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Objectives: With diabetes self-management continuing to become more complex for older adults, self-management programs have been shown to support this population in meeting their multifaceted medical needs. Building on our previous systematic review and meta-analysis, we aimed to update the literature on the effectiveness of diabetes self-management programs and investigate the impact of specific self-management interventions on clinical and patient-reported outcomes. Methods: We updated our literature search in the following databases: Medline, EMBASE, PsychINFO, CINAHL and Cochrane Database of Randomized Controlled Trials from November 2013 to July 2023 for studies that may fit our inclusion criteria. Two independent reviewers screened and extracted data from the included group of studies. Results: A total of 17 studies with 21 comparison arms met the inclusion criteria, totalling 5976 older adults (3510 individuals randomized to self-management programming and 2466 to usual care). The pooled effectiveness of diabetes self-management programs in older adults on glycemic control (hemoglobin A1C) was a reduction of -0.32 (95% CI -0.44, -0.19). Specifically, the most effective approach on glycemic control (A1C) was the use of feedback (-0.52%; 95% CI -0.68, -0.36). Overall, self-management programs improved behaviour change outcomes, with feedback interventions being most effective (standardized mean difference [SMD] 0.91; 95% CI 0.39, 1.43). The effect of self-management programs on body mass index, weight and lipids were statistically and clinically significant. Conclusions: The evidence for diabetes self-management programs for older adults demonstrates a small but clinically meaningful reduction in A1C, improvement in patient-reported outcomes (behaviour, self-efficacy, knowledge), and other clinical outcomes (BMI, weight and lipids). The specific strategy used in diabetes self-management programs for older adults should be considered to achieve optimal results on outcomes.
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Objective: To investigate the perceptions of mentors, mentees, administrators (including chairs, co-chairs, and coordinators of the mentoring program), and leadership regarding the Faculty Mentorship Program at AKU School of Nursing and Midwifery (AKU-SONAM). Additionally, the study aimed to explore the strengths and challenges faced by the program. Methods: A qualitative exploratory study on mentorship was carried out in AKU-SONAM from February till December 2021. In this study we conducted purposive criterion sampling. The study participants included mentors, mentees, administrators, and the dean of AKU-SONAM. An interview guide was developed, validated, and reviewed by experts. After piloting, two focused group discussions and three in-depth interviews were conducted. Results: Thematic analysis of the data revealed the following themes: "Nurturing growth and development in mentoring relationships," "Establishing a strong foundation for effective mentoring," and "Opportunities for growth and development through overcoming challenges." Conclusion: The participants expressed confidence in the existing support system, leadership, and mentorship program at the institution. They highlighted the significance of regular monitoring to recognize areas of improvement uphold high standards and ensure excellence.
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Background: Although there is evidence of peer support in high-income countries, the use of peer support as an intervention for cardiometabolic disease management, including type 2 diabetes (T2DM), in low- and middle-income countries (LMICs), is unclear. Methods: A scoping review methodology was used to search the databases MEDLINE, Embase, Emcare, PsycINFO, LILACS, CDSR, and CENTRAL. Results: Twenty-eight studies were included in this scoping review. Of these, 67% were developed in Asia, 22% in Africa, and 11% in the Americas. The definition of peer support varied; however, peer support offered a social and emotional dimension to help individuals cope with negative emotions and barriers while promoting disease management. Conclusions: Findings from this scopingreview highlight a lack of consistency in defining peer support as a component of CMD management in LMICs. A clear definition of peer support and ongoing program evaluation is recommended for future research.
