Mitochondrial complex I activity in microglia sustains neuroinflammation.

Sustained smouldering, or low-grade activation, of myeloid cells is a common hallmark of several chronic neurological diseases, including multiple sclerosis1. Distinct metabolic and mitochondrial features guide the activation and the diverse functional states of myeloid cells2. However, how these metabolic features act to perpetuate inflammation of the central nervous system is unclear. Here, using a multiomics approach, we identify a molecular signature that sustains the activation of microglia through mitochondrial complex I activity driving reverse electron transport and the production of reactive oxygen species. Mechanistically, blocking complex I in pro-inflammatory microglia protects the central nervous system against neurotoxic damage and improves functional outcomes in an animal disease model in vivo. Complex I activity in microglia is a potential therapeutic target to foster neuroprotection in chronic inflammatory disorders of the central nervous system3.

A stochastic model for topographically influenced cell migration.

Migrating cells traverse a range of topographic configurations presented by the native extracellular environment to conduct their physiologic functions. It is well documented cells can modulate their behaviour in response to different topographic features, finding promising applications in biomaterial and bioimplant design. It is useful, in these areas of research, to be able to predict which topographic arrangements could be used to promote certain patterns of migration prior to laboratory experimentation. Despite a profusion of study and interest shown in these fields by experimentalists, the related modelling literature is as yet relatively sparse and tend to focus more on either cell-matrix interaction or morphological responses of cells. We propose a mathematical model for individual cell migration based on an Ornstein-Uhlenbeck process, and set out to see if the model can be used to predict migration patterns on 2-d isotropic and anisotropic topographies, whose characteristics can be broadly described as either uniform flat, uniform linear with variable ridge density or non-uniform disordered with variable feature density. Results suggest the model is capable of producing realistic patterns of migration for flat and linear topographic patterns, with calibrated output closely approximating NIH3T3 fibroblast migration behaviour derived from an experimental dataset, in which migration linearity increased with ridge density and average speed was highest at intermediate ridge densities. Exploratory results for non-uniform disordered topographies suggest cell migration patterns may adopt disorderedness present in the topography and that 'distortion' introduced to linear topographic patterns may not impede linear guidance of migration, given its magnitude is bounded within certain limits. We conclude that an Ornstein-Uhlenbeck based model for topographically influenced migration may be useful to predict patterns of migration behaviour for certain isotropic (flat) and anisotropic (linear) topographies in the NIH3T3 fibroblast cell line, but additional investigation is required to predict with confidence migration patterns for non-uniform disordered topographic arrangements.

Effects of grass species and harvest date on cell wall components and feed efficiency of dairy cows.

There is a balance between DM yield and feed value when choosing types of grasses on a farm depending on the acreages of farmland and types of ruminants to be fed. Therefore, optimisation of the harvest strategy for grass silage is important for profitable dairy farming. Tall fescue has high DM yield and can replace traditional grasses, such as timothy, in Northern Europe in a changing climate as it has been shown to be more drought tolerant. As differences in climate responses previously have been related to differences in cell wall structure between grass species and, consequently, in digestibility, it is highly relevant to compare these species at similar maturity stages and to investigate if a very early harvest date will diminish potential differences between the species. This study evaluated the effects of harvest date and forage species on the concentration of hydroxycinnamic acids in silages and its relationship to feed efficiency of dairy cows. Tall fescue and timothy were harvested at very early date on May 25 or at early date on May 31 in the spring growth cycle. Forty lactating dairy cows were used in a block design. Cows received 1 of 4 treatments: (1) tall fescue harvested at very early date, (2) timothy harvested at very early date, (3) tall fescue harvested at early date, and (4) timothy harvested at early date. Diets were formulated to have the same forage-to-concentrate ratio (49:51 on DM basis). Tall fescue silages showed greater concentrations of DM, ash, and CP than timothy silages. Grasses harvested at early date showed greater concentrations of NDF, ADL, and cell wall than grasses harvested at very early date. Tall fescue silages showed greater concentration of p-coumaric acid and lower in vitro organic matter digestibility (IVOMD) compared to timothy silages. Milk production and composition were not affected by treatments but cows fed tall fescue-based diets showed lower milk protein yield and greater milk urea nitrogen than when timothy-based diets were fed. Furthermore, cows receiving timothy-based diets showed greater feed efficiency compared to cows receiving tall fescue-based diets. Thus, the lower concentration of p-coumaric acid and the higher IVOMD was associated with greater feed efficiency of cows fed timothy-based diets compared to tall fescue-based diets.

