elimination",doi:"10.5772/intechopen.96879",slug:"the-role-of-adaptive-surveillance-as-a-core-intervention-to-achieve-malaria-elimination",totalDownloads:366,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Adaptive surveillance systems are essential for national programmes to achieve their malaria elimination goals. Core principles of surveillance systems including accurate diagnosis and reporting of malaria cases, integration of health data across administrative levels and the need to link data to a response are well defined by international guidelines. Nevertheless, while the requirements of surveillance systems along the transmission continuum are clearly documented, the operationalization remains challenging for national programmes. Firstly, because the multi-level increase of surveillance efforts demanding real-time and case-based data as well as the capacity of the health force to trigger locally customized responses, is resource intensive and requires substantial investment. Secondly, because there is a gap in international alignment on best tools and practices on how to operationally implement these requirements. Recently, several initiatives have started to address this gap in international coordination, aiming to establish the operational guidance for elimination programmes to successfully implement adaptive surveillance systems.",signatures:"Arantxa Roca-Feltrer, Ann-Sophie Stratil and James K. Tibenderana",downloadPdfUrl:"/chapter/pdf-download/75830",previewPdfUrl:"/chapter/pdf-preview/75830",authors:[{id:"214902",title:"Dr.",name:"Arantxa",surname:"Roca-Feltrer",slug:"arantxa-roca-feltrer",fullName:"Arantxa Roca-Feltrer"},{id:"332284",title:"MSc.",name:"Ann-Sophie",surname:"Stratil",slug:"ann-sophie-stratil",fullName:"Ann-Sophie Stratil"},{id:"346611",title:"Dr.",name:"James K.",surname:"Tibenderana",slug:"james-k.-tibenderana",fullName:"James K. Tibenderana"}],corrections:null},{id:"76221",title:"Increased Trends of P. vivax in Sub-Saharan Africa: What Does it Mean for Malaria Elimination?",doi:"10.5772/intechopen.97189",slug:"increased-trends-of-em-p-vivax-em-in-sub-saharan-africa-what-does-it-mean-for-malaria-elimination-",totalDownloads:241,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Plasmodium vivax being the most geographically spread Plasmodium species is considered sparsely distributed in sub-Saharan Africa (sSA) while P. falciparum is the most prevalent species in this region. Thus, control strategies in sSA have been disproportionately targeted towards falciparum malaria. Nevertheless, with the use of more sensitive malaria diagnostic platforms, there are more reports of P. vivax and other non-falciparum malaria in sSA. In addition, P. vivax is presumed benign, however there are new findings of severe cases recorded from P. vivax single or mixed infection with other Plasmodium species. Besides, the extended dormant period (lasting for weeks or months) is a challenge for achieving effective cure for vivax infections. Although, chloroquine has been proscribed for treatment P. falciparum, it still remains the drug of choice for P. vivax in most Asian countries where it is predominant. In sSA, artemisinin combination-based therapies (ACTs) are used for treatment of falciparum malaria and, it is probable that the use of ACT could be enhancing adaptive selection for P. vivax in the face of its increasing prevalence in the population. Hence, understanding epidemiological and biological factors, and data that could be contributing to the observed steady increase in P. vivax prevalence in sSA is important. In this chapter, we discuss the mechanisms for invasion of red blood cells, trends in increasing prevalence of vivax malaria, diagnostic tools, and the public health implications of P. vivax and P. falciparum co-endemicity in Africa.",signatures:"Mary Aigbiremo Oboh, Mamadou Ndiath, Olumide Ajibola, Kolapo Oyebola and Alfred Amambua-Ngwa",downloadPdfUrl:"/chapter/pdf-download/76221",previewPdfUrl:"/chapter/pdf-preview/76221",authors:[{id:"335612",title:"Dr.",name:"Mary",surname:"Oboh",slug:"mary-oboh",fullName:"Mary Oboh"},{id:"335772",title:"Dr.",name:"Mamadou",surname:"Ndiath",slug:"mamadou-ndiath",fullName:"Mamadou Ndiath"},{id:"335773",title:"Dr.",name:"Olumide",surname:"Ajibola",slug:"olumide-ajibola",fullName:"Olumide Ajibola"},{id:"335774",title:"Dr.",name:"Kolapo",surname:"Oyebola",slug:"kolapo-oyebola",fullName:"Kolapo Oyebola"},{id:"336147",title:"Dr.",name:"Alfred",surname:"Amambua-Ngwa",slug:"alfred-amambua-ngwa",fullName:"Alfred Amambua-Ngwa"}],corrections:null},{id:"75466",title:"Plasmodium falciparum: Experimental and Theoretical Approaches in Last 20 Years",doi:"10.5772/intechopen.96529",slug:"-em-plasmodium-falciparum-em-experimental-and-theoretical-approaches-in-last-20-years",totalDownloads:348,totalCrossrefCites:2,totalDimensionsCites:3,hasAltmetrics:0,abstract:"Malaria, the severe vector-borne disease has embedded serious consequences on mankind since ages, causing deterioration of health, leading to deaths. The causative parasite has a wide distribution aligned from tropical to subtropical regions. Out of all the five species Plasmodium vivax and Plasmodium falciparum have registered about more than 600 million cases worldwide. Throughout the decades, identification of various antimalarial drugs, targets, preventive measures and advancement of vaccines were achieved. The key to executing malaria elimination is the appropriate laboratory diagnosis. Development includes positive scientific judgments for a vaccine, advanced progress of 3 non-pyrethroid insecticides, novel genetic technologies, possibilities to alter malaria parasite mediation by the mosquito, identification of drug resistance markers, initiation of Plasmodium vivax liver stage assessment, perspective to mathematical modeling and screening for active ingredients for drugs and insecticides. Although the last century witnessed many successful programs with scientific progress, however, this was matched with notable obstacles. The mutation in the genes has changed the overall gameplay of eradication. This chapter aims to examine the numerous experimental and theoretical works that have been established in the last two decades along with the ongoing methodologies consisting of detailed explanations necessary for the establishment of new targets and drugs.",signatures:"Abhichandan Das, Upasana Pathak, Sanchaita Rajkhowa and Anupam Nath Jha",downloadPdfUrl:"/chapter/pdf-download/75466",previewPdfUrl:"/chapter/pdf-preview/75466",authors:[{id:"325925",title:"Assistant Prof.",name:"Anupam Nath",surname:"Jha",slug:"anupam-nath-jha",fullName:"Anupam Nath Jha"},{id:"326183",title:"Dr.",name:"Sanchaita",surname:"Rajkhowa",slug:"sanchaita-rajkhowa",fullName:"Sanchaita Rajkhowa"},{id:"345976",title:"Dr.",name:"Abhichandan",surname:"Das",slug:"abhichandan-das",fullName:"Abhichandan Das"},{id:"345977",title:"Ms.",name:"Upasana",surname:"Pathak",slug:"upasana-pathak",fullName:"Upasana Pathak"}],corrections:null},{id:"77261",title:"Malaria Lethality in Children under 5 Years of Age and Study of Risk Factors in MbujiMayi Paediatric Environment, a Neglected Deadly Epidemic in the Democratic of Republic of Congo",doi:"10.5772/intechopen.98511",slug:"malaria-lethality-in-children-under-5-years-of-age-and-study-of-risk-factors-in-mbujimayi-paediatric",totalDownloads:245,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"The objective of this study was to determine the risk factors for malaria lethality in the MbujiMayi paediatric environment, a follow-up study of hospitalised cases over 5 years was conducted between January 2016 and December 2020 in the four hospitals. The case rate was 6.9% for the total (139 cases of death for 2017 cases of severe malaria for 5 years,) and varied from year to year (10.7% in 2016 to 4.6% in 2020). Cox Proportional Risk Model results including significant covariates in multivariate analysis [HR (IC95%)]. In multivariate analysis, two models were considered. The case-fatality rate was independently associated with late arrival after 48 hours [3.1 (1.9–5.1); p < 0.001], types of pre-hospital recourse such as recourse to the church [1.4 (1.1–2.1),; p = 0.042) and tradipractor [3.2 (1.8–6.1); p < 0.001] for severe malaria, children under 12 months of age [1.8 (1.2–2.8); p < 0.001], those with circulatory collapse [2.6 (1.1–6.1); p < 0.001] and those in deep coma [1.9 (1.1–3.4); p = 0.016]. The second model with the number of associated syndromes, showed that the risk was 1.7 plus for children with a complex clinical picture, made up of the combination of several signs [1.7 (1.1–2.6); p < 0.001]. These results highlight the need for more information campaigns to encourage people to seek institutional care for malaria. Our results also suggest that prophylactic treatment may be advisable for children under 5 years of age.",signatures:"Félicien Ilunga-Ilunga, Alain Levêque, Vévé Mbuyi Kanyinda, Jean Paul Mbikayi Muya and Michèle Dramaix",downloadPdfUrl:"/chapter/pdf-download/77261",previewPdfUrl:"/chapter/pdf-preview/77261",authors:[{id:"332220",title:"Associate Prof.",name:"Ilunga-Ilunga",surname:"Félicien",slug:"ilunga-ilunga-felicien",fullName:"Ilunga-Ilunga Félicien"},{id:"332323",title:"Prof.",name:"Leveque",surname:"Alain",slug:"leveque-alain",fullName:"Leveque Alain"},{id:"332324",title:"Prof.",name:"Dramaix",surname:"Michèle",slug:"dramaix-michele",fullName:"Dramaix Michèle"},{id:"357379",title:"Mr.",name:"Mbuyi Kanyinda",surname:"Veve",slug:"mbuyi-kanyinda-veve",fullName:"Mbuyi Kanyinda Veve"},{id:"357380",title:"MSc.",name:"Mbikayi Muya",surname:"Jean Paul",slug:"mbikayi-muya-jean-paul",fullName:"Mbikayi Muya Jean Paul"}],corrections:null},{id:"76680",title:"New Challenges in Malaria Elimination",doi:"10.5772/intechopen.96532",slug:"new-challenges-in-malaria-elimination",totalDownloads:374,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"In recent years, efforts to eliminate malaria has gained a tremendous momentum, and many countries have achieved this goal — but it has faced many challenges. Recent COVID-19 pandemic has compounded the challenges due to cessation of many on-field operations. Accordingly, the World Health Organization (WHO) has advocated to all malaria-endemic countries to continue the malaria elimination operations following the renewed protocols. The recent reports of artemisinin resistance in Plasmodium falciparum followed by indication of chloroquine resistance in P. vivax, and reduced susceptibility of synthetic pyrethroids used in long lasting insecticide nets are some issues hindering the elimination efforts. Moreover, long distance night migration of vector mosquitoes in sub-Saharan Africa and invasion of Asian vector Anopheles stephensi in many countries including Africa and Southeast Asia have added to the problems. In addition, deletion of histidine rich protein 2 and 3 (Pfhrp2/3) genes in P. falciparum in many countries has opened new vistas to be addressed for point-of-care diagnosis of this parasite. It is needed to revisit the strategies adopted by those countries have made malaria elimination possible even in difficult situations. Strengthening surveillance and larval source management are the main strategies for successful elimination of malaria. New technologies like Aptamar, and artificial intelligence and machine learning would prove very useful in addressing many ongoing issues related to malaria elimination.",signatures:"Susanta Kumar Ghosh and Chaitali Ghosh",downloadPdfUrl:"/chapter/pdf-download/76680",previewPdfUrl:"/chapter/pdf-preview/76680",authors:[{id:"301164",title:"Prof.",name:"Susanta",surname:"Ghosh",slug:"susanta-ghosh",fullName:"Susanta Ghosh"},{id:"306830",title:"Dr.",name:"Chaitali",surname:"Ghosh",slug:"chaitali-ghosh",fullName:"Chaitali Ghosh"}],corrections:null},{id:"75582",title:"Elimination of Plasmodium vivax Malaria: Problems and Solutions",doi:"10.5772/intechopen.96604",slug:"elimination-of-em-plasmodium-vivax-em-malaria-problems-and-solutions",totalDownloads:381,totalCrossrefCites:2,totalDimensionsCites:2,hasAltmetrics:1,abstract:"Malaria is caused by multiple parasitic species of the genus Plasmodium. Although P. falciparum accounts for the highest mortality, P. vivax is the most geographically dispersed and the most common species outside of Africa. Several unique biological features make P. vivax less responsive to conventional control measures and allow it to persist even after elimination of P. falciparum. The ability of P. vivax to develop in diverse vectors at lower ambient temperatures bestows it a greater distribution range and resilience to ecological changes. Its tropism for reticulocytes often causes low-density infections below the levels detectable by routine diagnostic tests, demanding the development of more sensitive diagnostics. P. vivax produces gametocytes early enabling transmission before the manifestation of clinical symptoms, thus emphasizing the need for an integrated vector control strategy. More importantly, its dormant liver stage which engenders relapse is difficult to diagnose and treat. The deployment of available treatments for the liver hypnozoites, including primaquine and the recent U.S. Food and Drug Administration-approved tafenoquine, requires point-of-care diagnostics to detect glucose-6-phosphate dehydrogenase deficiency among endemic human populations. Here we review the continued challenges to effectively control P. vivax and explore integrated technologies and targeted strategies for the elimination of vivax malaria.",signatures:"Liwang Cui, Awtum Brashear, Lynette Menezes and John Adams",downloadPdfUrl:"/chapter/pdf-download/75582",previewPdfUrl:"/chapter/pdf-preview/75582",authors:[{id:"333570",title:"Prof.",name:"Liwang",surname:"Cui",slug:"liwang-cui",fullName:"Liwang Cui"},{id:"344788",title:"Dr.",name:"Awtum",surname:"Brashear",slug:"awtum-brashear",fullName:"Awtum Brashear"},{id:"344789",title:"Prof.",name:"Lynette",surname:"Menezes",slug:"lynette-menezes",fullName:"Lynette Menezes"},{id:"344790",title:"Prof.",name:"John",surname:"Adams",slug:"john-adams",fullName:"John Adams"}],corrections:null},{id:"75791",title:"Plasmodium vivax and Plasmodium ovale in the Malaria Elimination Agenda in Africa",doi:"10.5772/intechopen.96867",slug:"-em-plasmodium-vivax-em-and-em-plasmodium-ovale-em-in-the-malaria-elimination-agenda-in-africa",totalDownloads:215,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"In recent times, several countries in sub-Saharan Africa have reported cases of Plasmodium vivax (Pv) with a considerable number being Duffy negative. Current efforts at malaria elimination are focused solely on Plasmodium falciparum (Pf) excluding non-falciparum malaria. Pv and Plasmodium ovale (Po) have hypnozoite forms that can serve as reservoirs of infection and sustain transmission. The burden of these parasites in Africa seems to be more than acknowledged, playing roles in migrant and autochthonous infections. Considering that elimination and eradication is a current aim for WHO and Roll Back Malaria (RBM), the inclusion of Pv and Po in the elimination agenda cannot be over-emphasized. The biology of Pv and Po are such that the same elimination strategies as are used for Pf cannot be applied so, going forward, new approaches will be required to attain elimination and eradication targets.",signatures:"Isaac K. Quaye and Larysa Aleksenko",downloadPdfUrl:"/chapter/pdf-download/75791",previewPdfUrl:"/chapter/pdf-preview/75791",authors:[{id:"156685",title:"Prof.",name:"Isaac K.",surname:"Quaye",slug:"isaac-k.-quaye",fullName:"Isaac K. Quaye"},{id:"348439",title:"Dr.",name:"Larysa",surname:"Aleksenko",slug:"larysa-aleksenko",fullName:"Larysa Aleksenko"}],corrections:null},{id:"75815",title:"Progress in Parasite Genomics and Its Application to Current Challenges in Malaria Control",doi:"10.5772/intechopen.96530",slug:"progress-in-parasite-genomics-and-its-application-to-current-challenges-in-malaria-control",totalDownloads:335,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:1,abstract:"A wide deployment of malaria control tools have significantly reduced malaria morbidity and mortality across Africa. However, in the last five to seven years, there has been a resurgence of malaria in several African countries, raising the questions of whether and why current control mechanisms are failing. Since the first Plasmodium falciparum reference genome was published in 2002, few thousands more representing a broad range of geographical isolates have been sequenced. These advances in parasite genomics have improved our understanding of mutational changes, molecular structure, and genetic mechanisms associated with diagnostic testing, antimalarial resistance, and preventive measures such as vaccine development. In this chapter, we summarize the current progress on: (1) genomic characteristics of P. falciparum; (2) novel biomarkers and revolutionary techniques for diagnosing malaria infections; and (3) current vaccine targets and challenges for developing efficacious and long-lasting malaria vaccines.",signatures:"Cheikh Cambel Dieng, Colby T. Ford, Jennifer Huynh, Linda E. Amoah, Yaw A. Afrane, Daniel A. Janies and Eugenia Lo",downloadPdfUrl:"/chapter/pdf-download/75815",previewPdfUrl:"/chapter/pdf-preview/75815",authors:[{id:"60524",title:"Dr.",name:"Yaw A.",surname:"Afrane",slug:"yaw-a.