Awareness, treatment, and control of diabetes in Bangladesh : Evidence from the Bangladesh Demographic and Health Survey 2017/18

Background. The prevalence of diabetes is increasing in Bangladesh from ∼5% in 2001 to ∼13% in 2017/18 (∼8.4 million cases). The prevalence of undiagnosed diabetes was also found to be higher at 6% in 2017/18. However, very little is known about the management of diabetes assessed by diabetes awareness, treatment, and control. We aimed to estimate the age-standardised prevalence of awareness, treatment, and control of diabetes and its associated factors. Methods. Cross-sectional data from 1,174 Bangladeshi adults aged 18 years and older available from the most recent nationally representative Bangladesh Demographic and Health Survey (BDHS) 2017–18 were analysed. Outcomes were age-standardised prevalence of awareness, treatment, and control of diabetes, estimated using the direct standardisation. Multilevel mixed-effects Poisson regression models were used to identify factors associated with awareness, treatment, and control of diabetes. Results. Of the respondents we analysed, 30.9% (95% CI, 28.2–33.6) were aware that they had the condition, and 28.2% (95% CI, 25.6–30.7) were receiving treatment. Among those treated for diabetes, 26.5% (95% CI, 19.5–33.5) had controlled diabetes. The prevalence of diabetes awareness, treatment, and control was lower in men than women. Factors positively associated with awareness and treatment were increasing age and hypertension, while factors negatively associated with awareness and treatment were being men and lower education. Factors associated with poor control were secondary education and residing in Rajshahi and Rangpur divisions. Conclusions. This study provides evidence of poor management of diabetes in Bangladesh, especially in men. Less than one-third of the people with diabetes were aware of their condition. Just over one-fourth of the people with diabetes were on treatment, and among those who were treated only one-fourth had controlled diabetes. Interventions targeting younger people, in particular men and those with lower education, are urgently needed. Government policies that address structural factors including the cost of diabetes care and that strengthen diabetes management programmes within primary healthcare in Bangladesh are urgently needed

A unified Krylov-Bogoliubov-Mitropolskii method for solving hyperbolic-type nonlinear partial differential systems

A general asymptotic solution is presented for investigating the transient response of non-linear systems modeled by hyperbolic-type partial differential equations with small nonlinearities. The method covers all the cases when eigen-values of the corresponding unperturbed systems are real, complex conjugate, or purely imaginary. It is shown that by suitable substitution for the eigen-values in the general result that the solution corresponding to each of the three cases can be obtained. The method is an extension of the unified Krylov-Bogoliubov-Mitropolskii method, which was initially developed for un-darnped, under-clamped and over-clamped cases of the second order ordinary differential equation. The methods also cover a special condition of the over-damped case in which the general solution is useless

An Implicit Method for Numerical Solution of Singular and Stiff Initial Value Problems

An implicit method has been presented for solving singular initial value problems. The method is simple and gives more accurate solution than the implicit Euler method as well as the second order implicit Runge-Kutta (RK2) (i.e., implicit midpoint rule) method for some particular singular problems. Diagonally implicit Runge-Kutta (DIRK) method is suitable for solving stiff problems. But, the derivation as well as utilization of this method is laborious. Sometimes it gives almost similar solution to the two-stage third order diagonally implicit Runge-Kutta (DIRK3) method and the five-stage fifth order diagonally implicit Runge-Kutta (DIRK5) method. The advantage of the present method is that it is used with less computational effort.</jats:p

Prevalence of, and risk factors for, diabetes and prediabetes in Bangladesh : Evidence from the national survey using a multilevel Poisson regression model with a robust variance