Beyond overlap: Considering habitat preference and fitness outcomes in the umbrella species concept.

Umbrella species and other surrogate-species approaches to conservation provide an appealing framework to extend the reach of conservation efforts beyond single species. For the umbrella species concept to be effective, populations of multiple species of concern must persist in areas protected on behalf of the umbrella species. Most assessments of the concept, however, focus exclusively on geographic overlap among umbrella and background species, and not measures that affect population persistence (e.g., habitat quality or fitness). We quantified the congruence between the habitat preferences and nesting success of a high-profile umbrella species (greater sage-grouse, Centrocercus urophasianus, hereafter "sage-grouse"), and three sympatric species of declining songbirds (Brewer's sparrow Spizella breweri, sage thasher Oreoscoptes montanus, and vesper sparrow Pooecetes gramineus) in central Wyoming, USA during 2012 - 2013. We used machine-learning methods to create data-driven predictions of sage-grouse nest-site selection and nest survival probabilities by modeling field-collected sage-grouse data relative to habitat attributes. We then used field-collected songbird data to assess whether high-quality sites for songbirds aligned with those of sage-grouse. Nest sites selected by songbirds did not coincide with sage-grouse nesting preferences, with the exception that Brewer's sparrows preferred similar nest sites to sage-grouse in 2012. Moreover, the areas that produced higher rates of songbird nest survival were unrelated to those for sage-grouse. Our findings suggest that management actions at local scales that prioritize sage-grouse nesting habitat will not necessarily enhance the reproductive success of sagebrush-associated songbirds. Measures implemented to conserve sage-grouse and other purported umbrella species at broad spatial scales likely overlap the distribution of many species, however, broad-scale overlap may not translate to fine-scale conservation benefit beyond the umbrella species itself. The maintenance of microhabitat heterogeneity important for a diversity of species of concern will be critical for a more-holistic application of the umbrella species concept.

Intervention to promote adolescents' communication and engagement in diabetes clinic encounters: A pilot randomized controlled trial.

AIM: To conduct a pilot randomized trial of an intervention to improve adolescent question-asking and provider education during paediatric diabetes visits. METHODS: Adolescents aged 11 to 17 with type 1 diabetes and their parents were enrolled from two urban tertiary paediatric clinics. Adolescents were randomised to the intervention group or control group. Adolescent consultations were audio-recorded, their HbA1c level was recorded, and they completed surveys after three clinic appointments. The intervention group completed a question prompt list and watched a video on a tablet with their parents before meeting their doctor and completed a short evaluation after each visit. RESULTS: Six consultant endocrinologists and ninety-nine adolescents and their parents participated. The intervention increased adolescents' question asking and provider education in diabetes encounters. Total patient question-asking across the 3 consultations and a higher baseline HbA1c at time one was significantly associated with HbA1c at time three. CONCLUSIONS: Question prompt lists and an educational video are useful tools to increase adolescents' question-asking and communication between adolescents and their providers. PRACTICE IMPLICATIONS: Interventions that encourage adolescents' question-asking in healthcare encounters may lead to more meaningful providers-adolescents' communication and tailored education. Interventions to improve professionals' listening, communication and educational skills are also required.

Thermoneutral temperature exposure enhances slow-wave sleep with a correlated improvement in amyloid pathology in a triple-transgenic mouse model of Alzheimer's disease.

Accumulation of amyloid-ß (Aß) plays an important role in Alzheimer's disease (AD) pathology. There is growing evidence that disordered sleep may accelerate AD pathology by impeding the physiological clearance of Aß from the brain that occurs in normal sleep. Therapeutic strategies for improving sleep quality may therefore help slow disease progression. It is well documented that the composition and dynamics of sleep are sensitive to ambient temperature. We therefore compared Aß pathology and sleep metrics derived from polysomnography in 12-month-old female 3xTg-AD mice (n = 8) exposed to thermoneutral temperatures during the light period over 4 weeks to those of age- and sex-matched controls (n = 8) that remained at normal housing temperature (22°C) during the same period. The treated group experienced greater proportions of slow wave sleep (SWS)-i.e. epochs of elevated 0.5-2 Hz EEG slow wave activity during non-rapid eye movement (NREM) sleep-compared to controls. Assays performed on mouse brain tissue harvested at the end of the experiment showed that exposure to thermoneutral temperatures significantly reduced levels of DEA-soluble (but not RIPA- or formic acid-soluble) Aß40 and Aß42 in the hippocampus, though not in the cortex. With both groups pooled together and without regard to treatment condition, NREM sleep continuity and any measure of SWS within NREM at the end of the treatment period were inversely correlated with DEA-soluble Aß40 and Aß42 levels, again in the hippocampus but not in the cortex. These findings suggest that experimental manipulation of SWS could offer useful clues into the mechanisms and treatment of AD.