-afrane",fullName:"Yaw A. Afrane"},{id:"334184",title:"Ms.",name:"Jennifer",surname:"Huynh",slug:"jennifer-huynh",fullName:"Jennifer Huynh"},{id:"334185",title:"Dr.",name:"Eugenia",surname:"Lo",slug:"eugenia-lo",fullName:"Eugenia Lo"},{id:"334328",title:"Ph.D. Student",name:"Cheikh Cambel",surname:"Dieng",slug:"cheikh-cambel-dieng",fullName:"Cheikh Cambel Dieng"},{id:"342542",title:"Dr.",name:"Colby T.",surname:"Ford",slug:"colby-t.-ford",fullName:"Colby T. Ford"},{id:"345385",title:"Dr.",name:"Linda E.",surname:"Amoah",slug:"linda-e.-amoah",fullName:"Linda E. Amoah"},{id:"345386",title:"Dr.",name:"Daniel A",surname:"Janies",slug:"daniel-a-janies",fullName:"Daniel A Janies"}],corrections:null},{id:"77289",title:"Using an Educational Training Module to Increase Knowledge, Attitudes and Practices of Malaria among Medicine Vendors in Yobe, Nigeria",doi:"10.5772/intechopen.98512",slug:"using-an-educational-training-module-to-increase-knowledge-attitudes-and-practices-of-malaria-among-",totalDownloads:260,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"This training module focuses on providing basic guidance on the current recommended approaches regarding malaria basic information, signs/symptoms, case detection, treatment, referral, and effective prevention strategies. The module can be used for in-service training programs on malaria or to assist in improving other health educator’s work as well as serve as referral handbook for practicing health professionals. It can thus be used as a stand-alone training or together with modules dealing with other aspects of malaria control, prevention and elimination. The module uses a problem-solving approach to facilitate understanding and thereby motivate trainees on improved malaria case management. In essence, the training aims to generally improve the knowledge, attitudes and practices (KAP) of the most common handlers of malaria cases in this part of the world, the training module is then expected to improve services obtained by the majority of patients on malaria. On completion of training using this module, trainees will have acquired appreciable knowledge and skills on malaria basic-information, signs/symptoms, case detection/differentials, recommended drug treatment/appropriate dosing, indication for referral of complicated cases, effective prevention methods and the need to sensitise communities to stand up against malaria.",signatures:"Yahaya Mohammed Katagum, Hayati Binti Kadir Shahar, Faisal Bin Ibrahim, Anisah Baharom and Rafee Baharudin",downloadPdfUrl:"/chapter/pdf-download/77289",previewPdfUrl:"/chapter/pdf-preview/77289",authors:[{id:"274947",title:"Dr.",name:"Hayati Binti",surname:"Kadir Shahar",slug:"hayati-binti-kadir-shahar",fullName:"Hayati Binti Kadir Shahar"},{id:"276430",title:"Dr.",name:"Yahaya Mohammed",surname:"Katagum",slug:"yahaya-mohammed-katagum",fullName:"Yahaya Mohammed Katagum"},{id:"276433",title:"Dr.",name:"Rafee",surname:"Baharudin",slug:"rafee-baharudin",fullName:"Rafee Baharudin"},{id:"276435",title:"Prof.",name:"Faisal Bin",surname:"Ibrahim",slug:"faisal-bin-ibrahim",fullName:"Faisal Bin Ibrahim"},{id:"343625",title:"Dr.",name:"Anisah",surname:"Baharom",slug:"anisah-baharom",fullName:"Anisah Baharom"}],corrections:null},{id:"75792",title:"Herding and Stampeding: The Albatross of Mosquito/Malaria Control",doi:"10.5772/intechopen.96917",slug:"herding-and-stampeding-the-albatross-of-mosquito-malaria-control",totalDownloads:285,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Malaria is lingering globally with 3.3 billion people at risk of infection and 1.2 billion others classified as high risk. The economic burden caused by the disease and vectors is humongous globally. The epicenter is Sub-Sahara Africa which accounts for 92% of the annual death burden of 435,000 of which 61% are children of less than five years. Result of elimination activities are manifest in all other WHO regions except in Sub-Sahara Africa where efforts to control the disease/vector bear unsatisfactory testimony. This worst case scenario in the region is the handiwork of weak governments and institutions that appear to lead control strategies by showiness via information media; but in reality, they are part of the albatross that stampede the processes. Remedying the situation would require multi-tactics including arm-twisting relevant authorities in Africa by the international community and knowledge-based actions by private individuals and communities to stem the tide.",signatures:"Francis S.O. Ugwu",downloadPdfUrl:"/chapter/pdf-download/75792",previewPdfUrl:"/chapter/pdf-preview/75792",authors:[{id:"334311",title:"Dr.",name:"Francis S.O",surname:"Ugwu",slug:"francis-s.o-ugwu",fullName:"Francis S.O Ugwu"}],corrections:null},{id:"75935",title:"T Cell-Based Vaccines: Hope for Malaria Elimination",doi:"10.5772/intechopen.96767",slug:"t-cell-based-vaccines-hope-for-malaria-elimination",totalDownloads:300,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Among the numerous infectious diseases, malaria still remains the main cause of morbidity and mortality across the world. Every year more than 200 million cases are registered and death toll is of around 4,00,000. The emergence of insecticide and drug resistance has surged an alarming situation to find an effective means to tackle it. From various approaches used for reducing the damage created by malaria to the society, developing effective vaccine has gained the attention of scientific community. The large genome size (24 MB), heterogeneity of the genes, complex life cycle in two different hosts, and expression of wide range of these genes are claimed to hinder the malaria vaccine development. It requires good understanding of the host-pathogen interaction and its correlation with the sterile protection. Recently, subunit vaccine have shown certain promising responses; however, the currently in use of RTS,S vaccine has failed to generate the long-term sterile protection as well as effector memory CD8+T cells. However, the success of sterile protection through vaccination has been proven long back by experimental approaches, where it could be achieved using irradiated sporozoites (RAS) in rodents and humans. Similarly, GAP (genetically attenuated parasite) and CPS (chloroquine chemoprophylaxis with Plasmodium sporozoites) have been shown to induce sterile immunity. Despite all the developments, generation of species and stage specific-CD8+ T cell responses has been modest. In order to generate long-lasting immune response, particularly, liver-stage specific-CD8+ T cells, it is indeed required to study the CD8+ T cell epitope repertoire and its implications on the host immune system. In this chapter we will discuss the current status of T cell-based vaccines and the challenges associated with it.",signatures:"Nikunj Tandel and Sarat K. Dalai",downloadPdfUrl:"/chapter/pdf-download/75935",previewPdfUrl:"/chapter/pdf-preview/75935",authors:[{id:"229716",title:"Prof.",name:"Sarat K.",surname:"Dalai",slug:"sarat-k.-dalai",fullName:"Sarat K. Dalai"},{id:"284232",title:"Mr.",name:"Nikunj",surname:"Tandel",slug:"nikunj-tandel",fullName:"Nikunj Tandel"}],corrections:null}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},subseries:{id:"5",series:{id:"6",title:"Infectious Diseases",issn:"2631-6188",editor:{id:"131400",title:"Prof.",name:"Alfonso J.",middleName:null,surname:"Rodriguez-Morales",slug:"alfonso-j.-rodriguez-morales",fullName:"Alfonso J. Rodriguez-Morales",profilePictureURL:"https://mts.intechopen.com/storage/users/131400/images/system/131400.png",biography:"Dr. Rodriguez-Morales is an expert in tropical and emerging diseases, particularly zoonotic and vector-borne diseases (especially arboviral diseases). He is the president of the Travel Medicine Committee of the Pan-American Infectious Diseases Association (API), as well as the president of the Colombian Association of Infectious Diseases (ACIN). He is a member of the Committee on Tropical Medicine, Zoonoses, and Travel Medicine of ACIN. He is a vice-president of the Latin American Society for Travel Medicine (SLAMVI) and a Member of the Council of the International Society for Infectious Diseases (ISID). Since 2014, he has been recognized as a Senior Researcher, at the Ministry of Science of Colombia. He is a professor at the Faculty of Medicine of the Fundacion Universitaria Autonoma de las Americas, in Pereira, Risaralda, Colombia. He is an External Professor, Master in Research on Tropical Medicine and International Health, Universitat de Barcelona, Spain. He is also a professor at the Master in Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima, Peru. In 2021 he has been awarded the “Raul Isturiz Award” Medal of the API. Also, in 2021, he was awarded with the “Jose Felix Patiño” Asclepius Staff Medal of the Colombian Medical College, due to his scientific contributions to COVID-19 during the pandemic. He is currently the Editor in Chief of the journal Travel Medicine and Infectious Diseases. His Scopus H index is 47 (Google Scholar H index, 68).",institutionString:"Institución Universitaria Visión de las Américas, Colombia",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"8",totalChapterViews:"0",totalEditedBooks:"11",institution:null}}},tags:null},relatedBooks:[{type:"book",id:"825",title:"Current Topics in Tropical Medicine",subtitle:null,isOpenForSubmission:!1,hash:"ef65e8eb7a2ada65f2bc939aa73009e3",slug:"current-topics-in-tropical-medicine",bookSignature:"Alfonso J. 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Rodriguez-Morales",coverURL:"https://cdn.intechopen.com/books/images_new/8990.jpg",editedByType:"Edited by",editors:[{id:"131400",title:"Prof.",name:"Alfonso J.",surname:"Rodriguez-Morales",slug:"alfonso-j.-rodriguez-morales",fullName:"Alfonso J. Rodriguez-Morales"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}],ofsBooks:[]},correction:{item:{id:"79356",slug:"corrigentum-to-scientific-swift-in-bioremediation-an-overview",title:"Corrignedum to: Scientific Swift in Bioremediation: An Overview",doi:null,correctionPDFUrl:"https://cdn.intechopen.com/pdfs/82323.pdf",downloadPdfUrl:"/chapter/pdf-download/82323",previewPdfUrl:"/chapter/pdf-preview/82323",totalDownloads:null,totalCrossrefCites:null,bibtexUrl:"/chapter/bibtex/82323",risUrl:"/chapter/ris/82323",chapter:{id:"45227",slug:"scientific-swift-in-bioremediation-an-overview",signatures:"Ranjith N. Kumavath and Pratap Deverapalli",dateSubmitted:"October 10th 2012",dateReviewed:"March 18th 2013",datePrePublished:null,datePublished:"October 2nd 2013",book:{id:"3547",title:"Applied Bioremediation",subtitle:"Active and Passive Approaches",fullTitle:"Applied Bioremediation - Active and Passive Approaches",slug:"applied-bioremediation-active-and-passive-approaches",publishedDate:"October 2nd 2013",bookSignature:"Yogesh B. Patil and Prakash Rao",coverURL:"https://cdn.intechopen.com/books/images_new/3547.jpg",licenceType:"CC BY 3.0",editedByType:"Edited by",editors:[{id:"164249",title:"Dr.",name:"Yogesh",middleName:"Bhagwan",surname:"Patil",slug:"yogesh-patil",fullName:"Yogesh Patil"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}},authors:[{id:"163692",title:"Dr.",name:"Ranjith",middleName:null,surname:"Kumavath",fullName:"Ranjith Kumavath",slug:"ranjith-kumavath",email:"rnkumavath@gmail.com",position:null,institution:{name:"Central University of Kerala",institutionURL:null,country:{name:"India"}}},{id:"167339",title:"Mr.",name:"Pratap",middleName:null,surname:"Devarapalli",fullName:"Pratap Devarapalli",slug:"pratap-devarapalli",email:"pratap66666@gmail.com",position:null,institution:{name:"University of Tasmania",institutionURL:null,country:{name:"Australia"}}}]}},chapter:{id:"45227",slug:"scientific-swift-in-bioremediation-an-overview",signatures:"Ranjith N. Kumavath and Pratap Deverapalli",dateSubmitted:"October 10th 2012",dateReviewed:"March 18th 2013",datePrePublished:null,datePublished:"October 2nd 2013",book:{id:"3547",title:"Applied Bioremediation",subtitle:"Active and Passive Approaches",fullTitle:"Applied Bioremediation - Active and Passive Approaches",slug:"applied-bioremediation-active-and-passive-approaches",publishedDate:"October 2nd 2013",bookSignature:"Yogesh B. 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We currently live in an environment that has become more and more stressful. Escaping from the stress in society through various activities (e.g., acupuncture, massage, listening to classic music or natural sounds, etc.) is important for our mental health. We previously reported that optimal facial vibrotactile stimulation (i.e., 89 Hz frequency and 1.9 µm amplitude [89 Hz-S]) might activate the parasympathetic nervous system (Hiraba et al. 2008, 2011). Specifically, we showed that 89 Hz-S stimulation of the face led to increased salivation and a feeling of mental well-being through parasympathetic activity based on functional near-infrared spectroscopy (fNIRS) oxyhaemoglobin (oxyHb) activity. Namely, brain blood flow (BBF) oxyHb in the frontal cortex was near zero (Hiraba et al. 2011). We investigated adaptation to the continuous use of vibrotactile stimuli for 4 or 5 days in the same subjects to determine whether this resulted in decreased salivation (Despopoulos and Silbernagel, 2003; Principles of Neural Science, 2000a). Then, we compared resting and stimulated salivation and investigated the most effective frequency for increasing salivary secretion. Increased salivation in normal subjects was defined as a difference between resting and stimulated salivation (Hiraba et al. 2011).
\n\t\t\tFurthermore, to study the mechanism of increased salivation evoked by vibrotactile stimulation, we recorded changes in heartbeat frequency and pupillary reflex during stimulation. We reported that pulse frequency changes during vibrotactile stimulation. A decrease in pulse frequency and a contraction in pupil diameter suggest parasympathetic activity (Principles of Neural Science, 2000b). We believe these reflexes are coordinated by a highly interconnected set of structures in the brainstem and forebrain that form a central autonomic network (Principles of Neural Science, 2000b).
\n\t\t\tWe found that vibrotactile stimulation increased salivation, as reported by Hiraba et al. (2008). Furthermore, Hiraba et al. (2011) reported that increased salivation due to facial vibrotactile stimulation might be due to parasympathetic stimulation based on frontal cortex BBF measurements. Particularly, vibrotactile stimulation at 89 Hz-S using a single motor was most effective in increasing salivation without adaptation following continuous daily use. We know that autonomic activity changes heart rate and pupil diameter. Thus, we believe that heart rate and pupil diameter measurements during 89 Hz-S stimulation represent the effects of the autonomic nervous system. In this study, we demonstrated that 89 Hz-S stimulation led to mental stability due to parasympathetic activity.
\n\t\tThe vibrotactile stimulation apparatus consisted of an oscillating body and a control unit, as shown in Hiraba et al. (2008) and Yamaoka et al. (2007). The oscillating body was composed of the following two parts: (1) a headphone headset equipped with vibrators in the positions of the bilateral microphones and (2) a vibration electric motor (VEM; Rekishin Japan Co., LE12AOG) covered in silicon rubber (polyethyl methacrylate, dental mucosa protective material; Shyofu Co.) for conglobating the stimulation parts and preventing VEM warming due to long periods of vibration (Hiraba et al. 2008).
\n\t\t\t\tWe examined the amount of salivation during vibrotactile stimulation on the bilateral masseter muscle belly (on the parotid glands) and on bilateral parts of the submandibular angle (on the submandibular glands). We determined the amount of salivation using a dental cotton roll (1 cm width, 3 cm length) positioned at the opening of the secretory ducts (i.e., the right and left parotid glands and right and left submandibular and sublingual glands) during vibrotactile stimulation of the bilateral parotid and submandibular glands. The weights of the wet cotton rolls after 3 min of use were compared with their dry weights measured previously (Hiraba et al. 2008).
