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Maroufi S, Dehghankar L, Alizadeh A, Amerzadeh M, Motalebi SA. Transcultural adaptation and validation of Persian Version of Patient Assessment of Chronic Illness Care (PACIC-5As) Questionnaire in Iranian older patients with type 2 diabetes. BMC Health Serv Res 2024; 24:1073. [PMID: 39285400 PMCID: PMC11404006 DOI: 10.1186/s12913-024-11557-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 09/09/2024] [Indexed: 09/22/2024] Open
Abstract
BACKGROUND The Patient Assessment of Chronic Illness Care (PACIC-5As) questionnaire has been designed to evaluate the healthcare experiences of individuals with chronic diseases such as diabetes. Older adults are at higher risk for diabetes and its associated complications. The aim of this study was transcultural adaptation and evaluation of the validity and reliability of the PACIC-5As questionnaire in older patients with diabetes residing in Qazvin City, Iran. METHOD In this validation study, we recruited 306 older patients with diabetes from Comprehensive Health Centers in Qazvin, Iran. The multi-stage cluster sampling technique was used to choose a representative sample. The PACIC-5As questionnaire was translated into Persian using the World Health Organization (WHO) standardized method. The validity (face, content, and construct) and reliability (Cronbach's alpha) of the PACIC-5As were assessed. Data analysis was conducted using R software and the Lavaan package. RESULTS The mean age of the older patients was 69.99 ± 6.94 years old. Most older participants were female (n = 180, 58.82%) and married (n = 216, 70.59%). Regarding face validity, all items of PACIC-5As had impact scores greater than 1.5. In terms of content validity, all items had a content validity ratio > 0.49 and a content validity index > 0.79. The results of confirmatory factor analysis demonstrated that the model exhibited satisfactory fit across the expected five factors, including assess, advise, agree, assist, and arrange, for the 25 items of the PACIC-5As questionnaire. The Cronbach's alpha coefficient for the PACIC-5As questionnaire was 0.805. CONCLUSION This study indicates that the Persian version of the PACIC-5As questionnaire is valid and reliable for assessing healthcare experiences in older patients with diabetes. This means that the questionnaire can be effectively used in this population.
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Affiliation(s)
- Sahar Maroufi
- Student Research Committee, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Leila Dehghankar
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
- Department of Nursing, Guilan University of Medical Sciences, Rasht, Iran
| | - Ahad Alizadeh
- Medical Microbiology Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Mohammad Amerzadeh
- Non-communicable Diseases Research Center, Research Institute for Prevention of Non-communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Seyedeh Ameneh Motalebi
- Non-communicable Diseases Research Center, Research Institute for Prevention of Non-communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran.
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Boyle J, Vignarajan J, Greenup EP, Walters S, Byrne N, Henderson E, Brian G, Walker J, Mahendrarajah T, Karthik H, Cook J, Neilson C, Tame S, Malavisi P. Improving Access to Specialist Eye Care for Indigenous Australians via Telehealth: An Observational Cohort Study. Telemed J E Health 2024. [PMID: 39072681 DOI: 10.1089/tmj.2024.0175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2024] Open
Abstract
Background: Indigenous people are often neglected in eye health research and service delivery programs, despite having a greater burden of vision loss, most of which is avoidable. The objective of this work was to improve access to specialist eye care for Indigenous Australians living in rural and remote areas, by providing direct access to expert diagnostic services based in metropolitan areas through a tele-ophthalmology system. Methods: Over a four-year study period, 13 remote communities in Queensland and the Northern Territory were identified that had limited or no access to eye screening services. Relationships with health service providers in the communities were established to codesign a sustainable model of service delivery and referral pathways to ensure that patients identified with eye issues received appropriate treatment. Results: Over the course of the study, screening records from 378 patients were uploaded to a web-based telehealth system and diagnosed by ophthalmologists. From these examinations, 64 new cases of diabetic retinopathy (DR) were identified (including 2 cases of proliferative DR and 4 cases of severe nonproliferative DR), and diabetic macular edema was noted in 18 patients. The majority of participants screened had no eye problems, which enables the removal of these patients from the queues of overwhelmed specialist lists, improving service efficiency. The study also demonstrates capacity building of healthcare workers to perform eye screening and improved patient health awareness where the retinal cameras were used as an educational tool. Conclusions: A valuable screening service has been established in the target areas, where access to ophthalmic services has been improved for residents of the study screening locations. Routine eye examination (instead of opportunistic eye examination) is feasible for early detection of some eye diseases for remote and rural patients.
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Affiliation(s)
- Justin Boyle
- Commonwealth Scientific and Industrial Research Organisation, Brisbane, Australia
| | | | | | | | | | - Elizabeth Henderson
- Laynhapuy Homelands Aboriginal Corporation, acting through Laynhapuy Aboriginal Community Controlled Health Services, Yirrkala, Australia
| | | | | | | | | | - Jeff Cook
- Laynhapuy Homelands Aboriginal Corporation, acting through Laynhapuy Aboriginal Community Controlled Health Services, Yirrkala, Australia
| | | | - Simon Tame
- Vanguard Health, C/- Weipa Hospital, Queensland, Australia
| | - Peter Malavisi
- Marthakal Homeland & Resource Centre Aboriginal Corporation, acting though the Marthakal Homelands Health Service, Elcho Island, Australia
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Montesi L, Ramírez-Rojas MG, Elizarrarás-Rivas J. Health Care Delays and Social Suffering Among Indigenous People with Diabetic Foot Complications in Mexico. Med Anthropol 2024; 43:411-427. [PMID: 38865593 DOI: 10.1080/01459740.2024.2364241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2024]
Abstract
Diabetic foot (DF) is a leading cause of nontraumatic lower-extremity amputations, premature death, and a sign of social inequality in diabetes treatment. In Mexico, the incidence of DF is on the rise yet little is known about its impact among indigenous people, a disadvantaged group. Based on ethnographic research conducted in Oaxaca and analysis of institutional health-data, in this article we show the health care delays that rural indigenous people face when dealing with DF. Indigenous people's uncertainty regarding their right to health and the structural barriers to medical care favor DF complications, a phenomenon that should be read as social suffering. Since health data concerning indigenous health care service users is patchy and imprecise, indigenous people's social suffering is invisibilized. This omission or partiality in the official records limits public health decision-making and undermines the human rights of the population.
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Affiliation(s)
| | | | - Jesús Elizarrarás-Rivas
- Health Research Coordination, Mexican Institute of Social Security (IMSS), Oaxaca, Mexico
- Universidad Autónoma Benito Juárez de Oaxaca (UABJO), Oaxaca, Mexico
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Blanchette V, Patry J, Brousseau-Foley M, Todkar S, Libier S, Leclerc AM, Armstrong DG, Tremblay MC. Diabetic foot complications among Indigenous peoples in Canada: a scoping review through the PROGRESS-PLUS equity lens. Front Endocrinol (Lausanne) 2023; 14:1177020. [PMID: 37645408 PMCID: PMC10461566 DOI: 10.3389/fendo.2023.1177020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 07/18/2023] [Indexed: 08/31/2023] Open
Abstract
Introduction Indigenous peoples in Canada face a disproportionate burden of diabetes-related foot complications (DRFC), such as foot ulcers, lower extremity amputations (LEA), and peripheral arterial disease. This scoping review aimed to provide a comprehensive understanding of DRFC among First Nations, Métis, and Inuit peoples in Canada, incorporating an equity lens. Methods A scoping review was conducted based on Arksey and O'Malley refined by the Joanna Briggs Institute. The PROGRESS-Plus framework was utilized to extract data and incorporate an equity lens. A critical appraisal was performed, and Indigenous stakeholders were consulted for feedback. We identified the incorporation of patient-oriented/centered research (POR). Results Of 5,323 records identified, 40 studies were included in the review. The majority of studies focused on First Nations (92%), while representation of the Inuit population was very limited populations (< 3% of studies). LEA was the most studied outcome (76%). Age, gender, ethnicity, and place of residence were the most commonly included variables. Patient-oriented/centered research was mainly included in recent studies (16%). The overall quality of the studies was average. Data synthesis showed a high burden of DRFC among Indigenous populations compared to non-Indigenous populations. Indigenous identity and rural/remote communities were associated with the worse outcomes, particularly major LEA. Discussion This study provides a comprehensive understanding of DRFC in Indigenous peoples in Canada of published studies in database. It not only incorporates an equity lens and patient-oriented/centered research but also demonstrates that we need to change our approach. More data is needed to fully understand the burden of DRFC among Indigenous peoples, particularly in the Northern region in Canada where no data are previously available. Western research methods are insufficient to understand the unique situation of Indigenous peoples and it is essential to promote culturally safe and quality healthcare. Conclusion Efforts have been made to manage DRFC, but continued attention and support are necessary to address this population's needs and ensure equitable prevention, access and care that embraces their ways of knowing, being and acting. Systematic review registration Open Science Framework https://osf.io/j9pu7, identifier j9pu7.
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Affiliation(s)
- Virginie Blanchette
- Department of Human Kinetics and Podiatric Medicine, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
- VITAM-Centre de Recherche en Santé Durable, Québec, QC, Canada
- Centre de Recherche du Centre Intégré de Santé et Services Sociaux de Chaudière-Appalaches, Lévis, QC, Canada
| | - Jérôme Patry
- Centre de Recherche du Centre Intégré de Santé et Services Sociaux de Chaudière-Appalaches, Lévis, QC, Canada
- Faculty of Medicine, Family and Emergency Medicine Department, Université Laval, Québec, QC, Canada
| | - Magali Brousseau-Foley
- Department of Human Kinetics and Podiatric Medicine, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
- Faculty of Medicine, Centre Intégré Universitaire de Santé et de Services Sociaux de la Mauricie et du Centre-du-Québec Affiliated with Université de Montréal, Trois-Rivières Family Medicine University Clinic, Trois-Rivières, QC, Canada
| | - Shweta Todkar
- Department of Nursing, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Solène Libier
- Department of Human Kinetics and Podiatric Medicine, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Anne-Marie Leclerc
- Department of Nursing, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - David G. Armstrong
- Southwestern Academic Limb Salvage Alliance (SALSA), Department of Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA, United States
| | - Marie-Claude Tremblay
- VITAM-Centre de Recherche en Santé Durable, Québec, QC, Canada
- Faculty of Medicine, Family and Emergency Medicine Department, Université Laval, Québec, QC, Canada
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5
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Walker RC, Abel S, Palmer SC, Walker C, Heays N, Tipene-Leach D. "We Need a System that's Not Designed to Fail Māori": Experiences of Racism Related to Kidney Transplantation in Aotearoa New Zealand. J Racial Ethn Health Disparities 2023; 10:219-227. [PMID: 35018578 PMCID: PMC8751454 DOI: 10.1007/s40615-021-01212-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 12/09/2021] [Accepted: 12/15/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Reported experiences of racism in Aotearoa New Zealand are consistently associated with negative measures of health, self-rated health, life satisfaction, and reduced access to high-quality healthcare with subsequent poor health outcomes. In this paper, we report on perceptions and experiences of prejudice and racism by Indigenous Māori with kidney disease and their family members and donors who took part in a wider study about experiences of kidney transplantation. METHODS We conducted semi-structured interviews with 40 Māori between September and December 2020. Participants included those with kidney disease who had considered, were being worked up for, or who had already received a kidney transplant as well as family members and potential or previous donors. We examined the data for experiences of racism using a theoretical framework for racism on three levels: institutionalised racism, personally mediated racism, and internalised racism. RESULTS We identified subthemes at each level of racism: institutional (excluded and devalued by health system; disease stigmatization; discriminatory body weight criteria, lack of power), personally mediated (experiencing racial profiling; explicit racism), and internalized racism (shame and unworthiness to receive a transplant). CONCLUSIONS The wide-reaching experiences and perceptions of racism described by participants with kidney disease and their families in this research point to an unfair health system and suggest that racism may be contributing to kidney transplantation inequity in Aotearoa New Zealand. Addressing racism at all levels is imperative if we are to address inequitable outcomes for Māori requiring kidney transplantation.
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Affiliation(s)
- Rachael C. Walker
- Eastern Institute of Technology, 501 Gloucester Street, Taradale, Napier, 4112 Hawke’s Bay New Zealand
| | - Sally Abel
- Kaupapa Consulting Ltd, Napier, 4110 New Zealand
| | - Suetonia C. Palmer
- Department of Medicine, University of Otago Christchurch, Christchurch, 8140 New Zealand ,Department of Nephrology, Canterbury District Health Board, Christchurch, New Zealand
| | - Curtis Walker
- Department of Medicine, Midcentral District Health Board, Palmerston North, 4442 New Zealand
| | - Nayda Heays
- Hawke’s Bay District Health Board, Hastings, New Zealand
| | - David Tipene-Leach
- Eastern Institute of Technology, 501 Gloucester Street, Taradale, Napier, 4112 Hawke’s Bay New Zealand
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Bonin L, Levasseur-Puhach S, Guimond M, Gabbs M, Wicklow B, Vandenbroeck B, Copenace S, Delaronde M, Mosienko L, McGavock J, Katz LY, Roos LE, Diffey L, Dart A. Walking in two worlds with type 2 diabetes: a scoping review of prevention and management practices incorporating traditional indigenous approaches. Int J Circumpolar Health 2022; 81:2141182. [DOI: 10.1080/22423982.2022.2141182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Lynette Bonin
- University of Manitoba, Faculty of Arts, Department of Psychology Winnipeg, Manitoba Canada
| | - Sydney Levasseur-Puhach
- University of Manitoba, Faculty of Arts, Department of Psychology Winnipeg, Manitoba Canada
- Children’s Hospital Research Institute of Manitoba, and DREAM Theme, Diabetes Research Envisioned and Accomplished in Manitoba, Winnipeg, Manitoba, Canada
| | - Michelle Guimond
- Children’s Hospital Research Institute of Manitoba, and DREAM Theme, Diabetes Research Envisioned and Accomplished in Manitoba, Winnipeg, Manitoba, Canada
| | - Melissa Gabbs
- Children’s Hospital Research Institute of Manitoba, and DREAM Theme, Diabetes Research Envisioned and Accomplished in Manitoba, Winnipeg, Manitoba, Canada
- University of Manitoba, Max Rady College of Medicine, Department of Pediatric and Child Health, Winnipeg, Manitoba, Canada
| | - Brandy Wicklow
- Children’s Hospital Research Institute of Manitoba, and DREAM Theme, Diabetes Research Envisioned and Accomplished in Manitoba, Winnipeg, Manitoba, Canada
- University of Manitoba, Max Rady College of Medicine, Department of Pediatric and Child Health, Winnipeg, Manitoba, Canada
| | - Belinda Vandenbroeck
- University of Manitoba, Faculty of Arts, Department of Psychology Winnipeg, Manitoba Canada
| | - Sherry Copenace
- University of Manitoba, Faculty of Arts, Department of Psychology Winnipeg, Manitoba Canada
| | - Meagan Delaronde
- Children’s Hospital Research Institute of Manitoba, and DREAM Theme, Diabetes Research Envisioned and Accomplished in Manitoba, Winnipeg, Manitoba, Canada
| | - Lucas Mosienko
- Children’s Hospital Research Institute of Manitoba, and DREAM Theme, Diabetes Research Envisioned and Accomplished in Manitoba, Winnipeg, Manitoba, Canada
| | - Jonathan McGavock
- Children’s Hospital Research Institute of Manitoba, and DREAM Theme, Diabetes Research Envisioned and Accomplished in Manitoba, Winnipeg, Manitoba, Canada
- University of Manitoba, Max Rady College of Medicine, Department of Pediatric and Child Health, Winnipeg, Manitoba, Canada
| | - Laurence Y. Katz
- University of Manitoba, Max Rady College of Medicine, Department of Psychiatry, Winnipeg, Manitoba, Canada
| | - Leslie E. Roos
- University of Manitoba, Faculty of Arts, Department of Psychology Winnipeg, Manitoba Canada
- Children’s Hospital Research Institute of Manitoba, and DREAM Theme, Diabetes Research Envisioned and Accomplished in Manitoba, Winnipeg, Manitoba, Canada
| | - Linda Diffey
- Children’s Hospital Research Institute of Manitoba, and DREAM Theme, Diabetes Research Envisioned and Accomplished in Manitoba, Winnipeg, Manitoba, Canada
- University of Manitoba, Max Rady College of Medicine, Department of Community Health Sciences, Winnipeg, Manitoba, Canada
| | - Allison Dart
- Children’s Hospital Research Institute of Manitoba, and DREAM Theme, Diabetes Research Envisioned and Accomplished in Manitoba, Winnipeg, Manitoba, Canada
- University of Manitoba, Max Rady College of Medicine, Department of Pediatric and Child Health, Winnipeg, Manitoba, Canada
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7
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Wang X, Liang Y, Liu Q, Cai J, Tang X, Liu S, Zhang J, Xu M, Wei C, Mo X, Wei Y, Lin Y, Huang S, Mai T, Tan D, Luo T, Gou R, Qin J, Zhang Z. Association of CYP19A1 Gene, Plasma Zinc, and Urinary Zinc with the Risk of Type 2 Diabetes Mellitus in a Chinese Population. Biol Trace Elem Res 2022:10.1007/s12011-022-03502-1. [PMID: 36441497 DOI: 10.1007/s12011-022-03502-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 11/19/2022] [Indexed: 11/30/2022]
Abstract
To explore the effects of CYP19A1 gene polymorphisms, plasma zinc, and urinary zinc levels and their interactions on type 2 diabetes mellitus (T2DM) in residents of Gongcheng County, Guangxi, China. The case-control study was used for the investing. The MassARRAY System was applied to genotype the CYP19A1 genes rs752760, rs10046, rs10459592, and rs700518 in 540 study subjects. Plasma and urinary zinc concentrations were measured by inductively coupled plasma mass spectrometry (ICP-MS). Conditional logistic regression showed that rs752760 and plasma zinc were associated with T2DM risks with ORs of 0.593 (95% CI: 0.371-0.948) and 0.563 (95% CI: 0.356-0.889), respectively. Unconditional logistic regression analysis showed an association between urinary zinc levels and the risk of T2DM as well, with an OR of 0.352 (95% CI: 0.212-0.585). The results of the multiplicative interaction model showed that the rs752760 T allele was associated with a significantly reduced risk of T2DM with moderate/low plasma zinc levels, with ORs of 0.340 (95% CI: 0.161-0.715) and 0.583 (95% CI: 0.346-0.981), respectively, and the rs752760 T allele was also associated with a significantly decreased risk of T2DM with moderate/low urinary zinc levels, with ORs of 0.358 (95% CI: 0.201-0.635) and 0.321 (95% CI: 0.183-0.562), respectively. CYP19A1 rs752760 T allele and moderate/low plasma/urinary zinc levels reduce the risk of T2DM.
