A CROSS-SECTIONAL OBSERVATIONAL STUDY ON MISCONCEPTIONS ABOUT DIABETES AND RISK OF HYPOGLYCEMIA WITH CONCURRENT USE OF NATURAL HERBS/HERBAL PRODUCTS

Objective: To determine the various misconceptions in diabetes mellitus and the factors leading to such misconceptions. To find out the association of various misconceptions with the socio-demographic factors. Methods: A cross-sectional observational study was conducted among 350 diabetic patients for a period of 6 mo. The study was done in diabetic clinics in the districts of Salem and Erode. Results: The study included a total of 350 patients, among which 206 (58.86%) were females and 144 (41.14%) were males. The majority of the study population was between the age group 61-70 (30.86%). The total misconception scores were low (0-34) in 144 (41.14%), moderate (35-69) in 180 (51.43%) and high (70-104) in 26 (7.43%). Out of 25 patients identified with hypoglycemia 2 patients (8%) had only drug-drug interaction. 10 patients (40%) with both DI and HDI were identified. Herb-drug interactions alone were identified in 13 diabetic patients with hypoglycemia (52%) indicating the risk of hypoglycemia with concurrent use of herbs along with diabetic medications. Conclusion: In this study carried out in a study population of 350 patients, the majority of the population, which contributes to about 94% had high to moderate knowledge about their condition of diabetes mellitus. The misconceptions about diabetes mellitus were high in 6.57% of the study population

Effects and consequences of small-scale cage culture technology adoption in Kerala

Small-scale fish farming is critical in ensuring food security and employment in many developing countries. Small-scale cage culture for Etroplus suratensis was introduced in the state by the Department of Fisheries, Government of Kerala with the same objectives. The demand for the species has shown considerable increase in the recent years and f m gate prices are as high as Rs 450kg in the peak season. Elevation to the status of State Fish has also helped the culture of the species in attracting the attention of policy makers leading to promotion of its culture. Cage culture in brackishwater bodies, a relatively new technology to the State, was popularized among the tsunami affected fishermen along with extension and technical support. The implementation of cage culture was promoted through the Brackishwater Fish Farmers' Development Agency (BFFDAs) and Agency for Development ofAquaculture Kerala (ADAK), two subsidiaries of the Department of Fisheries, Government of Kerala. The present study probes the effects and consequences of cage culture technology adoption among farmers based on primary data collected from sample respondents during the initial year of culture

Production of a highly degenerate Fermi gas of metastable helium-3 atoms

We report on the achievement of quantum degeneracy in both components of a Bose-Fermi mixture of metastable helium atoms, $^4$He* and $^3$He*. Degeneracy is achieved via Doppler cooling and forced evaporation for $^4$He*, and sympathetically cooling $^3$He* with $^4$He*. We discuss our simplified implementation, along with the high versatility of our system. This technique is able to produce a degenerate Fermi gas with a minimum reduced temperature of $T/T_F=0.14(1)$, consisting of $2.5 \times 10^4$ $^3$He* atoms. Due to the high internal energy of both isotopes single atom detection is possible, opening the possibility of a large number of experiments into Bose-Fermi mixtures.Comment: 13 pages, 8 figure

Some insights into the credit transactions of small - scale fishers along the Kerala coast, India

This study examines the fishery credit delivery system in the state of Kerala that mainly involves informal players such as auctioneer-middlemen, third-party shareholders and private money lenders; and formal sources such as Matsyafed societies, co-operative banks, commercial banks and non-banking financial entities. The main features and credit contract conditions associated with each major type of credit source is discussed and their share in the credit basket of ring seine vessels is assessed empirically based on sample survey data collected from major landing centres. The findings from the study throw several insights into the general state of affairs related to Kerala’s fishery credit delivery system and provide some policy prescriptions for improving the service delivery

Statin safety in chinese: A population-based study of older adults

Background Compared to Caucasians, Chinese achieve a higher blood concentration of statin for a given dose. It remains unknown whether this translates to increased risk of serious statinassociated adverse events amongst Chinese patients. Methods We conducted a population-based retrospective cohort study of older adults (mean age, 74 years) newly prescribed a statin in Ontario, Canada between 2002 and 2013, where 19,033 Chinese (assessed through a validated surname algorithm) were matched (1:3) by propensity score to 57,099 non-Chinese. This study used linked healthcare databases. Findings The follow-up observation period (mean 1.1, maximum 10.8 years) was similar between groups, as were the reasons for censoring the observation period (end of follow-up, death, or statin discontinuation). Forty-seven percent (47%) of Chinese were initiated on a higher than recommended statin dose. Compared to non-Chinese, Chinese ethnicity did not associate with any of the four serious statin-associated adverse events assessed in this study [rhabdomyolysis hazard ratio (HR) 0.61 (95% CI 0.28 to 1.34), incident diabetes HR 1.02 (95% CI 0.80 to 1.30), acute kidney injury HR 0.90 (95% CI 0.72 to 1.13), or all-cause mortality HR 0.88 (95% CI 0.74 to 1.05)]. Similar results were observed in subgroups defined by statin type and dose. Conclusions We observed no higher risk of serious statin toxicity in Chinese than matched non-Chinese older adults with similar indicators of baseline health. Regulatory agencies should review available data, including findings from our study, to decide if a change in their statin dosing recommendations for people of Chinese ethnicity is warranted

Self-reported diabetes is associated with self-management behaviour: a cohort study