\n\t\t\tWe determined that a 3-min salivation measurement with a 5-min recovery time was sufficient from a previous experiment (Hiraba et al. 2008, Hiraba et al. 2011). Furthermore, salivation is most effectively induced by vibrotactile parotid gland stimulation at 89 Hz-S, which was used in this experiment. We examined adaptation to vibrotactile stimulation by monitoring changes in salivation during 4 or 5 continuous days using the same time schedule (i.e., 89 Hz-S). Frontal cortex recordings were acquired using a fNIRS OEG16 instrument (Spectratech, Inc., Shelton, CT, USA) during vibrotactile stimulation. We conducted salivation tests with 19 normal subjects (six males, 13 females; average age: 22 years) and resting-stimulation examinations for adaptation with 26 normal subjects (11 males and 15 females; average age: 25 years). We also performed fNIRS in eight normal subjects (six males, two females; average age: 22 years) to examine the effects of resting state and classical music (Mozart,
We recorded changes in power-spectral analysis of heart rates (HRV; Heart Rate Variability module, AD Instruments, Japan, under the following conditions: (1) resting state; (2) 89 Hz-S stimulation on the face (89 Hz-S face); (3) listening to Mozart (Mozart); (4) Mozart + 89 Hz-S on the face; (5) 89 Hz-S on the nape of the neck (89 Hz-S neck); and (6) listening to noise (Noise), as shown in Figure 2E. A power-spectral analysis of HRV module data was conducted using the period histogram analysis program based on distribution of the length of the RR interval for 3 min, and typical values during various stimuli were analysed in terms of the highest value (i.e., peak value) during the recording period. For example, Figure 1A shows RR intervals (n1, n2, n3, n4 ms, and so on,) on the electrocardiogram (ECG) during vibrotactile stimulation. Figure 1B shows a peak value example (1000 ms) during vibrotactile stimulation. Heart rates during rest and during various stimuli were recorded for 3 min, and then analyses of 3-min HRV data were performed off-line. When heart rates were compared among the rest and various stimulation conditions, we used the RR-interval peak value (i.e., 1000 ms in this example) obtained from the power-spectra analysis. We conducted these examinations with 16 normal subjects (11 males, five females; average age: 25 years). This experiment was performed at 3 and 5 pm in a quiet, temperature-controlled room.
\n\t\t\tHRV module analysis. Method used to measure RR intervals (n1, n2, n3, n4, etc.) on ECG recordings (A) and frequency spectrum based on RR interval length over 3 min during 89 Hz-S vibrotactile stimulation (B). Horizontal line indicates RR interval (ms), and vertical line indicates number. Note that the peak frequency spectrum was 1000 ms in this experiment.
IRIS (Iriscorder, Hamamatsu Photonics Co., [Japan]) records transverse diameter and velocity reactions and can take a picture of the eyes by illuminating visible light (infrared radiation). The resulting image can record the condition of the iris and eyeball movement on the monitor. For example, when normal subjects are exposed to continuous light stimulation for 1 sec, we can obtain a pupillogram from the IRIS apparatus; constricted pupils indicate parasympathetic activity, and pupil dilation indicates sympathetic activity. Pupil diameter in normal subjects is generally 2-5 mm, which changes under various adaptation conditions. We examined the transverse diameter and velocity of pupil constriction or dilatation after vibrotactile stimulation to explore changes in autonomic activity.
\n\t\t\t\tIRIS apparatus (A and B) and typical data acquired following light stimulation (C and D). IRIS records the bilateral pupillary reflex simultaneously. IRIS records the constricted and dilated pupil reflex for one second after light stimulation. Pupillary reflex parameters (e.g., most constricted pupil velocity) can be quantified. Experimental schedule (E).
\n\t\t\t\t\tFigure 2 shows the IRIS experimental apparatus used in Figures 2A and 2B. The pupillary light-reflex test was executed using an infrared pupillometer (Iriscorder C10641, Hamamatsu Photonics Co.), and pupil diameter in both the right and left eyes was measured after 3 min of rest or stimulation. Figure 2E shows the timeline of this experiment. Five particular experimental conditions were explored over 5 days; we recorded HRV modulation during the pupillary reflex adaptation test. However, only the right pupil was exposed to light stimulation, as shown in Figure 4. The pupillary test is non-invasive and enables real-time diagnosis. We examined the initial diameter (D1), minimum diameter (D2), constriction ratio (CR), time to total construction (T3), maximum velocity of constriction (VC), and maximum acceleration of constriction (AC) among the parameters obtained from the IRIS. Pupil diameter decreased with parasympathetic activity and increased with sympathetic activity. The IRIS records pupil parameters of the right and left eyes simultaneously. However, we adopted parameters from the right pupil because data from both sides were similar, as shown in Figure 4. We conducted these examinations with eight normal subjects (six males, two females; average age: 25 years). This experiment was performed at 3 and 5 pm in a quiet, temperature-controlled room. Furthermore, one parameter was explored each experimental day because we obtained information from adaptation to light stimulation, as shown by the experimental schedule in Figure 2E.
\n\t\t\tWe examined differences between vibrotactile stimulation of the parotid and submandibular glands. We found that the most effective frequency to induce salivation was 89 Hz-S regardless of whether vibrotactile stimulation was delivered to the parotid or submandibular glands, as shown in previous paper (Hiraba et al. 2011).
\n\t\t\t\tBecause patients with hyposalivation often have psychiatric disorders, we conducted an experiment to realistically approximate natural conditions. We examined whether effective salivation occurred continuously when vibrotactile stimulation was performed daily. Specifically, we used the 89 Hz-S frequency with a single motor from the previous experiment. None of the glands (i.e., right and left parotid glands or right submandibular and sublingual glands) showed a reduced response. Regression curves for each gland showed non-adaptation to continuous stimulation; instead they showed parallel or increasing curves, indicating that continuous use of this apparatus should not be problematic, as shown in a previous paper (Hiraba et al. 2011).
\n\t\t\tThe OEG16 spectroscope was used to record BBF haemoglobin concentration from areas in the frontal cortex using 16 channels. We determined the oxyHb concentration schema evoked by 89 Hz-S vibrotactile stimulation by analysing 16 channels. The results showed very weak oxyHb concentrations (i.e., near zero) during 89 Hz-S vibrotactile stimulation. Changes in oxyHb, deoxyhaemoglobin (deoxyHb), and total haemoglobin (totalHb) concentrations during salivation measurements at rest and for each vibrotactile stimulation frequency were measured. As shown in a previous paper (Hiraba et al. 2011), changes during the following six conditions were measured: (1) resting; (2) 89 Hz-S vibrotactile stimulation; (3) 89 Hz-D (89 Hz-D, 89 Hz frequency with double motors, 3.5-µm amplitude); (4) 114 Hz-S; (5) 114 Hz-D (114 Hz-D, 114 Hz frequency with double motors, 3.5-µm amplitude); and (6) “A-” phonation. Each wave was recorded for 3 min, and each 2-min vibrotactile stimulus is shown between the vertical lines (Fig. 6B and\n\t\t\t\t\tFig. 4 in the previous paper, 2011). Although each wave measured during resting salivation, at 114 Hz-D, and during “A-“ phonation showed increased activity, the 89 Hz-D and 114 Hz-S vibrotactile stimuli decreased activity. However, vibrotactile stimulation at 89 Hz-S showed a value of almost zero. Particularly, when we focused on oxyHb changes based on these results, increased oxyHb occurred during “A-” phonation, the resting condition, and at 114 Hz-D vibrotactile stimulation, whereas a decrease in oxyHb was observed during vibrotactile stimulation at 114 Hz-S and at 89 Hz-D. However, oxyHb concentration during vibrotactile stimulation at 89 Hz-D was almost zero, as were all other data (oxyHb, deoxyHb, totalHb). From these results, we computed oxyHb integral rates over 2 min, as shown by the area between the longitudinal bars (Fig. 6B and\n\t\t\t\t\tFig. 4 in the previous paper, 2011).
\n\t\t\t\tFurthermore, we examined integral rates while subjects listened to classical music for 2 min. We divided the subjects into two groups: (1) one group that disliked listening to classical music and (2) one group that enjoyed listening to classical music. Although the subjects who enjoyed the music did not show a larger spread of values, the former did. Specifically, vibrotactile stimulation at 89 Hz-S led to a small, similar value spread. All integral rates during the vibrotactile stimulation at 89 Hz-S and listening to classical music showed similar averages and standard deviations (SDs), as shown in Figure 6B.
\n\t\t\tDuring facial 89 Hz-S stimulation, values of total salivation and salivation in the parotid or submandibular and sublingual glands were examined in comparison with resting salivation values. Submandibular and sublingual gland total salivation values increased; however, parotid gland salivation values were similar, as shown in Figure 3. Parotid gland salivation values were 0.15 ± 0.12 m
Salivation during the resting condition and 89 Hz-S vibrotactile stimulation over 3 min. Wilcoxon signed-rank test (two-tailed), **:
Among the parameters obtained from the IRIS, we examined D1, D2, CR, T3, VC, and AC, as shown in Figures 4\n\t\t\t\t\tA and 4B. The pupillary light reflex showed significantly decreased D1, D2, and T3 compared with the resting state. Furthermore, the pupillary light reflex showed increased AC, as shown in Figure 4B. Data from the right and left pupils were similar following light stimulation, as shown in Figure 4B. Thus, we employed data from the right pupillary reflex for data analysis.
\n\t\t\t\tTypical example of data from the pupillary reflex. Right pupillary reflex data after light stimulation in the right pupil (A-a and B-a) and left pupillary reflex data after light stimulation in the left pupil (A-b and B-b).
Effect of the pupillary reflex following right-side light stimulation between the resting condition and 89 Hz-S vibrotactile stimulation.
We analysed right pupillary reflex data from eight normal subjects, as shown in Figure 5. D1 was 6.15 ± 0.64 mm under the resting condition and 5.20 ± 1.12 mm under the 89 Hz-S condition (
We recorded typical heart rate changes and performed a power-spectral analysis (HRV module, AD Instruments, Japan) under the following six conditions: (1) resting state; (2) 89 Hz-S face; (3) listening to Mozart (Mozart); (4) Mozart + 89 Hz-S face; (5) 89 Hz-S neck; and (6) listening to noise (Noise), as shown in Figure 6. For example, Mozart + 89 Hz-S face "pulse (+)" indicates that participants were listening to Mozart classical music while receiving 89 Hz-S vibrotactile stimulation on the face. When comparing heart rates between the rest state and under various stimuli, we used the RR interval peak value from the power-spectral analysis (Fig. 6A and 6C). RR interval peak values (ms) from the power-spectral analysis were compared. The values were as follows: resting state, 757.5 ± 57.0 ms; 89 Hz-S face, 905.1 ± 189.5 ms, Mozart, 771.7 ± 86.7 ms; Mozart + 89 Hz-S face, 875.3 ± 188.3 ms; 89 Hz-S neck, 901.7 ± 188.4 ms; and Noise, 831.7 ± 114.6 ms (Fig. 6C). Significant differences were observed between resting state and 89 Hz-S face (paired
The resting-state peak value had the lowest frequency. The Mozart-listening peak value was closest to the resting-state value, which might be because the majority of subjects disliked listening to classical music (three subjects favourite music was classical, and seven people reported classical music was not their favourite), as shown in Figure 6C. The 89 Hz-S stimulation led to the highest heart-beat frequency in comparison with the resting condition, as shown in Figures 6A and 6C. However, 89 Hz-S face stimulation was effective in many subjects, as 89 Hz-S face had the smallest SD, as shown in Figure 6C. On the other hand, heart rates during the resting condition and while listening to noise were similar. We generated noise with fractioned foam polystyrene. Many subjects may have felt discomfort due to the noise; however, we believe that discomfort induced by this noise was unlikely.
\n\t\t\tChanges in power spectrums (A) and HRV modulation (C) during various stimuli. B. fNIRS OxyHb concentration during various stimuli (this graph was described in a previous article, Hiraba et al. 2011). RS, 89 Hz-S face, Mozart, Mozart + 89 Hz-S face, 89 Hz-S neck, and Noise indicate 89 Hz-S on the face, listening to Mozart, both listening to Mozart and 89 Hz-S vibrotactile stimulation on the face, 89 Hz-S vibrotactile stimulation on the nape of the neck, and listening to noise, respectively. There were significant differences between RS and 89 Hz-S face (paired
We reported that 89 Hz-S vibrotactile stimulation evoked rest and increased salivation, as shown in previous papers (Hiraba et al. 2008, 2011). We further investigated increased salivation during 89 Hz-S. We were the first to show that increased salivation during 89 Hz-S stimulation was due to increased salivation from the submandibular and sublingual glands but not from the parotid glands, as shown in Figure 3. We knew that the amylase-rich parotid glands were principally responsible for the increased salivation. Salivation also occurs during mechanical stimulation during mastication when eating (Matuo, 2003). In addition to hunger- and mastication-induced salivation, salivation was also increased through 89 Hz-S vibrotactile stimulation of the facial and intraoral structures. This increased salivation may be different from salivation produced by hunger, as increased salivation during 89 Hz-S caused salivation in the submandibular and sublingual glands. In particular, increased salivation evoked by 89 Hz-S vibrotactile stimulation may be due to somatosensory input from the facial skin and intraoral cavity. Vibrotactile stimulation at 89 Hz-S may evoke a different perception from masticatory mechanical stimuli.
\n\t\t\t\tThe frontal cortex is associated with cognitive function, including memory, attention, abstract reasoning, and higher cognitive processes (Principles of Neural Science, 2000a). We recorded changes in frontal cortex BBF to examine typical changes in fNIRS parameters based on increased oxyHb and totalHb and decreased deoxyHb, as reported by Sakatani et al. (2006). The effect of 89 Hz-S vibrotactile stimulation was almost zero for oxyHb, deoxyHb, and totalHb, as shown in a previous paper (Hiraba et al. 2011). The fNIRS activity focuses on excitatory behaviours that increase oxyHb. In animal experiments, changes in oxyHb and BBF are related, and fNIRS activity changes in oxyHb are used as a marker of neuronal activity (Hoshi et al. 2001). Thus, changes in oxyHb produced by 89 Hz-S vibrotactile stimulation may indicate mental stability. This may be due to the trend in oxyHb concentration between the 89 Hz-S vibrotactile stimulation in subjects who liked to listen to classical music (Fig. 6B). People relax when they listen to classical music, so we think that 89 Hz-S vibrotactile stimulation elicits excitation of the parasympathetic system. In particular, although the 89 Hz-S vibrotactile stimulation always led to parasympathetic excitation, listening to classical music caused different activity depending on music preference (Fig. 6B). Those subjects who enjoyed Mozart classical music found it relaxing, whereas those who disliked it perceived it as noise. However, 89 Hz-S vibrotactile stimulation may lead to a balanced mental condition, regardless of preference. This phenomenon suggests that the effect caused by the 89 Hz-S vibrotactile stimulation and the feeling experienced by those listening to Mozart who enjoyed it may be the same. Thus, we suggest that these feelings were produced by parasympathetic activity. We further investigated pupillary reflex and heart rate during 89 Hz-S stimulation.
\n\t\t\tOur heartbeat increases when we are frightened (Principles of Neural Science, 2000b). The parasympathetic nervous system is responsible for rest, digestion, basal heart rate maintenance, respiration, and metabolism under normal resting conditions (Principles of Neural Science, 2000b). We examined parasympathetic effects by observing changes in the amount of salivation, HRV modulation of heart rate, and pupillary reflex induced by light stimulation during various stimuli.