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Affiliation(s)
- Xuexiu Wang
- Department of Environmental and Occupational Health, School of Public Health, Guangxi Medical University, Nanning, China
| | - Yujian Liang
- Department of Environmental and Occupational Health, School of Public Health, Guangxi Medical University, Nanning, China
| | - Qiumei Liu
- Department of Environmental and Occupational Health, School of Public Health, Guangxi Medical University, Nanning, China
| | - Jiansheng Cai
- Department of Environmental and Occupational Health, School of Public Health, Guangxi Medical University, Nanning, China
- Key Laboratory of Tumor Immunology and Microenvironmental Regulation, Guilin Medical University, Guilin, China
| | - Xu Tang
- Department of Environmental and Occupational Health, School of Public Health, Guangxi Medical University, Nanning, China
| | - Shuzhen Liu
- Department of Environmental and Occupational Health, School of Public Health, Guangxi Medical University, Nanning, China
| | - Junling Zhang
- Department of Environmental and Occupational Health, School of Public Health, Guangxi Medical University, Nanning, China
| | - Min Xu
- Department of Environmental and Occupational Health, School of Public Health, Guangxi Medical University, Nanning, China
| | - Chunmei Wei
- Department of Environmental and Occupational Health, School of Public Health, Guangxi Medical University, Nanning, China
| | - Xiaoting Mo
- Department of Environmental and Occupational Health, School of Public Health, Guangxi Medical University, Nanning, China
| | - Yanfei Wei
- Department of Environmental and Occupational Health, School of Public Health, Guangxi Medical University, Nanning, China
| | - Yinxia Lin
- Department of Environmental and Occupational Health, School of Public Health, Guangxi Medical University, Nanning, China
| | - Shenxiang Huang
- Department of Environmental and Occupational Health, School of Public Health, Guangxi Medical University, Nanning, China
| | - Tingyu Mai
- Department of Environmental Health and Occupational Medicine, School of Public Health, Guilin Medical University, Guilin, China
| | - Dechan Tan
- Department of Environmental Health and Occupational Medicine, School of Public Health, Guilin Medical University, Guilin, China
| | - Tingyu Luo
- Department of Environmental Health and Occupational Medicine, School of Public Health, Guilin Medical University, Guilin, China
| | - Ruoyu Gou
- Department of Environmental Health and Occupational Medicine, School of Public Health, Guilin Medical University, Guilin, China
| | - Jian Qin
- Department of Environmental and Occupational Health, School of Public Health, Guangxi Medical University, Nanning, China.
- Guangxi Colleges and Universities Key Laboratory of Prevention and Control of Highly Prevalent Diseases, Guangxi Medical University, Nanning, China.
- Guangxi Key Laboratory of Environment and Health Research, Guangxi Medical University, Nanning, China.
- Key Laboratory of Longevity and Aging-Related Diseases of Chinese Ministry of Education, Guangxi Medical University, Nanning, China.
| | - Zhiyong Zhang
- Department of Environmental and Occupational Health, School of Public Health, Guangxi Medical University, Nanning, China.
- Department of Environmental Health and Occupational Medicine, School of Public Health, Guilin Medical University, Guilin, China.
- Guangxi Key Laboratory of Environmental Exposomics and Entire Lifecycle Health, Guilin Medical University, Guilin, China.
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Rhee CM, Edwards D, Ahdoot RS, Burton JO, Conway PT, Fishbane S, Gallego D, Gallieni M, Gedney N, Hayashida G, Ingelfinger J, Kataoka-Yahiro M, Knight R, Kopple JD, Kumarsawami L, Lockwood MB, Murea M, Page V, Sanchez JE, Szepietowski JC, Lui SF, Kalantar-Zadeh K. Living Well With Kidney Disease and Effective Symptom Management: Consensus Conference Proceedings. Kidney Int Rep 2022; 7:1951-1963. [PMID: 36090498 PMCID: PMC9459054 DOI: 10.1016/j.ekir.2022.06.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 06/08/2022] [Accepted: 06/20/2022] [Indexed: 11/23/2022] Open
Abstract
Chronic kidney disease (CKD) confers a high burden of uremic symptoms that may be underrecognized, underdiagnosed, and undertreated. Unpleasant symptoms, such as CKD-associated pruritus and emotional/psychological distress, often occur within symptom clusters, and treating 1 symptom may potentially alleviate other symptoms in that cluster. The Living Well with Kidney Disease and Effective Symptom Management Consensus Conference convened health experts and leaders of kidney advocacy groups and kidney networks worldwide to discuss the effects of unpleasant symptoms related to CKD on the health and well-being of those affected, and to consider strategies for optimal symptom management. Optimizing symptom management is a cornerstone of conservative and preservative management which aim to prevent or delay dialysis initiation. In persons with kidney dysfunction requiring dialysis (KDRD), incremental transition to dialysis and home dialysis modalities offer personalized approaches. KDRD is proposed as the preferred term given the negative connotations of "failure" as a kidney descriptor, and the success stories in CKD journeys. Engaging persons with CKD to identify and prioritize their personal values and individual needs must be central to ensure their active participation in CKD management, including KDRD. Person-centered communication and care are required to ensure diversity, equity, and inclusion; education/awareness that considers the health literacy of persons with CKD; and shared decision-making among the person with CKD, care partners, and providers. By putting the needs of people with CKD, including effective symptom management, at the center of their treatment, CKD can be optimally treated in a way that aligns with their goals.
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Affiliation(s)
- Connie M. Rhee
- Division of Nephrology Hypertension and Kidney Transplantation, University of California Irvine, Orange, California, USA
| | - Dawn Edwards
- Forum of ESRD Networks Kidney Patient Advisory Council, New York, New York, USA
| | - Rebecca S. Ahdoot
- Division of Nephrology Hypertension and Kidney Transplantation, University of California Irvine, Orange, California, USA
| | | | - Paul T. Conway
- American Association of Kidney Patients, Washington, USA
| | - Steven Fishbane
- Donald and Barbara Zucker School of Medicine at Hofstra / Northwell Health, Great Neck, New York, New York, USA
| | | | - Maurizio Gallieni
- Department of Biomedical and Clinical Sciences, Università di Milano, Milan, Italy
| | | | - Glen Hayashida
- National Kidney Foundation of Hawaii, Honolulu, Hawaii, USA
| | | | - Merle Kataoka-Yahiro
- University of Hawaii at Manoa, Nancy Atmospera-Walch School of Nursing, Honolulu, Hawaii, USA
| | - Richard Knight
- American Association of Kidney Patients, Washington, USA
| | | | | | - Mark B. Lockwood
- Department of Biobehavioral Nursing Science, University of Illinois at Chicago, College of Nursing, Chicago, Illinois, USA
| | - Mariana Murea
- Wake Forest School of Medicine, Winston Salem, North Carolina, USA
| | - Victoria Page
- National Kidney Foundation of Hawaii, Honolulu, Hawaii, USA
| | | | - Jacek C. Szepietowski
- Department of Dermatology, Venereology and Allergology, Medical University, Wroclaw, Poland
| | - Siu-Fai Lui
- Hong Kong Kidney Foundation, Hong Kong, China
| | - Kamyar Kalantar-Zadeh
- Division of Nephrology Hypertension and Kidney Transplantation, University of California Irvine, Orange, California, USA,Tibor Rubin Veterans Affairs Long Beach Health Care Center, Long Beach, California, USA,Correspondence: Kamyar Kalantar-Zadeh, Division of Nephrology, Hypertension, and Kidney Transplantation, University of California Irvine School of Medicine, 333 City Boulevard West. Orange, California 92868, USA.
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9
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Okpechi IG, Hariramani VK, Sultana N, Ghimire A, Zaidi D, Muneer S, Tinwala MM, Ye F, Sebastianski M, Abdulrahman A, Braam B, Jindal K, Khan M, Klarenbach S, Shojai S, Thompson S, Bello AK. The impact of community-based non-pharmacological interventions on cardiovascular and kidney disease outcomes in remote dwelling Indigenous communities: A scoping review protocol. PLoS One 2022; 17:e0269839. [PMID: 35687551 PMCID: PMC9187124 DOI: 10.1371/journal.pone.0269839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 05/27/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction Indigenous people represent approximately 5% of the world’s population. However, they often have a disproportionately higher burden of cardiovascular disease (CVD) risk and chronic kidney disease (CKD) than their equivalent general population. Several non-pharmacological interventions (e.g., educational) have been used to reduce CVD and kidney disease risk factors in Indigenous groups. The aim of this paper is to describe the protocol for a scoping review that will assess the impact of non-pharmacological interventions carried out in Indigenous and remote dwelling populations to reduce CVD risk factors and CKD. Materials and methods This scoping review will be guided by the methodological framework for conducting scoping studies developed by Arksey and O’Malley. Both empirical (Medline, Embase, Cochrane Library, CINAHL, ISI Web of Science and PsycINFO) and grey literature references will be assessed if they focused on interventions targeted at reducing CVD or CKD among Indigenous groups. Two reviewers will independently screen references in consecutive stages of title/abstract screening and then full-text screening. Impact of interventions used will be assessed using the reach, effectiveness, adoption, implementation, maintenance (RE-AIM) framework. A descriptive overview, tabular summaries, and content analysis will be carried out on the extracted data. Ethics and dissemination This review will collect and analyse evidence on the impact of interventions of research carried out to reduce CVD and CKD among Indigenous populations. Such evidence will be disseminated using traditional approaches that includes open-access peer-reviewed publication, scientific presentations, and a report. Also, we will disseminate our findings to the government and Indigenous leaders. Ethical approval will not be required for this scoping review as the data used will be extracted from already published studies with publicly accessible data.
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Affiliation(s)
- Ikechi G. Okpechi
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
- Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
| | - Vinash Kumar Hariramani
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Naima Sultana
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Anukul Ghimire
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Deenaz Zaidi
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Shezel Muneer
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Mohammed M. Tinwala
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Feng Ye
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Megan Sebastianski
- Knowledge Translation Platform, Alberta SPOR SUPPORT Unit Department of Pediatrics, University of Alberta, Edmonton, Canada
| | - Abdullah Abdulrahman
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Branko Braam
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Kailash Jindal
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Maryam Khan
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Scott Klarenbach
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Soroush Shojai
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Stephanie Thompson
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Aminu K. Bello
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- * E-mail:
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Mullane T, Harwood M, Warbrick I, Tane T, Anderson A. Understanding the workforce that supports Māori and Pacific peoples with type 2 diabetes to achieve better health outcomes. BMC Health Serv Res 2022; 22:672. [PMID: 35585592 PMCID: PMC9118861 DOI: 10.1186/s12913-022-08057-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 05/04/2022] [Indexed: 11/13/2022] Open
Abstract
Background Prevalence of Type 2 diabetes mellitus (T2DM) is high among Māori and other Pacific Island peoples in New Zealand. Current health services to address T2DM largely take place in primary healthcare settings and have, overall, failed to address the significant health inequities among Māori and Pacific people with T2DM. Culturally comprehensive T2DM management programmes, aimed at addressing inequities in Māori or Pacific diabetes management and workforce development, are not extensively available in New Zealand. Deliberate strategies to improve cultural safety, such as educating health professionals and fostering culturally safe practices must be priority when funding health services that deliver T2DM prevention programmes. There is a significant workforce of community-based, non-clinical workers in South Auckland delivering diabetes self-management education to Māori and Pacific peoples. There is little information on the perspectives, challenges, effectiveness, and success of dietitians, community health workers and kai manaaki (KM) in delivering these services. This study aimed to understand perspectives and characteristics of KM and other community-based, non-clinical health workers, with a focus on how they supported Māori and Pacific Peoples living with T2DM to achieve better outcomes. Methods This qualitative study undertaken was underpinned by the Tangata Hourua research framework. Focus groups with dietitians, community health workers (CHWs) and KM took place in South Auckland, New Zealand. Thematic analysis of the transcripts was used to identify important key themes. Results Analysis of focus group meetings identified three main themes common across the groups: whakawhanaungatanga (actively building relationships), cultural safety (mana enhancing) and cultural alignment to role, with a further two themes identified only by the KM and CHWs, who both strongly associated a multidisciplinary approach to experiences of feeling un/valued in their roles, when compared with dietitians. Generally, all three groups agreed that their roles required good relationships with the people they were working with and an understanding of the contexts in which Māori and Pacific Peoples with T2DM lived. Conclusions Supporting community based, non-clinical workers to build meaningful and culturally safe relationships with Māori and Pacific people has potential to improve diabetes outcomes.
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Affiliation(s)
- Tania Mullane
- Whitireia Institute, DX Box: SX33459, Porirua, Wellington, New Zealand.
| | - Matire Harwood
- Department of General Practice and Primary Care, Faculty of Medical and Health Sciences, University of Auckland Private Bag 92019, Auckland Mail Centre, Auckland, 1142, New Zealand
| | - Isaac Warbrick
- Faculty of Health and Environmental Sciences, Auckland University of Technology Private Bag 92006, Auckland, 1142, New Zealand
| | - Taria Tane
- Faculty of Medical and Health Sciences, Te Kupenga Hauora Māori, University of Auckland Private Bag 92019, Auckland Mail Centre, Auckland, 1142, New Zealand
| | - Anneka Anderson
- Faculty of Medical and Health Sciences, Te Kupenga Hauora Māori, University of Auckland Private Bag 92019, Auckland Mail Centre, Auckland, 1142, New Zealand
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He H, Zhang J, Gong W, Liu M, Liu H, Li X, Wu Y, Lu Q. Involvement of CircRNA Expression Profile in Diabetic Retinopathy and Its Potential Diagnostic Value. Front Genet 2022; 13:833573. [PMID: 35251136 PMCID: PMC8891611 DOI: 10.3389/fgene.2022.833573] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 01/27/2022] [Indexed: 12/14/2022] Open
Abstract
Background: Circular RNAs (circRNAs), a class of non-coding and undegradable RNAs, play many pathological functions by acting as miRNA sponges, interacting with RNA-binding proteins, and others. The recent literature indicates that circRNAs possess the advanced superiority for the early screening of diabetic retinopathy (DR). Methods: CircRNA sources of peripheral blood mononuclear cells (PBMCs) from healthy controls (n = 4), diabetes mellitus patients (DM) (n = 4), and DR patients (n = 4) were extracted for circular RNA microarray analysis. Enriched biological modules and signaling pathways were analyzed by Gene Ontology Enrichment and Kyoto Encyclopedia of Genes and Genomes analysis, respectively. Real-time quantitative reverse transcription PCR (RT-qPCR) was performed to validate differentiated levels of several circRNAs (fold change ≥2, p < .05) in different groups of healthy control subjects (n = 20), DM patients (n = 60), and DR patients (n = 42). Based on our clinical data from DR, the diagnostic performance of candidate circRNAs was measured by operating characteristic curves (ROCs). Subsequently, their circRNA–miRNA networks were constructed by bioinformatics analysis. Results: Circular RNA microarray analysis was performed, and 2,452 and 289 circRNAs were screened with differential expression in DR patients compared to healthy controls and DM patients, respectively. Enrichment analyses showed that circRNAs in DR patients were enriched in extracellular matrix (ECM)–receptor interaction and focal adhesion pathways. The top 5 differential circRNAs in circRNA microarray analysis were subsequently quantified and verified by RT-qPCR. Consistently, a significant 2.2-fold reduction of hsa_circ_0095008 and 1.7-fold increase in hsa_circ_0001883 were identified in DR patients compared to DM patients. Meanwhile, the area under curves of hsa_circ_0095008 and hsa_circ_0001883 were 0.6710 (95% CI, 0.5646–0.7775) (p = 0.003399) and 0.6071 (95% CI, 0.4953–0.7189) (p = 0.06644), respectively, indicating a good diagnostic value. Conclusion: Our study provided a new sight for the pathological mechanism of DR and revealed the potential value of hsa_circ_0095008 and hsa_circ_0001883 as diagnostic biomarkers for the early diagnosis of DR patients.