Exposure to Lead in Drinking Water Causes Cognitive Impairment via an Alzheimer's Disease Gene-Dependent Mechanism in Adult Mice.

Background: Exposure to lead (Pb) is a major public health problem that could occur through contaminated soil, air, food, or water, either during the course of everyday life, or while working in hazardous occupations. Although Pb has long been known as a neurodevelopmental toxicant in children, a recent and growing body of epidemiological research indicates that cumulative, low-level Pb exposure likely drives age-related neurologic dysfunction in adults. Environmental Pb exposure in adulthood has been linked to risk of late-onset Alzheimer's disease (AD) and dementia. Objective: Although the biological mechanism underlying this link is unknown, it has been proposed that Pb exposure may increase the risk of AD via altering the expression of AD-related genes and, possibly, by activating the molecular pathways underlying AD-related pathology. Methods: We investigated Pb exposure using a line of genetically modified mice with AD-causing knock-in mutations in the amyloid precursor protein and presenilin 1 (APPΔNL/ΔNL x PS1P264L/P264L) that had been crossed with Leprdb/db mice to impart vulnerability to vascular pathology. Results: Our data show that although Pb exposure in adult mice impairs cognitive function, this effect is not related to either an increase in amyloid pathology or to changes in the expression of common AD-related genes. Pb exposure also caused a significant increase in blood pressure, a well known effect of Pb. Interestingly, although the increase in blood pressure was unrelated to genotype, only mice that carried AD-related mutations developed cognitive dysfunction, in spite of showing no significant change in cerebrovascular pathology. Conclusions: These results raise the possibility that the increased risk of dementia associated with Pb exposure in adults may be tied to its subsequent interaction with either pre-existing or developing AD-related neuropathology.

Widespread service fragmentation for patients and families with tuberous sclerosis complex (TSC) in the Republic of Ireland.

Background: Tuberous sclerosis complex (TSC) is a rare approximate 1:6000 birth incidence, a genetic disease with a wide variability of physical and neuropsychiatric symptoms. Patients require lifelong care from multiple healthcare specialities, for which International and United Kingdom (UK) TSC consensus recommendations exist. Personalised care delivered by a centralised coordinated team of TSC experts is recommended. There is no such service for the estimated 600 TSC patients in the Republic of Ireland (ROI) and there is a paucity of information regarding the healthcare of this group. Purpose: Evaluate the baseline care of patients with TSC attending epilepsy services in the Republic of Ireland (ROI) against UK TSC consensus recommendations. Methods: Patients with a diagnosis of TSC attending 12 adult and paediatric epilepsy centres in the ROI were identified. Clinical audits measured the baseline care of a subset of these patients against UK, TSC clinical recommendations. Data was anonymised and analysed at Trinity College Dublin. Results: One hundred thirty-five TSC patients attending twelve epilepsy centres were identified. Adults (n = 67) paediatric (n = 68). The care of 83 patients was audited (n = 63 ≥ 18 years) and (n = 20 < 18 years). Many baseline tests were completed, however, they required intra or interhospital referral. Care appears fragmented and there was no evidence of formal disease surveillance plans. Conclusions: The number of TSC patients attending epilepsy services is lower than expected (n = 135). Specialist services and treatments for TSC are available through informal referral pathways. Although UK, TSC consensus baseline recommendations are roughly adhered to, care is fragmented. Increased coordination of care could benefit disease management. Supplementary Information: The online version contains supplementary material available at 10.1007/s44162-024-00049-8.

Mitochondrial reverse electron transport in myeloid cells perpetuates neuroinflammation.