<p>Abstract</p> <p>Background</p> <p>The purposes of this cohort study were to establish how frequently people with physician-diagnosed diabetes self-reported the disease, to determine factors associated with self-reporting of diabetes, and to evaluate subsequent differences in self-management behaviour, health care utilisation and clinical outcomes between people who do and do not report their disease.</p> <p>Methods</p> <p>We used a registry of physician-diagnosed diabetes as a reference standard. We studied respondents to a 2000/01 population-based health survey who were in the registry (n = 1,812), and we determined the proportion who reported having diabetes during the survey. Baseline factors associated with self-report and subsequent behavioural, utilisation and clinical differences between those who did and did not self-report were defined from the survey responses and from linkage with administrative data sources.</p> <p>Results</p> <p>Only 75% of people with physician-diagnosed diabetes reported having the disease. People who did self-report were more likely to be male, to live in rural areas, to have longer disease duration and to have received specialist physician care. People who did not report having diabetes in the survey were markedly less likely to perform capillary blood glucose monitoring in the subsequent two years (OR 0.05, 95% CI 0.02 to 0.08). They were also less likely to receive specialist physician care (OR 0.55, 95% CI 0.37 to 0.86), and were less likely to require hospital care for hypo- or hyperglycaemia (OR 0.09, 95% CI 0.01 to 0.28).</p> <p>Conclusion</p> <p>Many people with physician-diagnosed diabetes do not report having the disease, but most demographic and clinical features do not distinguish these individuals. These individuals are much less likely to perform capillary glucose monitoring, suggesting that their diabetes self-management is inadequate. Clinicians may be able to use the absence of glucose monitoring as a screening tool to identify people needing a detailed evaluation of their disease knowledge.</p

Screening and Treatment Outcomes in Adults and Children With Type 1 Diabetes and Asymptomatic Celiac Disease: The CD-DIET Study.

OBJECTIVE: To describe celiac disease (CD) screening rates and glycemic outcomes of a gluten-free diet (GFD) in patients with type 1 diabetes who are asymptomatic for CD. RESEARCH DESIGN AND METHODS: Asymptomatic patients (8-45 years) were screened for CD. Biopsy-confirmed CD participants were randomized to GFD or gluten-containing diet (GCD) to assess changes in HbA RESULTS: Adults had higher CD-seropositivity rates than children (6.8% [95% CI 4.9-8.2%, CONCLUSIONS: CD is frequently observed in asymptomatic patients with type 1 diabetes, and clinical vigilance is warranted with initiation of a GFD

Deficiencies in the Quality of Diabetes Care: Comparing Specialist with Generalist Care Misses the Point

The quality of diabetes care delivered to patients falls below the expectations of practice guidelines and clinical trial evidence. Studies in many jurisdictions with varying health care systems have shown that recommended processes of care occur less often than they should; hence, outcomes of care are inadequate. Many studies comparing care between specialists and generalists have found that specialists are more likely to implement processes of care. However, this provides little insight into improving quality of care, as the difference between specialists and generalists in these studies is small compared to the overall deficiency in quality. Therefore, future research should instead focus on ways to implement high quality care, regardless of specialty. To date, few methodologically rigorous studies have uncovered interventions that can improve quality of care. The development of such interventions to help all physicians implement better quality care could greatly benefit people with diabetes

Evaluation of a toolkit to improve cardiovascular disease screening and treatment for people with type 2 diabetes: protocol for a cluster-randomized pragmatic trial

<p>Abstract</p> <p>Background</p> <p>The gap between the level of care recommended by evidence-based clinical practice guidelines and the actual care delivered to patients in practice has been well established. The Canadian Diabetes Association (CDA) created an implementation strategy to improve the implementation of its 2008 guidelines. This study will evaluate the impact of the strategy to improve cardiovascular disease (CVD) screening, prevention and treatment for people with diabetes.</p> <p>Design</p> <p>A pragmatic cluster-randomized trial will be conducted to evaluate the CDA's CVD Toolkit. All family physicians in Ontario, Canada were randomly allocated to receive the Toolkit, which includes several printed educational materials targeting CVD screening, prevention and treatment, either in spring 2009 (intervention arm) or in spring 2010 (control arm). Randomization occurred at the level of the practice. Forty family physicians from each arm will be recruited to participate, and the medical records for 20 of their diabetic patients at high risk for CVD will be retrospectively reviewed. Outcome measures will be assessed for each patient between July 2009 and March 2010. The primary outcome will be that the patient is receiving a statin. Secondary outcomes will include 1) the receipt of an angiotensin converting enzyme inhibitor or angiotensin receptor blocker, 2) various intermediate measures (A1c, blood pressure, LDL-cholesterol, total-/HDL-cholesterol ratio, body mass index and waist circumference), and 3) clinical inertia (the failure to change therapy in response to an abnormal A1c, blood pressure or cholesterol reading). The analysis will be carried out using multilevel hierarchical logistic regression models to account for the clustered nature of the data. The group assignment will be a physician-level variable. In addition, a process evaluation study with six focus groups of family physicians will assess the acceptability of the CDA's Toolkit and will explore factors contributing to any change or lack of change in behaviour, from the perspectives of family physicians.</p> <p>Discussion</p> <p>Printed educational materials for physicians have been shown to exert small-to-moderate changes in patient care. The CDA's CVD Toolkit is an example of a practice guideline implementation strategy that can be disseminated to a wide audience relatively inexpensively, and so demonstrating its effectiveness at improving diabetes care could have important consequences for guideline developers, policy makers and clinicians.</p> <p>Trial Registration</p> <p>The trial is registered with <url>http://www.clinicaltrials.gov</url>, ID # NCT01026688</p