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Affiliation(s)
- Hengqian He
- Department of Ophthalmology, The Affiliated People’s Hospital of Ningbo University, Ningbo, China
| | - Juntao Zhang
- Department of Ophthalmology, The Affiliated People’s Hospital of Ningbo University, Ningbo, China
| | - Weikun Gong
- Department of Ophthalmology, The Affiliated People’s Hospital of Ningbo University, Ningbo, China
| | - Mengyun Liu
- Department of Ophthalmology, The Affiliated People’s Hospital of Ningbo University, Ningbo, China
| | - Hao Liu
- Department of Ophthalmology, The Affiliated People’s Hospital of Ningbo University, Ningbo, China
| | - Xiaoyong Li
- Center for Disease Control and Prevention of Yinzhou District, Ningbo, China
| | - Yufei Wu
- Department of Ophthalmology, The Affiliated People’s Hospital of Ningbo University, Ningbo, China
| | - Qinkang Lu
- Department of Ophthalmology, The Affiliated People’s Hospital of Ningbo University, Ningbo, China
- *Correspondence: Qinkang Lu,
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Ezzatvar Y, Ramírez-Vélez R, Izquierdo M, García-Hermoso A. Racial differences in all-cause mortality and future complications among people with diabetes: a systematic review and meta-analysis of data from more than 2.4 million individuals. Diabetologia 2021; 64:2389-2401. [PMID: 34455457 DOI: 10.1007/s00125-021-05554-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 07/13/2021] [Indexed: 11/29/2022]
Abstract
AIMS/HYPOTHESIS The aim of this work was to quantify racial/ethnic differences in risk for future diabetic complications and all-cause mortality by performing a meta-analysis of prospective studies. METHODS A systematic search in PubMed and EMBASE was performed from inception to May 2021. Prospective cohort studies that reported HRs and associated 95% CIs of diabetes complications and all-cause mortality among racial/ethnic groups, with White people as the reference group, were included. Study characteristics and HR estimates were extracted from each study. Estimates were pooled using random-effects inverse-variance model with the Hartung-Knapp-Sidik-Jonkman variance estimator. RESULTS A total of 23 studies were included, comprising 2,416,516 individuals diagnosed with diabetes (White 59.3%, Black 11.2%, Asian 1.3%, Hispanic-American 2.4%, Native American 0.2%, East Asian 1.9%, South Asian 0.8%, Pacific Islander 2.3%, Māori 2.4% and others 18.2%). Compared with White individuals with diabetes, individuals of Māori ethnicity were at higher risk for all-cause mortality (HR 1.88 [95% CI 1.61, 2.21]; I2 = 7.1%), Hispanic-American individuals had a significantly lower risk for CVD (HR 0.66 [95% CI 0.53, 0.81]; I2 = 0%) and Black individuals had higher risk for end-stage renal disease (HR 1.54 [95% CI 1.05, 2.24]; I2 = 95.4%). No significant higher risk for diabetes complications was found in other racial/ethnic groups relative to White people. CONCLUSIONS/INTERPRETATION Racial/ethnic differences exist in the risk for future diabetic complications and all-cause mortality. Our results support the use of such categories for international diabetes clinical guideline recommendations until better predictors become available. Efforts to identify high-risk groups and to better control cardiovascular risk factors across ethnically diverse populations are therefore needed. REGISTRATION PROSPERO registration ID CRD42021239274.
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Affiliation(s)
- Yasmin Ezzatvar
- Department of Nursing, Universitat de València, Valencia, Spain
| | - Robinson Ramírez-Vélez
- Navarrabiomed, Navarra Hospital Complex (CHN), Public University of Navarra (UPNA), IdiSNA, Pamplona, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Mikel Izquierdo
- Navarrabiomed, Navarra Hospital Complex (CHN), Public University of Navarra (UPNA), IdiSNA, Pamplona, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Antonio García-Hermoso
- Navarrabiomed, Navarra Hospital Complex (CHN), Public University of Navarra (UPNA), IdiSNA, Pamplona, Spain.
- CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain.
- Sciences of Physical Activity, Sports and Health School, University of Santiago of Chile (USACH), Santiago, Chile.
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Padhy SK, Akkulugari V, Kandagori M, Padhi TR, Rathi VM, Das T. Tribal Odisha Eye Disease Study (TOES) Report # 9. Eye diseases and retinal disorders in an adult and elderly tribal community in Odisha, India - A community hospital-based study. Indian J Ophthalmol 2021; 69:1846-1849. [PMID: 34146041 PMCID: PMC8374820 DOI: 10.4103/ijo.ijo_3420_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose: To measure the proportion of people with major ophthalmic and retinal disorders in the tribal and non-tribal people presenting to a community eye hospital in an Indian state with a sizeable tribal population. Methods: Hospital-based cross-sectional retrospective study of all new adult patients, examined between September 2015 and June 2020. A tribal was defined as per the Indian ethnic classification. Blindness and visual impairment were defined as per the WHO standards. Diabetes and hypertension were defined as per Indian standards. The proportion of common ophthalmic and retinal disorders between the tribal and non-tribal community were compared. Results: This cohort consisted of 76,166 people (45.8%; n = 34,869, tribal); 39.4% (n = 29,989; non-tribal 23.6% and tribal 15.8%) people had ophthalmic disorders. In the examined people 2.3% were blind (higher in tribal community 4.7% versus 0.8%; P < 0.001) and 8.4% had moderate-to-severe visual impairment (higher in tribal community 14.4% versus 4.4%; P < 0.001). Refractive error (64.4%; higher in non-tribal community, 77.3% versus 44.6%, P < 0.001) and operable cataract (23.9%; higher in tribal community, 40.9% versus 11.8%, P < 0.001) were the principal ophthalmic disorders. Retinal disorders were higher in non-tribal people (5.9% vs. 2.9%; P < 0.001), but the tribal group had higher proportion of retinitis pigmentosa (20% vs. 6.4%; P < 0.001) and lower proportion of diabetic retinopathy (8% vs. 40.7%; P < 0.001). Conclusion: The health-seeking behavior of the tribal community in India is low. A tribal person in India apparently visits the hospital when vision is grossly affected. It calls for greater advocacy, increased access to healthcare, and a larger population-based study.
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Affiliation(s)
- Srikanta Kumar Padhy
- Vitreoretinal Services, Mithu Tulsi Chanrai Campus, LV Prasad Eye Institute, Bhubaneswar, Odisha, India
| | - Vidhyadhar Akkulugari
- Srimati Kanuri Santhamma Center for Vitreoretinal Diseases, LV Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, India
| | - Meenaketan Kandagori
- Naraindas Morbai, Budhrani Eye Centre and JK Centre for Tribal Eye Health, L V Prasad Eye Institute, Rayagada, Odisha, India
| | - Tapas Ranjan Padhi
- Vitreoretinal Services, Mithu Tulsi Chanrai Campus, LV Prasad Eye Institute, Bhubaneswar, Odisha, India
| | - Varsha M Rathi
- Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Taraprasad Das
- Srimati Kanuri Santhamma Center for Vitreoretinal Diseases, LV Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, India
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Gall A, Butler TL, Lawler S, Garvey G. Traditional, complementary and integrative medicine use among Indigenous peoples with diabetes in Australia, Canada, New Zealand and the United States. Aust N Z J Public Health 2021; 45:664-671. [PMID: 34028943 DOI: 10.1111/1753-6405.13120] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 02/01/2021] [Accepted: 03/01/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE This systematic review aimed to describe traditional, complementary and integrative medicine (TCIM) use among Indigenous peoples with diabetes from Australia, Canada, New Zealand and the United States (US). METHODS A systematic search following the PRISMA (Preferred Reporting Items for Systematic Reviews and MetaAnalyses) statement guidelines was conducted. Data were analysed using meta-aggregation. RESULTS Thirteen journal articles from 12 studies across Australia, Canada and the US were included in the review (no articles from New Zealand were identified). Indigenous peoples used various types of TCIM alongside conventional treatment for diabetes, particularly when conventional treatment did not meet Indigenous peoples' holistic understandings of wellness. TCIM provided opportunities to practice important cultural and spiritual activities. While TCIM was often viewed as an effective treatment through bringing balance to the body, definitions of treatments that comprise safe and effective TCIM use were lacking in the articles. CONCLUSIONS The concurrent use of TCIM and conventional treatments is common among Indigenous peoples with diabetes, but clear definitions of safe and effective TCIM use are lacking. Implications for public health: Healthcare providers should support Indigenous peoples to safely and effectively treat diabetes with TCIM alongside conventional treatment.
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Affiliation(s)
- Alana Gall
- Menzies School of Health Research, Charles Darwin University, Queensland
| | - Tamara L Butler
- Menzies School of Health Research, Charles Darwin University, Queensland
| | - Sheleigh Lawler
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland
| | - Gail Garvey
- Menzies School of Health Research, Charles Darwin University, Queensland
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Chakraborty A, Pearson O, Schwartzkopff KM, O'rourke I, Ranasinghe I, Mah PM, Adams R, Boyd M, Wittert G. The effectiveness of in-hospital interventions on reducing hospital length of stay and readmission of patients with Type 2 Diabetes Mellitus: A systematic review. Diabetes Res Clin Pract 2021; 174:108363. [PMID: 32771487 DOI: 10.1016/j.diabres.2020.108363] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 07/20/2020] [Accepted: 07/30/2020] [Indexed: 01/04/2023]
Abstract
AIM This review aimed to assess the effectiveness of multifaceted in-hospital interventions for patients with type 2 diabetes mellitus on hospital readmission, hospital length of stay (LOS), and glycated haemoglobin (HbA1c). METHODS The search included MEDLINE, EMBASE, Emcare, Web of Science, PsycINFO and Google Scholar from 2007 to current date and restricted to English. The differences in outcome measures were calculated to determine the effectiveness. RESULTS The title and abstract of 3251 records were initially screened. Nine studies met the inclusion criteria. Most studies comprised of a wide range of intervention components and outcome measures. The reduction in hospital LOS ranged from 0.5 to 0.8 of a day. Clinically significant improvements in HbA1c concentration levels ranged from a mean reduction of -1.1 (±2.2) mmol/L to -2.8 (±2.7) mmol/L. There were no significant changes in hospital readmission rates and no evidence of the impact of HbA1c on hospital LOS and readmission. Common strategies in reducing hospital LOS and HbA1c were a dedicated care team, hospital wide approach, quality improvement focus, insulin therapy, early short-term intensive program, transition to primary care physicians, and on-going outpatient follow-up for at least 6-12 months. CONCLUSIONS The findings illustrate that multifaceted in-hospital intervention for patients diagnosed with type 2 diabetes can contribute to improvements in hospital LOS and HbA1c concentration.
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Affiliation(s)
- Amal Chakraborty
- South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia; Research Centre for Palliative Care, Death and Dying, Flinders University, Bedford Park, SA 5042.
| | - Odette Pearson
- South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia; Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5000, Australia
| | - Kate M Schwartzkopff
- South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia
| | - Iris O'rourke
- South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia
| | - Isuru Ranasinghe
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5000, Australia
| | - Peak Mann Mah
- Northern Adelaide Local Health Network (NALHN), SA Health, SA 5000, Australia
| | - Robert Adams
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5000, Australia
| | - Mark Boyd
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5000, Australia; Lyell McEwin Hospital, Elizabeth Vale, SA 5112, Australia
| | - Gary Wittert
- South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia; Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5000, Australia; Royal Adelaide Hospital, Adelaide, SA 5000, Australia
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Mackenzie ML, Yuan Y, Shen Y, Toth EL, Bell RC, Oster RT. Pregnancy and development of diabetes in First Nations and non-First Nations women in Alberta, Canada. Diabet Med 2021; 38:e14372. [PMID: 32745272 DOI: 10.1111/dme.14372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 05/26/2020] [Accepted: 07/27/2020] [Indexed: 12/12/2022]
Abstract
AIM To conduct a retrospective population-based study to examine the risk of developing diabetes after delivery in First Nations and non-First Nations women in Alberta. METHODS Delivery records (1999-2014) were linked to provincial administrative data, which allowed for a maximum follow-up of 16 years after delivery. Prevalence of pregnancy risk factors were compared by First Nations status. Hazard ratios for diabetes after delivery by First Nations status, high pre-pregnancy body weight (≥91 kg) and gestational diabetes status were estimated using the Cox proportional hazards model. RESULTS Age-adjusted prevalence of gestational diabetes (7.9% vs 4.6%; P<0.0001), high pre-pregnancy body weight (18.8% vs 10.2%; P<0.0001) and diabetes after delivery (3.9% vs 1.1%; P<0.0001) were higher in First Nations women than in non-First Nations women. Development of diabetes after delivery was higher with First Nations status (hazard ratio 3.0, 95% CI 2.6-3.4), high pre-pregnancy body weight (hazard ratio 3.6, 95% CI 3.3-4.0) and gestational diabetes status (hazard ratio 19.2, 95% CI 17.9-20.6). The highest risk was within First Nations women with high pre-pregnancy body weight and gestational diabetes (hazard ratio 54.8, 95% CI 45.2-66.5) compared to women without these three risk factors. Reduced prenatal visits per pregnancy (8.4 vs 10.7; P<0.0001) and delayed first prenatal visit (time to delivery 23.7 vs 26.7 weeks; P<0.0001) were observed in First Nations women compared to non-First Nations women. CONCLUSION First Nations women are at greater risk of developing diabetes after pregnancy, with gestational diabetes being the strongest predictor. Strategies that target the specific needs of First Nations women before, during and after pregnancy are required.
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Affiliation(s)
- M L Mackenzie
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - Y Yuan
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Y Shen
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - E L Toth
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - R C Bell
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - R T Oster
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
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Marvibaigi M, Hosseini SM, Amini N. Launaea acanthodes (Boiss) O. Kuntze mediates hepatic glucose metabolism and ameliorates impaired pancreatic function in streptozotocin-induced diabetic rats. JOURNAL OF ETHNOPHARMACOLOGY 2021; 268:113577. [PMID: 33171271 DOI: 10.1016/j.jep.2020.113577] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 10/26/2020] [Accepted: 11/06/2020] [Indexed: 06/11/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Launaea acanthodes (Boiss.) O. Kuntze is native to semiarid regions of central Iran, traditionally used in the treatment of numerous disorders including diabetes. AIM OF THE STUDY The current study aimed to explore hypoglycemic activity of Launaea acanthodes extract in streptozotocin-induced diabetic rats. Furthermore, gene expression study was carried out to examine expression levels of key glucose metabolism-related genes. METHODS For in vitro study, Folin-Ciocalteus, DPPH and aluminum chloride colorimetric assays were used to determine the total phenolic content, antioxidant capacity and total flavonoid content of extracts, respectively. For in vivo study, streptozotocin-induced diabetic Wistar rats were orally administered with metformin (50 mg/kg) and various doses of extracts (100, 200 and 400 mg/kg body weight) for 28 days. Fasting blood glucose, body weight, food and water intake were assessed during the course of treatment. At the end of the intervention, oral glucose tolerance test (OGTT), lipid profile and glycated hemoglobin (HbA1c) were evaluated. Furthermore, functional liver enzymes, oxidative stress markers and histopathology of pancreas were examined. Lastly, quantitative real time polymerase chain reaction (qRT-PCR) was applied to explore the mRNA levels of genes relevant to glucose metabolism in the pancreas and liver tissues of diabetic rats. RESULTS Based on the in vitro results, the hydroalcoholic extract revealed potential radical scavenging activity and contained highest amount of phenolic and flavonoid. The in vivo results demonstrated that the extract lowered fasting blood glucose level, increased the body weight, restored the alterations in the levels of water and food intake, attenuated HbA1c, improved lipid profile and ameliorated the OGTT in diabetic rats. The extract administration alleviated the histopathological changes in the pancreas, suppressed malondialdehyde (MDA) level and further restored attenuated levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), glutathione peroxidase (GPx) and superoxide dismutase (SOD) in diabetic rats. Analysis of real time PCR data showed that extract administration reversed the expression levels of hepatic glucokinase (GK), phosphenolpyruvate carboxykinase (PEPCK) and glucose-6-phosphatase (G6Pase). Meanwhile, the extract upregulated the expression level of glucose transporter-2 (GLUT-2) and pancreatic-duodenal homeobox (PDX-1) in diabetic rats. CONCLUSION Collectively, the results demonstrate that Launaea acanthodes hydroalcoholic extract exerts hypoglycemic effect possibly via regulating key enzymes of glucose metabolism and ameliorating pancreatic dysfunction through its antioxidant properties.