Subject(s)
Developing Countries , Diabetes Mellitus, Type 2 , Humans , Diabetes Mellitus, Type 2/epidemiology , Diabetes Mellitus, Type 2/therapy , Income , Program Evaluation , AsiaABSTRACT
PURPOSE: Chronic Respiratory Disease Questionnaire Self-Administered Standardized (CRQ-SAS) is a valid and reliable tool that evaluates the health-related quality of life among the adult population affected with chronic respiratory disorders (CRDs) and has been translated into many languages as per need. The main objective of this study was to translate the CRQ-SAS into the Urdu language and evaluate its psychometric properties. METHODOLOGY: It was a two-staged study that consisted of translating the original version into Urdu language and then psychometric testing of the translated version. The reliability of the translated questionnaire was assessed by measuring its internal consistency, test-retest reliability, standard error of mean (SEM) & minimal detectable change (MDC). Validity was determined by evaluating its content for content validity, construct (convergent and discriminative) validity, and exploratory factor analysis. Data was analyzed using SPSS v 28 with an alpha level < 0.05 considered to be significant. RESULTS: CRQ-SAS U had an excellent internal consistency (Cronbach's Alpha α = 0.89), test-retest reliability (ICC2,1) = 0.91 of all items, and low SEM = 0.11 and MDC = 0.65. S-CVI was 0.9, with statistically significant difference across the response of COPD patients and healthy subjects, and a high degree of correlation with St Georges Respiratory Questionnaire (r = 0.7-0.9) proving CRQ-SAS U content, discriminant and convergent valid respectively. Exploratory factor analysis identified two factors responsible for 80% of the variance. CONCLUSION: CRQ-SAS U demonstrated optimal psychometric properties which renders it to be used in Urdu speaking populations with COPD.
Subject(s)
Pulmonary Disease, Chronic Obstructive , Quality of Life , Adult , Humans , Reproducibility of Results , Language , Surveys and Questionnaires , Psychometrics , Pulmonary Disease, Chronic Obstructive/diagnosisABSTRACT
Background & Objective: Faculty members require mentoring in all stages of their professional development. Aga Khan University (AKU) has initiated mentorship programs for students and faculty at AKU Medical College (AKU- MC) and AKU School of Nursing and Midwifery (AKU-SONAM). This study aimed to explore perceptions of mentors, mentees, administrators (chairs, co-chairs, founder members and coordinators of the mentoring program) and leadership and further investigate the strengths and challenges faced by 'Faculty Mentorship Program' at AKU- MC. Methods: We conducted a qualitative exploratory study from February till December 2021 after approval from AKU using purposive criterion sampling. Mentors, mentees, administrators and dean of AKU- MC were included in the study. The interview guide was developed, validated and reviewed by experts. After piloting, four focused group discussions and 8 in-depth interviews were conducted in AKU- MC. Results: The findings described the transition from informal to formal mentorship, identified challenges faced by mentors and mentees and suggested the role of leadership / administrators. The themes identified were "Continuous improvement of mentoring practices", "Building strong foundations for mentoring relationships", and "Growth and development through challenging experiences". Conclusion: The faculty mentorship program at AKU-MC was in line with the goals and vision of the institution. All participants identified the need of additional resources, administrative support, rewards, incentives and recognition of mentors for sustainability of the program.
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Pulp-Dentin regeneration is a key aspect of maintain tooth vitality and enabling good oral-systemic health. This study aimed to investigate a nanofibrous scaffold loaded with a small molecule i.e. Tideglusib to promote odontogenic differentiation. Tideglusib (GSK-3ß inhibitor) interaction with GSK-3ß was determined using molecular docking and stabilization of ß-catenin was examined by confocal microscopy. 3D nanofibrous scaffolds were fabricated through electrospinning and their physicochemical characterizations were performed. Scaffolds were seeded with mesenchymal stem cells or pre-odontoblast cells to determine the cells proliferation and odontogenic differentiation. Our results showed that Tideglusib (TG) binds with GSK-3ß at Cys199 residue. Stabilization and nuclear translocation of ß-catenin was increased in the odontoblast cells treated with TG. SEM analysis revealed that nanofibers exhibited controlled architectural features that effectively mimicked the natural ECM. UV-Vis spectroscopy demonstrated that TG was incorporated successfully and released in a controlled manner. Both kinds of biomimetic nanofibrous matrices (PCLF-TG100, PCLF-TG1000) significantly stimulated cells proliferation. Furthermore, these scaffolds significantly induced dentinogenic markers (ALP, and DSPP) expression and biomineralization. In contrast to current pulp capping material driving dentin repair, the sophisticated, polymeric scaffold systems with soluble and insoluble spatiotemporal cues described here can direct stem cell differentiation and dentin regeneration. Hence, bioactive small molecule-incorporated nanofibrous scaffold suggests an innovative clinical tool for dentin tissue engineering.
