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.

Prevalence of undiagnosed diabetes and the relative importance of its risk factors among adults in Bangladesh: Findings from a nationwide survey.

AIM: To estimate the prevalence of undiagnosed diabetes, and to identify the relative importance of risk factors for undiagnosed diabetes among Bangladeshi adults. METHOD: Data from 11, 421 Bangladeshi adults aged 18 years and older available from the most recent nationally representative 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 undiagnosed diabetes was age-standardised with direct standarisation, and risk factors were identified using multilevel mix-effects Poisson regression models with robust variance. RESULTS: The overall age-standardised prevalence of undiagnosed diabetes was 6.0% (95 %CI, 5.5-6.4%) (men: 6.1%, women: 5.9%). Risk factors associated with undiagnosed diabetes were older age, elevated body mass index (BMI), highest wealth quintile, hypertension, and being male. The top two modifiable risk factors contributing over 50% to undiagnosed diabetes were BMI and wealth quintiles. CONCLUSION: Undiagnosed diabetes affects a substantial proportion of Bangladeshi adults. Since elevated BMI and the highest wealth quintile are strong risk factors, these offer an opportunity for early detection and screening to reduce undiagnosed diabetes in Bangladesh. In addition, wide-reaching awareness campaigns among the general public, clinicians, and policymakers are needed.

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.

The experiences of children and adolescents undergoing forced separation from their parents during migration: A systematic review.

Globally, the migration of unaccompanied minors is increasing, however, the experiences of these children have not been examined. We systematically synthesised the existing qualitative literature to examine the experiences of children undergoing forced separation from their parents during migration. The review was structured based on the PRISMA statement. A systematic search of Ovid MEDLINE, EMBASE, PsychINFO and Scopus databases from inception to November 23, 2020 was conducted to retrieve eligible studies. Only qualitative studies of children aged ≤18 years were reviewed. The data analysis and synthesis were informed by the intersectionality framework. The search yielded 10,956 studies of which eight were included in this review. Thematic analysis identified the following themes: unaccompanied minors experience a deep sense of loss; anxiety over the uncertainty of the migration process; difficulty adjusting to their new life in the host country and adverse health effects. These experiences were heightened by children's exposure to violence during migration. The intersectionality framework suggests that unaccompanied minors experience separation from their parents during migration in ways that marginalise them and widen inequalities. Migration processes need to be streamlined to provide integrated health, emotional, legal and educational supports for unaccompanied children with particular attention given to treating the trauma of past violence. More research is needed to explore how to facilitate the integration of unaccompanied children into host communities in ways that are healing and empowering.

Prevalence, awareness, treatment, and control of hypertension in Bangladesh: Findings from National Demographic and Health Survey, 2017-2018.

The purpose of this study was to estimate the age-standardised prevalence, awareness, treatment, and control of hypertension and to identify their risk factors in Bangladeshi adults. Data from 12 904 adults aged 18-95 years, available from the most recent nationally representative 2017-2018 Bangladesh Demographic and Health Survey were used. Hypertension was defined as having systolic blood pressure ≥140 mmHg and/or a diastolic blood pressure ≥90 mmHg, and/or taking anti-hypertensive drugs to control blood pressure. Age-standardized prevalence of hypertension and management were estimated with direct standardisation. A multilevel mixed-effects Poisson regression model with a robust variance was used to identify risk factors associated with hypertension and its awareness, treatment, and control. The overall age-standardized prevalence of hypertension was 26.2% (95% CI, 25.5-26.9); (men: 23.5%, women: 28.9%). Among those with hypertension (n = 3531), 36.7% were aware that they had the condition, and only 31.1% received anti-hypertensive medication. The prevalence of controlled hypertension was 12.7% among those with hypertension and 43.6% among those treated for hypertension (n = 1306). Factors independently associated with hypertension were increasing age, higher body mass index, being women, having diabetes, and residing in selected administrative divisions. A declining trend of hypertension control was observed with increasing age and low education. Hypertension is highly prevalent (one in four) in Bangladeshi adults, while awareness, treatment, and control are low. Irrespective of the risks associated with hypertension and its management, programs to increase its awareness, treatment, and control should be given high priority in reducing hypertension prevalence and improving hypertension control in Bangladesh.