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Affiliation(s)
- Mohsen Marvibaigi
- Medicine, Quran and Hadith Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Seyed Morteza Hosseini
- Medicine, Quran and Hadith Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran.
| | - Neda Amini
- Department of Biology, Kavian Institute of Higher Education, Mashhad, Iran
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Beks H, Ewing G, Charles JA, Mitchell F, Paradies Y, Clark RA, Versace VL. Mobile primary health care clinics for Indigenous populations in Australia, Canada, New Zealand and the United States: a systematic scoping review. Int J Equity Health 2020; 19:201. [PMID: 33168029 PMCID: PMC7652411 DOI: 10.1186/s12939-020-01306-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 10/19/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Mobile clinics have been used to deliver primary health care to populations that otherwise experience difficulty in accessing services. Indigenous populations in Australia, Canada, New Zealand, and the United States experience greater health inequities than non-Indigenous populations. There is increasing support for Indigenous-governed and culturally accessible primary health care services which meet the needs of Indigenous populations. There is some support for primary health care mobile clinics implemented specifically for Indigenous populations to improve health service accessibility. The purpose of this review is to scope the literature for evidence of mobile primary health care clinics implemented specifically for Indigenous populations in Australia, Canada, New Zealand, and the United States. METHODS This review was undertaken using the Joanna Brigg Institute (JBI) scoping review methodology. Review objectives, inclusion criteria and methods were specified in advance and documented in a published protocol. The search included five academic databases and an extensive search of the grey literature. RESULTS The search resulted in 1350 unique citations, with 91 of these citations retrieved from the grey literature and targeted organisational websites. Title, abstract and full-text screening was conducted independently by two reviewers, with 123 citations undergoing full text review. Of these, 39 citations discussing 25 mobile clinics, met the inclusion criteria. An additional 14 citations were snowballed from a review of the reference lists of included citations. Of these 25 mobile clinics, the majority were implemented in Australia (n = 14), followed by United States (n = 6) and Canada (n = 5). No primary health mobile clinics specifically for Indigenous people in New Zealand were retrieved. There was a pattern of declining locations serviced by mobile clinics with an increasing population. Furthermore, only 13 mobile clinics had some form of evaluation. CONCLUSIONS This review identifies geographical gaps in the implementation of primary health care mobile clinics for Indigenous populations in Australia, Canada, New Zealand, and the United States. There is a paucity of evaluations supporting the use of mobile clinics for Indigenous populations and a need for organisations implementing mobile clinics specifically for Indigenous populations to share their experiences. Engaging with the perspectives of Indigenous people accessing mobile clinic services is imperative to future evaluations. REGISTRATION The protocol for this review has been peer-reviewed and published in JBI Evidence Synthesis (doi: 10.11124/JBISRIR-D-19-00057).
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Affiliation(s)
- Hannah Beks
- School of Medicine, Deakin University, Geelong, Victoria Australia
| | - Geraldine Ewing
- School of Medicine, Deakin University, Geelong, Victoria Australia
| | - James A. Charles
- National Indigenous Knowledges Education Research Innovation (NIKERI) Institute, Deakin University, Geelong, Victoria Australia
| | - Fiona Mitchell
- School of Medicine, Deakin University, Geelong, Victoria Australia
| | - Yin Paradies
- Faculty of Arts and Education, Deakin University, Burwood, Victoria Australia
| | - Robyn A. Clark
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia
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Systemic Disease and Ocular Comorbidity Analysis of Geographically Isolated Federally Recognized American Indian Tribes of the Intermountain West. J Clin Med 2020; 9:jcm9113590. [PMID: 33171720 PMCID: PMC7694968 DOI: 10.3390/jcm9113590] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 11/04/2020] [Accepted: 11/06/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The American Indian Navajo and Goshute peoples are underserved patient populations residing in the Four Corners area of the United States and Ibupah, Utah, respectively. METHODS We conducted a cross-sectional study of epidemiological factors and lipid biomarkers that may be associated with type II diabetes, hypertension and retinal manifestations in tribal and non-tribal members in the study areas (n = 146 participants). We performed multivariate analyses to determine which, if any, risk factors were unique at the tribal level. Fundus photos and epidemiological data through standardized questionnaires were collected. Blood samples were collected to analyze lipid biomarkers. Univariate analyses were conducted and statistically significant factors at p < 0.10 were entered into a multivariate regression. RESULTS Of 51 participants for whom phenotyping was available, from the Four Corners region, 31 had type II diabetes (DM), 26 had hypertension and 6 had diabetic retinopathy (DR). Of the 64 participants from Ibupah with phenotyping available, 20 had diabetes, 19 had hypertension and 6 had DR. Navajo participants were less likely to have any type of retinopathy as compared to Goshute participants (odds ratio (OR) = 0.059; 95% confidence interval (CI) = 0.016-0.223; p < 0.001). Associations were found between diabetes and hypertension in both populations. Older age was associated with hypertension in the Four Corners, and the Navajo that reside there on the reservation, but not within the Goshute and Ibupah populations. Combining both the Ibupah, Utah and Four Corners study populations, being American Indian (p = 0.022), residing in the Four Corners (p = 0.027) and having hypertension (p < 0.001) increased the risk of DM. DM (p < 0.001) and age (p = 0.002) were significantly associated with hypertension in both populations examined. When retinopathy was evaluated for both populations combined, hypertension (p = 0.037) and living in Ibupah (p < 0.001) were associated with greater risk of retinopathy. When combining both American Indian populations from the Four Corners and Ibupah, those with hypertension were more likely to have DM (p < 0.001). No lipid biomarkers were found to be significantly associated with any disease state. CONCLUSIONS We found different comorbid factors with retinal disease outcome between the two tribes that reside within the Intermountain West. This is indicated by the association of tribe and with the type of retinopathy outcome when we combined the populations of American Indians. Overall, the Navajo peoples and the Four Corners had a higher prevalence of chronic disease that included diabetes and hypertension than the Goshutes and Ibupah. To the best of our knowledge, this is the first study to conduct an analysis for disease outcomes exclusively including the Navajo and Goshute tribe of the Intermountain West.
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Yuan S, Larsson SC. An atlas on risk factors for type 2 diabetes: a wide-angled Mendelian randomisation study. Diabetologia 2020; 63:2359-2371. [PMID: 32895727 PMCID: PMC7527357 DOI: 10.1007/s00125-020-05253-x] [Citation(s) in RCA: 118] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/10/2020] [Indexed: 02/08/2023]
Abstract
AIMS/HYPOTHESIS The aim of this study was to use Mendelian randomisation (MR) to identify the causal risk factors for type 2 diabetes. METHODS We first conducted a review of meta-analyses and review articles to pinpoint possible risk factors for type 2 diabetes. Around 170 possible risk factors were identified of which 97 risk factors with available genetic instrumental variables were included in MR analyses. To reveal more risk factors that were not included in our MR analyses, we conducted a review of published MR studies of type 2 diabetes. For our MR analyses, we used summary-level data from the DIAbetes Genetics Replication And Meta-analysis consortium (74,124 type 2 diabetes cases and 824,006 controls of European ancestry). Potential causal associations were replicated using the FinnGen consortium (11,006 type 2 diabetes cases and 82,655 controls of European ancestry). The inverse-variance weighted method was used as the main analysis. Multivariable MR analysis was used to assess whether the observed associations with type 2 diabetes were mediated by BMI. We used the Benjamini-Hochberg method that controls false discovery rate for multiple testing. RESULTS We found evidence of causal associations between 34 exposures (19 risk factors and 15 protective factors) and type 2 diabetes. Insomnia was identified as a novel risk factor (OR 1.17 [95% CI 1.11, 1.23]). The other 18 risk factors were depression, systolic BP, smoking initiation, lifetime smoking, coffee (caffeine) consumption, plasma isoleucine, valine and leucine, liver alanine aminotransferase, childhood and adulthood BMI, body fat percentage, visceral fat mass, resting heart rate, and four plasma fatty acids. The 15 exposures associated with a decreased risk of type 2 diabetes were plasma alanine, HDL- and total cholesterol, age at menarche, testosterone levels, sex hormone binding globulin levels (adjusted for BMI), birthweight, adulthood height, lean body mass (for women), four plasma fatty acids, circulating 25-hydroxyvitamin D and education years. Eight associations remained after adjustment for adulthood BMI. We additionally identified 21 suggestive risk factors (p < 0.05), such as alcohol consumption, breakfast skipping, daytime napping, short sleep, urinary sodium, and certain amino acids and inflammatory factors. CONCLUSIONS/INTERPRETATION The present study verified several previously reported risk factors and identified novel potential risk factors for type 2 diabetes. Prevention strategies for type 2 diabetes should be considered from multiple perspectives on obesity, mental health, sleep quality, education level, birthweight and smoking.
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Affiliation(s)
- Shuai Yuan
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Nobelsväg 13, 17177, Stockholm, Sweden
| | - Susanna C Larsson
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Nobelsväg 13, 17177, Stockholm, Sweden.
- Department of Surgical Sciences, Uppsala University, Dag Hammarskjölds Väg 14B, 75185, Uppsala, Sweden.
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Drinkwater JJ, Davis WA, Turner AW, McAullay D, Davis TME. Differences in retinopathy prevalence and progression between Anglo-Celt and Aboriginal Australians: the Fremantle Diabetes Study Phase II. Intern Med J 2020; 52:590-598. [PMID: 33040394 DOI: 10.1111/imj.15090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 10/08/2020] [Accepted: 10/08/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Indigenous populations have higher rates of diabetes and diabetic complications, yet there is a paucity of contemporary data on diabetic retinopathy (DR) prevalence and incidence in urban dwelling Aboriginal Australians. AIMS The aim of the study was to compare the prevalence of DR and incidence of new or worsening DR between Aboriginal Australians and Anglo-Celts with Type 2 diabetes. METHODS Participants from the community-based Fremantle Diabetes Study Phase II (817 Anglo-Celts, 94 Aboriginal people) recruited between 2008 and 2011 underwent fundus photography at baseline and biennial reviews. The prevalence of any DR and moderate non-proliferative DR (NPDR), and the incidence of new or worsening DR were ascertained using baseline and 4-year follow-up data. RESULTS Compared with Anglo-Celts, the Aboriginal participants had a higher prevalence of any DR (33.0% vs 52.1%) and moderate NPDR or worse (5.1% vs 24.4%), and new or worsening DR during follow up (6.7% vs 23.5%). The unadjusted odds ratios (95% confidence interval) of any DR and moderate NPDR at baseline were 2.21 (1.43, 3.39) and 5.98 (3.40, 10.50), respectively, and of new or worsening DR 4.32 (1.33, 13.98). In adjusted models, Aboriginal ethnicity was only associated with the prevalence of moderate NPDR or worse (5.58 (2.44, 12.76)). CONCLUSIONS Aboriginal participants had a higher prevalence of DR and new or worsening DR, reflecting conventional risk factors including suboptimal glycaemic control. Their significantly higher odds of moderate NPDR or worse in adjusted models suggest ethnic-specific determinants of DR severity. These findings highlight the need for equitable, culturally appropriate diabetes/ophthalmic care.
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Affiliation(s)
- Jocelyn J Drinkwater
- Medical School, The University of Western Australia, Fremantle Hospital, Perth, Western Australia, Australia
| | - Wendy A Davis
- Medical School, The University of Western Australia, Fremantle Hospital, Perth, Western Australia, Australia
| | - Angus W Turner
- Lions Eye Institute, Perth, Western Australia, Australia.,Centre for Ophthalmology and Visual Science, University of Western Australia, Perth, Western Australia, Australia
| | - Daniel McAullay
- Kurongkurl Katitjin, Edith Cowan University, Perth, Western Australia, Australia
| | - Timothy M E Davis
- Medical School, The University of Western Australia, Fremantle Hospital, Perth, Western Australia, Australia
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23
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Hare MJL, Barzi F, Boyle JA, Guthridge S, Dyck RF, Barr ELM, Singh G, Falhammar H, Webster V, Shaw JE, Maple-Brown LJ. Diabetes during pregnancy and birthweight trends among Aboriginal and non-Aboriginal people in the Northern Territory of Australia over 30 years. LANCET REGIONAL HEALTH-WESTERN PACIFIC 2020; 1:100005. [PMID: 34327339 PMCID: PMC8315488 DOI: 10.1016/j.lanwpc.2020.100005] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/15/2020] [Accepted: 06/29/2020] [Indexed: 10/27/2022]
Abstract
Background Early-life risk factors, including maternal hyperglycaemia and birthweight, are thought to contribute to the high burden of cardiometabolic disease experienced by Indigenous populations. We examined rates of pre-existing diabetes in pregnancy, gestational diabetes mellitus (GDM) and extremes of birthweight over three decades in the Northern Territory (NT) of Australia. Methods We performed a retrospective cohort analysis of the NT Perinatal Data Collection from 1987 to 2016, including all births >20 weeks gestation, stratified by maternal Aboriginal identification. Key outcomes were annual rates of pre-existing diabetes, GDM, small-for-gestational-age, large-for-gestational-age, low birthweight (<2500 g), and high birthweight (>4000 g). Logistic regression was used to assess trends and interactions. Findings 109 349 babies were born to 64 877 mothers, 36% of whom identified as Aboriginal ethnicity. Among Aboriginal women, rates of GDM and pre-existing diabetes, respectively, were 3 · 4% and 0 · 6% in 1987 and rose to 13% and 5 · 7% in 2016 (both trends p<0 · 001). Among non-Aboriginal women, rates of GDM increased from 1 · 9% in 1987 to 11% in 2016 (p<0 · 001), while pre-existing diabetes was uncommon (≤0 · 7% throughout). Rates of small-for-gestational-age decreased, while rates of large-for-gestational-age and high birthweight increased in both groups (all trends p<0 · 001). Multivariable modelling suggests that hyperglycaemia was largely responsible for the growing rate of large-for-gestational-age births among Aboriginal women. Interpretation The burden of hyperglycaemia in pregnancy has grown substantially in the NT over three decades and is impacting birthweight trends. The prevalence of pre-gestational diabetes in Aboriginal women is among the highest in the world. Funding Diabetes Australia Research Program.
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Affiliation(s)
- Matthew J L Hare
- Wellbeing and Chronic Preventable Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Department of Endocrinology, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Federica Barzi
- Wellbeing and Chronic Preventable Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Jacqueline A Boyle
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia
| | - Steven Guthridge
- Centre for Child Development and Education, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Roland F Dyck
- Department of Medicine, Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, Canada
| | - Elizabeth L M Barr
- Wellbeing and Chronic Preventable Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Clinical Diabetes and Epidemiology, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Gurmeet Singh
- Child Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia.,Department of Paediatrics, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Henrik Falhammar
- Wellbeing and Chronic Preventable Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Department of Endocrinology, Royal Darwin Hospital, Darwin, Northern Territory, Australia.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden
| | - Vanya Webster
- Indigenous Reference Group, Diabetes across the Lifecourse: Northern Australia Partnership, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Jonathan E Shaw
- Clinical Diabetes and Epidemiology, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Louise J Maple-Brown
- Wellbeing and Chronic Preventable Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Department of Endocrinology, Royal Darwin Hospital, Darwin, Northern Territory, Australia
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24
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Maple-Brown L, Lee IL, Longmore D, Barzi F, Connors C, Boyle JA, Moore E, Whitbread C, Kirkwood M, Graham S, Hampton V, Simmonds A, Van Dokkum P, Kelaart J, Thomas S, Chitturi S, Eades S, Corpus S, Lynch M, Lu ZX, O'Dea K, Zimmet P, Oats J, McIntyre HD, Brown ADH, Shaw JE. Pregnancy And Neonatal Diabetes Outcomes in Remote Australia: the PANDORA study-an observational birth cohort. Int J Epidemiol 2020; 48:307-318. [PMID: 30508095 DOI: 10.1093/ije/dyy245] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND In Australia's Northern Territory, 33% of babies are born to Indigenous mothers, who experience high rates of hyperglycemia in pregnancy. We aimed to determine the extent to which pregnancy outcomes for Indigenous Australian women are explained by relative frequencies of diabetes type [type 2 diabetes (T2DM) and gestational diabetes (GDM)]. METHODS This prospective birth cohort study examined participants recruited from a hyperglycemia in pregnancy register. Baseline data collected were antenatal and perinatal clinical information, cord blood and neonatal anthropometry. Of 1135 women (48% Indigenous), 900 had diabetes: 175 T2DM, 86 newly diagnosed diabetes in pregnancy (DIP) and 639 had GDM. A group of 235 women without hyperglycemia in pregnancy was also recruited. RESULTS Diabetes type differed for Indigenous and non-Indigenous women (T2DM, 36 vs 5%; DIP, 15 vs 7%; GDM, 49 vs 88%, p < 0.001). Within each diabetes type, Indigenous women were younger and had higher smoking rates. Among women with GDM/DIP, Indigenous women demonstrated poorer birth outcomes than non-Indigenous women: large for gestational age, 19 vs 11%, p = 0·002; neonatal fat 11.3 vs 10.2%, p < 0.001. In the full cohort, on multivariate regression, T2DM and DIP were independently associated (and Indigenous ethnicity was not) with pregnancy outcomes. CONCLUSIONS Higher rates of T2DM among Indigenous women predominantly contribute to absolute poorer pregnancy outcomes among Indigenous women with hyperglycemia. As with Indigenous and minority populations globally, prevention or delay of type 2 diabetes in younger women is vital to improve pregnancy outcomes and possibly to improve the long-term health of their offspring.