Subject(s)
Nanofibers , Tissue Scaffolds , Tissue Scaffolds/chemistry , Nanofibers/chemistry , beta Catenin , Glycogen Synthase Kinase 3 beta/pharmacology , Molecular Docking Simulation , Cells, Cultured , Cell Differentiation , Tissue Engineering , Dental PulpABSTRACT
OBJECTIVE: To investigate the effect of natural crosslinkers proanthocyanidin, genipin and glutaraldehyde on shear bond strength at the composite resin-dentin interface . METHODS: The in-vitro study was conducted at the Postgraduate Medical Institute, Lahore, Pakistan, from June to September 2018. Exposed dentin surfaces of extracted teeth were conditioned and randomly divided into proanthocyanidin, genipin, glutaraldehyde and control groups according to the type of surface treatment. The dentin surfaces were treated with 6.5% of primers proanthocyanidin, genipin, glutaraldehyde in the relevant groups, while teeth in the control group did not receive any primer application. After thorough rinsing, surfaces of all teeth were restored with a bonding agent and a restorative composite. After 24h, shear bond strength was tested at the Pakistan Council of Scientific and Industrial Research laboratories in Lahore. Pattern of fractures and quality of interface were investigated microscopically at the Lahore campus of COMSATS University, Islamabad. Data was analysed using SPSS 22. RESULTS: Of the 80 teeth, there were 20(25%) in each of the 4 groups. Surface treatment in the three intervention groups significantly raised the shear bond strength at the composite resin-dentin interface compared to the control group (p<0.05). CONCLUSIONS: Chemical modification with collagen crosslinkers improved bond strength at the composite resin-dentin interface.
Subject(s)
Dentin-Bonding Agents , Dentin , Composite Resins , Humans , Materials Testing , Pakistan , Shear StrengthABSTRACT
Bacterial cell immobilization offer considerable advantages over traditional biotreatment systems using free cells. Calcium alginate matrix usually used for bacterial immobilization is susceptible to biodegradation in harsh environment. Current study aimed to produce and characterize stable macrocapsules (MCs) of Chlorpyrifos (CP) degrading bacterial consortium using biocompatible calcium alginate matrix coupled with environmentally stable polysulfone. In current study bacterial consortium capable of CP biodegradation was immobilized using calcium alginate in a form of microcapsule (MC) reinforced by being coated with a synthetic polymer polysulfone (PSf) through phase inversion. Consortium comprised of five bacterial strains was immobilized using optimized concentration of sodium alginate (2.5gL-1), calcium chloride (6gL-1), biomass (600mgL-1) and polysulfone (10gL-1). It has been observed that MCs have high thermal, pH and chemical stability than CAMs. In synthetic media complete biodegradation of CP (100-600mgL-1) was achieved using macrocapsules (MCs) within 18h. CAMs could be reused effectively only upto 5cycles, contrary to this MCs could be used 13 times to achieve more than >96% CP degradation. Shelf life and reusability studies conducted for MCs indicated unaltered biomass retention and CP biodegradation activity (95%) over 16weeks of storage. MCs achieved complete biodegradation of CP (536mgL-1) in real industrial wastewater and reused several times effectively. Metabolites (3,5,6-trichloro-2-pyridinol (TCP), 3,5,6-trichloro-2-methoxypyridine (TMP) and diethyl-thiophosphate (DETP) were traced using GC-MS and possible metabolic pathway was constructed. Study indicated MCs could be used for cleanup of CP contaminated wastewater repeatedly, safely, efficiently for a longer period of time.
Subject(s)
Biodegradation, Environmental , Chlorpyrifos/metabolism , Waste Disposal, Fluid/methods , Water Pollutants, Chemical/metabolism , Alginates/chemistry , Bacteria/metabolism , Biomass , Chlorpyrifos/analysis , Glucuronic Acid/chemistry , Hexuronic Acids/chemistry , Microspheres , Polymers/chemistry , Sulfones/chemistry , Wastewater/chemistry , Wastewater/microbiology , Water Pollutants, Chemical/analysisABSTRACT
Application of chlorpyrifos (CP) has increased its environmental concentration. Increasing CP concentration has increased chances of adverse health effects. Its removal from environment has attained researcher's attention. CP degrading bacterial strains were isolated from wastewater and agricultural soil. Finally, selected five bacterial strains were identified using 16S rRNA nucleotide sequence analysis as Pseudomonas kilonensis SRK1, Serratia marcescens SRK2, Bacillus pumilus SRK4, Achromobacter xylosoxidans SRK5, and Klebsiella sp. T13. Interaction studies among bacterial strains demonstrated possibility for development of five membered bacterial consortium. Biodegradation potential of bacterial consortium was investigated in the presence of petrochemicals and trace metals. About 98 % CP removal was observed in sequencing batch reactors at inoculum level, 10 %; pH, 7; CP concentration, 400 mgL-1, and HRT, 48 h. Experimental data has shown an excellent fit to first order growth model. Among all petrochemicals only toluene (in low concentration) has stimulatory effect on biodegradation of CP. Addition of petrochemicals (benzene, toluene, and xylene) in high concentration (100 mg L-1) inhibited bacterial activity and decreased CP removal. At low concentration i.e., 1 mg L-1 of inorganic contaminants (Cu, Hg, and Zn) >96 % degradation was observed. Addition of Cu(II) in low concentration has stimulated CP removal efficiency. Hg(II) in all concentrations has strongly inhibited biodegradation rate except at 1 mgL-1. In simulated pesticide, wastewater CP removal efficiency decreased to 77.5 %. Outcomes of study showed that both type and concentration of petrochemicals and trace metals influenced biodegradation of CP.