Program Evaluation of the Inner South Community Health Oral Health Program for Priority Populations.

BACKGROUND: This study evaluated an Oral Health Program for Priority Populations (OHPPP) in the Inner South of Melbourne, Victoria. METHODS: Social Ecological Theory and the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework informed the study. It involved administering satisfaction questionnaires to 29 clients and conducting eight in-depth interviews and four focus group discussions with either clients, health care workers or partner agencies. RESULTS: Most (92%) clients surveyed felt more positive about their health as a result of the OHPPP. Three themes emerged from the qualitative analyses: 1) good oral health is central to improving general health; 2) the OHPPP is valuable; and 3) there are difficulties in implementing the OHPPP. CONCLUSIONS: Clients and service providers view the OHPPP as accessible and rewarding. Our findings point to the need for policies that recognise the greater treatment needs of disadvantaged populations and that streamline the provision of their dental care.

A focus group study investigating medical decision making in octogenarians of high socioeconomic status with successful outcomes following cardiac surgery.

AIM: To explore medical decision making in octogenarians having cardiac surgery. METHODS: Five focus groups conducted in a private hospital setting with octogenarians of high socioeconomic status who had successful cardiac surgery in the previous 3-13 months. RESULTS: Octogenarian's motivations for having cardiac surgery include survival, relief of symptoms, convenience and improving quality of life. The decision to have surgery involved clinical advice by doctors that the time had come to take up a surgical option. Patient's decisions did not take into account alternative treatment options either because these had not been presented by doctors or because medical management had failed. The final decision was made by patients. CONCLUSIONS: Decisions to have cardiac surgery in octogenarians are made by patients after discussions with family based on their risks as communicated by their doctors. This underlines the importance of effective risk communication by doctors to help patients make appropriate medical decisions.

Closing the gap in maternal and child health: a qualitative study examining health needs of migrant mothers in Dandenong, Victoria, Australia.

We conducted a qualitative study that explored the views and perceptions of migrant women in, Dandenong, Victoria, Australia about sociocultural barriers and health needs during pregnancy and in the postnatal period. The study was informed by the Social Identity Theory and the Acculturation Theory. It involved five focus group discussions with 35 migrant mothers from Afghanistan, Africa, China, Palestine, Lebanon, Syria, Iran and Jordan. Five themes emerged from the analysis: (1) the need for family support and complex social environments; (2) dealing with two cultural identities; (3) the health of mother and offspring; (4) access to the health system; and (5) life-skills for better health. Pregnancy and motherhood are challenges that are made more difficult by migration. The findings point towards the need for policies and interventions: (1) to reduce the negative impact of social isolation and lack of support during pregnancy and postnatally; (2) to support greater fathers' involvement in childcare; and (3) to reconcile different practices and expectations between traditional cultures and Australian norms. They also suggest a need to test culturally competent interventions that address health and lifestyle needs in migrant women and education programs for mothers that effectively address their concerns about maternal and child health.

Evaluating the impact of depression, anxiety & autonomic function on health related quality of life, vocational functioning and health care utilisation in acute coronary syndrome patients: the ADVENT study protocol.