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Affiliation(s)
- Louise Maple-Brown
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, NT, Australia.,Endocrinology Department, Division of Medicine, Royal Darwin Hospital, Darwin, NT, Australia
| | - I-Lynn Lee
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, NT, Australia
| | - Danielle Longmore
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, NT, Australia
| | - Federica Barzi
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, NT, Australia
| | - Christine Connors
- Remote Primary Health Care, Top End Health Services, Northern Territory Department of Health, Darwin, NT, Australia
| | - Jacqueline A Boyle
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, NT, Australia.,Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Elizabeth Moore
- Public Health Unit, Aboriginal Medical Services Alliance, Darwin, NT, Australia
| | - Cherie Whitbread
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, NT, Australia.,Endocrinology Department, Division of Medicine, Royal Darwin Hospital, Darwin, NT, Australia
| | - Marie Kirkwood
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, NT, Australia
| | - Sian Graham
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, NT, Australia
| | - Vanya Hampton
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, NT, Australia
| | - Alison Simmonds
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, NT, Australia
| | - Paula Van Dokkum
- Aboriginal Health Domain, Baker Heart and Diabetes Institute, Alice Springs, NT, Australia
| | - Joanna Kelaart
- Aboriginal Health Domain, Baker Heart and Diabetes Institute, Alice Springs, NT, Australia
| | - Sujatha Thomas
- Division of Maternal and Child Health, Royal Darwin Hospital, Darwin, NT, Australia
| | - Shridhar Chitturi
- Endocrinology Department, Division of Medicine, Royal Darwin Hospital, Darwin, NT, Australia
| | - Sandra Eades
- Clinical and Population Health, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Sumaria Corpus
- Clinical Services, Danila Dilba Health Service, Darwin, NT, Australia
| | - Michael Lynch
- Pathology Network, Top End Health and Hospital Services, Darwin, NT, Australia
| | - Zhong X Lu
- Biochemistry Department, Melbourne Pathology, Melbourne, VIC, Australia.,Department of Medicine, Monash University, Melbourne, Australia
| | - Kerin O'Dea
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, NT, Australia.,School of Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Paul Zimmet
- Department of Diabetes, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Jeremy Oats
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Harold D McIntyre
- Faculty of Medicine, Mater Medical Research Institute, University of Queensland, Brisbane, QLD, Australia
| | - Alex D H Brown
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Jonathan E Shaw
- Clinical and Population Health, Baker Heart and Diabetes Institute, Melbourne, Australia
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Working Towards Eye Health Equity for Indigenous Australians with Diabetes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16245060. [PMID: 31842249 PMCID: PMC6950403 DOI: 10.3390/ijerph16245060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 12/06/2019] [Accepted: 12/08/2019] [Indexed: 12/18/2022]
Abstract
Type 2 diabetes mellitus (T2DM) poses significant challenges to individuals and broader society, much of which is borne by disadvantaged and marginalised population groups including Indigenous people. The increasing prevalence of T2DM among Indigenous people has meant that rates of diabetes-related complications such as blindness from end-stage diabetic retinopathy (DR) continue to be important health concerns. Australia, a high-income and resource-rich country, continues to struggle to adequately respond to the health needs of its Indigenous people living with T2DM. Trends among Indigenous Australians highlight that the prevalence of DR has almost doubled over two decades, and the prevalence of diabetes-related vision impairment is consistently reported to be higher among Indigenous Australians (5.2%–26.5%) compared to non-Indigenous Australians (1.7%). While Australia has collated reliable estimates of the eye health burden owing to T2DM in its Indigenous population, there is fragmentation of existing data and limited knowledge on the underlying risk factors. Taking a systems approach that investigates the social, environmental, clinical, biological and genetic risk factors, and—importantly—integrates these data, may give valuable insights into the most important determinants contributing to the development of diabetes-related blindness. This knowledge is a crucial initial step to reducing the human and societal impacts of blindness on Indigenous Australians, other priority populations and society at large.
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Ovtcharenko N, Thomson BKA. Interventions to Improve Clinical Outcomes in Indigenous or Remote Patients With Chronic Kidney Disease: A Scoping Review. Can J Kidney Health Dis 2019; 6:2054358119887154. [PMID: 31798926 PMCID: PMC6859680 DOI: 10.1177/2054358119887154] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 09/24/2019] [Indexed: 11/30/2022] Open
Abstract
Background: Chronic kidney disease (CKD) associates with a significant health care burden with a disproportionate impact on indigenous persons or people living in remote areas. Although screening programs have expanded in these communities, there remains a paucity of evidence-based interventions to enhance clinical renal outcomes in these populations. Objective: The objective of this study was to identify evidence-based interventions to enhance renal outcomes in these populations. Design: A scoping review was conducted for studies in the Cochrane, MEDLINE, and Embase databases and from major nephrology meetings. Setting: Chronic kidney disease, including those on dialysis. Patients: Remote or indigenous populations Measurements: Studies that performed an intervention that was followed by measurement of renal outcomes or patient-centered outcomes (ie, quality of life) were included. Methods: All studies were described by study type, intervention, and clinical outcome, and trends were identified by both authors. Meta-analysis was not conducted due to study heterogeneity. Results: Thirty-two studies met inclusion criteria, only 2 (6.3%) of which were randomized controlled trials. Intervention types included multidisciplinary (34.4%), satellite (32.3%), telehealth (25.0%), or other (9.4%). All multidisciplinary interventions were performed in the CKD (non-dialysis) setting and reported improved patient travel time, waiting time, quality of life, kidney function, proteinuria, and blood pressure. Telehealth interventions improved program cost, patient attendance, hospitalization, and quality of life. Satellite interventions were performed in the hemodialysis setting, with 1 study evaluating acute hemodialysis. Satellite interventions improved patient travel time, dialysis clearance, quality of life, and survival, but increased program costs. Limitations: The study was restricted to interventional trials assessing clinical outcomes and to studies in developed countries, which likely excluded some research contributing to this field. Conclusions: There is significant heterogeneity among studies of interventions for patients with CKD who are indigenous or live remotely. Interventions were more likely to be successful when the remote or indigenous community was included in program development, with a culturally safe approach. More large, high-quality studies are needed to identify effective interventions to enhance clinical renal outcomes in indigenous or remote populations. Trial Registration: This trial is registered under PROSPERO, Registration Number 128453.
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Affiliation(s)
- N Ovtcharenko
- Division of Internal Medicine, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - B K A Thomson
- Division of Internal Medicine, Department of Medicine, Queen's University, Kingston, ON, Canada.,Division of Nephrology, Department of Medicine, Queen's University, Kingston, ON, Canada
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Abhari S, Niakan Kalhori SR, Ebrahimi M, Hasannejadasl H, Garavand A. Artificial Intelligence Applications in Type 2 Diabetes Mellitus Care: Focus on Machine Learning Methods. Healthc Inform Res 2019; 25:248-261. [PMID: 31777668 PMCID: PMC6859270 DOI: 10.4258/hir.2019.25.4.248] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 10/06/2019] [Accepted: 10/09/2019] [Indexed: 12/18/2022] Open
Abstract
Objectives The incidence of type 2 diabetes mellitus has increased significantly in recent years. With the development of artificial intelligence applications in healthcare, they are used for diagnosis, therapeutic decision making, and outcome prediction, especially in type 2 diabetes mellitus. This study aimed to identify the artificial intelligence (AI) applications for type 2 diabetes mellitus care. Methods This is a review conducted in 2018. We searched the PubMed, Web of Science, and Embase scientific databases, based on a combination of related mesh terms. The article selection process was based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Finally, 31 articles were selected after inclusion and exclusion criteria were applied. Data gathering was done by using a data extraction form. Data were summarized and reported based on the study objectives. Results The main applications of AI for type 2 diabetes mellitus care were screening and diagnosis in different stages. Among all of the reviewed AI methods, machine learning methods with 71% (n = 22) were the most commonly applied techniques. Many applications were in multi method forms (23%). Among the machine learning algorithms applications, support vector machine (21%) and naive Bayesian (19%) were the most commonly used methods. The most important variables that were used in the selected studies were body mass index, fasting blood sugar, blood pressure, HbA1c, triglycerides, low-density lipoprotein, high-density lipoprotein, and demographic variables. Conclusions It is recommended to select optimal algorithms by testing various techniques. Support vector machine and naive Bayesian might achieve better performance than other applications due to the type of variables and targets in diabetes-related outcomes classification.
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Affiliation(s)
- Shahabeddin Abhari
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Sharareh R Niakan Kalhori
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Ebrahimi
- Department of Internal Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.,Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hajar Hasannejadasl
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Garavand
- Department of Health Information Management and Technology, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Adinan J, Manongi R, Temu GA, Kapologwe N, Marandu A, Wajanga B, Dika H, Maongezi S, Laizer S, Manyuti R, Nassir RA, Renju J, Todd J. Preparedness of health facilities in managing hypertension & diabetes mellitus in Kilimanjaro, Tanzania: a cross sectional study. BMC Health Serv Res 2019; 19:537. [PMID: 31366384 PMCID: PMC6670222 DOI: 10.1186/s12913-019-4316-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 07/01/2019] [Indexed: 11/10/2022] Open
Abstract
Background Hypertension and Diabetes mellitus are risk factors for cardiovascular diseases that cause 17 million deaths globally. Many of these deaths could have been prevented if hypertensive and diabetic patients had their blood pressure and glucose controlled. Less than 30% of hypertensive and diabetic patients on management have controlled their blood pressure and glucose respectively. This study aimed to determine the preparedness of health facilities in managing hypertensive and diabetic patients in terms of personnel; laboratory services provision, and local use of routinely collected data, and shows differences in preparedness between the levels of facilities. Methods We conducted a cross-sectional study in Government, faith-based and private health facilities in two districts in Kilimanjaro region in Tanzania from March to July 2017. We collected data through interviews and observations on the preparedness of the facilities for managing hypertension and DM. Results Forty-three (43) health facilities and 62 healthcare workers (HCW) participated in the survey. Services for hypertension and DM were available in 37 (86%) and 34 (79%) health facilities respectively. Eighteen (53%) and five (15%) facilities had HCW trained on hypertension and DM management respectively within two years preceding the survey. Regular adherence to treatment guideline was reported in 18 (53%) of the health facilities. More than third of health facilities were without basic equipment for managing hypertension and DM. All the recommended laboratory tests were only available in four (15%) hospitals and one health center. Valid first line medicines for both hypertension and DM were available in six (50%) health centers, four (24%) dispensaries and in four (80.0%) hospitals. Health data collection, analysis and local use for planning were reported in all hospitals, nine (75%) health centers and four (24%) dispensaries. Conclusions Health facilities are not fully prepared to manage hypertension and DM. Health centers and dispensaries are mostly affected levels of health facilities. Government interventions to improve facility factors and collaborative approaches to build capacity to HCW are needed to enable health facilities be responsive to these diseases.
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Affiliation(s)
- Juma Adinan
- School of AMO KCMC, 3010, Moshi, Kilimanjaro, Tanzania. .,Kilimanjaro Christian Medical University College, 2240, Moshi, Kilimanjaro, Tanzania. .,Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania.
| | - Rachel Manongi
- Kilimanjaro Christian Medical University College, 2240, Moshi, Kilimanjaro, Tanzania
| | - Gloria August Temu
- Kilimanjaro Christian Medical University College, 2240, Moshi, Kilimanjaro, Tanzania
| | - Ntuli Kapologwe
- Kilimanjaro Christian Medical University College, 2240, Moshi, Kilimanjaro, Tanzania.,President's Office - Regional Administration and Local Government (PORALG), Dodoma, Tanzania
| | - Annette Marandu
- Mawenzi Regional Referral Hospital, Moshi, Kilimanjaro, Tanzania
| | - Bahati Wajanga
- Catholic University of Health and Allied Sciences, 1464, Mwanza, Tanzania
| | - Haruna Dika
- Catholic University of Health and Allied Sciences, 1464, Mwanza, Tanzania
| | - Sarah Maongezi
- Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
| | - Sweetness Laizer
- Kilimanjaro Christian Medical University College, 2240, Moshi, Kilimanjaro, Tanzania
| | - Ridhiwani Manyuti
- Kilimanjaro Christian Medical University College, 2240, Moshi, Kilimanjaro, Tanzania
| | | | - Jenny Renju
- Kilimanjaro Christian Medical University College, 2240, Moshi, Kilimanjaro, Tanzania.,Department of Population Health, LSHTM, London, UK
| | - Jim Todd
- Kilimanjaro Christian Medical University College, 2240, Moshi, Kilimanjaro, Tanzania.,Department of Population Health, LSHTM, London, UK
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Kelly L, Matsumoto CL, Schreiber Y, Gordon J, Willms H, Olivier C, Madden S, Hopko J, Tobe SW. Prevalence of chronic kidney disease and cardiovascular comorbidities in adults in First Nations communities in northwest Ontario: a retrospective observational study. CMAJ Open 2019; 7:E568-E572. [PMID: 31501170 PMCID: PMC6768774 DOI: 10.9778/cmajo.20190040] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The prevalence of adult chronic kidney disease and cardiovascular comorbidities in Canadian Indigenous communities is largely unknown. We conducted a study to document the prevalence of chronic kidney disease and concurrent diabetes mellitus, hypertension and dyslipidemia in a First Nations population in northwest Ontario. METHODS In this observational study, we used retrospective data collected from regional electronic medical records of 16 170 adults (age ≥ 18 yr) from 26 First Nations communities in northwest Ontario from May 2014 to May 2017. Demographic and laboratory data included age, gender, prescribed medications, estimated glomerular filtration rate, urine albumin:creatinine ratio, low-density lipoprotein cholesterol (LDL-C) level and glycated hemoglobin (HbA1c) concentration. We identified patients with diabetes by an HbA1c concentration of 6.5% or higher, or the use of a diabetic medication, those with dyslipidemia by an elevated LDL-C level (≥ 2.0 mmol/L) or use of lipid-lowering medication, and those with hypertension by use of antihypertensive medication. RESULTS Of the 16 170 adults residing in the communities, 5224 unique patients (32.3%) had renal testing (albumin:creatinine ratio and/or estimated glomerular filtration rate). The age-adjusted prevalence of chronic kidney disease was 14.5%, and the prevalence of stage 3-5 chronic kidney disease (estimated glomerular filtration rate < 60 mL/min) was 7.0%. Most patients with chronic kidney disease (1487 [80.0%]) had at least 1 cardiovascular comorbidity. A total of 1332 patients (71.6%) had diabetes, 1313 (70.6%) had dyslipidemia, and 1098 (59.1%) had hypertension; all 3 comorbidities were present in 716 patients (38.5%). INTERPRETATION We document a high prevalence of advanced chronic kidney disease in this First Nations population, 7.0%, double the rate in the general population. High rates of cardiovascular comorbidities were also common in these patients with chronic kidney disease, which places them at increased risk for cardiovascular disease.
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Affiliation(s)
- Len Kelly
- Anishinaabe Bimaadiziwin Research Program (Kelly, Schreiber, Willms), Sioux Lookout Meno Ya Win Health Centre; Approaches to Community Wellbeing (Matsumoto) and Health Services (Gordon, Hopko), Sioux Lookout First Nations Health Authority, Sioux Lookout, Ont.; Division of Infectious Diseases (Schreiber), The Ottawa Hospital, University of Ottawa; The Ottawa Hospital Research Institute (Schreiber); School of Epidemiology and Public Health (Schreiber), University of Ottawa, Ottawa, Ont.; University of Saskatchewan (Olivier), Saskatoon, Sask.; Division of Clinical Sciences (Madden), Northern Ontario School of Medicine, Sioux Lookout, Ont.; Department of Medicine (Tobe), Sunnybrook Health Sciences Centre, Toronto, Ont.