\n\t\t\t\tWe verified increased salivation induced by 89 Hz-S vibrotactile stimulation; the higher RR frequency was induced by the 89 Hz-S neck stimulation (Fig. 6C), and the greatest pupil contraction following light stimulation was induced by 89 Hz-S vibrotactile stimulation (Fig. 5). Furthermore, the 89 Hz-S face stimulation increased salivation the most (Fig. 3). Specifically, increased salivation was due to saliva secretion by the submandibular and sublingual glands but not the parotid glands. This was likely not due to hunger because the amount of salivation in the parotid glands did not increase. From these results, as for 89Hz-S neck, the relaxation effect might be big, however the salivated promotion effect was very weak. Conversely, the difference between pupil diameter before (D1) and after (D2) light stimulation during the resting condition was great, but the difference between pupil diameter before (a-D1) and after (a-D2) light stimulation during 89 Hz-S face was small, as shown in Figure 4. Furthermore, as shown in Figure 5, the AC (acceleration) was significantly different between the resting and the 89 Hz-S conditions (
We examined parasympathetic activity in three organs. Autonomic function must ultimately be coordinated for adaptation to environmental changes. The autonomic nervous system is composed of visceral sensory and motor system; the visceral reflexes are controlled by various local circuits in the brainstem and spinal cord. These reflexes are regulated by networks of central autonomic control nuclei in the brainstem, hypothalamus, and forebrain and are not under voluntary control, nor do they impinge on consciousness, with a few exceptions (Principles of Neural Science, 2000b). The pupillodilator muscle in the iris (pupil diameter), salivary glands, and heart rate are driven by sympathetic and parasympathetic nerves. Pupil diameter contracts, heart rate elongates, and salivation increases due to parasympathetic nerve activity. We also believe that changes in the frontal cortex BBF may represent autonomic activity. This coordination is carried out by a highly interconnected set of structures in the brainstem and forebrain that form a central autonomic network. The key component of this network is initiated by integrated information from the parabrachial nucleus of the solitary tract and trigeminal sensory complex in the brainstem. These nuclei receive inputs from somatosensory and visceral afferents of the trigeminal, facial, glossopharyngeal, and vagus nerves and then use the information to modulate autonomic function. The somatosensory and visceral sensory outputs from the trigeminal and solitary nuclei are relayed to the forebrain and amygdala by the parabrachial nucleus, which is important for behavioural responses to somatosensory, taste, and other visceral sensations (Principles of Neural Science, 2000b). Information arriving in the amygdala leads to sensations of pleasure and pain. In contrast, the parabrachial nucleus is a taste-sensation relay nucleus in rats (Scott and Small, 2009), and the rodent parabrachial nucleus sends integral limbic and reward system information (Yamamoto et al. 2009). Although their functions in humans are unknown, we think that these nuclei may play roles as relay nuclei of the autonomic system. On the other hand, we showed that a projection from the trigeminal sensory complex (e.g., the parabrachial nucleus) can also record the response to tactile stimuli from facial skin (Chiang et al. 1994). Furthermore, somatosensory information projects to the primary somatosensory cortex and is then relayed to the frontal cortex via the parietal association area (Handbook of Neuropsychology, 1994).
\n\t\t\t\t\n\t\t\t\tWhat does BBF activity in the frontal cortex indicate? We think that the information transmitted via the parabrachial nucleus dominates by way of the parietal association area. Thus, information in the frontal cortex is assumed to arrive via the parabrachial nucleus. The hypothalamus is the centre of the autonomic system. We perceive emotional experiences such as fear, pleasure, and contentment, and these perceptions reflect the interplay between higher brain centres and sub-cortical regions such as the hypothalamus and amygdala (Principles of Neural Science, 2000a). Patients in whom the prefrontal cortex or the cingulate gyrus has been removed are no longer bothered by pain but exhibit appropriate autonomic reactions; however, the sensation is not perceived as a powerfully unpleasant experience (Principles of Neural Science, 2000a). Furthermore, the anatomical connections between the amygdala and the temporal (cingulate gyrus) and frontal (prefrontal) association cortices provide the means by which visceral and somatosensory sensations trigger a rich assortment of associations or the cognitive interpretation of emotional states (Principles of Neural Science, 2000b).
\n\t\t\t\tPathways responsible for somatosensory information in the brain. Somatosensory information evoked by vibrotactile stimulation is relayed by the trigeminal sensory complex and solitary and parabrachial nuclei, which arrive at the hypothalamus, thalamus, amygdala, and frontal cortex, respectively. The autonomic system (particularly the parasympathetic nervous system) produces increased salivation. The lateral branch of the trigeminal sensory nucleus projects to the parabrachial nucleus. Information from the parabrachial nucleus is received by the amygdala and frontal cortex. Furthermore, somatosensory information is projected to the primary somatosensory cortex and relayed to the frontal cortex via the parietal association area. Thus, this information finally leads to a relaxed feeling, and BBF waves reflect parasympathetic activity (modified from schemas in
The 89 Hz-S stimulation evokes parasympathetic activity. This conclusion was based on increased salivation and heart rate and decreased pupil diameter during 89 Hz-S vibrotactile stimulation. Increased parotid gland salivation may be due to appetite, and increased salivation in the submandibular and sublingual glands may be associated with feelings of calm. On the other hand, we examined changes in the HRV module (RR intervals) between the resting state and exposure to various stimuli, and we showed increased heart rates during 89 Hz-S stimulation in comparison with the resting state (Billman, 2011). Furthermore, we think that the pupillary light-reflex test (Brashow, 1968) and heart rate HRV module (Billman, 2011) are the best tests for examining autonomic nervous system function (Gadner and Martin, 2000).
\n\t\t\t\n\t\t\tWe showed that the most effective changes in salivation, pupil contraction, and HRV modulation (RR interval) were elicited by 89 Hz-S vibrotactile stimulation on the face. We thus conclude that 89 Hz-S vibrotactile stimulation affected parasympathetic activity based on changes observed in three organs. We also investigated autonomic activity by observing fNIRS waves. Because increased salivation was only observed in the submandibular and sublingual glands, it was likely not due to hunger. Furthermore, pupil constriction due to 89 Hz-S stimulation was less than that due to light following the resting condition. This likely indicated parasympathetic activity induced by 89 Hz-S stimulation. Changes in heart rate (RR intervals) during various stimuli were as effective as changes due to various stimuli combined with the 89 Hz-S stimulation. BBF oxyHb concentrations in the frontal cortex during 89 Hz-S vibrotactile stimulation were the same as those in subjects who preferred listening to classical music. Thus, 89 Hz-S vibrotactile stimulation may produce relaxation; salivation increases, pupil diameter constricts, and the heart rate (RR interval) is prolonged due to parasympathetic excitation. Thus, we believe that fNIRS in the frontal cortex reflects autonomic activity.
\n\t\tThis work was supported by a Sogoshigaku research grant and the Sato Fund, as well grants from the Ministry of Education and a Grant-in-Aid for Scientific Research (21592539).
\n\t\tSouth Africa (SA) is a middle-income country that is characterised by contrasting living conditions ranging from wealthy urban suburbs to lower-income, underdeveloped areas. [1] SA has faced many socio-economic challenges such as high levels of poverty, inequality and unemployment [1, 2] despite having the second largest economy on the African continent. Since the country’s transition to democracy in 1994, progress has been made, but unemployment rates and poverty levels remain high. [1] Poverty is the main underlying factor contributing to food insecurity. [3, 4] The food insecure often use strategies to cope with the inability to access food. One of these include reducing the quality and quantity of food consumed, thus consuming poor diversity diets which can have detrimental consequences such as hunger, malnutrition [5, 6] and increased prevalence of metabolic and cardiovascular diseases (CVDs) [7] due to it hindering individuals’ ability to choose the most appropriate foods and beverages for an adequate diet. [8] A disadvantage of food insecurity is thus monotonous diets with consumption of more affordable energy-dense staples and foods that may have detrimental health outcomes such as obesity and its chronic disease comorbidities. [9] Food insecurity thus does not only cause under-nutrition, but also in over-nutrition such as obesity and its comorbidities, especially in low-income communities. [10] SA is a country in health transition and suffers from a quadruple burden of (a) poverty and nutrition-related chronic diseases of lifestyle [CDL], (b) communicable diseases, (c) peri-natal, maternal and injury-related disorders, [11] and (d) a nutrition transition. A recent study has found that this quadruple burden of disease is predominantly present in the black African population. [1] Urbanisation and westernisation of the Black African population of SA is marked not only by demographic transition, but also by increased animal protein, total dietary fat and added sugar intakes [11] and a health transition resulting in an increased prevalence of obesity [6] and CDL such as CVD. [11, 12]
The South African population of approximately 59 million people consists of 81% black Africans. [13] In 2017, it was reported that 56% of the SA population lived in poverty [14] with 28% living in extreme poverty, thus not having enough money to purchase enough food to consume around 2,100 calories per day for a month (food poverty). The most vulnerable to food poverty are women, children (66.8%), those with low education (79.2%) and people from the black population group (64.2%). [15, 16]
CVD incidence is increasing rapidly among all population groups in SA. [11] CDLs contribute 51% to the mortality rate, with CVD and diabetes accounting for 19% and 8% of the total deaths. Many people in SA have poor living conditions and limited resources to maintain health and well-being. [15] In spite of cultural background, people that has been subjected to urbanisation, has adopted a more Western lifestyle with lower dietary fibre and higher dietary fat and added sugar intakes, as well as lower physical activity levels. These dietary changes have led to higher prevalence of CDL, [17] specifically an increased risk and susceptibility of CVD among the black population, [18] and not only in adults, but also among children. [19] The face of CVD has thus changed in recent years. Initially it was a disease of the white population group, the affluent and older generations, but since the 2000s, it was also observed that the prevalence of CVD risk factors, such as dyslipidaemia and obesity, has increased among black Africans [20] as well as children and adolescents. [21, 22, 23, 24]
The aim of this chapter was thus to investigate the prevalence of the various cardiovascular risk factors, specifically those that are irreversible, among children (6–18 years old) in peri-urban Free State (FS), [25] rural Eastern Cape (EC), [24, 26, 27, 28] peri-urban [29] and urban [30, 31, 32, 33] Gauteng; adults (19–59 years old) in urban Gauteng [30, 31, 34, 35, 36, 37] and peri-urban FS; [38, 39, 40] and elderly (≥60 years) in urban Gauteng, [41, 42, 43] including both genders, living in poverty in SA. Gauteng was chosen as the authors both resided in Gauteng and it was the focus of the university for funding. No data had been available for the cardiovascular risk factors in the above-mentioned communities and a valuable research opportunity was created to address the paucity of information in these communities. For this reason, the FS and EC provinces were chosen because of funding opportunities and gap in the knowledge base on the areas included in these studies.
A search of electronic databases focusing on poverty, food insecurity and cardiovascular risk factors was carried out between 2010 and 2020. Databases used included: MEDLINE (PubMed), Web of Science, ScienceDirect, Scopus, EBSCOHost, Springer Link, and Sabinet. The keywords used included: “poverty”, “food security”, “nutrition security”, “food and nutrition security”, “cardiovascular disease”, “CVD”, “cardiovascular risk”, “CVR”, “cholesterol”, “triglycerides”, “HDL”, “LDL”, “C-reactive protein”, “CRP”, “fibrinogen”, “homocysteiene”, “vitamin B6”, “vitamin B9”, “folate”, “folic acid”, “vitamin B12”, “glucose”, “insulin”, “obesity”, “overweight”, “nutritional status”, “hypertension”, “high blood pressure”, “dietary diversity”, “dietary intake”, “children”, “adults”, “elderly”, “older people”, “aged”, “double burden”, and “South Africa”.
The data used for this chapter included all the databases and articles published for the various studies undertaken by the authors between 2000 and 2020 among black children in the EC, FS and Gauteng, [24, 25, 26, 27, 28, 30, 31, 32, 36] adults in Gauteng and the FS [25, 30, 35, 37, 40] and the elderly in Gauteng [37, 41, 43] in various urban, peri-urban and rural areas of SA. For the purpose of this book chapter, urban areas include cities and towns that are developed, thus having a density of human structures such as houses, commercial buildings, roads, and public transport. Peri-urban areas are underdeveloped areas on the outskirts of the towns and cities where people live, but no public transportation or commercial buildings are present. Rural areas refer to areas with low population density and large areas of undeveloped land where people mainly live far apart from their neighbours.
Comparative tables were drawn up using the published articles and, where data were not published, descriptive statistical analyses (frequencies) were calculated using IBM SPSS Statistics, version 26, from the study databases that had not been destroyed. The ethical and scientific procedures for the sampling strategy and data collection methods were the same for the published and unpublished data.
Poverty and food insecurity were observed in all seven study communities. A large majority of the adults (75.7%–78.0%) [35, 44] and child caregivers (53.0%–94.0%) [27, 29, 30, 44] were unemployed, had either no or only primary education (39.9%–78.8%), [27, 29, 30, 34, 36, 43, 44] and lived in poverty (67.7–100%). [27, 29, 35, 36, 44] The poverty rates of all the communities were more than double the 25.2% national food poverty rate. [15] This may have been due to the high unemployment rate and low education levels found among the adults in all the communities. A chronic money shortage to buy food was also reported in large percentages of the study population.
Many risk factors for CVD have been identified in the scientific literature and can be reversible or irreversible (Table 1). In 2016, 20% of the South African adults (15+ years) were smoking. [45] Risk factors present in the South African adult (18+ years) population are obesity (68% women; 31% men) hypertension (46% in women and 44% in men), [46] physical inactivity (37%), high blood pressure (24%) and hyperglycaemia (10%). [45] There is a paucity of national data for other CVD risk factors in adults, and very little CVD national data are available for children, except for the prevalence of overweight and obesity.
The history of CVD of an individual is directly proportional to the risk of CVD (the earlier the age of onset and the more family members affected the greater is the risk of CVD). [47] It is known that men are at greater risk of developing CVD than women [47, 48] maybe because oestrogen has an inhibiting effect on low density lipoprotein-cholesterol (LDL-C) oxidation and increasing the production of large very low-density lipoproteins (VLDL) and therefore has a protective effect against atherogenesis. [50] Low levels of education in middle-income countries like SA had a significantly higher risk of major CVD events compared to those with high incomes. [49] The majority (>70%) of our communities showed low education (no or primary school education), [29, 31, 34, 35, 43] except for the peri-urban adults in the FS (44.2%); [44] and caregivers of the peri-urban children in Gauteng (39.9%), [29] however, these percentages are still high. High unemployment rates (53.0–94.0%) [29, 30, 31, 35, 44] for the majority of all the communities were also observed. The low education and high unemployment rates of the communities could be some of the main reasons for the high poverty rates in the study communities (67.7–100%). [26, 35, 36, 44] Research has found that people with low education may not have access to health care that may prevent detecting and treating disease and thus compromise their health even further. [50]
Cigarette smoking doubles the risk of coronary artery disease and contributes seven-fold to the increase in risk for peripheral arterial disease. [51] Cigarette smoking and increases blood pressure and increases the heart’s workload. It deprives the heart muscle of oxygen and damages the platelets that increase coagulation and clot formation. Toxins in cigarettes may also damage the blood vessels and increase atherosclerosis. [48, 52] In SA, the proportion of adult (15+ years) women that smoke (37%) daily is higher than in men (8%). [46] Smoking patterns among children were not measured in our studies, but we previously reported 11.7%, 15.2% and 23.6% smoking among urban elderly, [43] peri-urban adults in Gauteng [31] and rural adults in the FS. [37]
Obesity is considered a multi-factorial condition [20, 53, 54] associated with an increased risk for comorbidities such as type 2 diabetes, insulin resistance, cancer, stroke, [53] hypertension, dyslipidaemia, [53, 55] and hypertriglyceridaemia. [55] Obesity is also considered an independent risk factor for CVD. [40] For every 1% increase above ideal body mass index (BMI), the cardiovascular risk (CVR) increases by 3.3% for females and 3.6% for males. [56] In our studies, the majority of the adults and elderly were overweight/obese. [44, 57] Although we did not report gender differences in this chapter, previous published results confirmed a higher prevalence among women in rural FS [37] and urban elderly [41] than in men. Our results further showed that the urban women in Gauteng had the highest prevalence (82.3%) of overweight/obesity, but cannot be compared to the peri-urban adults and urban elderly that included both men and women. However, the overweight/obesity prevalence among the urban elderly in Gauteng [57] and the peri-urban adults in the FS [44] was consistent with the national prevalence.