Sustained smouldering, or low grade, activation of myeloid cells is a common hallmark of several chronic neurological diseases, including multiple sclerosis (MS) 1 . Distinct metabolic and mitochondrial features guide the activation and the diverse functional states of myeloid cells 2 . However, how these metabolic features act to perpetuate neuroinflammation is currently unknown. Using a multiomics approach, we identified a new molecular signature that perpetuates the activation of myeloid cells through mitochondrial complex II (CII) and I (CI) activity driving reverse electron transport (RET) and the production of reactive oxygen species (ROS). Blocking RET in pro-inflammatory myeloid cells protected the central nervous system (CNS) against neurotoxic damage and improved functional outcomes in animal disease models in vivo . Our data show that RET in myeloid cells is a potential new therapeutic target to foster neuroprotection in smouldering inflammatory CNS disorders 3 .

Technical Factors Contributing to Nonunion in Supracondylar Distal Femur Fractures Treated With Lateral Locked Plating: A Risk-Stratified Analysis.

OBJECTIVE: To identify technical factors associated with nonunion after operative treatment with lateral locked plating. DESIGN: Retrospective cohort study. SETTING: Ten Level I trauma centers. PATIENT SELECTION CRITERIA: Adult patients with supracondylar distal femur fractures (OTA/AO type 33A or C) treated with lateral locked plating from 2010 through 2019. OUTCOME MEASURES AND COMPARISONS: Surgery for nonunion stratified by risk for nonunion. RESULTS: The cohort included 615 patients with supracondylar distal femur fractures. The median patient age was 61 years old (interquartile range: 46 -72years) and 375 (61%) were female. Observed were nonunion rates of 2% in a low risk of nonunion group (n = 129), 4% in a medium-risk group (n = 333), and 14% in a high-risk group (n = 153). Varus malreduction with an anatomic lateral distal femoral angle greater than 84 degrees, was associated with double the odds of nonunion compared to those without such varus [odds ratio, 2.1; 95% confidence interval (CI), 1.1-4.2; P = 0.03]. Malreduction by medial translation of the articular block increased the odds of nonunion, with 30% increased odds per 4 mm of medial translation (95% CI, 1.0-1.6; P = 0.03). Working length increased the odds of nonunion in the medium risk group, with an 18% increase in nonunion per 10-mm increase in working length (95% CI, 1.0-1.4; P = 0.01). Increased proximal screw density was protective against nonunion (odds ratio, 0.71; 95% CI, 0.53-0.92; P = 0.02) but yielded lower mRUST scores with each 0.1 increase in screw density associated with a 0.4-point lower mRUST (95% CI, -0.55 to -0.15; P < 0.001). Lateral plate length and type of plate material were not associated with nonunion. ( P > 0.05). CONCLUSIONS: Malreduction is a surgeon-controlled variable associated with nonunion after lateral locked plating of supracondylar distal femur fractures. Longer working lengths were associated with nonunion, suggesting that bridge plating may be less likely to succeed for longer fractures. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Systemic and Dermatologic Impact of Mpox: An Overview of Guideline-Based Management for Nigerian Healthcare Workers.

Monkeypox/Mpox is an Orthopoxvirus infection of the skin and mucous membranes in the same family as smallpox virus. Infection mainly affects the skin, but the eyes, lungs, brain, gastrointestinal tract, and other organs may also be involved to varying degrees. This narrative review on the systematic and dermatologic impact of Mpox is meant for healthcare workers, providers of social services, community leaders, religious leaders, staff of schools, influencers, and institutions. This is in a bid to bring them up to date with the clinical protocol involved in the diagnosis, management, and prevention of the spread of Mpox. Data and other pieces of information used in this review were accessed from PubMed, Google Scholar, and situation reports from the website of the Nigerian Centre for Disease Control (NCDC), the World Health Organization (WHO), and the Centre for Disease Control and Prevention (CDC). The search date was from 1980 to May 2022. Prompt recognition and diagnosis were found to be predicated on a high index of clinical suspicion while diagnosis can be confirmed through viral DNA polymerase chain reaction tests. The management of Mpox involves a multidisciplinary approach with Dermatologists playing a central role alongside other specialists and experts as it affects diagnosis, management, and follow-up. The Government should provide an enabling environment for surveillance, notification, and research of this global infection. Since the clinical presentation of Mpox is regularly changing, a regular review of the available guidelines is recommended.