| | - Cai-Lei Matsumoto
- Anishinaabe Bimaadiziwin Research Program (Kelly, Schreiber, Willms), Sioux Lookout Meno Ya Win Health Centre; Approaches to Community Wellbeing (Matsumoto) and Health Services (Gordon, Hopko), Sioux Lookout First Nations Health Authority, Sioux Lookout, Ont.; Division of Infectious Diseases (Schreiber), The Ottawa Hospital, University of Ottawa; The Ottawa Hospital Research Institute (Schreiber); School of Epidemiology and Public Health (Schreiber), University of Ottawa, Ottawa, Ont.; University of Saskatchewan (Olivier), Saskatoon, Sask.; Division of Clinical Sciences (Madden), Northern Ontario School of Medicine, Sioux Lookout, Ont.; Department of Medicine (Tobe), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Yoko Schreiber
- Anishinaabe Bimaadiziwin Research Program (Kelly, Schreiber, Willms), Sioux Lookout Meno Ya Win Health Centre; Approaches to Community Wellbeing (Matsumoto) and Health Services (Gordon, Hopko), Sioux Lookout First Nations Health Authority, Sioux Lookout, Ont.; Division of Infectious Diseases (Schreiber), The Ottawa Hospital, University of Ottawa; The Ottawa Hospital Research Institute (Schreiber); School of Epidemiology and Public Health (Schreiber), University of Ottawa, Ottawa, Ont.; University of Saskatchewan (Olivier), Saskatoon, Sask.; Division of Clinical Sciences (Madden), Northern Ontario School of Medicine, Sioux Lookout, Ont.; Department of Medicine (Tobe), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Janet Gordon
- Anishinaabe Bimaadiziwin Research Program (Kelly, Schreiber, Willms), Sioux Lookout Meno Ya Win Health Centre; Approaches to Community Wellbeing (Matsumoto) and Health Services (Gordon, Hopko), Sioux Lookout First Nations Health Authority, Sioux Lookout, Ont.; Division of Infectious Diseases (Schreiber), The Ottawa Hospital, University of Ottawa; The Ottawa Hospital Research Institute (Schreiber); School of Epidemiology and Public Health (Schreiber), University of Ottawa, Ottawa, Ont.; University of Saskatchewan (Olivier), Saskatoon, Sask.; Division of Clinical Sciences (Madden), Northern Ontario School of Medicine, Sioux Lookout, Ont.; Department of Medicine (Tobe), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Hannah Willms
- Anishinaabe Bimaadiziwin Research Program (Kelly, Schreiber, Willms), Sioux Lookout Meno Ya Win Health Centre; Approaches to Community Wellbeing (Matsumoto) and Health Services (Gordon, Hopko), Sioux Lookout First Nations Health Authority, Sioux Lookout, Ont.; Division of Infectious Diseases (Schreiber), The Ottawa Hospital, University of Ottawa; The Ottawa Hospital Research Institute (Schreiber); School of Epidemiology and Public Health (Schreiber), University of Ottawa, Ottawa, Ont.; University of Saskatchewan (Olivier), Saskatoon, Sask.; Division of Clinical Sciences (Madden), Northern Ontario School of Medicine, Sioux Lookout, Ont.; Department of Medicine (Tobe), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Christopher Olivier
- Anishinaabe Bimaadiziwin Research Program (Kelly, Schreiber, Willms), Sioux Lookout Meno Ya Win Health Centre; Approaches to Community Wellbeing (Matsumoto) and Health Services (Gordon, Hopko), Sioux Lookout First Nations Health Authority, Sioux Lookout, Ont.; Division of Infectious Diseases (Schreiber), The Ottawa Hospital, University of Ottawa; The Ottawa Hospital Research Institute (Schreiber); School of Epidemiology and Public Health (Schreiber), University of Ottawa, Ottawa, Ont.; University of Saskatchewan (Olivier), Saskatoon, Sask.; Division of Clinical Sciences (Madden), Northern Ontario School of Medicine, Sioux Lookout, Ont.; Department of Medicine (Tobe), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Sharen Madden
- Anishinaabe Bimaadiziwin Research Program (Kelly, Schreiber, Willms), Sioux Lookout Meno Ya Win Health Centre; Approaches to Community Wellbeing (Matsumoto) and Health Services (Gordon, Hopko), Sioux Lookout First Nations Health Authority, Sioux Lookout, Ont.; Division of Infectious Diseases (Schreiber), The Ottawa Hospital, University of Ottawa; The Ottawa Hospital Research Institute (Schreiber); School of Epidemiology and Public Health (Schreiber), University of Ottawa, Ottawa, Ont.; University of Saskatchewan (Olivier), Saskatoon, Sask.; Division of Clinical Sciences (Madden), Northern Ontario School of Medicine, Sioux Lookout, Ont.; Department of Medicine (Tobe), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Josh Hopko
- Anishinaabe Bimaadiziwin Research Program (Kelly, Schreiber, Willms), Sioux Lookout Meno Ya Win Health Centre; Approaches to Community Wellbeing (Matsumoto) and Health Services (Gordon, Hopko), Sioux Lookout First Nations Health Authority, Sioux Lookout, Ont.; Division of Infectious Diseases (Schreiber), The Ottawa Hospital, University of Ottawa; The Ottawa Hospital Research Institute (Schreiber); School of Epidemiology and Public Health (Schreiber), University of Ottawa, Ottawa, Ont.; University of Saskatchewan (Olivier), Saskatoon, Sask.; Division of Clinical Sciences (Madden), Northern Ontario School of Medicine, Sioux Lookout, Ont.; Department of Medicine (Tobe), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Sheldon W Tobe
- Anishinaabe Bimaadiziwin Research Program (Kelly, Schreiber, Willms), Sioux Lookout Meno Ya Win Health Centre; Approaches to Community Wellbeing (Matsumoto) and Health Services (Gordon, Hopko), Sioux Lookout First Nations Health Authority, Sioux Lookout, Ont.; Division of Infectious Diseases (Schreiber), The Ottawa Hospital, University of Ottawa; The Ottawa Hospital Research Institute (Schreiber); School of Epidemiology and Public Health (Schreiber), University of Ottawa, Ottawa, Ont.; University of Saskatchewan (Olivier), Saskatoon, Sask.; Division of Clinical Sciences (Madden), Northern Ontario School of Medicine, Sioux Lookout, Ont.; Department of Medicine (Tobe), Sunnybrook Health Sciences Centre, Toronto, Ont
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Naseribafrouei A, Eliassen BM, Melhus M, Svartberg J, Broderstad AR. Estimated 8-year cumulative incidence of diabetes mellitus among Sami and non-Sami inhabitants of Northern Norway - The SAMINOR Study. BMC Endocr Disord 2019; 19:66. [PMID: 31234837 PMCID: PMC6591838 DOI: 10.1186/s12902-019-0399-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 06/19/2019] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND The aim of the study was to estimate and compare the 8-year cumulative incidence of diabetes mellitus (DM) among Sami and non-Sami inhabitants of rural districts in Northern Norway. METHODS Longitudinal study based on linkage of two cross-sectional surveys, the SAMINOR 1 Survey (2003-2004) and the SAMINOR 2 Clinical Survey (2012-2014). Ten municipalities in rural Northern Norway were included in the study. DM-free participants aged 30 and 36-71 years in SAMINOR 1 were followed from 2 years after SAMINOR 1 to attendance in SAMINOR 2. The average follow-up time was 8.1 years. Of 5875 subjects who had participated in SAMINOR 1 and could potentially be followed to SAMINOR 2, 3303 were included in the final analysis. Self-reported DM and/or HbA1c ≥ 6.5% were used to identify incident cases of DM. RESULTS At baseline, body mass index (BMI) and waist-to-height ratio (WHtR) were higher among Sami than among their non-Sami counterparts. After 8 years of follow-up, 201 incident cases of DM were identified (6.1% both Sami and non-Sami subjects). No statistically significant difference was observed in the cumulative incidence of DM between the Sami and non-Sami. CONCLUSIONS No statistically significant difference in the 8-year cumulative incidence of DM among Sami and non-Sami was observed, although Sami men and women had higher baseline BMI and WHtR.
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Affiliation(s)
- Ali Naseribafrouei
- Centre for Sami Health Research, Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Box 6050 Langnes, N-9037 Tromsø, Norway
| | | | - Marita Melhus
- Centre for Sami Health Research, Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Box 6050 Langnes, N-9037 Tromsø, Norway
| | - Johan Svartberg
- Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
- Tromsø Endocrine Research Group, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Ann Ragnhild Broderstad
- Centre for Sami Health Research, Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Box 6050 Langnes, N-9037 Tromsø, Norway
- Department of Medicine, University Hospital of North Norway, Harstad, Norway
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Gurney JK, Stanley J, York S, Sarfati D. Regional variation in the risk of lower-limb amputation among patients with diabetes in New Zealand. ANZ J Surg 2019; 89:868-873. [PMID: 30920078 DOI: 10.1111/ans.15079] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 12/20/2018] [Accepted: 12/28/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Lower-limb amputation is one of the most substantial and debilitating consequences of diabetes mellitus; however, the risk of lower-limb amputation is not equally shared across the diabetic population. The aims of this study were to (i) describe regional variation in the rate of lower-limb amputation in New Zealand among a national prevalent cohort of patients with diabetes; and (ii) explore the plausible factors that could be contributing to this variation. METHODS Our cohort were the national prevalent cohort of individuals with diabetes in New Zealand in 2011, according to the Virtual Diabetes Register (n = 215 676). Using descriptive analysis and Poisson regression, we compared the rate of lower-limb amputation within each of New Zealand's 20 District Health Boards with the national rate of amputation, adjusting for demographic, health care access and patient-level factors. RESULTS We observed nearly four-fold variation in the rate of major lower-limb amputation between regions in New Zealand, as well as nearly two-fold variation in the rate of minor lower-limb amputation. Adjustment for differences between regions in terms of ethnicity reduced this variation substantially for many District Health Boards. Despite adjustment for sex, age, ethnicity, deprivation, rurality, comorbidity and prior amputation, the rate of lower-limb amputation in a number of District Health Boards remained substantially higher than the national rate. CONCLUSIONS These observations could help to inform the funding and provision of diabetic foot care services across New Zealand; however, more work is required to further untangle the drivers of national variation in rates of lower-limb amputation.
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Affiliation(s)
- Jason K Gurney
- Cancer and Chronic Conditions (C3) Research Group, Department of Public Health, University of Otago, Wellington, New Zealand
| | - James Stanley
- Cancer and Chronic Conditions (C3) Research Group, Department of Public Health, University of Otago, Wellington, New Zealand
| | - Steve York
- High Risk Foot Clinic, Northland District Health Board, Whangarei, New Zealand
| | - Diana Sarfati
- Cancer and Chronic Conditions (C3) Research Group, Department of Public Health, University of Otago, Wellington, New Zealand
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Prevalence of Diabetes, Prediabetes, and Obesity in the Indigenous Kuna Population of Panamá. J Racial Ethn Health Disparities 2019; 6:743-751. [PMID: 30805801 DOI: 10.1007/s40615-019-00573-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 02/06/2019] [Accepted: 02/10/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Diabetes is a burgeoning disease affecting more than 8% of the world population. Indigenous communities are disproportionately impacted by diabetes; however, limited data is available on prevalence and correlates of diabetes. METHODS Data was collected from 211 Indigenous Kuna adults off the coast of Panamá in the San Blas region of the Caribbean. Diabetes and prediabetes were measured by HbA1c. Obesity was defined using the US BMI categories as well as categories defined by the WHO to assess obesity among Asian populations. Univariate analyses (chi2 tests) were used to investigate diabetes status and obesity by demographic factors. Logistic regression was used to examine the correlates of diabetes and obesity. RESULTS Of the 211 adults, 13% had diabetes, 35% had prediabetes, and approximately 39% were obese. Using the Asian cut point for obesity, this number increased to 61%. Income was statistically significantly related to an HbA1c cut point of 6.5 (p = 0.005). Individuals who reported a monthly income of greater than $250 had increased odds of prediabetes and diabetes nearly sixfold for HbA1c of > 6.5 (OR 6.3; CI 1.43-28.45) and HbA1c of > 5.7 (OR 5.1; CI 1.03-26.14). CONCLUSIONS These findings represent one of the first studies examining diabetes and prediabetes in indigenous Kuna of the San Blas region. Our findings suggest Kuna Indians may be at an increased risk for diabetes and prediabetes. Current national estimates for diabetes is considered low in this population. Greater understanding of determinants of diabetes and obesity are needed in order to address diabetes in this indigenous community.
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Spurr S, Bullin C, Bally J, Trinder K, Khan S. Nurse-led diabetic retinopathy screening: a pilot study to evaluate a new approach to vision care for Canadian Aboriginal peoples. Int J Circumpolar Health 2019; 77:1422670. [PMID: 29384012 PMCID: PMC5795657 DOI: 10.1080/22423982.2017.1422670] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Diabetic retinopathy is the most common cause of new cases of blindness and is pandemic among Aboriginal people around the world. To reduce health inequities, accessible vision screening among these high-risk populations is essential. To assess cardio-metabolic co-morbidities associated with type 2 diabetes and the use of a portable fundus camera as a novel approach for convenient, earlier and more accessible vision screening for Aboriginal peoples living with type 2 diabetes in northern and remote Canadian communities. This quantitative pilot study screened participants diagnosed with type 2 diabetes for commonly associated cardio-metabolic co-morbidities using anthropometrical measurements, blood pressure and a A1c (HbA1c) blood glucose test, followed by vision exams conducted first by a trained nurse and then by an ophthalmologist to screen for signs of retinopathy using fundus photography. Large numbers of the participants presented with overweight/obese (84.8%), pre-hypertension/hypertension (69.7%) and an elevated A1C (78.8%). Inter-rater reliability demonstrated substantial agreement between vision exam judgements made by the nurse and ophthalmologist (k = .67). Nurse-led vision screening in remote or northern communities can improve the standard of care by extending access to health services, lowering the costs to families by reducing travel expenses and preventing vision loss in a family member.
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Affiliation(s)
- Shelley Spurr
- a College of Nursing , University of Saskatchewan , Saskatoon , Canada
| | - Carol Bullin
- a College of Nursing , University of Saskatchewan , Saskatoon , Canada
| | - Jill Bally
- a College of Nursing , University of Saskatchewan , Saskatoon , Canada
| | - Krista Trinder
- b College of Medicine , University of Saskatchewan , Saskatoon , Canada
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Njume C, Donkor O, McAinch AJ. Predisposing factors of type 2 diabetes mellitus and the potential protective role of native plants with functional properties. J Funct Foods 2019. [DOI: 10.1016/j.jff.2018.12.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Jeyaraman K, Berhane T, Hamilton M, Chandra AP, Falhammar H. Mortality in patients with diabetic foot ulcer: a retrospective study of 513 cases from a single Centre in the Northern Territory of Australia. BMC Endocr Disord 2019; 19:1. [PMID: 30606164 PMCID: PMC6318899 DOI: 10.1186/s12902-018-0327-2] [Citation(s) in RCA: 92] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 12/14/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Diabetic foot ulcers (DFU) are a common problem in longstanding diabetes. However, mortality outcomes in Australian patients with DFU are still unclear. METHODS All patients with DFU presenting for the first time to the Multi-Disciplinary Foot Clinic (MDFC) at Royal Darwin Hospital, Northern Territory Australia, between January 2003 and June 2015 were included in this study. These patients were followed until 2017, or death. Individual patient data was extracted from hospital and primary care information systems. Kaplan-Meier survival curves were developed. The association between various risk factors and mortality was analysed using Cox regression. RESULTS In total 666 subjects were screened, and 513 were included in the final analysis. Of these subjects, 247 were Indigenous and 266 were non-Indigenous. The median follow-up period was 5.8 years (IQR, 3.1-9.8). The mean age at inclusion was 59.9 ± 12.3 years and 62.8% were males. The majority (93.6%) had type 2 diabetes and the median diabetes duration was 7 years (IQR, 3-12). There were 199 deaths, with a 5-year-mortality rate of 24.6%, and a 10-year-mortality rate of 45.4%. The mean age at death was 64.6 ± 11.8 years. In a multivariate analysis, the following variables were associated with mortality (adjusted HR, 95% CI): age 1.04 (1.02-1.05, P < 0.001); chronic kidney disease 1.22 (1.11-1.33, P < 0.001), and plasma albumin 0.96 (0.94-0.99, P < 0.05). The most common causes of death were chronic kidney disease (24.6%), cardiovascular events (19.6%), sepsis (15.6%), respiratory failure (10.0%), malignancy (9.5%) and multi-organ failure (5.0%). CONCLUSION Patients with DFU have high mortality. Age, chronic kidney disease, and low albumin levels increase the risk of mortality. Strategies should focus on ulcer prevention and aggressive risk factor reduction.
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Affiliation(s)
- Kanakamani Jeyaraman
- Department of Endocrinology, Royal Darwin Hospital, Darwin, Northern Territory Australia
| | - Thomas Berhane
- Department of Prosthetics and Orthotics, Royal Darwin Hospital, Darwin, Northern Territory Australia
| | - Mark Hamilton
- Department of Vascular Surgery, Royal Darwin Hospital, Darwin, Northern Territory Australia
- Menzies School of Health Research, Darwin, NT Australia
| | - Abhilash P. Chandra
- Department of Vascular Surgery, Royal Darwin Hospital, Darwin, Northern Territory Australia
- Menzies School of Health Research, Darwin, NT Australia
| | - Henrik Falhammar
- Department of Endocrinology, Royal Darwin Hospital, Darwin, Northern Territory Australia
- Menzies School of Health Research, Darwin, NT Australia
- Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
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Aronson BD, Gregoire AR, Kading ML, RedBrook SM, Wilson R, Walls ML. Self-reported eye diseases among American Indian individuals with type 2 diabetes from the northern Midwest. EYE REPORTS 2019; 5:9-14. [PMID: 31559003 PMCID: PMC6762022 DOI: 10.16964/er.v5i1.66] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To determine the prevalence of eye diseases and utilization of dilated eye exams among a sample of American Indian (AI) individuals with type 2 diabetes. METHODS AI adults with type 2 diabetes utilizing health care at two reservation clinics were randomly sampled and recruited for interviewer-assisted paper surveys. The prevalence of eye diseases was compared across gender, age, income, and educational attainment. RESULTS The prevalence of retinopathy, cataracts, macular degeneration, and glaucoma were 9.4%, 26.7%, 5.2%, and 10.6% respectively, and 59.2% reported past year dilated eye exams. Older participants were more likely to report cataracts (p < 0.001) and glaucoma (p = .003). Those with lower income were more likely to report cataracts (p = 0.001). CONCLUSIONS Rates of self-reported eye diseases in this sample were higher, and dilated eye exams lower than other samples of the general United States population with diabetes, suggesting improvement can be made to improve the provision of care for AI individuals with type 2 diabetes.