There is usually a higher prevalence of overweight/obesity in urban than rural. [20] We did not have any rural adult communities to compare our results, but the urban elderly in Gauteng (61.0%) [57] had lower prevalence of overweight/obesity than the peri-urban adults in the FS (67.9%). [44] This was inconsistent with research from sub-Saharan Africa (SSA) [54] and SA where it was found that age is positively correlated with overweight and obesity. [58, 59] In all three the adult communities, the prevalence of obesity was higher than the prevalence of overweight. (Table 2). The increasing prevalence of childhood overweight/obesity in SA [11] is presenting a major public health problem. Childhood overweight/obesity is associated with early onset of hypertension and hyperglycaemia, both risk factors for CVD, [71] as well as adult obesity, [54] premature death and disability. [54] Similar to adults, a higher prevalence of overweight/obesity among children is found in urban areas. [54, 72, 73] (Table 3) However, our results showed higher prevalence among the rural children (4.3%) [24] compared to the urban children (1.0%). [32] In addition, the rural [28] and urban [32] children had the lowest prevalence of overweight and no obesity prevalence. Both peri-urban areas showed a prevalence of 21.0% in the FS [25] and 18.3% in Gauteng. [32, 33] This was higher than the national prevalence. In our studies among resource-poor communities, the prevalence of obesity was much lower than the prevalence of overweight. Our studies have found significantly higher prevalence of overweight/obesity in girls when compared to the boys. [24, 26] These results were consistent with national data [77] and for SSA, [54] but inconsistent with a recent systematic review and meta-analysis investigating overweight/obesity among 5–19 year old children in 15 countries in Africa where the boys and girls were equally affected by overweight/obesity. [71].
Irreversible | Gender (male) |
Ageing | |
Genetically inherited factors | |
Potentially reversible factors | Cigarette smoking |
Obesity | |
Hypertension Physical activity | |
Hyperglycaemia, diabetes | |
Increased haemostatic factors, decreased fibrinolysis, increased platelet aggregration | |
Increased levels of homocysteine | |
Increased inflammatory response (HS-CRP) | |
Dyslipidaemia (increased cholestrol, LDL, Triglyseride, decreased LDL) | |
Diet and dietary diversity | |
Psyschosocial | Low socio-economic class |
Stressful environment | |
Personality types | |
Geographic | Climate and season (cold weather increased risk) |
Soft drinking water | |
Environmental pollution |
Reversible and irreversible cardiovascular risk factors.
Variable | Reference values | Urban women Gauteng (n = 628) % | Peri-urban adults Free State (n = 271) % | Urban elderly Gauteng (n = 170) % |
---|---|---|---|---|
Overweight | BMI ≥ 25 < 30 [60] | 39.3 [37] | 26.0 [44] | 29.5 [57] |
Obese | BMI ≥ 30 [60] | 43.0 [37] | 41.9 [44] | 31.5 [57] |
High serum TC levels | ≥6.2 mmol/L [61] | 0.5 [37] | 16.7 | 22.3 [57] |
Low HDL-C levels | <1 mmol/L (adult men) <1.3 mmol/L (adult women) [61, 62] | 43.0 [37] | 62.7 [39] | 76.2 [57] |
High LDL-C levels | >4.1 mmol/L [60, 63] | 0.5 [37] | 16.7 | 14.6 [57] |
Hypertriglyceridaemia (High TRG levels) | ≥2.3 mmol/L [60, 63] | 24.7 [37] | 12.7 [39] | 13.8 [57] |
High normal BP | 130–139 mm Hg/85–89 mm Hg (systolic/diastolic blood pressure) [64] | 11.6 [37] | 12.7 | 10.8 [57] |
Hypertensive | ≥140/≥90 mm Hg (systolic/diastolic blood pressure) [64] | 36.4 [37] | 53.2 [39] | 68.0 [57] |
Hyperhomocysteienemia | >15 umol/L [61](serum homocysteiene) | — | — | 66.4 [57] |
Fibrinogen | >3.5 g/L [65] | — | — | 68.0 [57] |
Inflammation (HS-CRP) | ≥3 mg/dL [62] | — | 56.9 | 68.3 [57] |
Hyperglycaemia (serum glucose) | >5.5 mmol/L [66] | — | 16.0 [39] | 38.5 [57] |
Serum vitamin B6 | <8.6 mcg/L [67] | — | — | 98.0 [57] |
Serum vitamin B12 | <156 pmol/L [68, 69] | — | — | 4.8 [57] |
Serum folate | <5.9 nmol/dL [70] | — | — | 9.6 [57] |
Cardiovascular risk factors in adults and elderly.
Variable | Reference values | Rural children Eastern Cape (n = 232) % | Peri-urban children Free State (n = 98) % | Peri-urban children Gauteng (n = 203) % | Urban children Gauteng (n = 152) % |
---|---|---|---|---|---|
Overweight | BMI:A ≥ 2 < 3 [74] | 4.3 [24] | 17.0 [25] | 15.8 [29] | 1.0 [32] |
Obese | BMI:A ≥ 3 [74] | 0.0 [24] | 4.0 [25] | 2.5 [29] | 0.0 [32] |
High serum TC levels | ≥5.18 mmol/L [75] | 1.3 [24] | 19.4 | 3.0 | 10.2 [32] |
Low HDL-C levels | <1.04 mmol/L [75] | 42.5 [24] | 30.6 | 19.2 | 95.9 [32] |
High LDL-C levels | ≤3.37 mmol/L [75] | 2.12 [24] | 12.2 | 2.5 | 28.6 [32] |
Hypertriglyceridaemia (High TRG levels) | ≥1.12 mmol/L (0–9 years old) ≥1.47 mmol/L (10–19 years old)[75] | 12.4 [24] | 35.7 | 4.4 | 1.0 [32] |
Hyperhomocysteienaemia | >15 umol/L [61] | 1.6 | — | — | — |
Fibrinogen | >3.5 g/L [65] | 14.8 | — | — | — |
Inflammation (HS-CRP) | ≥3 mg/dL [62] | 19.0 [24] | 7.8 | — | — |
Hyperglycaemia (serum glucose) | >6.1 mmol/L [76] | 10.3[24] | 6.5 | 6.9 | — |
Serum vitamin B12 | <156 pmol/L [69] | 7.6 | — | — | — |
Serum folate | <5.9 nmol/dL [70] | 4.6 | — | — | — |
Cardiovascular risk factors of children.
To summarise, overweight/obesity is common among the poor-resource adults and elderly in our study population. The high prevalence observed among the adults, specifically women, and elderly may be due to poor nutrition (Table 2). Although the prevalence of obesity is not yet high among the children in our study communities, the results highlight the increasing burden of overweight among children (Table 3). The high prevalence of overweight and obesity in our study communities is a concern as the comorbidities associated with overweight/obesity have negative effects on health across the life cycle. [71]
Hypertension (blood pressure ≥ 140/90 mm Hg) [64] is considered one of the most important risk factors for developing CVD [50, 78] due to organ injury to the heart and kidneys. [79] Sharp increases in childhood hypertension have been reported in SA recently. [11] In childhood, hypertension treatment does not reverse the target organ injury and although hypertension treatment will significantly reduce event rates, the burden of CVD event rates will remain high though adulthood. [79] SA has a high hypertension burden with 44% and 41% of adult (≥15 years) black African women and men respectively. [46] In our adult populations the urban women in Gauteng had lower prevalence of 36.4% compared to the peri-urban adults in the FS (53.2%). [39] The elderly in urban Gauteng had the highest prevalence (68.%). [57] (Table 2) This was consistent with the national prevalence (84% among both genders aged ≥65 years), indicating that the hypertension burden increases with age. [46, 80] A recent national survey has found an overall prevalence of 43%, of which 58% were unaware of the condition and thus did not receive treatment. [80] Similar results were observed where only 36.8% of the hypertensive urban elderly in Gauteng used hypertensive medication. [43] No hypertension data were available for the children.
In summary, our results showed high levels of hypertension in adults and the elderly in both urban and peri-urban areas. A recent national survey has found older age, obesity and lower education levels as the main risk factors for hypertension in SA. [80] High prevalence of obesity and poor education levels have been identified in all our adult communities.
Diabetes mellitus is the most common, but also the most complex CDL. [81, 82] Hyperglycaemia affects multiple organs and can lead to arterial hypertension. [83] It is estimated that the cause of death in 80% of individuals suffering from type 2 diabetes will be due to thrombotic complications of which 75% will result from a cardiovascular event. [84] Data on the incident rates of children with diabetes are available for only 6% of African countries and may be due to lack of screening tests available in the poor and low income communities. [84] Results in Tables 2 and 3 indicated that 38.5% urban elderly (Gauteng), [57] 16.0% peri-urban adults (FS), [39] 10.3% rural children (EC), [24] 6.5% peri-urban children (FS), and 6.9% peri-urban children (Gauteng) had high serum glucose levels. An increased prevalence of diabetes was reported for developing countries, [85] and it can be concluded that the prevalence of hyperglycaemia in all age groups in urban, peri-urban and rural areas in SA is concerning.
The development of coronary artery disease and myocardial infarction has both atheromatous and thrombotic components. Haemostasis is a finely balanced system of clot formation and fibrinolysis. [86, 87, 88] Fibrinogen is recognised as an independent risk marker of CVD. Fibrinogen, because of its mass, also has a direct effect on the blood viscosity and a physical functional effect on platelet aggregation. [65, 89] Studies have indicated an increased level of plasma fibrinogen in black South Africans. [12, 57, 90] An increase of one gram per litre in plasma fibrinogen doubles the risk of CVD. [89] The fibrinogen levels were measured in two of the communities. High fibrinogen levels were observed in 68.0% of the elderly [57] (Table 2) and 14.8% of the rural children (Table 3), indicating an increased risk for CVD.
Several mechanisms have been proposed to clarify the link between homocysteine and pro-thrombotic state. The oxidative damage to the endothelium, combined with inhibition of the vasculo-protective function of nitric oxide, enhances thrombogenecity. [91] Homocysteine is metabolised by (a) the trans-sulphuration pathway which results in the production of cystathionine - a process that requires vitamin B6 and the main route of metabolism is via a methionine-conserving pathway - a process that requires methyltetrahydrofolate (from folic acid) and vitamin B12 as co-factor or alternatively (b) by the remethylation pathway taking place in the kidney and liver (where betaine is utilised instead of folate). [92, 93, 94, 95] An association between elevated plasma homocysteine and the development of atherosclerosis has been confirmed. [96] Studies in animal models have shown that elevated homocysteine promoted atherosclerosis by increased oxidative stress impaired endothelial function and increased thrombogenecity. [92, 93, 95, 96, 97, 98, 99] Epidemiological retrospective and prospective clinical studies established homocysteine as a potent independent risk factor for atherothrombotic vascular disease. [91, 92, 100] Additionally, homocysteine increase superoxide (O2—) levels resulting in increased oxidative stress, causing an inflammatory state and increased atherosclerosis and ischemia reperfusion. Oxidative stress in return inhibits the cobalamine metabolism and enhances the cycle. [101, 102] The frequency of hyperhomocysteienaemia as an independent risk factor for atherothrombotic vascular disease [91, 92, 100] was found in 66.4% and 1.6% of the urban elderly [57] and rural children respectively. Thus, although homocysteine measurement did not form part of the objectives in all our communities, prevalence of hyperhomocysteienaemia in the urban elderly (Gauteng) (Table 2) and the rural children (EC) (Table 3) is an additional confirmation of an increased risk for CVD in the low income South African population.
Vitamin B6 acts as coenzyme in the irreversible trans-sulfuration of homocysteine to cysteine. Higher vitamin B6 level are associated with lower homocysteine levels. Fat metabolism requires carnitine, obtained either directly [103] through diet or via synthesis requiring lysine and vitamin B6. Vitamin B6 deficiency was also found to be associated with decreased plasma PUFAs (n-6 and n-3) which may be associated with elevated cardiovascular risk and a contributing factor to the anti-inflammatory response. [104, 105] Low circulating vitamin B6 levels have been found inversely related to inflammatory markers (HS-CRP, fibrinogen, IL-6 and TNF-α) and are related to the incidence of inflammatory diseases (rheumatoid arthritis, CVD, and diabetes). [106, 107] Vitamin B6 levels were only available for the urban elderly and 98% of the respondents had low serum vitamin B6 levels (Table 2). Vitamin B6 levels were not available for any of the children, but pre-school children in Zambia indicated a suboptimal vitamin B6 in the studied group. [108] It would, therefore, be beneficial to include vitamin B6 serum levels in their analytical profile in future.
Low serum folate levels is a cardiovascular risk marker independently from homocysteine level. [109] Folate, as a donor of one-carbon units, is essential for methylation and affects numerous metabolisms involved in CVD [110] and accurate replication of deoxyribonucleic acid (DNA) and its repair. If DNA repair capacity of the cell is exceeded by the rate of damage to the genome, serious defects in cellular and tissue physiology occur, resulting in degenerative diseases including CVD. [111] The four mechanisms by which folate is involved in reducing atherosclerosis are: (1) Optimising methylation cycle and thereby directly reducing the homocysteine levels; (2) Acting directly as an antioxidant; (3) Interacting with enzyme endothelial nitric oxide synthase; (4) Affecting cofactor bioavailability of nitric oxide. Apart from being an independent cardiovascular risk marker, decreased serum folate levels also Indicate a decreased cell regeneration. [112] The serum folate levels were only available for two of the communities and 4.8% and 7.6% had low folate levels in the elderly [57] (Table 2) and rural children (EC) (Table 3) respectively. Study communities included in this study are therefore at risk for CVD and the general effect of ineffective cell recovery.
The cofactor cobalamin is required for the optimal function of the enzymes methionine synthase and L-methylmalonyl-CoA. [113, 114] During methionine synthase, homocysteine is converted to methionine, when the methyl group is transferred from 5-methylene tetrahydrofolate to cobalamin to form methylcobalamin and tetrahydrofolate while methylcobalamin donates its methyl group that binds to homocysteine to form methionin (required for the synthesis of S-adenosylmethionine [SAM]). [87, 115] SAM is required in many cellular methylation reactions, including the methylation ribonucleic acid (RNA) and DNA. [116, 117] Reduced synthesis of methionine as a result of insufficient cobalamine results in increased homocysteine levels. [104] Vitamin B12 is also the coenzyme required to remove the methyl group from folate, thereby activating folate. [117, 118] Serum vitamin B12 was only available for the elderly in Gauteng (Table 2) and the rural children (EC) (Table 3) and 4.8% [57] and 7.6% had low folate levels respectively, thus at risk of impaired homocysteine metabolism and CVD.
An inflammatory response is initiated by damage to the vascular cell lining resulting in a series of mechanisms (acute-phase response) including haemodynamic (vasodilatation) activation of endothelial cells (increased adhesion molecule expression), increased permeability (enhanced protein movement) and an increase in acute-phase proteins. [119, 120] Vessel injury can also be caused by high LDL-C, hypertension, cigarette toxins and elevated homocysteine levels. During the inflammatory response that aims to repair the damage to the artery wall, LDL-C becomes trapped in the lesion that is engulfed by the macrophages and the free radicals oxidise the LDL trapped in the macrophage and eventually become plaque. [48] CRP is a β-globulin which is bound strongly to phospholipids and increases twentyfold to thirtyfold during an infectious or inflammatory response and is, therefore, considered a credible marker for systemic inflammation. [47] The prevalence of systemic inflammation was found in 56.9% of the adult respondents (peri-urban FS) and in 68.3% of the elderly, [57] (Table 2) as well as 19% and 7.8% of the rural (EC) [26] and peri-urban children (FS) respectively. (Table 3) Elevated CRP is a strong independent predictor of risk of future cardiovascular events. [121, 122] Thus, the results from our studies indicate an increased risk for CVD.