Use of complementary and alternative medicine among midlife Arab women living in Qatar

The prevalence of use of complementary and alternative medicine [CAM] is widespread and is growing worldwide. This cross-sectional study in Qatar examined the use of CAM and its correlates among Arab women in their midlife years. Women aged 40-60 years [n = 814] were recruited at primary care centres in Qatar and completed a specially designed, pre-tested questionnaire. Overall, 38.2% of midlife women in Qatar had used CAM in the previous 12 months. Nutritional remedies and herbal remedies were the most commonly used CAM therapies, followed by physical methods. Qatari nationality and higher level of education were independently associated with CAM use. Menopause transition status was not independently associated with use of CAM. The prevalence of CAM use by women in Qatar was high, consistent with other reports worldwide. It is essential to educate and inform patients and health-care providers about the benefits and limitations associated with CAM

L'utilisation des médecines complémentaires et parallèles est largement prévalent et en augmentation dans le monde. La présente étude transversale au Qatar à examiné le recours aux médecines complémentaires et parallèles et ses corrélats chez des femmes arabes en milieu de vie. Des femmes âgées de 40 à 60 ans [n = 814] ont été recrutées dans des centres de soins de santé primaires au Qatar et ont rempli un questionnaire spécialement conçu ayant été testé au préalable. Au total 38,2% des femmes en milieu de vie interrogées vivant au Qatar avaient eu recours aux médecines complémentaires et parallèles durant les 12 mois précédents. Des remèdes nutritionnels et à base de plantes étaient les traitements complémentaires et parallèles les plus fréquemment utilisés, suivis par des méthodes physiques. La nationalité qatarie et un niveau d'études plus élevé étaient indépendamment associés à l'utilisation de médecines complémentaires et parallèles. Le statut de transition ménopausique n'était pas indépendamment associé à l'utilisation de ces médecines. La prévalence de leur utilisation chez les femmes au Qatar était élevée et concordait avec les études menées sur le sujet dans d'autre pays du monde. Il est essentiel d'éduquer et d'informer les patientes et les prestataires de soins de santé sur les bénéfices et les limites associés aux médecines complémentaires et parallèles

إن استخدام الطب المتمم والبديل منتر عى نطاق واسع، وهو في تزايد في جميع أنحاء العالم. وقد قامت هذه الدراسةالمستعرضة في قَطَر بدراسة استخدام الطب المتمم والبديل وارتباطاته لدى نساء عربيات في سنوات منتصف أعمارهن. فقد تطوعت60 سنة )العدد = 814 ( في مراكز الرعاية الصحية الأولية في قَطَر، وقمنَ بملء استبيان مصمَّم خصيصاً تم اختباره - نساء بأعار 40مسبقاً. فكان ما إجماليه 38.2 % من النساء في منتصف العمر في قَطَر قد استخدمن الطب المتمم والبديل في ال 12 شهراً السابقة.وكانت العلاجات الغذائية والعلاجات العشبية أكثر معالجات الطب المتمم والبديل شيوعاً في الاستخدام، تلتها الطرق الفيزيائية.وكانت الجنسية القطرية ومستوى التعليم الأعى مرتبطة - بشكل مستقل - مع استخدام الطب المتمم والبديل. ولم تكن حالة سنالإياس الانتقالية مرتبطة - بشكل مستقل - مع استخدام الطب المتمم والبديل. وكان انتشار استخدام الطب المتمم والبديل منقِبَل النساء في قَطَر مرتفعاً، با يتفق مع تقارير أخرى من جميع أنحاء العالم. وخلصت الدراسة إلى أن من الروري تثقيف المرضىومقدِّمي الرعاية الصحية وإطلاعهم عى الفوائد والقيود المرتبطة بالطب المتمم والبديل

Reversing Type 2 Diabetes in the Caribbean: Preliminary findings from a feasibility study in Barbados