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Affiliation(s)
- Benjamin D. Aronson
- Department of Pharmacy Practice and Pharmaceutical Sciences, University of Minnesota College of Pharmacy, Duluth, Minnesota, USA
| | | | - Margarette L. Kading
- Department of Pharmacy Practice and Pharmaceutical Sciences, University of Minnesota College of Pharmacy, Duluth, Minnesota, USA
| | - Shannon M. RedBrook
- Department of Biomedical Science, University of Minnesota Medical School-Duluth, Duluth, Minnesota, USA
| | - Ryan Wilson
- University of Minnesota Medical School-Duluth, Duluth, Minnesota, USA
| | - Melissa L. Walls
- Department of Biobehavioral Health & Population Sciences, University of Minnesota Medical School-Duluth, Duluth, Minnesota, USA
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Lima CGMG, Franco LJ, Dal Fabbro AL, Martinez EZ, Veira-Filho JPB, Ventura AACM, Prevelato L, Cruz AAV. Diabetic retinopathy among Brazilian Xavante Indians. Diabetol Metab Syndr 2018; 10:46. [PMID: 29983751 PMCID: PMC6001219 DOI: 10.1186/s13098-018-0348-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 06/01/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND To describe the frequency of diabetic retinopathy (DR) and its associated variables in Brazilian Xavante Indians. METHODS A population-based survey carried out in two Xavante Reservations between 2008 and 2012, included 948 Indians aged 20 years or more, identified 246 individuals with type 2 diabetes. A non-probabilistic cluster sample of 140 diabetic individuals were submitted to ophthalmologic examination. Due to operational conditions and to optimize the field work, only the larger Xavante villages were included. Ophthalmologic examinations were performed during one trip to each reservation, in their villages and consisted of measurement visual acuity, anterior segment biomicroscopy, applanation tonometry, and direct and indirect ophthalmoscopy. RESULTS The frequency of DR was 19.3%, distributed as follows: mild non-proliferative retinopathy in nine (33.3%) subjects, moderate in nine (33.3%), severe in six (22.3%), very severe in two (7.4%), and high-risk proliferative DR in one (3.7%). The occurrence of DR was higher among those with a longer duration of diabetes, higher levels of glycated hemoglobin (HbA1c) and fasting glucose, papillary excavation ≥ 0.5, and among individuals in older age group. Using the log-binomial regression model, diabetes duration > 24 months and HbA1c ≥ 6.5% were significantly associated with the occurrence of DR. CONCLUSIONS The presence of DR (19.3%) in Xavante Indians is an alert for health care providers for this population, since diabetes is a new disease among them. Its association with disease duration, high levels of HbA1c and blood glucose calls attention for the necessity of more actions to improve diabetes control in this recently contacted ethnic group that needs particular attention.
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Affiliation(s)
- Carlos Gustavo M. G. Lima
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes, 3900, Ribeirão Preto, SP 14049-900 Brazil
| | - Laercio Joel Franco
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP 14049-900 Brazil
| | - Amaury L. Dal Fabbro
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP 14049-900 Brazil
| | - Edson Z. Martinez
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP 14049-900 Brazil
| | | | | | - Leonardo Prevelato
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes, 3900, Ribeirão Preto, SP 14049-900 Brazil
| | - Antonio Augusto V. Cruz
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes, 3900, Ribeirão Preto, SP 14049-900 Brazil
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Wang B, Yu J, Wang T, Shen Y, Lin D, Xu X, Wang Y. Identification of megakaryocytes as a target of advanced glycation end products in diabetic complications in bone marrow. Acta Diabetol 2018; 55:419-427. [PMID: 29417230 DOI: 10.1007/s00592-018-1109-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 01/17/2018] [Indexed: 10/18/2022]
Abstract
AIMS To define the possible effect of diabetic conditions on megakaryocytes, the long-know precursors of platelets and lately characterized modulator of hematopoietic stem quiescence-activation transition. METHODS Megakaryoblastic MEG-01 cell culture and TPO/SCF/IL-3-induced differentiation of human umbilical blood mononuclear cells toward megakaryocytes were used to test effects of glycated bovine serum albumin (BSA-AGEs). The ob/ob mice and streptozotocin-treated mice were used as models of hyperglycemia. MTT was used to measure cell proliferation, FACS for surface marker and cell cycle, and RT-qPCR for the expression of interested genes. Megakaryocytes at different stages in marrow smear were checked under microscope. RESULTS When added in MEG-01 cultures at 200 μg/ml, BSA-AGEs increased proliferation of cells and enhanced mRNA expression of RAGE, VEGFα and PF4 in the cells. None of cell cycle distribution, PMA-induced platelet-like particles production, expression of GATA1/NF-E2/PU-1/IL-6/OPG/PDGF in MEG-01 cells nor TPO/SCF/IL-3 induced umbilical cord blood cells differentiation into megakaryocyte was affected by BSA-AGEs. In the ob/ob diabetic mice, MKs percentages in marrow cells and platelets in peripheral blood were significantly increased compared with control mice. In streptozotocin-induced diabetic mice, however, MKs percentage in marrow cells was decreased though peripheral platelet counts were not altered. Gene expression assay showed that the change in MKs in these two diabetic conditions might be explained by the alteration of GATA1 and NF-E2 expression, respectively. CONCLUSIONS Diabetic condition in animals might exert its influence on hematopoiesis via megakaryocytes-the newly identified modulator of hematopoietic stem cells in bone marrow.
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Affiliation(s)
- Benfang Wang
- MOH Key Lab of Thrombosis and Hemostasis, Collaborative Innovation Center of Hematology-Thrombosis and Hemostasis Group, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Soochow University, 708 Renmin Road, Suzhou, 215007, China
| | - Jianjiang Yu
- Department of Clinical Laboratory, The Affiliated Jiangyin Hospital of Southeast University, Jiangyin, 214400, China
| | - Ting Wang
- MOH Key Lab of Thrombosis and Hemostasis, Collaborative Innovation Center of Hematology-Thrombosis and Hemostasis Group, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Soochow University, 708 Renmin Road, Suzhou, 215007, China
| | - Ying Shen
- MOH Key Lab of Thrombosis and Hemostasis, Collaborative Innovation Center of Hematology-Thrombosis and Hemostasis Group, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Soochow University, 708 Renmin Road, Suzhou, 215007, China
| | - Dandan Lin
- MOH Key Lab of Thrombosis and Hemostasis, Collaborative Innovation Center of Hematology-Thrombosis and Hemostasis Group, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Soochow University, 708 Renmin Road, Suzhou, 215007, China
| | - Xin Xu
- Department of Hematology, The Affiliated Jiangyin Hospital of Southeast University, Jiangyin, 214400, China
| | - Yiqiang Wang
- MOH Key Lab of Thrombosis and Hemostasis, Collaborative Innovation Center of Hematology-Thrombosis and Hemostasis Group, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Soochow University, 708 Renmin Road, Suzhou, 215007, China.
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Crowshoe L, Dannenbaum D, Green M, Henderson R, Hayward MN, Toth E. Type 2 Diabetes and Indigenous Peoples. Can J Diabetes 2018; 42 Suppl 1:S296-S306. [DOI: 10.1016/j.jcjd.2017.10.022] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Indexed: 12/16/2022]
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Gurney JK, Stanley J, York S, Rosenbaum D, Sarfati D. Risk of lower limb amputation in a national prevalent cohort of patients with diabetes. Diabetologia 2018; 61:626-635. [PMID: 29101423 DOI: 10.1007/s00125-017-4488-8] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 10/09/2017] [Indexed: 10/18/2022]
Abstract
AIMS/HYPOTHESIS Lower limb amputation is a serious complication of diabetes mellitus. Understanding how amputation risk differs by population subgroups is crucial in terms of directing preventive strategies. In this study, we describe those factors that impact amputation risk in the entire prevalent diabetic population of New Zealand. METHODS A national prevalent cohort of 217,207 individuals with diabetes in 2010 were followed up until the end of 2013 for lower limb amputations, and 2014 for mortality. Inpatient hospitalisation data were used to define lower limb amputation using ICD-10 codes. Cox proportional hazards models were used to describe relative hazard of amputation over the follow-up period. RESULTS A total of 784 individuals (3.6 cases/1000 individuals) underwent a major (above-ankle) lower limb amputation during follow-up, while 1217 (5.6/1000) underwent a minor (below ankle) amputation. The risk of major and minor amputation was 39% and 77% greater for men than women, respectively (adjusted HR: major amputation 1.39, 95% CI 1.20, 1.61; minor amputation 1.77, 95% CI 1.56, 2.00). Indigenous Māori were at 65% greater risk of above-knee amputation compared with the European/Other diabetic population (HR 1.65, 95% CI 1.37, 1.97). Amputation risk increased with increasing comorbidity burden, and peripheral vascular disease conferred the greatest independent risk of all comorbid conditions. Prior minor amputation increased the risk of subsequent major amputation by tenfold (HR 10.04, 95% CI 7.83, 12.87), and increased the risk of another minor amputation by 20-fold (HR 21.39, 95% CI 17.89, 25.57). Death was common among the total cohort, but particularly among those who underwent amputation, with more than half of those who underwent a major amputation dying within 3 years of their procedure (57%). CONCLUSIONS/INTERPRETATION Using a large, well-defined, national prevalent cohort of people with diabetes, we found that being male, indigenous Māori, living in deprivation, having a high comorbidity burden and/or having a previous amputation were strongly associated with subsequent risk of lower limb amputation. The use of this prevalent cohort strengthens the value of our estimates in terms of applicability to the general population, and highlights the subgroups at greatest risk of lower limb amputation.
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Affiliation(s)
- Jason K Gurney
- Cancer and Chronic Conditions (C3) Research Group, Department of Public Health, University of Otago, 23a Mein St, Newtown, Wellington, New Zealand.
| | - James Stanley
- Cancer and Chronic Conditions (C3) Research Group, Department of Public Health, University of Otago, 23a Mein St, Newtown, Wellington, New Zealand
| | - Steve York
- High Risk Foot Clinic, Northland District Health Board, Whangarei, New Zealand
| | - Dieter Rosenbaum
- Movement Analysis Lab, University Hospital Muenster, Muenster, Germany
| | - Diana Sarfati
- Cancer and Chronic Conditions (C3) Research Group, Department of Public Health, University of Otago, 23a Mein St, Newtown, Wellington, New Zealand
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Huria T, Palmer S, Beckert L, Williman J, Pitama S. Inequity in dialysis related practices and outcomes in Aotearoa/New Zealand: a Kaupapa Māori analysis. Int J Equity Health 2018; 17:27. [PMID: 29458366 PMCID: PMC5819180 DOI: 10.1186/s12939-018-0737-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 02/04/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Aotearoa/New Zealand, Māori, as the indigenous people, experience chronic kidney disease at three times the rate of non-Māori, non-Pacific New Zealanders. Māori commence dialysis treatment for end-stage kidney disease at three times the rate of New Zealand European adults. To examine for evidence of inequity in dialysis-related incidence, treatment practices, and survival according to indigeneity in Aotearoa/New Zealand, utilising a Kaupapa Māori approach. METHODS We conducted a retrospective cohort study involving adults who commenced treatment for end-stage kidney disease in Aotearoa/New Zealand between 2002 and 2011. We extracted data from the Australian and New Zealand Dialysis and Transplant Registry (ANZDATA) linked to the New Zealand National Health Index (NHI). Propensity score methods were used to assemble a cohort of 1039 Māori patients matched 1:1 on clinical and socio-demographic characteristics with a cohort of 1026 non-Māori patients. We compared incidence of end-stage kidney disease and treatment practices. Differences in the risks of all-cause mortality during treatment between propensity-matched cohorts were estimated using Cox proportional hazards and generalised linear models. RESULTS Non-Māori patients were older, more frequently lived in urban areas (83% versus 67% [standardised difference 0.38]) and bore less socioeconomic deprivation (36% living in highest decile areas versus 14% [0.53]). Fewer non-Māori patients had diabetes (35% versus 69%, [- 0.72]) as a cause of kidney failure. Non-Māori patients were more frequently treated with peritoneal dialysis (34% versus 29% [0.11]), received a pre-emptive kidney transplant (4% vs 1% [0.19]), and were referred to specialist care < 3 months before treatment (25% vs 19% [0.15]) than Māori patients. Fewer non-Māori started dialysis with a non-tunnelled dialysis vascular catheter (43% versus 47% [- 0.08]). The indigenous-age standardised incidence rate ratio for non-Māori commencing renal replacement therapy in 2011 was 0.50 (95% CI, 0.40-0.61) compared with Māori. Propensity score matching generated cohorts with similar characteristics, although non-Māori less frequently started dialysis with a non-tunnelled venous catheter (30% versus 47% [- 0.35]) or lived remotely (3% versus 14% [- 0.50]). In matched cohorts, non-Māori experienced lower all-cause mortality at 5 yr. after commencement of treatment (risk ratio 0.78, 95% CI 0.72-0.84). New Zealand European patients experienced lower mortality than Māori patients in indigenous age-standardised analyses (age-standardised mortality rate ratio 0.58, 95% CI 0.51-0.67). CONCLUSIONS Non-Māori patients are treated with temporary dialysis vascular access less often than Māori, and experience longer life expectancy with dialysis, even when socioeconomic, demographic, and geographical factors are equivalent. Based on these disparities, health services should monitor and address inequitable treatment practices and outcomes in end-stage kidney disease care.
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Affiliation(s)
- Tania Huria
- Māori and Indigenous Health Institute, University of Otago Christchurch, 2 Riccarton Ave, Christchurch, 8140, New Zealand.
| | - Suetonia Palmer
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Lutz Beckert
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Jonathan Williman
- Department of Population Health, University of Otago Christchurch, Christchurch, New Zealand
| | - Suzanne Pitama
- Māori and Indigenous Health Institute, University of Otago Christchurch, 2 Riccarton Ave, Christchurch, 8140, New Zealand
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Pedersen ML. Microvascular complications in Nuuk, Greenland, among Greenlanders and non-Greenlanders diagnosed with type 2 diabetes. Diabetes Res Clin Pract 2018; 136:1-6. [PMID: 29199001 DOI: 10.1016/j.diabres.2017.11.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 11/21/2017] [Accepted: 11/28/2017] [Indexed: 10/18/2022]
Abstract
AIM The objective of this study was to estimate and compare between Greenlanders and non-Greenlanders living in Nuuk the proportion of patients with type 2 diabetes with microvascular complications. METHODS This study was performed as a cross-sectional register study based on information in the Electronic Medical Record (EMR). All patients diagnosed with type 2 diabetes and with permanent addresses in Nuuk were included. Patients born in Greenland were considered to be Greenlanders, while patients born outside Greenland were considered as non-Greenlanders. Proportions of patients with retinopathy, microalbuminuria, nephropathy and neuropathy were estimated based on information from the EMR. RESULTS A total of 393 patients (295 Greenlanders and 98 non-Greenlanders) were included. In total 83.0% of all patients have been screened for retinopathy, while 66.4% were screened for microalbuminuria and 64.6% for neuropathy within a two year period. The most frequent microvascular complication was neuropathy, which was observed among half (49.6%) of all patients followed by microalbuminuria (28.4%), retinopathy (10.7%) and nephropathy (7.3%). Retinopathy was observed among 21.4% of the non-Greenlanders compared to only 7.0% of the Greenlanders (p = .001). Microalbuminuria was also observed more frequently (p = .047) among non-Greenlanders (37.5%) than among Greenlanders (24.9%). CONCLUSION Greenlanders seem to be less prone to especially retinopathy than are non-Greenlanders.
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Affiliation(s)
- Michael Lynge Pedersen
- Queen Ingrid Primary Health Care Center, Nuuk, Greenland; Greenland center of Health Research, Institute of Nursing and Health Science, University of Greenland, Nuuk, Greenland.
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The hefty fetal phenotype hypothesis revisited: high birth weight, type 2 diabetes and gestational diabetes in a Saskatchewan cohort of First Nations and non-First Nations women. J Dev Orig Health Dis 2017; 10:48-54. [DOI: 10.1017/s2040174417000988] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Although low birth weight (LBW) increases the risk for type 2 diabetes (T2DM), the relationship between high birth weight (HBW) and T2DM is less definitive and largely confined to North American Indigenous populations. We re-examined the relationship between LBW (<2500 g) and HBW (>4000 g) and both T2DM and gestational diabetes (GDM) among First Nations and non-First Nations women in Saskatchewan. We analyzed new data for female subjects from a 2001 case-control study that led to our hefty fetal phenotype hypothesis. Using survival analysis techniques and a validated algorithm for identifying diabetes in health care administrative data, we followed a 1950–1984 birth cohort of 2003 women until March 31, 2013. Cox regression analysis determined the time to occurrence of first episode of GDM and diagnosis of T2DM by birth weight and ethnicity. First Nations women with HBW demonstrated a greater risk for developing both T2DM [hazard ratios (HR) 1.568; 95% confidence interval (CI) 1.188, 2.069] and GDM (HR 1.468; 95% CI 1.016, 2.121) than those with normal birth weight (NBW). Non-First Nations women with LBW had a greater risk of developing GDM than those with NBW (HR 1.585; 95% CI 1.001, 2.512). HBW is a risk factor for GDM and T2DM among First Nations women. This is likely due to exposure of these women to their own mothers’ diabetic pregnancies or gestational impaired glucose tolerance. This inter-generational amplification of T2DM risk mediated throughprenatalexposures appears to play a substantial role in the epidemic of T2DM among First Nations peoples.
