Association between socio-economic status and hemoglobin A1c levels in a Canadian primary care adult population without diabetes.

BACKGROUND: Hgb A1c levels may be higher in persons without diabetes of lower socio-economic status (SES) but evidence about this association is limited; there is therefore uncertainty about the inclusion of SES in clinical decision support tools informing the provision and frequency of Hgb A1c tests to screen for diabetes. We studied the association between neighborhood-level SES and Hgb A1c in a primary care population without diabetes. METHODS: This is a retrospective study using data routinely collected in the electronic medical records (EMRs) of forty six community-based family physicians in Toronto, Ontario. We analysed records from 4,870 patients without diabetes, age 45 and over, with at least one clinical encounter between January 1st 2009 and December 31st 2011 and one or more Hgb A1c report present in their chart during that time interval. Residential postal codes were used to assign neighborhood deprivation indices and income levels by quintiles. Covariates included elements known to be associated with an increase in the risk of incident diabetes: age, gender, family history of diabetes, body mass index, blood pressure, LDL cholesterol, HDL cholesterol, triglycerides, and fasting blood glucose. RESULTS: The difference in mean Hgb A1c between highest and lowest income quintiles was -0.04% (p = 0.005, 95% CI -0.07% to -0.01%), and between least deprived and most deprived was -0.05% (p = 0.003, 95% CI -0.09% to -0.02%) for material deprivation and 0.02% (p = 0.2, 95% CI -0.06% to 0.01%) for social deprivation. After adjustment for covariates, a marginally statistically significant difference in Hgb A1c between highest and lowest SES quintile (p = 0.04) remained in the material deprivation model, but not in the other models. CONCLUSIONS: We found a small inverse relationship between Hgb A1c and the material aspects of SES; this was largely attenuated once we adjusted for diabetes risk factors, indicating that an independent contribution of SES to increasing Hgb A1c may be limited. This study does not support the inclusion of SES in clinical decision support tools that inform the use of Hgb A1c for diabetes screening.

Frequency of high risk human papillomavirus types in squamous cell carcinoma of cervix among women.

OBJECTIVE: To determine the frequency of high-risk subtypes of Human papillomavirus (HPV) 16, 18, 31 and 45 in squamous cell carcinoma of cervix (SCC) among women. METHODS: A descriptive study was conducted in the department of Molecular Genetics Laboratory, Ziauddin University Hospital, North Nazimabad, Karachi, Pakistan. A total of fifty formalin-fixed paraffin embedded samples (blocks) of SCC of cervix were collected from two Pathology laboratories through convenience sampling. These blocks were analyzed for presence of HPV and its subtype. DNA was extracted by QIAamp DNA Kit and amplification was done by Polymerase chain reaction (PCR). General primers were used for HPV DNA and HPV genotyping for 16, 18, 31 and 45 was done by using a standard kit. RESULTS: HPV was detected in nine (18%) out of fifty paraffin embedded tissues of squamous cell carcinoma of cervix. Out of the 9 cases that were positive, five (55.6%) were infected with HPV16, while in the rest of the positive samples, the genotype could not be identified in four (44.4%). HPV was not determined in majority (82%) of the samples. CONCLUSION: This study concluded that HPV might not be the major cause of SCC of cervix. There could be other causes among women leading to prevalentHPV types that the study did not look into due to limitations.