OBJECTIVE: In a high proportion of persons recently diagnosed with Type 2 diabetes, a short (2–3 months) very low calorie diet is able to restore normal glucose and insulin metabolism. The objective of this study is to determine the feasibility of this approach in Barbados. SUBJECTS AND METHODS: Twenty-five individuals aged 20to 69 years with Type 2 diabetes diagnosed within the past six years, not on insulin, and body mass index (BMI) > 27kg.m-2 were recruited. Hypoglycaemic medication was stopped on commencement of the eight-week liquid (760calorie) diet, during which participants were assessed weekly. Findings from the liquid diet phase and the following three months are presented. RESULTS: The study participants comprised 10 men and 15women (mean age 48 years, range 26–68 years). Mean(SD, range) BMI was 34.2 kg.m-2 (6.0, 27.0–52.8) and fasting plasma glucose (FPG) was 9.2 mmol.l-1 (2.2, 6.7–14.6). Over the eight-week intervention, mean weight loss was 10.1 kg (4.7, 1.5–20.8) and waist circumference loss10.9 cm (4.0, 5.1–20.8). Fasting plasma glucose fell by 2.2mmol.l-1 (range 1.5–7.9). At eight weeks, FPG was < 7mmol.l-1, the diagnostic cut point for diabetes, in 15 participants compared to three at baseline (p = 0.004). At three months post liquid diet, 17 had FPG < 7 mmol.l-1 (still off medication). CONCLUSION: There was substantial weight loss and fall inFPG in the majority of participants, sustained at three months follow-up. Data on changes in pancreatic function are being analysed. These findings will inform a larger, pragmatic, multi-centre Caribbean trial.

Everything with a pinch of salt: what knowledge have adult Barbadians gained from recent salt reduction messages and what impact have the messages had on their dietary choices?

OBJECTIVE: To ascertain whether adult Barbadians, 25-55 years, could identify and understand messages contained in phase one of the ‘Battling the Hidden Enemy” Salt Reduction Campaign, and to assess if these messages impacted dietary choices, particularly salt consumption. DESIGN AND METHODS: Purposeful sampling was used to recruit 22 Barbadians from a public and a private clinic to participate in five focus groups. Recorded group sessions were analysed using inductive and deductive reasoning and data was classified and organised according to key themes, concepts and emergent categories using framework analysis, aided by the software programme, Atlas.ti. RESULTS: Participants could identify and understood the public service announcement (PSA) messages but did not report an increase in skills and self-efficacy in selecting low salt food options as they were still unable to read labels and make better food choices. Mainly female participants stated an inability to limit their salt intake and pointed to barriers to changing their behaviours such as heavily advertised products, low-cost foods high in salt, addiction to tasty (salty) foods, inadequate labeling and a lack of nutritional information in food establishments. CONCLUSIONS: Education alone was ineffective in reducing the perceived salt consumption levels of focus group members, who judged the PSAs as educational but not effective. A multi-pronged approach should be used including a targeted, consistent campaign, supported by interventions that change the food environment in ways that encourage population-wide behaviour change.

Barriers and facilitators to physical activity amongst overweight and obese women in the Caribbean: a qualitative study

OBJECTIVE: To identify modifiable barriers to physical activity and to explore factors that facilitate physical activity among overweight and obese women in Barbados. DESIGN AND METHODS: Seventeen women aged 25 to 35 years with a body mass index (BMI) ≥25, purposefully sampled from a population-based cross-sectional study, were recruited to participate in in-depth semi-structured interviews. Twelve women participated in one or more additional ethnographic sessions in which the researcher joined and observed a routine activity chosen by the participant. More than 50 hours of ethnographic data collection were accumulated and documented in field notes. Thematic content analysis was performed on transcribed interviews and field notes. RESULTS: Social, health-related, and structural barriers to physical activity were identified. Social factors related to gender norms and expectations. Women tended to be active with their female friends rather than partners or male peers, and reported peer support but also alienation. Being active also competed with family responsibilities and expectations. Health-related barriers included perceptions about chronic disease and competing strategies for weight loss. Structural barriers included few opportunities for active commuting, limited indoor space for exercise in the home, and low perceived access to convenient and affordable exercise classes. Several successful strategies associated with sustained activity were observed, including walking and highly social, low-cost exercise groups. CONCLUSIONS: This study highlights the role that gender norms and health beliefs play in shaping experiences of physical activity. Affordable and accessible group exercise classes are feasible within a Caribbean context and successful models have the potential to be replicated.