BACKGROUND: Depression and anxiety are highly prevalent and co-morbid in acute coronary syndrome patients. Somatic and cognitive subtypes of depression and anxiety in acute coronary syndrome have been shown to be associated with mortality although their association with patient outcomes is unknown, as are the mechanisms that underpin these associations. We are conducting a prospective cohort study which aims to examine in acute coronary syndrome patients: (1) the role of somatic subtypes of depression and anxiety as predictors of health related quality of life outcomes; (2) how somatic subtypes of depression and anxiety relate to long term vocational functioning and healthcare utilisation; and (3) the role of the autonomic nervous system assessed by heart rate variability as a moderator of these associations. METHODS: Patients are being screened after index admission for acute coronary syndrome at a single, high volume centre, MonashHeart, Monash Health, Victoria, Australia. The inclusion criterion is all patients aged > 21 years old and fluent in English admitted to MonashHeart, Monash Health with a diagnosis of acute coronary syndrome. The primary outcome is mean health related quality of life (Short Form-36) Physical and Mental Health Summary scores at 12 and 24 months in subtypes with somatic symptoms of depression and anxiety. Depressive domains are assessed by the Beck Depression Inventory II and the Cardiac Depression Scale. Anxiety is measured using the Speilberger State-Trait Anxiety Inventory and the Crown Crisp Phobic Anxiety questionnaire. Secondary outcomes include clinical variables, healthcare service utilisation and vocational functioning. DISCUSSION: This manuscript presents the protocol for a prospective cohort study which will investigate the role of somatic subtypes of depression and anxiety as predictors of health related quality of life, long-term vocational functioning and health service use, and the role of the autonomic nervous system in moderating these associations. Findings from the study have the potential to inform more effective pharmacological, psychological and behavioural interventions and better guide health policy on the use of health care resources.

Urbanisation, urbanicity, and health: a systematic review of the reliability and validity of urbanicity scales.

BACKGROUND: Despite a plethora of studies examining the effect of increased urbanisation on health, no single study has systematically examined the measurement properties of scales used to measure urbanicity. It is critical to distinguish findings from studies that use surrogate measures of urbanicity (e.g. population density) from those that use measures rigorously tested for reliability and validity. The purpose of this study was to assess the measurement reliability and validity of the available urbanicity scales and identify areas where more research is needed to facilitate the development of a standardised measure of urbanicity. METHODS: Databases searched were MEDLINE with Full Text, CINAHL with Full Text, and PsycINFO (EBSCOhost) as well as Embase (Ovid) covering the period from January 1970 to April 2012. Studies included in this systematic review were those that focused on the development of an urbanicity scale with clearly defined items or the adoption of an existing scale, included at least one outcome measure related to health, published in peer-reviewed journals, the full text was available in English and tested for validity and reliability. RESULTS: Eleven studies met our inclusion criteria which were conducted in Sri Lanka, Austria, China, Nigeria, India and Philippines. They ranged in size from 3327 to 33,404 participants. The number of scale items ranged from 7 to 12 items in 5 studies. One study measured urban area socioeconomic disadvantage instead of urbanicity. The emerging evidence is that increased urbanisation is associated with deleterious health outcomes. It is possible that increased urbanisation is also associated with access and utilisation of health services. However, urbanicity measures differed across studies, and the reliability and validity properties of the used scales were not well established. CONCLUSION: There is an urgent need for studies to standardise measures of urbanicity. Longitudinal cohort studies to confirm the relationship between increased urbanisation and health outcomes are urgently needed.

A cohort study of osteoporosis health knowledge and medication use in older adults with minimal trauma fracture.

UNLABELLED: We measured osteoporosis knowledge in an older adult population with minimal trauma fracture. At follow-up, health literacy and osteoporosis knowledge had not changed significantly from baseline, and 14 (23 %) patients reported not taking any osteoporosis medication. Current osteoporosis care does not result in increased patient knowledge about their disease. INTRODUCTION: We aimed to measure health literacy and osteoporosis knowledge in an older adult population with minimal trauma fracture (MTF). METHODS: A cohort study with 3-month follow-up in Australia was conducted. Participants were hospital admissions with an MTF confirmed by X-ray. Main outcomes were the Rapid Estimate of Adult Literacy in Medicine (REALM) and Osteoporosis Knowledge Assessment Tool (OKAT) scores. Supplementary data about osteoporosis knowledge, medication use and family practitioner visits regarding osteoporosis were obtained. RESULTS: Complete data are available in 60 participants. On admission, 97 % participants had high REALM scores [mean (range) 64.7 (46.66)] and low OKAT scores [8.83 (2.16)]. At follow-up, three (5 %) participants had a further fracture. REALM and OKAT scores had not changed significantly from baseline. There was no association between OKAT score at follow-up and current treatment for osteoporosis, beliefs relating to treatment or bone health, and discussion with health care worker since discharge after adjusting for Mini Mental State Examination score. Health literacy or reading ability was not related to OKAT score. CONCLUSIONS: Osteoporosis knowledge assessed by the OKAT did not improve in the 3 months after MTF in this cohort of literate older adults, although there was some evidence of improvements in health beliefs. Current care in osteoporosis does not increase patient knowledge about their disease adequately which may impair patient effectiveness in obtaining appropriate treatment.