To estimate the age-standardized prevalence of diabetes and prediabetes and identify factors associated with these conditions at individual, household, and community levels. Data from 11952 Bangladeshi adults aged 18–95 years available from the most recent Bangladesh Demographic and Health Survey 2017–18 were used. Anthropometric measurements and fasting blood glucose samples were taken as part of the survey. Prevalence estimates of diabetes and prediabetes were age-standardized with direct standardization, and risk factors were identified using multilevel mix-effects Poisson regression models with robust variance. The overall age-standardised prevalence of diabetes was 9.2% (95%CI 8.7–9.7) (men: 8.8%, women: 9.6%), and prediabetes was 13.3% (95%CI 12.7–13.9) (men: 13.0%, women: 13.6%). Among people with diabetes, 61.5% were unaware that they had the condition. 35.2% took treatment regularly, and only 30.4% of them had controlled diabetes. Factors associated with an increased prevalence of having diabetes were increasing age, male, overweight/obesity, hypertension, being in the highest wealth quintile, and living in the Dhaka division. People currently employed and living in the Rangpur division were less likely to have diabetes than those currently not employed and living in the Barishal division. Diabetes and prediabetes affect a substantial proportion (over one-quarter) of the Bangladeshi adult population. Continuing surveillance and effective prevention and control measures, focusing on obesity reduction and hypertension management, are urgently needed

Componentes fenólicos en aceites de oliva vírgenes monovarietales de Argelia

The high oxidative stability of virgin olive oil is related to its high monounsaturated/polyunsaturated ratio and to the presence of antioxidant compounds, such as tocopherols and phenols. In this paper, the isolation of phenolic compounds from virgin olive oil from several Algerian varieties was tested and discussed in order to know its potential uses and benefits. Quantification of phenolic and o-diphenolic substances was performed using the traditional Folin-Ciocalteau method and the sodium molybdate reaction, respectively. The qualitative and quantitative characterizations of phenolic compounds were carried out by HPLC. The experimental results show that tyrosol, hydroxytyrosol and 4-HBA (4-hydroxybenzoic acid) are the main individual phenolic compounds identified in the varieties studied. The varieties with large fruits (Grosse du Hamma, Aghenfas, Azeradj, Aguenaou, Aberkane, Bouchouk de Guergour, X-Aghenfas, Rougette de Guelma, Sigoise) are clearly distinguished from the varieties with medium-sized and small fruits by having the highest levels of individual phenolic compounds. Moreover, varieties with small fruits (Hamra, Chemlal, Boughenfas, Limli, Aimel and Mekki) presented the highest levels of oleuropein.La alta estabilidad oxidativa de los aceites de oliva vírgenes está relacionada con su alta relación de ácidos grasos monoinsaturados/poliinsaturados y con la presencia de componentes antioxidantes, como tocoferoles y polifenoles. En este trabajo se llevó acabo un aislamiento y cuantificación de compuestos fenólicos de aceites de oliva virgenes de variedades argelinas, con el fin de conocer sus potenciales usos y beneficios. La cuantificación de los componentes fenólicos y o-difenólicos se realizó por método tradicional de Folin-Ciocalteu y mediante la reacción con molibdato de sodio, respectivamente. Los compuestos fenólicos individuales cualitativos y cuantitativos en los extractos y en una mezcla estándar fueron determinados por HPLC. Los resultados experimentales muestran que el tirosol, hidroxitirosol y el 4-HBA (ácido 4-hidroxibenzoico) son los principales compuestos fenólicos individuales identificados en el conjunto de la población de las variedades estudiadas. Por otra parte, la población de las variedades con frutos grandes (Grosse du Hamma, Aghenfas, Azeradj, Aguenaou, Aberkane, Bouchouk de Guergour, X-Aghenfas, Rougette de Guelma, Sigoise) se distinguen claramente de las variedades con frutos medios y pequeños. Además, la población de variedades con frutos pequeños (Hamra, Chemlal, Boughenfas, Limli, Aimel y Mekki) presentó el nivel más alto en oleuropeína

General Versus Neuraxial Anesthesia for Appendectomy: A Multicenter International Study

Background: In resource-limited countries, open appendectomy is still performed under general anesthesia (GA) or neuraxial anesthesia (NA). We sought to compare the postoperative outcomes of appendectomy under NA versus GA. Methods: We conducted a post hoc analysis of the International Patterns of Opioid Prescribing (iPOP) multicenter study. All patients ≥ 16 years-old who underwent an open appendectomy between October 2016 and March 2017 in one of the 14 participating hospitals were included. Patients were stratified into two groups: NA—defined as spinal or epidural—and GA. All-cause morbidity, hospital length of stay (LOS), and pain severity were assessed using univariate analysis followed by multivariable logistic regression adjusting for the following preoperative characteristics: age, gender, body mass index (BMI), smoking, history of opioid use, emergency status, and country. Results: A total of 655 patients were included, 353 of which were in the NA group and 302 in the GA group. The countries operating under NA were Colombia (39%), Thailand (31%), China (23%), and Brazil (7%). Overall, NA patients were younger (mean age (SD): 34.5 (14.4) vs. 40.7 (17.9), p-value 3 days, OR, 95% CI: 0.47 [0.32–0.68]) compared to GA. There was no difference in postoperative pain severity between the two techniques. Conclusions: Open appendectomy performed under NA is associated with improved outcomes compared to that performed under GA. Further randomized controlled studies should examine the safety and value of NA in lower abdominal surgery. © 2021, Société Internationale de Chirurgie