The prevalence of dyslipidaemia varies across the regions in SSA due to increased urbanisation and change of lifestyle factors (epidemiological transition). [123] A similar variation was observed in SA where a significant difference in the prevalence of dyslipidaemia occurs in different ethnic groups. [124] Although, studies indicated that people from an African decent showed an athero-protective lipid profile (lower total cholesterol) compared to their white European or Indian fellow countrymen, widespread low High density Lipoprotein (HDL-C) was present. [125] The use of antiretroviral therapy (ARV) also leads to an increase in dyslipidaemia. With the high prevalence of HIV/AIDS in SA [45, 46], is ARV treatment (the largest health programme internationally) is considered as a contributing factor to dyslipidaemia in SA. [126]. Previous studies indicated that prevalence of dyslipidaemia among black South Africans (independent of rural or urban) varies between 30% and 63%. [125, 127, 128]
The high protein component of high-density lipoprotein-cholesterol (HDL-C) accounts for its metabolic function of removing cholesterol from tissue back to the liver, and is considered as an important anti-atherogenic pathway modulating inflammation. The inverse correlation between serum HDL-C and cardiovascular risk (CVR) is well known and widely accepted. [129] Studies showed that improving poor lifestyle habits to have a positive effect on the HDL-C levels. [130]
With reference to the reported results in Tables 2 and 3, the prevalence of increased total serum cholesterol (TC) with the lowest in the urban adult women in Gauteng where 0.5% of participants had an increased TC. The highest prevalence was observed among the urban elderly population of Gauteng, where 22.3% of participants had an increased TC. The prevalence of low serum HDL-C levels was significantly decreased in all the study communities with the lowest prevalence in the peri-urban children where 19.2% had a HDL-C of less than 130 mg/dl. The highest prevalence was in the urban children where 95.6% had a decreased HDL-C level. The percentage of participants with the highest prevalence of abnormal LDL-C levels was found in the urban children in Gauteng (28.6%) and the lowest prevalence was found in the urban women of Gauteng (0.5%). In contrast, the lowest prevalence of participants with increased serum triglyceride levels were found in the urban children of Gauteng and the highest prevalence was in the urban (Gauteng) women (24.7%). Results obtained from our studies are in line with results obtained from other studies in SA [125, 126, 127, 128], confirming that prevalence of dyslipidaemia (mainly decreased HDL-C) is becoming an increasing concern that needs to be consciously addressed in planning for Health care interventions.
Dyslipidaemia is regarded as an independent CVR marker. [124] As indicated in Figure 1, a total of 4.1% Peri-urban children from the FS had four elevated lipid risk factors, additionally, of the urban elderly from Gauteng 3.8% had four, 13.1% had three, 12.3% had two and 47.7% had one elevated lipid parameter. Interestingly, more than one lipid risk factor were present in almost all the communities (>10% of adults and elderly), even in the children (>5%).
Dyslipidaemic factors present in study groups.
Dietary diversity has a significant positive association with health. [34] An inverse relationship between dietary diversity and CVD risk factors, namely hypertension, hypercholesterolaemia and high HDL-C has been observed. [131] Although we did not measure dietary diversity in all the communities, poor to moderate dietary diversity were observed in all of the communities. [26, 29, 33, 35, 38, 57]. This may have been due to their socio-economic status and food insecurity and may be a risk factor for CVD.
An association between higher dietary sugar intakes and overweight/obesity and CDLs such as CVD exists. Increased dietary glycaemic load, caused by high sugar consumption, results in increased hepatic lipogenesis, dyslipidaemia,[132] and CVD. [133] Childhood overweight/obesity risk and morbidity were associated with consumption of sugar-sweetened beverages (SSBs) and highly processed foods and snacks. [54] The World Health Organisation recommends the intake of added sugar to be <10% of total energy intake. [134] More than 20% of the adults, elderly [57] and children in rural EC had high added sugar intakes whereas the children in peri-urban FS and urban Gauteng [33] had no added sugar intakes. Although SSB consumption has not been investigated in our studies, during the past 50 years, SBB consumption has increased [132] and SA is in the top 10 countries with the highest consumption of SSBs globally. [135]
Vegetables, legumes, whole grains and fruit all contribute to dietary fibre intake. Dietary fibre is differentiated as soluble (dissolves in water and forms a gel) and insoluble fibres. Good sources of soluble fibre are oats, citrus fruit, barley and legumes. It lowers LDL-C and glucose levels and, therefore, has a protective effect against CVD. [136] Lowering of cholesterol is achieved by the binding of fibre to bile acids, thereby escalating its excretion. This inhibits the production of cholesterol by the liver, resulting in lower blood cholesterol. [137] Food sources of insoluble dietary fibre include whole grains and vegetables. It cannot be fermented and promotes bowel movement and alleviates constipation. [138] A large majority (0–100%) of the children and adults in all our communities had low dietary fibre intakes. [24, 26, 29, 33, 34, 35, 38, 43, 44, 57] This may be due to the mainly refined carbohydrate-rich diet consumed by all these communities.
Dietary fats consist mainly of cholesterol and fatty acids. Total dietary fat (% of total energy [TE]) intakes were higher than recommended for all the communities, ranging from 13.7% to 32.7% in urban Gauteng women and elderly respectively. [24, 26, 29, 32, 35, 36, 38, 39, 42, 43, 44, 57] High-fat diets cause an increase in postprandial triglyceride levels that are associated with risk of coronary heart disease (CHD). [139, 140] Fatty acids can be either protective against the development of CVD or can be risk factors for CVD. Saturated fatty acids (SFAs) and trans fatty acids (TFAs) have the greatest adverse effect on atherogenic cholesterol levels and are both associated with risk of CVD. [136, 141] Increased SFA intakes increase LDL-C levels. [142] TFAs have a HDL-C lowering effect and also increase LDL-C levels and, therefore, increase the risk of CVD.[47]. The contribution of TFA to CVD is a multiple pathway mechanism affecting lipid metabolism, increased inflammatory response and adiposity, and decreased endothelial function and insulin sensitivity. [143]
Dietary SFA intakes of <10% and TFAs of <1% of total energy intakes are recommended. [144] High TFA intakes were observed in less than 10% of our communities, except for the children in rural EC where the proportion of respondents with high intakes of TFAs was 36.7%. The proportion of the respondents that had high SFA intakes ranged from 18.6% to 42.9%. [24, 26, 32, 34, 37, 38, 42] The elderly (40.0%) [57] and peri-urban children (41.6% in Gauteng and 42.9% in the FS) [25, 29] had the highest prevalence of high TFA intakes (40.0%). Low-cost processed meats such as polony and Russians as well as chicken feet and heads were frequently consumed by our communities and may have contributed to the large intakes. Although there has been controversy about SFA intake and CVD risk, sufficient evidence exists that high SFA intakes cause increased LDL-C level by downregulating LDL receptors. [136]
PUFAs have a protective effect against CVD, specifically omega-6 PUFAs that significantly reduces total cholesterol and LDL-C levels as well as inflammatory markers. [145] High intakes of omega-3 PUFAs lowers the risk for myocardial infarction, CHD and CVD mortality and CVD events. [136] In addition, a diet rich in PUFA reduces the TC:HDL-C ratio and CHD incidence. [146] Linolenic acid (omega-3 fatty acid) and linoleic acid (omega-6 fatty acid) are essential fatty acids that cannot be physiologically produced and, therefore, need to be supplied by food sources. [147] Omega-3 decreases the risk of CVD by preventing thrombus formation, lowering blood pressure and protecting against irregular heart beat. [142] Replacing dietary carbohydrates and SFAs by an increased intake of omega-6 PUFAs lower LDL-C and increase HDL-C levels [148]. A large proportion of all of our communities had low PUFA intakes (33.0–100%), particularly for both omega-3 (93.1–100%) and omega-6 (2.4–29.7%) fatty acids. MUFA intakes were low in a large proportion of the participants (29.0–77.6%), except for the peri-urban children in Gauteng where only 4.8% of the children had low MUFA intakes. The majority of these children also showed high dietary cholesterol intakes (57.6%) whereas the rest of the study communities had relatively low prevalence (<20%) of high dietary cholesterol intakes. Because most of our communities live in poverty, it is questionable if they can afford oily fish, olive oil and the other MUFA and PUFA dietary sources, however, they do consume mostly sunflower oil, but in small quantities. [26, 29, 33, 34, 38, 57]
Dietary sources of vitamin B6 include meat, fish, potatoes and bananas which are good sources. However, it is also present in nuts, whole grain, fortified cereal and leafy vegetables, chicken, legumes, non-citrus fruit, liver and soy products. [149, 150, 151, 152] The bioavailability differs according to food type, with pyridoxine glycoside as the least bioavailable. Vitamin B6 (5–75%) obtained from plant sources is in the form of glycosylated pyridoxine. [153, 154] Owing to the abundance of vitamin B6 in a variety of food sources, deficiency is not very common, however, in our communities, large proportions of the adults (79.1% in peri-urban FS Province and 85.7% urban women in Gauteng) and elderly (91.0%) [57] had low vitamin B6 intakes. Among the children, 36.7% of the rural and 24.8% of the peri-urban children in Gauteng showed low intakes of vitamin B6. Vitamin B6 deficiency often occurs in conjunction with other nutritional disorders and is associated with an increased risk of CVD. [155] Vitamin B6 not only has a homocysteine lowering effect, but is also needed for the metabolism of omega-3 PUFAs. [96]
Folate is the major determinant of homocysteiene [96] and thus has homocysteiene lowering effect. A recent meta-analysis showed that folic acid supplementation resulted in a 4% reduced risk for CVD events and the benefit was even greater among participants without pre-existing CVD or low folate levels. [156] Because folate cannot be physiologically synthesised, concentration depends on consumption. [65] All of our communities showed large proportions of participants (>40.0% ≤ 95.0%) with low dietary folate intakes. Green leafy vegetables, citrus fruit, legumes, yeast, liver and organ meats contain the highest concentration of folate. [155] Low intakes of these food items have been found in our studies. [25, 26, 29, 30, 31, 33, 35, 38, 43, 44, 57] Folate is omnipresent in nature, but heat and oxidation during food preparation and storage have a destructive effect and can destroy up to 50% of the original concentration. [157]
Vitamin B12, together with folate, plays a key role for the enzyme methionine synthase needed for the re-methylation of homocysteine to methionine. [96] Dietary sources of vitamin B12 are animal products (meat, fish, chicken, milk and cheese) and rarely found in plants or yeast. [158] Vitamin B12 is stored in large quantities in the liver and a deficiency is developed over years. [65] The majority of our communities showed large proportions of participants (≥60% ≤ 95.2%) with low intakes of vitamin B12, except for the peri-urban children in Gauteng where 14.4% of the participants had low vitamin B12 intakes. This may be mainly due to the mainly carbohydrate-based diet with low meat and cheese intakes.
Sodium is an essential nutrient that is required for many physiological functions. [146] The daily physiological requirement for sodium is estimated at 0.1–1.0 gram. [159] High sodium intakes have been established as the major cause of hypertension in many epidemiological, experimental, controlled clinical and population trials. [160, 161] Sodium is mainly consumed as (a) salt (sodium-chloride) which is added during food preparation and cooking or at meal time, and (b) from sodium used in processed foods in SA. [162] Unfortunately we did not measure dietary sodium intakes in all our communities. Bread was identified as the largest contributor to salt intakes and that 41.0% of the South African population has a high salt intake. [162] Bread also consistently appeared in the top 20 most commonly consumed foods among our study communities [26, 29, 30, 31, 33, 34, 38, 43, 44, 57]. Another contributor to sodium intake in SA is sodium glutamate that is used as a condiment, [163] as well as salt in soup, gravy and spice mixes and powders, margarine and atchar, a spicy condiment, [163] biscuits/cookies, and breakfast cereals [164]. Stock cubes are regularly used for flavouring meat and vegetable dishes in SA [165, 166]. High stock cube consumption has also been observed in these communities by the authors.
In the studies reported among various communities, low education and employment status were observed as well as poverty in a large majority of the respondents. The scientific literature shows a strong association between poverty and CVD [163]. Poverty is an underlying factor of food insecurity that often results in poor dietary intakes that were observed in our communities. Many of the dietary CVD risk factors were present in large proportions of the communities. The literature is clear that these dietary factors may be associated with some of the risk factors for CVD, such as obesity, hypertension and the biochemical risk factors for CVD. Irreversible and potentially reversible and physiological (low income) risk markers were found to prevail. A summary of the elevated cardiovascular risk markers in our study is schematically presented in Figure 2. Multiple preventable CVR markers were present among the children, adults and elderly in rural, peri-urban and urban areas. It can thus be concluded that a double burden of poverty and risk of CVD exists across the different age groups and geographical locations in these resource-poor communities. Prevention of CVD can be achieved through nutrition education and awareness programs. It is recommended that policy makers give serious attention to CVR and screening should be done from an early age to identify those at risk and implement appropriate interventions.
Cardiovascular risk factors prevalent among children, adults and the elderly.
We thank the National Research Foundation (NRF) and Vaal University of Technology (VUT) for financial support. Replamed (Cornel Pretorius) provided technical support, Prof A Egal, Centre of Sustainable Livelihoods (VUT) staff member and team members from the CARE research group for their operational support.
The authors have no conflict of interest to declare.
"Open access contributes to scientific excellence and integrity. It opens up research results to wider analysis. It allows research results to be reused for new discoveries. And it enables the multi-disciplinary research that is needed to solve global 21st century problems. Open access connects science with society. It allows the public to engage with research. To go behind the headlines. And look at the scientific evidence. And it enables policy makers to draw on innovative solutions to societal challenges".
\n\nCarlos Moedas, the European Commissioner for Research Science and Innovation at the STM Annual Frankfurt Conference, October 2016.
",metaTitle:"About Open Access",metaDescription:"Open access contributes to scientific excellence and integrity. It opens up research results to wider analysis. It allows research results to be reused for new discoveries. And it enables the multi-disciplinary research that is needed to solve global 21st century problems. Open access connects science with society. It allows the public to engage with research. To go behind the headlines. And look at the scientific evidence. And it enables policy makers to draw on innovative solutions to societal challenges.\n\nCarlos Moedas, the European Commissioner for Research Science and Innovation at the STM Annual Frankfurt Conference, October 2016.",metaKeywords:null,canonicalURL:"about-open-access",contentRaw:'[{"type":"htmlEditorComponent","content":"The Open Access publishing movement started in the early 2000s when academic leaders from around the world participated in the formation of the Budapest Initiative. They developed recommendations for an Open Access publishing process, “which has worked for the past decade to provide the public with unrestricted, free access to scholarly research—much of which is publicly funded. Making the research publicly available to everyone—free of charge and without most copyright and licensing restrictions—will accelerate scientific research efforts and allow authors to reach a larger number of readers” (reference: http://www.budapestopenaccessinitiative.org)
\\n\\nIntechOpen’s co-founders, both scientists themselves, created the company while undertaking research in robotics at Vienna University. Their goal was to spread research freely “for scientists, by scientists’ to the rest of the world via the Open Access publishing model. The company soon became a signatory of the Budapest Initiative, which currently has more than 1000 supporting organizations worldwide, ranging from universities to funders.
\\n\\nAt IntechOpen today, we are still as committed to working with organizations and people who care about scientific discovery, to putting the academic needs of the scientific community first, and to providing an Open Access environment where scientists can maximize their contribution to scientific advancement. By opening up access to the world’s scientific research articles and book chapters, we aim to facilitate greater opportunity for collaboration, scientific discovery and progress. We subscribe wholeheartedly to the Open Access definition:
\\n\\n“By “open access” to [peer-reviewed research literature], we mean its free availability on the public internet, permitting any users to read, download, copy, distribute, print, search, or link to the full texts of these articles, crawl them for indexing, pass them as data to software, or use them for any other lawful purpose, without financial, legal, or technical barriers other than those inseparable from gaining access to the internet itself. The only constraint on reproduction and distribution, and the only role for copyright in this domain, should be to give authors control over the integrity of their work and the right to be properly acknowledged and cited” (reference: http://www.budapestopenaccessinitiative.org)
\\n\\nOAI-PMH
\\n\\nAs a firm believer in the wider dissemination of knowledge, IntechOpen supports the Open Access Initiative Protocol for Metadata Harvesting (OAI-PMH Version 2.0). Read more
\\n\\nLicense
\\n\\nBook chapters published in edited volumes are distributed under the Creative Commons Attribution 3.0 Unported License (CC BY 3.0). IntechOpen upholds a very flexible Copyright Policy. There is no copyright transfer to the publisher and Authors retain exclusive copyright to their work. All Monographs/Compacts are distributed under the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0). Read more
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\\n\\nAll scientific works are Peer Reviewed prior to publishing. Read more
\\n\\nOA Publishing Fees
\\n\\nThe Open Access publishing model employed by IntechOpen eliminates subscription charges and pay-per-view fees, enabling readers to access research at no cost. In order to sustain operations and keep our publications freely accessible we levy an Open Access Publishing Fee for manuscripts, which helps us cover the costs of editorial work and the production of books. Read more
\\n\\nDigital Archiving Policy
\\n\\nIntechOpen is committed to ensuring the long-term preservation and the availability of all scholarly research we publish. We employ a variety of means to enable us to deliver on our commitments to the scientific community. Apart from preservation by the Croatian National Library (for publications prior to April 18, 2018) and the British Library (for publications after April 18, 2018), our entire catalogue is preserved in the CLOCKSS archive.