A nurse-assisted screening and referral program for depression among survivors of colorectal cancer: feasibility study.

OBJECTIVE: To test the feasibility and acceptability of a telephone-based program to screen survivors of colorectal cancer (CRC) for distress, and to refer distressed patients to their treating health service. DESIGN, SETTING AND PARTICIPANTS: A prospective, multicentre study involving 59 patients with CRC recruited from six public and private health services in Melbourne, Victoria, from 15 June 2008 to 22 September 2009. Patients who had completed adjuvant chemotherapy for CRC were contacted (7-10 days after recruitment [outcall one] and again 4 weeks later [outcall two]) by the Cancer Council Victoria's helpline nurse, and screened for distress with the Distress and Impact Thermometer (DIT); participants were given tailored information and support and those with distress scores of > or = 5, and impact scores of > or = 4, were referred for follow-up. Telephone interviews were conducted 4 weeks after outcall two. Participating helpline and health service staff were surveyed on the feasibility and acceptability of the service. MAIN OUTCOME MEASURE: Anxiety and depression, measured by the Hospital Anxiety and Depression Scale (HADS). RESULTS: Of the 59 patients (87%) who agreed to participate, 63% were men; their mean age was 59 years (SD, 9.5 years). HADS depression decreased significantly from baseline (mean score, 4.93; SD, 4.22) to follow-up (mean score, 3.84; SD, 4.10; Z = -2.375; P = 0.02). However, there was no significant difference in HADS anxiety between baseline (mean score, 5.29; SD, 4.11) and follow-up (mean score, 4.78; SD, 3.65). Outcall one generated two referrals (4% of participants) and outcall two generated four referrals (8%); five of these six participants took up the referrals. Satisfaction with the program among participants was high; 82% found outcall one "quite or very helpful" and 79% found outcall two "quite or very helpful". Helpline and health service staff reported a straightforward process that did not adversely affect workloads. CONCLUSION: This model of care carries the potential to meet ongoing psychosocial needs of survivors of CRC.

Randomised controlled trial evaluating lifestyle interventions in people with impaired glucose tolerance.

AIM: To evaluate the effectiveness of lifestyle interventions in people with impaired glucose tolerance (IGT). METHODS: Participants with IGT (n=78), diagnosed on two consecutive oral glucose tolerance tests (OGTTs), were randomly assigned to a 2-year lifestyle intervention or to a control group. Main outcome measures were changes from baseline in: nutrient intake; physical activity; anthropometry, glucose tolerance and insulin sensitivity. Measurements were repeated at 6, 12 and 24 months follow-up. RESULTS: After 24 months follow-up, there was a significant fall in total fat consumption (difference in change between groups (Delta intervention-Delta control)= -17.9, 95% confidence interval (CI) -33.6 to -2.1g/day) as a result of the intervention. Body mass was significantly lower in the intervention group compared with controls after 6 months (-1.6, 95% CI -2.9 to -0.4 kg) and 24 months (-3.3, 95% CI -5.7 to -0.89 kg). Whole body insulin sensitivity, assessed by the short insulin tolerance test (ITT), improved after 12 months in the intervention group (0.52, 95% CI 0.15-0.89%/min). CONCLUSIONS: These findings complement the findings of the Finnish Diabetes Prevention Study and the American Diabetes Prevention Study, both of which tested intensive interventions, by showing that pragmatic lifestyle interventions result in improvements in obesity and whole body insulin sensitivity in individuals with IGT, without change in other cardiovascular risk factors.