Assessing performance of the Healthcare Access and Quality Index, overall and by select age groups, for 204 countries and territories, 1990-2019: a systematic analysis from the Global Burden of Disease Study 2019

Background: Health-care needs change throughout the life course. It is thus crucial to assess whether health systems provide access to quality health care for all ages. Drawing from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 (GBD 2019), we measured the Healthcare Access and Quality (HAQ) Index overall and for select age groups in 204 locations from 1990 to 2019. Methods: We distinguished the overall HAQ Index (ages 0–74 years) from scores for select age groups: the young (ages 0–14 years), working (ages 15–64 years), and post-working (ages 65–74 years) groups. For GBD 2019, HAQ Index construction methods were updated to use the arithmetic mean of scaled mortality-to-incidence ratios (MIRs) and risk-standardised death rates (RSDRs) for 32 causes of death that should not occur in the presence of timely, quality health care. Across locations and years, MIRs and RSDRs were scaled from 0 (worst) to 100 (best) separately, putting the HAQ Index on a different relative scale for each age group. We estimated absolute convergence for each group on the basis of whether the HAQ Index grew faster in absolute terms between 1990 and 2019 in countries with lower 1990 HAQ Index scores than countries with higher 1990 HAQ Index scores and by Socio-demographic Index (SDI) quintile. SDI is a summary metric of overall development. Findings: Between 1990 and 2019, the HAQ Index increased overall (by 19·6 points, 95% uncertainty interval 17·9–21·3), as well as among the young (22·5, 19·9–24·7), working (17·2, 15·2–19·1), and post-working (15·1, 13·2–17·0) age groups. Large differences in HAQ Index scores were present across SDI levels in 2019, with the overall index ranging from 30·7 (28·6–33·0) on average in low-SDI countries to 83·4 (82·4–84·3) on average in high-SDI countries. Similarly large ranges between low-SDI and high-SDI countries, respectively, were estimated in the HAQ Index for the young (40·4–89·0), working (33·8–82·8), and post-working (30·4–79·1) groups. Absolute convergence in HAQ Index was estimated in the young group only. In contrast, divergence was estimated among the working and post-working groups, driven by slow progress in low-SDI countries. Interpretation: Although major gaps remain across levels of social and economic development, convergence in the young group is an encouraging sign of reduced disparities in health-care access and quality. However, divergence in the working and post-working groups indicates that health-care access and quality is lagging at lower levels of social and economic development. To meet the needs of ageing populations, health systems need to improve health-care access and quality for working-age adults and older populations while continuing to realise gains among the young. Funding: Bill & Melinda Gates Foundation

The global burden of adolescent and young adult cancer in 2019 : a systematic analysis for the Global Burden of Disease Study 2019