\\n\\nOpen Science is transparent and accessible knowledge that is shared and developed through collaborative networks.
\\n\\nOpen Science is about increased rigour, accountability, and reproducibility for research. It is based on the principles of inclusion, fairness, equity, and sharing, and ultimately seeks to change the way research is done, who is involved and how it is valued. It aims to make research more open to participation, review/refutation, improvement and (re)use for the world to benefit.
\\n\\nOpen Science refers to doing traditional science with more transparency involved at various stages, for example by openly sharing code and data. It implies a growing set of practices - within different disciplines - aiming at:
\\n\\nWe aim at improving the quality and availability of scholarly communication by promoting and practicing:
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The Open Access publishing movement started in the early 2000s when academic leaders from around the world participated in the formation of the Budapest Initiative. They developed recommendations for an Open Access publishing process, “which has worked for the past decade to provide the public with unrestricted, free access to scholarly research—much of which is publicly funded. Making the research publicly available to everyone—free of charge and without most copyright and licensing restrictions—will accelerate scientific research efforts and allow authors to reach a larger number of readers” (reference: http://www.budapestopenaccessinitiative.org)
\n\nIntechOpen’s co-founders, both scientists themselves, created the company while undertaking research in robotics at Vienna University. Their goal was to spread research freely “for scientists, by scientists’ to the rest of the world via the Open Access publishing model. The company soon became a signatory of the Budapest Initiative, which currently has more than 1000 supporting organizations worldwide, ranging from universities to funders.
\n\nAt IntechOpen today, we are still as committed to working with organizations and people who care about scientific discovery, to putting the academic needs of the scientific community first, and to providing an Open Access environment where scientists can maximize their contribution to scientific advancement. By opening up access to the world’s scientific research articles and book chapters, we aim to facilitate greater opportunity for collaboration, scientific discovery and progress. We subscribe wholeheartedly to the Open Access definition:
\n\n“By “open access” to [peer-reviewed research literature], we mean its free availability on the public internet, permitting any users to read, download, copy, distribute, print, search, or link to the full texts of these articles, crawl them for indexing, pass them as data to software, or use them for any other lawful purpose, without financial, legal, or technical barriers other than those inseparable from gaining access to the internet itself. The only constraint on reproduction and distribution, and the only role for copyright in this domain, should be to give authors control over the integrity of their work and the right to be properly acknowledged and cited” (reference: http://www.budapestopenaccessinitiative.org)
\n\nOAI-PMH
\n\nAs a firm believer in the wider dissemination of knowledge, IntechOpen supports the Open Access Initiative Protocol for Metadata Harvesting (OAI-PMH Version 2.0). Read more
\n\nLicense
\n\nBook chapters published in edited volumes are distributed under the Creative Commons Attribution 3.0 Unported License (CC BY 3.0). IntechOpen upholds a very flexible Copyright Policy. There is no copyright transfer to the publisher and Authors retain exclusive copyright to their work. All Monographs/Compacts are distributed under the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0). Read more
\n\nPeer Review Policies
\n\nAll scientific works are Peer Reviewed prior to publishing. Read more
\n\nOA Publishing Fees
\n\nThe Open Access publishing model employed by IntechOpen eliminates subscription charges and pay-per-view fees, enabling readers to access research at no cost. In order to sustain operations and keep our publications freely accessible we levy an Open Access Publishing Fee for manuscripts, which helps us cover the costs of editorial work and the production of books. Read more
\n\nDigital Archiving Policy
\n\nIntechOpen is committed to ensuring the long-term preservation and the availability of all scholarly research we publish. We employ a variety of means to enable us to deliver on our commitments to the scientific community. Apart from preservation by the Croatian National Library (for publications prior to April 18, 2018) and the British Library (for publications after April 18, 2018), our entire catalogue is preserved in the CLOCKSS archive.
\n\nOpen Science is transparent and accessible knowledge that is shared and developed through collaborative networks.
\n\nOpen Science is about increased rigour, accountability, and reproducibility for research. It is based on the principles of inclusion, fairness, equity, and sharing, and ultimately seeks to change the way research is done, who is involved and how it is valued. It aims to make research more open to participation, review/refutation, improvement and (re)use for the world to benefit.
\n\nOpen Science refers to doing traditional science with more transparency involved at various stages, for example by openly sharing code and data. It implies a growing set of practices - within different disciplines - aiming at:
\n\nWe aim at improving the quality and availability of scholarly communication by promoting and practicing:
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In particular, this work addresses the diversity of available atomizers, the drying kinetics and the importance of the configuration of the drying chamber, and the efficiency of the collection devices. The final properties of the dried products are influenced by a variety of factors, namely the spray dryer design, the feed characteristics and the processing parameters. The impact of those variables in optimizing both the spray-drying process and the synthesis of dried particles with desirable characteristics is discussed. 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In the case of nonbiodegradable inorganic compounds, bioremediation takes the form of bioaccumulation or conversion of one toxic species to a less toxic form for example Cr(VI) is converted to less toxic (III). Bioremediation is considered an environmentally friendly way for pollution clean-up. Microbial clean up can be applied in situ (in place of contamination) or ex situ (off the site of contamination). In situ remediation in the natural environment is deemed slow and often times difficult to control and optimize the different parameters affecting the bioremediation. To this end, use of engineered bioreactors is preferred. Engineered bioreactors providing for optimum conditions for microbial growth and biodegradation have been developed for use in bioremediation processes to achieve the different desired remediation goals. Bioreactors in use range in mode of operation from batch, continuous, and fed batch bioreactors and are designed to optimize microbial processes in relationship to contaminated media and nature of pollutant. 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In the future, we envision HyStem’s flexibility and clinical use history forming the basis for a new generation of therapeutics. Two examples described here include HyStem’s use for patient-derived organoid culture to develop new drugs as well as for bioprinting to manufacture new organs.",book:{id:"8353",slug:"hydrogels-smart-materials-for-biomedical-applications",title:"Hydrogels",fullTitle:"Hydrogels - Smart Materials for Biomedical Applications"},signatures:"Thomas I. 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Dr. Bobek is a member of the editorial boards of six international journals and a member of the Strategic Council of the Minister of Foreign Affairs of the Republic of Slovenia. He has a long history in academia, consulting, and entrepreneurship. His own consulting firm, Palemid, has managed twenty significant projects, such as Cooperation Program Interreg V-A (Slovenia-Austria) and Capacity Building for the Serbian Chamber of Enforcement Agents. He has also participated in many international projects in Italy, Germany, Great Britain, the United States, Spain, Turkey, France, Romania, Croatia, Montenegro, Malaysia, and China. Dr. Bobek is also a co-founder of the Academy of Regional Management in Slovenia.",institutionString:"Universities of Applied Sciences FH Joanneum, Austria",institution:{name:"Universities of Applied Sciences Joanneum",institutionURL:null,country:{name:"Austria"}}},editorTwo:{id:"293992",title:"Dr.",name:"Tatjana",middleName:null,surname:"Horvat",slug:"tatjana-horvat",fullName:"Tatjana Horvat",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002hXb0hQAC/Profile_Picture_1642419002203",biography:"Tatjana Horvat works as a professor for accountant and auditing at the University of Primorska, Slovenia. She is a Certified State Internal Auditor (licensed by Ministry of Finance RS) and Certified Internal Auditor for Business Sector and Certified accountant (licensed by Slovenian Institute of Auditors). At the Ministry of Justice of Slovenia, she is a member of examination boards for court expert candidates and judicial appraisers in the following areas: economy/finance, valuation of companies, banking, and forensic investigation of economic operations/accounting. At the leading business newspaper Finance in Slovenia (Swedish ownership), she is the editor and head of the area for business, finance, tax-related articles, and educational programs.",institutionString:null,institution:{name:"University of Primorska",institutionURL:null,country:{name:"Slovenia"}}},editorThree:null},{id:"87",title:"Economics",coverUrl:"https://cdn.intechopen.com/series_topics/covers/87.jpg",isOpenForSubmission:!0,editor:{id:"327730",title:"Prof.",name:"Jaime",middleName:null,surname:"Ortiz",slug:"jaime-ortiz",fullName:"Jaime Ortiz",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00002zaOKZQA2/Profile_Picture_1642145584421",biography:"Dr. Jaime Ortiz holds degrees from Chile, the Netherlands, and the United States. He has held tenured faculty, distinguished professorship, and executive leadership appointments in several universities around the world. 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Ms. Mehtab has published seven papers in international conferences and one of her papers has been accepted for publication in a reputable international journal. She has won the best paper awards in two prestigious international conferences – BAICONF 2019, and ICADCML 2021, organized in the Indian Institute of Management, Bangalore, India in December 2019, and SOA University, Bhubaneswar, India in January 2021. Besides, Ms. Mehtab has also published two book chapters in two books. Seven of her book chapters will be published in a volume shortly in 2021 by Cambridge Scholars’ Press, UK. Currently, she is working as the joint editor of two edited volumes on Time Series Analysis and Forecasting to be published in the first half of 2021 by an international house. Currently, she is working as a Data Scientist with an MNC in Delhi, India.",institutionString:"NSHM College of Management and Technology",institution:{name:"Association for Computing Machinery",country:{name:"United States of America"}}},{id:"226240",title:"Dr.",name:"Andri Irfan",middleName:null,surname:"Rifai",slug:"andri-irfan-rifai",fullName:"Andri Irfan Rifai",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/226240/images/7412_n.jpg",biography:"Andri IRFAN is a Senior Lecturer of Civil Engineering and Planning. He completed the PhD at the Universitas Indonesia & Universidade do Minho with Sandwich Program Scholarship from the Directorate General of Higher Education and LPDP scholarship. He has been teaching for more than 19 years and much active to applied his knowledge in the project construction in Indonesia. His research interest ranges from pavement management system to advanced data mining techniques for transportation engineering. He has published more than 50 papers in journals and 2 books.",institutionString:null,institution:{name:"Universitas Internasional Batam",country:{name:"Indonesia"}}},{id:"314576",title:"Dr.",name:"Ibai",middleName:null,surname:"Laña",slug:"ibai-lana",fullName:"Ibai Laña",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/314576/images/system/314576.jpg",biography:"Dr. Ibai Laña works at TECNALIA as a data analyst. He received his Ph.D. in Artificial Intelligence from the University of the Basque Country (UPV/EHU), Spain, in 2018. He is currently a senior researcher at TECNALIA. His research interests fall within the intersection of intelligent transportation systems, machine learning, traffic data analysis, and data science. He has dealt with urban traffic forecasting problems, applying machine learning models and evolutionary algorithms. He has experience in origin-destination matrix estimation or point of interest and trajectory detection. Working with large volumes of data has given him a good command of big data processing tools and NoSQL databases. He has also been a visiting scholar at the Knowledge Engineering and Discovery Research Institute, Auckland University of Technology.",institutionString:"TECNALIA Research & Innovation",institution:{name:"Tecnalia",country:{name:"Spain"}}},{id:"314575",title:"Dr.",name:"Jesus",middleName:null,surname:"L. Lobo",slug:"jesus-l.-lobo",fullName:"Jesus L. Lobo",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/314575/images/system/314575.png",biography:"Dr. Jesús López is currently based in Bilbao (Spain) working at TECNALIA as Artificial Intelligence Research Scientist. In most cases, a project idea or a new research line needs to be investigated to see if it is good enough to take into production or to focus on it. That is exactly what he does, diving into Machine Learning algorithms and technologies to help TECNALIA to decide whether something is great in theory or will actually impact on the product or processes of its projects. So, he is expert at framing experiments, developing hypotheses, and proving whether they’re true or not, in order to investigate fundamental problems with a longer time horizon. He is also able to design and develop PoCs and system prototypes in simulation. He has participated in several national and internacional R&D projects.\n\nAs another relevant part of his everyday research work, he usually publishes his findings in reputed scientific refereed journals and international conferences, occasionally acting as reviewer and Programme Commitee member. Concretely, since 2018 he has published 9 JCR (8 Q1) journal papers, 9 conference papers (e.g. ECML PKDD 2021), and he has co-edited a book. He is also active in popular science writing data science stories for reputed blogs (KDNuggets, TowardsDataScience, Naukas). Besides, he has recently embarked on mentoring programmes as mentor, and has also worked as data science trainer.",institutionString:"TECNALIA Research & Innovation",institution:{name:"Tecnalia",country:{name:"Spain"}}},{id:"103779",title:"Prof.",name:"Yalcin",middleName:null,surname:"Isler",slug:"yalcin-isler",fullName:"Yalcin Isler",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRyQ8QAK/Profile_Picture_1628834958734",biography:"Yalcin Isler (1971 - Burdur / Turkey) received the B.Sc. degree in the Department of Electrical and Electronics Engineering from Anadolu University, Eskisehir, Turkey, in 1993, the M.Sc. degree from the Department of Electronics and Communication Engineering, Suleyman Demirel University, Isparta, Turkey, in 1996, the Ph.D. degree from the Department of Electrical and Electronics Engineering, Dokuz Eylul University, Izmir, Turkey, in 2009, and the Competence of Associate Professorship from the Turkish Interuniversity Council in 2019.\n\nHe was Lecturer at Burdur Vocational School in Suleyman Demirel University (1993-2000, Burdur / Turkey), Software Engineer (2000-2002, Izmir / Turkey), Research Assistant in Bulent Ecevit University (2002-2003, Zonguldak / Turkey), Research Assistant in Dokuz Eylul University (2003-2010, Izmir / Turkey), Assistant Professor at the Department of Electrical and Electronics Engineering in Bulent Ecevit University (2010-2012, Zonguldak / Turkey), Assistant Professor at the Department of Biomedical Engineering in Izmir Katip Celebi University (2012-2019, Izmir / Turkey). He is an Associate Professor at the Department of Biomedical Engineering at Izmir Katip Celebi University, Izmir / Turkey, since 2019. In addition to academics, he has also founded Islerya Medical and Information Technologies Company, Izmir / Turkey, since 2017.