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Hooper P, Boucher MC, Cruess A, Dawson KG, Delpero W, Greve M, Kozousek V, Lam WC, Maberley DAL. Excerpt from the Canadian Ophthalmological Society evidence-based clinical practice guidelines for the management of diabetic retinopathy. Can J Ophthalmol 2017; 52 Suppl 1:S45-S74. [PMID: 29074014 DOI: 10.1016/j.jcjo.2017.09.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Philip Hooper
- Philip Hooper, London, ON (Chair) (retina and uveitis); Marie Carole Boucher, Montreal, QC (retina and teleophthalmology); Alan Cruess, Halifax, NS (retina); Keith G. Dawson, Vancouver, BC (endocrinology); Walter Delpero, Ottawa, ON (cataract and strabismus); Mark Greve, Edmonton, AB (retina and teleophthalmology); Vladimir Kozousek, Halifax, NS (medical retina); Wai-Ching Lam, Toronto, ON (retina and research); David A.L. Maberley, Vancouver, BC (retina)..
| | - Marie Carole Boucher
- Philip Hooper, London, ON (Chair) (retina and uveitis); Marie Carole Boucher, Montreal, QC (retina and teleophthalmology); Alan Cruess, Halifax, NS (retina); Keith G. Dawson, Vancouver, BC (endocrinology); Walter Delpero, Ottawa, ON (cataract and strabismus); Mark Greve, Edmonton, AB (retina and teleophthalmology); Vladimir Kozousek, Halifax, NS (medical retina); Wai-Ching Lam, Toronto, ON (retina and research); David A.L. Maberley, Vancouver, BC (retina)
| | - Alan Cruess
- Philip Hooper, London, ON (Chair) (retina and uveitis); Marie Carole Boucher, Montreal, QC (retina and teleophthalmology); Alan Cruess, Halifax, NS (retina); Keith G. Dawson, Vancouver, BC (endocrinology); Walter Delpero, Ottawa, ON (cataract and strabismus); Mark Greve, Edmonton, AB (retina and teleophthalmology); Vladimir Kozousek, Halifax, NS (medical retina); Wai-Ching Lam, Toronto, ON (retina and research); David A.L. Maberley, Vancouver, BC (retina)
| | - Keith G Dawson
- Philip Hooper, London, ON (Chair) (retina and uveitis); Marie Carole Boucher, Montreal, QC (retina and teleophthalmology); Alan Cruess, Halifax, NS (retina); Keith G. Dawson, Vancouver, BC (endocrinology); Walter Delpero, Ottawa, ON (cataract and strabismus); Mark Greve, Edmonton, AB (retina and teleophthalmology); Vladimir Kozousek, Halifax, NS (medical retina); Wai-Ching Lam, Toronto, ON (retina and research); David A.L. Maberley, Vancouver, BC (retina)
| | - Walter Delpero
- Philip Hooper, London, ON (Chair) (retina and uveitis); Marie Carole Boucher, Montreal, QC (retina and teleophthalmology); Alan Cruess, Halifax, NS (retina); Keith G. Dawson, Vancouver, BC (endocrinology); Walter Delpero, Ottawa, ON (cataract and strabismus); Mark Greve, Edmonton, AB (retina and teleophthalmology); Vladimir Kozousek, Halifax, NS (medical retina); Wai-Ching Lam, Toronto, ON (retina and research); David A.L. Maberley, Vancouver, BC (retina)
| | - Mark Greve
- Philip Hooper, London, ON (Chair) (retina and uveitis); Marie Carole Boucher, Montreal, QC (retina and teleophthalmology); Alan Cruess, Halifax, NS (retina); Keith G. Dawson, Vancouver, BC (endocrinology); Walter Delpero, Ottawa, ON (cataract and strabismus); Mark Greve, Edmonton, AB (retina and teleophthalmology); Vladimir Kozousek, Halifax, NS (medical retina); Wai-Ching Lam, Toronto, ON (retina and research); David A.L. Maberley, Vancouver, BC (retina)
| | - Vladimir Kozousek
- Philip Hooper, London, ON (Chair) (retina and uveitis); Marie Carole Boucher, Montreal, QC (retina and teleophthalmology); Alan Cruess, Halifax, NS (retina); Keith G. Dawson, Vancouver, BC (endocrinology); Walter Delpero, Ottawa, ON (cataract and strabismus); Mark Greve, Edmonton, AB (retina and teleophthalmology); Vladimir Kozousek, Halifax, NS (medical retina); Wai-Ching Lam, Toronto, ON (retina and research); David A.L. Maberley, Vancouver, BC (retina)
| | - Wai-Ching Lam
- Philip Hooper, London, ON (Chair) (retina and uveitis); Marie Carole Boucher, Montreal, QC (retina and teleophthalmology); Alan Cruess, Halifax, NS (retina); Keith G. Dawson, Vancouver, BC (endocrinology); Walter Delpero, Ottawa, ON (cataract and strabismus); Mark Greve, Edmonton, AB (retina and teleophthalmology); Vladimir Kozousek, Halifax, NS (medical retina); Wai-Ching Lam, Toronto, ON (retina and research); David A.L. Maberley, Vancouver, BC (retina)
| | - David A L Maberley
- Philip Hooper, London, ON (Chair) (retina and uveitis); Marie Carole Boucher, Montreal, QC (retina and teleophthalmology); Alan Cruess, Halifax, NS (retina); Keith G. Dawson, Vancouver, BC (endocrinology); Walter Delpero, Ottawa, ON (cataract and strabismus); Mark Greve, Edmonton, AB (retina and teleophthalmology); Vladimir Kozousek, Halifax, NS (medical retina); Wai-Ching Lam, Toronto, ON (retina and research); David A.L. Maberley, Vancouver, BC (retina)
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Marushka L, Batal M, Sharp D, Schwartz H, Ing A, Fediuk K, Black A, Tikhonov C, Chan HM. Fish consumption is inversely associated with type 2 diabetes in Manitoba First Nations communities. Facets (Ott) 2017. [DOI: 10.1139/facets-2017-0023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Consumption of fish and n-3 fatty acids (n-3 FAs) has been postulated to prevent type 2 diabetes (T2D).Objective: To explore the association between self-reported T2D and fish consumption, dietary n-3 FAs, and persistent organic pollutants (POP) intake in a regionally representative sample of First Nations (FNs) in Manitoba.Design: Data from the cross-sectional First Nations Food, Nutrition and Environment Study (FNFNES) collected from 706 members of 8 Manitoba FNs in 2010 were used. Household interviews were used to collect social and lifestyle data. The consumption of fish was estimated using a traditional food frequency questionnaire. Fish samples were analyzed for the presence of POP. Multiple logistic regression models adjusted for potential risk factors for T2D were developed.Results: A negative, dose–response relationship was found between fish intake and self-reported T2D. Fish consumptions of 2–3 portions per month and ≥1/week were inversely associated with T2D with odds ratio (OR) values of 0.51 (95% CI: 0.28–0.91) and 0.40 (95% CI: 0.19–0.82), respectively, compared with no fish intake. Similarly, intake of n-3 FAs was negatively associated with T2D (OR = 0.48 (95% CI: 0.30–0.77). Dietary POP intake was not associated with T2D.Conclusion: These findings suggest that the consumption of traditionally harvested fish may have a beneficial effect on T2D in Manitoba FNs.
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Affiliation(s)
- Lesya Marushka
- Biology Department, University of Ottawa, 180 Gendron Hall, 30 Marie Curie, Ottawa, ON K1N 6N5, Canada
| | - Malek Batal
- Nutrition Department, Faculty of Medicine, Université de Montréal, Pavillon Liliane de Stewart, 2405 Côte-Sainte-Catherine Street, Montreal, QC H3T 1A8, Canada
| | - Donald Sharp
- Assembly of First Nations, 55 Metcalfe St #1600, Ottawa, ON K1P 6L5, Canada
| | - Harold Schwartz
- Health Canada, Environmental Public Health Division, First Nations and Inuit Health Branch (FNIHB), Room 2000A Jeanne Mance Bldg. AL 1920A, Tunney’s Pasture, Ottawa, ON K1A 0K9, Canada
| | - Amy Ing
- Nutrition Department, Faculty of Medicine, Université de Montréal, Pavillon Liliane de Stewart, 2405 Côte-Sainte-Catherine Street, Montreal, QC H3T 1A8, Canada
| | - Karen Fediuk
- Dietitian and Nutrition Researcher, Ladysmith, BC, Canada
| | - Andrew Black
- Assembly of First Nations, 55 Metcalfe St #1600, Ottawa, ON K1P 6L5, Canada
| | - Constantine Tikhonov
- Health Canada, Environmental Public Health Division, First Nations and Inuit Health Branch (FNIHB), Room 2000A Jeanne Mance Bldg. AL 1920A, Tunney’s Pasture, Ottawa, ON K1A 0K9, Canada
| | - Hing Man Chan
- Biology Department, University of Ottawa, 180 Gendron Hall, 30 Marie Curie, Ottawa, ON K1N 6N5, Canada
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Vanstone M, Rewegan A, Brundisini F, Giacomini M, Kandasamy S, DeJean D. Diet modification challenges faced by marginalized and nonmarginalized adults with type 2 diabetes: A systematic review and qualitative meta-synthesis. Chronic Illn 2017; 13:217-235. [PMID: 27884930 DOI: 10.1177/1742395316675024] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives Diet modification is an important part of the prevention and treatment of type 2 diabetes, but sustained dietary change remains elusive for many individuals. This paper describes and interprets the barriers to diet modification from the perspective of people with type 2 diabetes, paying particular attention to the experiences of people who experience social marginalization. Methods A systematic review of primary, empirical qualitative research was performed, capturing 120 relevant studies published between 2002 and 2015. Qualitative meta-synthesis was used to provide an integrative analysis of this knowledge. Results Due to the central role of food in social life, dietary change affects all aspects of a person's life, and barriers related to self-discipline, emotions, family and social support, social significance of food, and knowledge were identified. These barriers are inter-linked and overlapping. Social marginalization magnifies barriers; people who face social marginalization are trying to make the same changes as other people with diabetes with fewer socio-material resources in the face of greater challenges. Discussion A social-ecological model of behavior supports our findings of challenges at all levels, and highlights the need for interventions and counseling strategies that address the social and environmental factors that shape and sustain dietary change.
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Affiliation(s)
- Meredith Vanstone
- 1 Department of Family Medicine, McMaster University, Hamilton, ON, Canada.,2 Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada
| | - Alex Rewegan
- 3 MA Program in Social Anthropology, York University, Hamilton, ON, Canada
| | - Francesca Brundisini
- 2 Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada.,4 Health Policy PhD Program, McMaster University, Hamilton, ON, Canada
| | - Mita Giacomini
- 2 Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada.,5 Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Sujane Kandasamy
- 5 Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Deirdre DeJean
- 2 Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada.,5 Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
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Breastfeeding Initiation Associated With Reduced Incidence of Diabetes in Mothers and Offspring. Obstet Gynecol 2017; 128:1095-1104. [PMID: 27741196 DOI: 10.1097/aog.0000000000001689] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To examine associations between breastfeeding initiation and subsequent diabetes among First Nations (indigenous people in Canada who are not Métis or Inuit) and non-First Nations mothers and their offspring with and without gestational diabetes mellitus (GDM). METHODS This retrospective database study included 334,553 deliveries (1987-2011) in Manitoba with up to 24 years of follow-up for diabetes using population-based databases. Information of breastfeeding initiation before hospital discharge was obtained from hospital abstracts recorded by nurses in postpartum wards. Cox proportional hazard models were applied to examine the association between breastfeeding initiation and risk of diabetes in mothers and their offspring. RESULTS Breastfeeding initiation was recorded in 83% of non-First Nations mothers and 56% of First Nations mothers (P<.001). Breastfeeding initiation was associated with a reduced risk of incident (later developed) diabetes in non-First Nations mothers without GDM (hazard ratio [HR] 0.73 [or -27% of risk], 95% confidence interval [CI] 0.68-0.79), non-First Nations mothers with GDM (HR 0.78 or -22% of risk, CI 0.69-0.89), First Nations mothers without GDM (HR 0.89 or -11% of risk, CI 0.81-0.98), and First Nations mothers with GDM (HR 0.82 or -18% of risk, CI 0.73-0.92) with 24 years of follow-up or less. With 24 years of follow-up or less, breastfeeding initiation was associated with a 17% lower risk of youth-onset type 2 diabetes in offspring (HR 0.83, CI 0.69-0.99, P=.038). The association between breastfeeding initiation and subsequent diabetes in mothers and offspring was independent of family income, rural residence, First Nations status, GDM, parity, gestational hypertension, and age of the mother. CONCLUSION Breastfeeding initiation is associated with a reduced risk of diabetes among women and their offspring in Manitoba. The results suggest that breastfeeding might be a potentially modifiable factor to reduce the risk of diabetes in both First Nations and non-First Nations women and children.
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Tsai CY, Wen SY, Cheng SY, Wang CH, Yang YC, Viswanadha VP, Huang CY, Kuo WW. Nrf2 Activation as a Protective Feedback to Limit Cell Death in High Glucose-Exposed Cardiomyocytes. J Cell Biochem 2017; 118:1659-1669. [PMID: 27859591 DOI: 10.1002/jcb.25785] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 11/07/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Cheng-Yen Tsai
- Department of Pediatrics; China Medical University Beigang Hospital; Yunlin 651 Taiwan,ROC
- School of Chinese Medicine; College of Chinese Medicine; China Medical University; Taichung 40402 Taiwan
| | - Su-Ying Wen
- Department of Dermatology; Taipei City Hospital; Renai Branch; Taipei Taiwan
- Center for General Education; Mackay Junior College of Medicine; Nursing, and Management; Taipei Taiwan
| | - Shi-Yann Cheng
- Department of Medical Education and Research and Department of Obstetrics and Gynecology; China Medical University Beigang Hospital; Yunlin 651 Taiwan,ROC
- Department of Obstetrics and Gynecology; China Medical University An Nan Hospital; Yunlin 651 Taiwan,ROC
- Obstetrics and Gynecology; School of Medicine; China Medical University; Taichung Taiwan
| | - Chung-Hsing Wang
- Department of Pediatrics; China Medical University Hospital; Taichung 404 Taiwan,ROC
| | - Yao-Chih Yang
- Department of Biological Science and Technology; College of Biopharmaceutical and Food Sciences; China Medical University; Taichung 404 Taiwan,ROC
| | | | - Chih-Yang Huang
- Graduate Institute of Basic Medical Science; China Medical University; Taichung 404 Taiwan,ROC
- Department of Chinese Medicine; China Medical University Hospital; Taichung 404 Taiwan,ROC
- Department of Health and Nutrition Biotechnology; Asia University; Taichung 413 Taiwan,ROC
| | - Wei-Wen Kuo
- Department of Biological Science and Technology; College of Biopharmaceutical and Food Sciences; China Medical University; Taichung 404 Taiwan,ROC
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Hayward MN, Mequanint S, Paquette-Warren J, Bailie R, Chirila A, Dyck R, Green M, Hanley A, Tompkins J, Harris S. The FORGE AHEAD clinical readiness consultation tool: a validated tool to assess clinical readiness for chronic disease care mobilization in Canada's First Nations. BMC Health Serv Res 2017; 17:233. [PMID: 28335823 PMCID: PMC5364708 DOI: 10.1186/s12913-017-2175-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 03/18/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Given the astounding rates of diabetes and related complications, and the barriers to providing care present in Indigenous communities in Canada, intervention strategies that take into account contextual factors such as readiness to mobilize are needed to maximize improvements and increase the likelihood of success and sustainment. As part of the national FORGE AHEAD Program, we sought to develop, test and validate a clinical readiness consultation tool aimed at assessing the readiness of clinical teams working on-reserve in First Nations communities to participate in quality improvement (QI) to enhance diabetes care in Canada. METHODS A literature review was conducted to identify existing readiness tools. The ABCD - SAT was adapted using a consensus approach that emphasized a community-based participatory approach and prioritized the knowledge and wisdom held by community members. The tool was piloted with a group of 16 people from 7 provinces and 11 partnering communities to assess language use, clarity, relevance, format, and ease of completion using examples. Internal reliability analysis and convergence validity were conducted with data from 53 clinical team members from 11 First Nations communities (3-5 per community) who have participated in the FORGE AHEAD program. RESULTS The 27-page Clinical Readiness Consultation Tool (CRCT) consists of five main components, 21 sub-components, and 74 items that are aligned with the Expanded Chronic Care Model. Five-point Likert scale feedback from the pilot ranged from 3.25 to 4.5. Length of the tool was reported as a drawback but respondents noted that all the items were needed to provide a comprehensive picture of the healthcare system. Results for internal consistency showed that all sub-components except for two were within acceptable ranges (0.77-0.93). The Team Structure and Function sub-component scale had a moderately significant positive correlation with the validated Team Climate Inventory, r = 0.45, p < 0.05. CONCLUSIONS The testing and validation of the FORGE AHEAD CRCT demonstrated that the tool is acceptable, valid and reliable. The CRCT has been successfully used to support the implementation of the FORGE AHEAD Program and the health services changes that partnering First Nations communities have designed and undertaken to improve diabetes care. TRIAL REGISTRATION NUMBER Current ClinicalTrial.gov protocol ID NCT02234973 . Date of Registration: July 30, 2014.
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Affiliation(s)
- Mariam Naqshbandi Hayward
- Centre for Studies in Family Medicine, Western Centre for Public Health and Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond Street, London, Ontario, N6A 3K7, Canada.
| | - Selam Mequanint
- Centre for Studies in Family Medicine, Western Centre for Public Health and Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond Street, London, Ontario, N6A 3K7, Canada
| | - Jann Paquette-Warren
- Centre for Studies in Family Medicine, Western Centre for Public Health and Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond Street, London, Ontario, N6A 3K7, Canada
| | - Ross Bailie
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Alexandra Chirila
- Centre for Studies in Family Medicine, Western Centre for Public Health and Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond Street, London, Ontario, N6A 3K7, Canada
| | - Roland Dyck
- Canadian Center for Health and Safety in Agriculture, Department of Medicine, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Michael Green
- Departments of Family Medicine and Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Anthony Hanley
- Departments of Nutritional Sciences and Medicine and the Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Jordan Tompkins
- Centre for Studies in Family Medicine, Western Centre for Public Health and Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond Street, London, Ontario, N6A 3K7, Canada
| | - Stewart Harris
- Centre for Studies in Family Medicine, Western Centre for Public Health and Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond Street, London, Ontario, N6A 3K7, Canada
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Editorial. Cardiovasc Endocrinol 2017; 6:44. [PMID: 31646119 DOI: 10.1097/xce.0000000000000112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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