Health inequities in diabetes, its risk factors, and adverse outcomes in populations living in the Caribbean: a systematic review

OBJECTIVES: Following the WHO Commission on the Social Determinants of Health, Caribbean countries committed to identifying and reducing health inequities (Rio Political Declaration 2011). We undertook a systematic review to determine what is known about the social distribution of diabetes (DM), its risk factors and major complications in the Caribbean. This paper describes findings on the distribution by ethnicity, education, occupation and income. DESIGN AND METHODS: We searched Medline, Embase and the Virtual Health Library for Caribbean studies published between 2007 and 2013 that described the distribution by ethnicity, income, education and occupation of: known risk factors for type 2 DM, prevalence of DM, DM control or complications. Only quantitative studies were included; each was assessed for risk of bias. RESULTS: Out of 2796 unique records, 81 articles required full text review, and 29 articles met the inclusion criteria. Few studies examined DM, its risk factors or complications by education (4), income (2) or occupation (1). None described significant relationships but all had a high risk of bias. Statistically significant findings were described from Barbados, Cuba and Trinidad on the distribution of diabetes by ethnicity: higher in Blacks than Whites, and in South Asians in Trinidad compared to other groups (OR 1.87, 95% CI 1.14, 3.05). CONCLUSION: Published data in the Caribbean on the social distribution of diabetes, its risk factors and complications were very limited and of overall low quality. Work to better identify health inequities in the Caribbean is required if governments are to meet their commitment to addressing them.

The importance of gender as a social determinant of diabetes in the Caribbean: a systematic review and meta-analysis

OBJECTIVES: We undertook a systematic review to determine the social distribution of diabetes (DM) its risk factors and major complications in the Caribbean. This paper describes our findings on the distribution by gender. DESIGN AND METHODS: We searched Medline, Embase and the Virtual Health Library for Caribbean studies published between 2007 and 2013 that described the distribution by gender of: known risk factors for Type 2 DM, prevalence of DM, and DM control or complications. Only quantitative studies (n>50) were included; each was assessed for risk of bias. Meta-analyses were performed, where appropriate, on studies with a low or medium risk of bias, using random effects models. RESULTS: We found 50 articles from 27 studies, yielding 118 relationships between gender and the outcomes. Women were more likely to have DM, obesity, be less physically active but less likely to smoke. In meta-analyses of good quality population based studies odds ratios for women vs. men for DM, obesity and smoking were: 1.65 (95% CI 1.43, 1.91), 3.10 (2.43, 3.94), and 0.24 (0.17, 0.34). Three studies found men more likely to have better glycaemic control but only one achieved statistical significance. CONCLUSION: Female gender is a determinant of DM prevalence in the Caribbean. In the vast majority of world regions women are at a similar or lower risk of type 2 diabetes than men, even when obesity is higher in women. Caribbean female excess of diabetes may be due to a much greater excess of risk factors in women, especially obesity and physical inactivity.

Evolución del hábito tabáquico durante el embarazo y el posparto / Evolution of tobacco habits during pregnancy and postpartum period

Objetivo. Describir la evolución del hábito tabáquico durante el embarazo y en un largo período posparto, y analizar los factores asociados con el abandono del tabaco. Diseño. Estudio descriptivo retrospectivo. Emplazamiento. Centro de atención primaria de Badia del Vallès (Barcelona).Participantes. Mujeres con gestaciones a término en un período de 3 años (n = 309; 68 por ciento de la población diana). Mediciones principales. Tabaquismo antes del embarazo. Cesación en el embarazo y factores relacionados (sociodemográficos, hábito tabáquico, creencias sobre la salud). Recaídas en el posparto. Resultados. El 50 por ciento fumaba antes del embarazo. De ellas, el 46 por ciento dejó de fumar durante la gestación y el 44 por ciento disminuyó el consumo. En las gestantes primíparas se apreció un mayor riesgo de continuar fumando cuanto mayor fuera el consumo de tabaco previo (odds ratio [OR] = 5,3 si 20 cigarrillos/día y OR = 4,7 para 10-19 cigarrillos/día) y al no creer en el efecto del tabaco sobre la salud del niño (OR = 3,9). En las gestantes multíparas se asoció con la ausencia de abandono del tabaco en anteriores embarazos (OR = 43,8) y con el tabaquismo de la pareja (OR = 7,2). En los 2 años posteriores el parto recayó el 80 por ciento de las que dejaron de fumar. Conclusiones. En nuestro medio coexiste una elevada prevalencia de fumadoras antes del embarazo con una alta tasa de abandonos durante la gestación. Finalmente, una de cada 4 mujeres fuma durante el embarazo. El abandono del tabaco se relaciona con factores como la dependencia, la motivación, el entorno y la experiencia previa (AU)