Subject(s)
Biodegradation, Environmental , Chlorpyrifos/metabolism , Pesticides/metabolism , Toluene/pharmacology , Achromobacter denitrificans/drug effects , Achromobacter denitrificans/genetics , Achromobacter denitrificans/metabolism , Aerobiosis , Bacillus pumilus/drug effects , Bacillus pumilus/genetics , Bacillus pumilus/metabolism , Batch Cell Culture Techniques , Bioreactors/microbiology , Copper/pharmacology , Klebsiella/drug effects , Klebsiella/genetics , Klebsiella/metabolism , Mercury/pharmacology , Molecular Typing , Pseudomonas/drug effects , Pseudomonas/genetics , Pseudomonas/metabolism , RNA, Bacterial/genetics , RNA, Ribosomal, 16S/genetics , Serratia marcescens/drug effects , Serratia marcescens/genetics , Serratia marcescens/metabolism , Toluene/metabolism , Water Pollutants, Chemical/metabolism , Water Purification , Zinc/pharmacologyABSTRACT
Bacteria tolerant to high pesticide concentration could be used for designing an efficient treatment technology. Bacterial strains T14 was isolated from pesticide-contaminated soil in mineral salt medium (MSM) and identified as Psychrobacter alimentarius T14 using 16S rRNA gene sequence analysis. Bench scale bioreactor was evaluated for biotreatment of high Chlorpyrifos (CP) concentration using P. alimentarius T14. Effect of various parameters on bioreactor performance was examined and optimum removal was observed at optical density (OD600â nm): 0.8; pH: 7.2; CP concentration: 300â mgâ L(-1) and hydraulic retention time: 48â h. At optimum conditions, 70.3/79% of CP/chemical oxygen demand (COD) removal was achieved in batch bioreactors. In addition, P. alimentarius T14 achieved 95/91, 62.3/75, 69.8/64% CP/COD removal efficiency with addition of CS (co-substrates), CS1 (yeast extract + synthetic wastewater), CS2 (glucose + synthetic wastewater) and CS3 (yeast extract), respectively. Addition of CS1 to bioreactor could accelerate CP removal rate up to many cycles with considerable efficiency. However, accumulation of 3, 5, 6-trichloro-2-pyridinol affects reactor performance in cyclic mode. First-order rate constant k1 0.062â h(-1) and t1/2 11.1â h demonstrates fast degradation. Change in concentration of total chlorine and nitrogen could be the result of complete mineralization. Photodegradation of CP in commercial product was more than its pure form. Commercial formulation accelerated photodegradation process; however no effect on biodegradation process was observed. After bio-photodegradation, negligible toxicity for seeds of Triticum aestivum was observed. Study suggests an efficient treatment of wastewater containing CP and its metabolites in batch bioreactors could be achieved using P. alimentarius.