Background In estimating the global burden of cancer, adolescents and young adults with cancer are often overlooked, despite being a distinct subgroup with unique epidemiology, clinical care needs, and societal impact. Comprehensive estimates of the global cancer burden in adolescents and young adults (aged 15-39 years) are lacking. To address this gap, we analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, with a focus on the outcome of disability-adjusted life-years (DALYs), to inform global cancer control measures in adolescents and young adults. Methods Using the GBD 2019 methodology, international mortality data were collected from vital registration systems, verbal autopsies, and population-based cancer registry inputs modelled with mortality-to-incidence ratios (MIRs). Incidence was computed with mortality estimates and corresponding MIRs. Prevalence estimates were calculated using modelled survival and multiplied by disability weights to obtain years lived with disability (YLDs). Years of life lost (YLLs) were calculated as age-specific cancer deaths multiplied by the standard life expectancy at the age of death. The main outcome was DALYs (the sum of YLLs and YLDs). Estimates were presented globally and by Socio-demographic Index (SDI) quintiles (countries ranked and divided into five equal SDI groups), and all estimates were presented with corresponding 95% uncertainty intervals (UIs). For this analysis, we used the age range of 15-39 years to define adolescents and young adults. Findings There were 1.19 million (95% UI 1.11-1.28) incident cancer cases and 396 000 (370 000-425 000) deaths due to cancer among people aged 15-39 years worldwide in 2019. The highest age-standardised incidence rates occurred in high SDI (59.6 [54.5-65.7] per 100 000 person-years) and high-middle SDI countries (53.2 [48.8-57.9] per 100 000 person-years), while the highest age-standardised mortality rates were in low-middle SDI (14.2 [12.9-15.6] per 100 000 person-years) and middle SDI (13.6 [12.6-14.8] per 100 000 person-years) countries. In 2019, adolescent and young adult cancers contributed 23.5 million (21.9-25.2) DALYs to the global burden of disease, of which 2.7% (1.9-3.6) came from YLDs and 97.3% (96.4-98.1) from YLLs. Cancer was the fourth leading cause of death and tenth leading cause of DALYs in adolescents and young adults globally. Interpretation Adolescent and young adult cancers contributed substantially to the overall adolescent and young adult disease burden globally in 2019. These results provide new insights into the distribution and magnitude of the adolescent and young adult cancer burden around the world. With notable differences observed across SDI settings, these estimates can inform global and country-level cancer control efforts. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.Peer reviewe

Pancreaticoduodenectomy in Trauma Patients with Grade IV-V Duodenal or Pancreatic Injuries: A Post Hoc Analysis of an EAST Multicenter Trial

INTRODUCTION: The utility of pancreaticoduodenectomy (PD) for high-grade traumatic injuries remains unclear and data surrounding its use are limited. We hypothesized that PD does not result in improved outcomes when compared with non-PD surgical management of grade IV-V pancreaticoduodenal injuries. METHODS: This is a retrospective, multicenter analysis from 35 level 1 trauma centers from January 2010 to December 2020. Included patients were ≥15 years of age with the American Association for the Surgery of Trauma grade IV-V duodenal and/or pancreatic injuries. The study compared operative repair strategy: PD versus non-PD. RESULTS: The sample (n=95) was young (26 years), male (82%), with predominantly penetrating injuries (76%). There was no difference in demographics, hemodynamics, or blood product requirement on presentation between PD (n=32) vs non-PD (n=63). Anatomically, PD patients had more grade V duodenal, grade V pancreatic, ampullary, and pancreatic ductal injuries compared with non-PD patients (all p CONCLUSION: While PD patients did not have worse hemodynamics or blood product requirements on admission, they sustained more complex anatomic injuries and had more GI complications and longer LOS than non-PD patients. We suggest that the role of PD should be limited to cases of massive destruction of the pancreatic head and ampullary complex, given the likely procedure-related morbidity and adverse outcomes when compared with non-PD management. LEVEL OF EVIDENCE: IV, Multicenter retrospective comparative study

Mitigating humanitarian crises during non-international armed conflicts:the role of human rights and ceasefire agreements

Situations of humanitarian crisis are often caused by armed conflicts. Given the prevalence of non-international armed conflicts today, ways of ameliorating these situations are at the forefront of concerns. The international humanitarian law rules governing non-international armed conflict remain much less developed than those for international armed conflicts. This is exacerbated by the lack of direct human rights obligations for non-state armed groups, which makes governing the behaviour of non-state parties to non-international armed conflicts (non-state armed groups) even more challenging. Although several initiatives have been taken to encourage non-state actors to mitigate situations of humanitarian crisis, the role of human rights law is in need of further clarification. The paper aims to assess what role human rights may have in improving humanitarian crises, suggesting one specific way: The paper will first discuss the international laws applicable to situations of non-international armed conflict, before critically analysing some of the initiatives that have already been taken to govern the behaviour of non-state armed groups. Part 3 will assess the possibility of using cease-fire agreements to impose specific human rights obligations on all parties to a non-international armed conflict. Finally, a conclusion will be drawn in Part 4 as to the role that human rights and ceasefire agreements could have during humanitarian crises