\n\nHis main research interests cover biomedical signal processing, pattern recognition, medical device design, programming, and embedded systems. He has many scientific papers and participated in several projects in these study fields. He was an IEEE Student Member (2009-2011) and IEEE Member (2011-2014) and has been IEEE Senior Member since 2014.",institutionString:null,institution:{name:"Izmir Kâtip Çelebi University",country:{name:"Turkey"}}},{id:"339677",title:"Dr.",name:"Mrinmoy",middleName:null,surname:"Roy",slug:"mrinmoy-roy",fullName:"Mrinmoy Roy",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/339677/images/16768_n.jpg",biography:"An accomplished Sales & Marketing professional with 12 years of cross-functional experience in well-known organisations such as CIPLA, LUPIN, GLENMARK, ASTRAZENECA across different segment of Sales & Marketing, International Business, Institutional Business, Product Management, Strategic Marketing of HIV, Oncology, Derma, Respiratory, Anti-Diabetic, Nutraceutical & Stomatological Product Portfolio and Generic as well as Chronic Critical Care Portfolio. A First Class MBA in International Business & Strategic Marketing, B.Pharm, D.Pharm, Google Certified Digital Marketing Professional. Qualified PhD Candidate in Operations and Management with special focus on Artificial Intelligence and Machine Learning adoption, analysis and use in Healthcare, Hospital & Pharma Domain. Seasoned with diverse therapy area of Pharmaceutical Sales & Marketing ranging from generating revenue through generating prescriptions, launching new products, and making them big brands with continuous strategy execution at the Physician and Patients level. Moved from Sales to Marketing and Business Development for 3.5 years in South East Asian Market operating from Manila, Philippines. Came back to India and handled and developed Brands such as Gluconorm, Lupisulin, Supracal, Absolut Woman, Hemozink, Fabiflu (For COVID 19), and many more. In my previous assignment I used to develop and execute strategies on Sales & Marketing, Commercialization & Business Development for Institution and Corporate Hospital Business portfolio of Oncology Therapy Area for AstraZeneca Pharma India Ltd. Being a Research Scholar and Student of ‘Operations Research & Management: Artificial Intelligence’ I published several pioneer research papers and book chapters on the same in Internationally reputed journals and Books indexed in Scopus, Springer and Ei Compendex, Google Scholar etc. Currently, I am launching PGDM Pharmaceutical Management Program in IIHMR Bangalore and spearheading the course curriculum and structure of the same. I am interested in Collaboration for Healthcare Innovation, Pharma AI Innovation, Future trend in Marketing and Management with incubation on Healthcare, Healthcare IT startups, AI-ML Modelling and Healthcare Algorithm based training module development. I am also an affiliated member of the Institute of Management Consultant of India, looking forward to Healthcare, Healthcare IT and Innovation, Pharma and Hospital Management Consulting works.",institutionString:null,institution:{name:"Lovely Professional University",country:{name:"India"}}},{id:"1063",title:"Prof.",name:"Constantin",middleName:null,surname:"Volosencu",slug:"constantin-volosencu",fullName:"Constantin Volosencu",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/1063/images/system/1063.png",biography:"Prof. Dr. Constantin Voloşencu graduated as an engineer from\nPolitehnica University of Timișoara, Romania, where he also\nobtained a doctorate degree. He is currently a full professor in\nthe Department of Automation and Applied Informatics at the\nsame university. Dr. Voloşencu is the author of ten books, seven\nbook chapters, and more than 160 papers published in journals\nand conference proceedings. He has also edited twelve books and\nhas twenty-seven patents to his name. He is a manager of research grants, editor in\nchief and member of international journal editorial boards, a former plenary speaker, a member of scientific committees, and chair at international conferences. His\nresearch is in the fields of control systems, control of electric drives, fuzzy control\nsystems, neural network applications, fault detection and diagnosis, sensor network\napplications, monitoring of distributed parameter systems, and power ultrasound\napplications. He has developed automation equipment for machine tools, spooling\nmachines, high-power ultrasound processes, and more.",institutionString:'"Politechnica" University Timişoara',institution:null},{id:"221364",title:"Dr.",name:"Eneko",middleName:null,surname:"Osaba",slug:"eneko-osaba",fullName:"Eneko Osaba",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/221364/images/system/221364.jpg",biography:"Dr. Eneko Osaba works at TECNALIA as a senior researcher. He obtained his Ph.D. in Artificial Intelligence in 2015. He has participated in more than twenty-five local and European research projects, and in the publication of more than 130 papers. He has performed several stays at universities in the United Kingdom, Italy, and Malta. Dr. Osaba has served as a program committee member in more than forty international conferences and participated in organizing activities in more than ten international conferences. He is a member of the editorial board of the International Journal of Artificial Intelligence, Data in Brief, and Journal of Advanced Transportation. He is also a guest editor for the Journal of Computational Science, Neurocomputing, Swarm, and Evolutionary Computation and IEEE ITS Magazine.",institutionString:"TECNALIA Research & Innovation",institution:{name:"Tecnalia",country:{name:"Spain"}}},{id:"275829",title:"Dr.",name:"Esther",middleName:null,surname:"Villar-Rodriguez",slug:"esther-villar-rodriguez",fullName:"Esther Villar-Rodriguez",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/275829/images/system/275829.jpg",biography:"Dr. Esther Villar obtained a Ph.D. in Information and Communication Technologies from the University of Alcalá, Spain, in 2015. She obtained a degree in Computer Science from the University of Deusto, Spain, in 2010, and an MSc in Computer Languages and Systems from the National University of Distance Education, Spain, in 2012. Her areas of interest and knowledge include natural language processing (NLP), detection of impersonation in social networks, semantic web, and machine learning. Dr. Esther Villar made several contributions at conferences and publishing in various journals in those fields. Currently, she is working within the OPTIMA (Optimization Modeling & Analytics) business of TECNALIA’s ICT Division as a data scientist in projects related to the prediction and optimization of management and industrial processes (resource planning, energy efficiency, etc).",institutionString:"TECNALIA Research & Innovation",institution:{name:"Tecnalia",country:{name:"Spain"}}},{id:"49813",title:"Dr.",name:"Javier",middleName:null,surname:"Del Ser",slug:"javier-del-ser",fullName:"Javier Del Ser",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/49813/images/system/49813.png",biography:"Prof. Dr. Javier Del Ser received his first PhD in Telecommunication Engineering (Cum Laude) from the University of Navarra, Spain, in 2006, and a second PhD in Computational Intelligence (Summa Cum Laude) from the University of Alcala, Spain, in 2013. He is currently a principal researcher in data analytics and optimisation at TECNALIA (Spain), a visiting fellow at the Basque Center for Applied Mathematics (BCAM) and a part-time lecturer at the University of the Basque Country (UPV/EHU). His research interests gravitate on the use of descriptive, prescriptive and predictive algorithms for data mining and optimization in a diverse range of application fields such as Energy, Transport, Telecommunications, Health and Industry, among others. In these fields he has published more than 240 articles, co-supervised 8 Ph.D. theses, edited 6 books, coauthored 7 patents and participated/led more than 40 research projects. He is a Senior Member of the IEEE, and a recipient of the Biscay Talent prize for his academic career.",institutionString:"Tecnalia Research & Innovation",institution:{name:"Tecnalia",country:{name:"Spain"}}},{id:"278948",title:"Dr.",name:"Carlos Pedro",middleName:null,surname:"Gonçalves",slug:"carlos-pedro-goncalves",fullName:"Carlos Pedro Gonçalves",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRcmyQAC/Profile_Picture_1564224512145",biography:'Carlos Pedro Gonçalves (PhD) is an Associate Professor at Lusophone University of Humanities and Technologies and a researcher on Complexity Sciences, Quantum Technologies, Artificial Intelligence, Strategic Studies, Studies in Intelligence and Security, FinTech and Financial Risk Modeling. He is also a progammer with programming experience in:\n\nA) Quantum Computing using Qiskit Python module and IBM Quantum Experience Platform, with software developed on the simulation of Quantum Artificial Neural Networks and Quantum Cybersecurity;\n\nB) Artificial Intelligence and Machine learning programming in Python;\n\nC) Artificial Intelligence, Multiagent Systems Modeling and System Dynamics Modeling in Netlogo, with models developed in the areas of Chaos Theory, Econophysics, Artificial Intelligence, Classical and Quantum Complex Systems Science, with the Econophysics models having been cited worldwide and incorporated in PhD programs by different Universities.\n\nReceived an Arctic Code Vault Contributor status by GitHub, due to having developed open source software preserved in the \\"Arctic Code Vault\\" for future generations (https://archiveprogram.github.com/arctic-vault/), with the Strategy Analyzer A.I. module for decision making support (based on his PhD thesis, used in his Classes on Decision Making and in Strategic Intelligence Consulting Activities) and QNeural Python Quantum Neural Network simulator also preserved in the \\"Arctic Code Vault\\", for access to these software modules see: https://github.com/cpgoncalves. He is also a peer reviewer with outsanding review status from Elsevier journals, including Physica A, Neurocomputing and Engineering Applications of Artificial Intelligence. Science CV available at: https://www.cienciavitae.pt//pt/8E1C-A8B3-78C5 and ORCID: https://orcid.org/0000-0002-0298-3974',institutionString:"University of Lisbon",institution:{name:"Universidade Lusófona",country:{name:"Portugal"}}},{id:"310576",title:"Prof.",name:"Erick Giovani",middleName:null,surname:"Sperandio Nascimento",slug:"erick-giovani-sperandio-nascimento",fullName:"Erick Giovani Sperandio Nascimento",position:null,profilePictureURL:"https://intech-files.s3.amazonaws.com/0033Y00002pDKxDQAW/ProfilePicture%202022-06-20%2019%3A57%3A24.788",biography:"Prof. Erick Sperandio is the Lead Researcher and professor of Artificial Intelligence (AI) at SENAI CIMATEC, Bahia, Brazil, also working with Computational Modeling (CM) and HPC. He holds a PhD in Environmental Engineering in the area of Atmospheric Computational Modeling, a Master in Informatics in the field of Computational Intelligence and Graduated in Computer Science from UFES. He currently coordinates, leads and participates in R&D projects in the areas of AI, computational modeling and supercomputing applied to different areas such as Oil and Gas, Health, Advanced Manufacturing, Renewable Energies and Atmospheric Sciences, advising undergraduate, master's and doctoral students. He is the Lead Researcher at SENAI CIMATEC's Reference Center on Artificial Intelligence. In addition, he is a Certified Instructor and University Ambassador of the NVIDIA Deep Learning Institute (DLI) in the areas of Deep Learning, Computer Vision, Natural Language Processing and Recommender Systems, and Principal Investigator of the NVIDIA/CIMATEC AI Joint Lab, the first in Latin America within the NVIDIA AI Technology Center (NVAITC) worldwide program. He also works as a researcher at the Supercomputing Center for Industrial Innovation (CS2i) and at the SENAI Institute of Innovation for Automation (ISI Automação), both from SENAI CIMATEC. He is a member and vice-coordinator of the Basic Board of Scientific-Technological Advice and Evaluation, in the area of Innovation, of the Foundation for Research Support of the State of Bahia (FAPESB). He serves as Technology Transfer Coordinator and one of the Principal Investigators at the National Applied Research Center in Artificial Intelligence (CPA-IA) of SENAI CIMATEC, focusing on Industry, being one of the six CPA-IA in Brazil approved by MCTI / FAPESP / CGI.br. He also participates as one of the representatives of Brazil in the BRICS Innovation Collaboration Working Group on HPC, ICT and AI. He is the coordinator of the Work Group of the Axis 5 - Workforce and Training - of the Brazilian Strategy for Artificial Intelligence (EBIA), and member of the MCTI/EMBRAPII AI Innovation Network Training Committee. He is the coordinator, by SENAI CIMATEC, of the Artificial Intelligence Reference Network of the State of Bahia (REDE BAH.IA). He leads the working group of experts representing Brazil in the Global Partnership on Artificial Intelligence (GPAI), on the theme \"AI and the Pandemic Response\".",institutionString:null,institution:null},{id:"241400",title:"Prof.",name:"Mohammed",middleName:null,surname:"Bsiss",slug:"mohammed-bsiss",fullName:"Mohammed Bsiss",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/241400/images/8062_n.jpg",biography:null,institutionString:null,institution:null},{id:"276128",title:"Dr.",name:"Hira",middleName:null,surname:"Fatima",slug:"hira-fatima",fullName:"Hira Fatima",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/276128/images/14420_n.jpg",biography:"Dr. Hira Fatima\nAssistant Professor\nDepartment of Mathematics\nInstitute of Applied Science\nMangalayatan University, Aligarh\nMobile: no : 8532041179\nhirafatima2014@gmal.com\n\nDr. Hira Fatima has received his Ph.D. degree in pure Mathematics from Aligarh Muslim University, Aligarh India. Currently working as an Assistant Professor in the Department of Mathematics, Institute of Applied Science, Mangalayatan University, Aligarh. She taught so many courses of Mathematics of UG and PG level. Her research Area of Expertise is Functional Analysis & Sequence Spaces. She has been working on Ideal Convergence of double sequence. She has published 17 research papers in National and International Journals including Cogent Mathematics, Filomat, Journal of Intelligent and Fuzzy Systems, Advances in Difference Equations, Journal of Mathematical Analysis, Journal of Mathematical & Computer Science etc. She has also reviewed few research papers for the and international journals. She is a member of Indian Mathematical Society.",institutionString:null,institution:null},{id:"417317",title:"Mrs.",name:"Chiedza",middleName:null,surname:"Elvina Mashiri",slug:"chiedza-elvina-mashiri",fullName:"Chiedza Elvina Mashiri",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Midlands State University",country:{name:"Zimbabwe"}}},{id:"352140",title:"Dr.",name:"Edina",middleName:null,surname:"Chandiwana",slug:"edina-chandiwana",fullName:"Edina Chandiwana",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Midlands State University",country:{name:"Zimbabwe"}}},{id:"342259",title:"B.Sc.",name:"Leonard",middleName:null,surname:"Mushunje",slug:"leonard-mushunje",fullName:"Leonard Mushunje",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Midlands State University",country:{name:"Zimbabwe"}}},{id:"347042",title:"Mr.",name:"Maxwell",middleName:null,surname:"Mashasha",slug:"maxwell-mashasha",fullName:"Maxwell Mashasha",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Midlands State University",country:{name:"Zimbabwe"}}},{id:"2941",title:"Dr.",name:"Alberto J.",middleName:"Jorge",surname:"Rosales-Silva",slug:"alberto-j.-rosales-silva",fullName:"Alberto J. Rosales-Silva",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Instituto Politécnico Nacional",country:{name:"Mexico"}}},{id:"437913",title:"Dr.",name:"Guillermo",middleName:null,surname:"Urriolagoitia-Sosa",slug:"guillermo-urriolagoitia-sosa",fullName:"Guillermo Urriolagoitia-Sosa",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Instituto Politécnico Nacional",country:{name:"Mexico"}}},{id:"435126",title:"Prof.",name:"Joaquim",middleName:null,surname:"José de Castro Ferreira",slug:"joaquim-jose-de-castro-ferreira",fullName:"Joaquim José de Castro Ferreira",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Aveiro",country:{name:"Portugal"}}},{id:"437899",title:"MSc.",name:"Miguel Angel",middleName:null,surname:"Ángel Castillo-Martínez",slug:"miguel-angel-angel-castillo-martinez",fullName:"Miguel Angel Ángel Castillo-Martínez",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Instituto Politécnico Nacional",country:{name:"Mexico"}}},{id:"289955",title:"Dr.",name:"Raja",middleName:null,surname:"Kishor Duggirala",slug:"raja-kishor-duggirala",fullName:"Raja Kishor Duggirala",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Jawaharlal Nehru Technological University, Hyderabad",country:{name:"India"}}}]}},subseries:{item:{id:"10",type:"subseries",title:"Animal Physiology",keywords:"Physiology, Comparative, Evolution, Biomolecules, Organ, Homeostasis, Anatomy, Pathology, Medical, Cell Division, Cell Signaling, Cell Growth, Cell Metabolism, Endocrine, Neuroscience, Cardiovascular, Development, Aging, Development",scope:"Physiology, the scientific study of functions and mechanisms of living systems, is an essential area of research in its own right, but also in relation to medicine and health sciences. The scope of this topic will range from molecular, biochemical, cellular, and physiological processes in all animal species. Work pertaining to the whole organism, organ systems, individual organs and tissues, cells, and biomolecules will be included. Medical, animal, cell, and comparative physiology and allied fields such as anatomy, histology, and pathology with physiology links will be covered in this topic. Physiology research may be linked to development, aging, environment, regular and pathological processes, adaptation and evolution, exercise, or several other factors affecting, or involved with, animal physiology.",coverUrl:"https://cdn.intechopen.com/series_topics/covers/10.jpg",hasOnlineFirst:!1,hasPublishedBooks:!1,annualVolume:11406,editor:{id:"202192",title:"Dr.",name:"Catrin",middleName:null,surname:"Rutland",slug:"catrin-rutland",fullName:"Catrin Rutland",profilePictureURL:"https://mts.intechopen.com/storage/users/202192/images/system/202192.png",biography:"Catrin Rutland is an Associate Professor of Anatomy and Developmental Genetics at the University of Nottingham, UK. She obtained a BSc from the University of Derby, England, a master’s degree from Technische Universität München, Germany, and a Ph.D. from the University of Nottingham. She undertook a post-doctoral research fellowship in the School of Medicine before accepting tenure in Veterinary Medicine and Science. 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Dr. Rutland has also written popular science books for the public. https://orcid.org/0000-0002-2009-4898. www.nottingham.ac.uk/vet/people/catrin.rutland",institutionString:null,institution:{name:"University of Nottingham",institutionURL:null,country:{name:"United Kingdom"}}},editorTwo:null,editorThree:null,series:{id:"10",title:"Physiology",doi:"10.5772/intechopen.72796",issn:"2631-8261"},editorialBoard:[{id:"306970",title:"Mr.",name:"Amin",middleName:null,surname:"Tamadon",slug:"amin-tamadon",fullName:"Amin Tamadon",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002oHR5wQAG/Profile_Picture_1623910304139",institutionString:null,institution:{name:"Bushehr University of Medical Sciences",institutionURL:null,country:{name:"Iran"}}},{id:"251314",title:"Dr.",name:"Juan Carlos",middleName:null,surname:"Gardón Poggi",slug:"juan-carlos-gardon-poggi",fullName:"Juan Carlos Gardón 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