Subject(s)
Bioreactors/microbiology , Chlorpyrifos/analysis , Chlorpyrifos/isolation & purification , Psychrobacter/metabolism , Water Pollutants, Chemical/analysis , Water Pollutants, Chemical/isolation & purification , Equipment Design , Kinetics , Wastewater/chemistryABSTRACT
Wastewater from pesticide industries, agricultural or surface runoff containing pesticides and their residues has adverse environmental impacts. Present study demonstrates effect of petrochemicals and trace metals on chlorpyrifos (CP) biotransformation often released in wastewater of agrochemical industry. Biodegradation was investigated using bacterial strain Pseudomonas kilonensis SRK1 isolated from wastewater spiked with CP. Optimal environmental conditions for CP removal were CFU (306 × 10(6)), pH (8); initial CP concentration (150 mg/L) and glucose as additional carbon source. Among various organic solvents (petrochemicals) used in this study toluene has stimulatory effect on CP degradation process using SRK1, contrary to this benzene and phenol negatively inhibited degradation process. Application of metal ions (Cu (II), Fe (II) Zn (II) at low concentration (1 mg/L) took part in biochemical reaction and positively stimulated CP degradation process. Metal ions at high concentrations have inhibitory effect on degradation process. A first order growth model was shown to fit the data. It could be concluded that both type and concentration of metal ions and petrochemicals can affect CP degradation process.
Subject(s)
Chlorpyrifos/metabolism , Insecticides/chemistry , Pseudomonas/metabolism , Soil Pollutants/metabolism , Biodegradation, Environmental , Humans , Metals, Heavy/metabolism , Soil Microbiology , Solvents/chemistry , Trace ElementsABSTRACT
BACKGROUND: Genome-wide association studies have recently revealed that several single-nucleotide polymorphisms (SNPs) in the interleukin (IL) 28B genes can predict the sustained virological response (SVR) to pegylated interferon-α2a/b plus ribavirin in hepatitis C virus (HCV)-genotype 1 patients. However, data for patients infected with HCV genotype 4 (HCV-G4) are limited. AIM: We analyzed the association of IL28B SNPs (hematological, biochemical, virological, and pathological factors) with SVR in the HCV-G4 monoinfected cohort of patients. PATIENTS AND METHODS: One hundred twenty-nine treatment-naïve HCV-G4 patients undergoing treatment were recruited from three tertiary care centers in Saudi Arabia. Five IL28B SNPs (rs12979860, rs12980275, rs8105790, rs8099917, and rs72486680) were identified by polymerase chain reaction and DNA sequencing. SVR was statistically correlated with various clinical, histopathological, virological, and genetic parameters. RESULTS: SVR was significantly associated with the CC and AA alleles of rs12979860 (p = 0.008) and rs12980275 (p = 0.004), respectively. Moreover, albumin levels (p = 0.002) and platelet count (p = 0.039) showed significant differences in the SVR and No SVR groups. On multivariate analysis, the CC allele of rs12979860 (OR, 2.89; 95 % CI 1.6-6.2, p = 0.006) and albumin levels (OR, 1.2; 95 % CI 1.1-1.4, p = 0.001) independently predicted SVR. CONCLUSIONS: IL28B polymorphism (CC allele of rs12979860) predicts the sustained response to antiviral therapy in HCV-G4.
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PURPOSE: Strong impact of hepatitis C virus (HCV) on normal regulation of cellular processes has been reported that could have significant implications for HCV pathogenesis. We aimed to determine the altered cellular processes during HCV infection with particular reference to advanced disease stages. METHODS: Liver biopsy specimens of chronic hepatitis C patients classified on histological basis as early (fibrosis stage 1-2) or advanced (fibrosis stage 3-4) HCV disease were studied using microarray technology (Affymetrix GeneChip™ System). For comparison, liver specimens from patients with non-viral hepatitis (NV-hepatitis) were also analyzed by microarray. Expression data generated were analyzed using software Genespring GX and Ingenuity Pathway analysis to find the association with biological functions. We further validated the microarray results using quantitative reverse transcriptase-polymerase chain reaction. RESULTS: Data analysis through Genespring software revealed that in advanced HCV (A-HCV) a total of 792 genes are differentially expressed when compared to early HCV (E-HCV) and 417 genes are differentially expressed when compared to NV-hepatitis. Most of these genes are involved in cancer, cellular growth and proliferation, and tissue morphology. Real time (RT) PCR analysis confirmed the differential expression of six of these genes. CONCLUSION: The results of this study reflect the changes taking place during the transition from early to advanced liver fibrosis, when the liver function becomes impaired and extracellular matrix deposition increases. In addition, it showed altered expression of genes with functions in cancer development, cell growth, proliferation, and cell death that might indicate high risk of cell transformation and hepatocellular carcinoma (HCC) in A-HCV disease patients.