Primary care management of diabetes in a low/middle income country: A multi-method, qualitative study of barriers and facilitators to care

<p>Abstract</p> <p>Background</p> <p>The management of patients with diabetes mellitus is complex. Some research has been done in developed countries to attempt to determine the factors that influence quality of care of patients with diabetes: Factors thus far postulated are usually categorised into patient, clinician and organisational factors. Our study sought to discover the main barriers and facilitators to care in the management of diabetes in primary care in a low/middle income country.</p> <p>Methods</p> <p>A qualitative study, based on reflexive ethnography using participant observation, semi-structured interviews of clinicians (10) and group interviews with paramedical staff (4) and patients (12) in three purposively sampled health centres, along with informal observation and discussions at over 50 other health centres throughout Tunisia. A content analysis of the data was performed.</p> <p>Results</p> <p>Over 400 potential barriers or facilitators to care of patients with diabetes in primary care in Tunisia emerged. Overall, the most common cited factor was the availability of medication at the health centre. Other frequently observed organisational factors were the existence of chronic disease clinics and clinicians workload. The most commonly mentioned health professional factor was doctor motivation. Frequently cited patient factors were financial issues, patient education and compliance and attendance issues. There were notable differences in the priority given to the various factors by the researcher, physicians, paramedical staff and the patients.</p> <p>Conclusion</p> <p>We have discovered a large number of potential barriers and facilitators to care that may potentially be influencing the care of patients with diabetes within primary care in Tunisia, a low/middle income country. An appreciation and understanding of these factors is essential in order to develop culturally appropriate interventions to improve the care of people with diabetes.</p

Contribution of type 2 diabetes associated loci in the Arabic population from Tunisia: a case-control study

<p>Abstract</p> <p>Background</p> <p>Candidate gene and genome-wide association studies have both reproducibly identified several common Single Nucleotide Polymorphisms (SNPs) that confer type 2 diabetes (T2D) risk in European populations. Our aim was to evaluate the contribution to T2D of five of these established T2D-associated loci in the Arabic population from Tunisia.</p> <p>Methods</p> <p>A case-control design comprising 884 type 2 diabetic patients and 513 control subjects living in the East-Center of Tunisia was used to analyze the contribution to T2D of the following SNPs: E23K in <it>KCNJ11/Kir6.2</it>, K121Q in <it>ENPP1</it>, the -30G/A variant in the pancreatic β-cell specific promoter of Glucokinase, rs7903146 in <it>TCF7L2 </it>encoding transcription factor 7-like2, and rs7923837 in <it>HHEX </it>encoding the homeobox, hematopoietically expressed transcription factor.</p> <p>Results</p> <p><it>TCF7L2</it>-rs7903146 T allele increased susceptibility to T2D (OR = 1.25 [1.06–1.47], <it>P </it>= 0.006) in our study population. This risk was 56% higher among subjects carrying the TT genotype in comparison to those carrying the CC genotype (OR = 1.56 [1.13–2.16], <it>P </it>= 0.002). No allelic or genotypic association with T2D was detected for the other studied polymorphisms.</p> <p>Conclusion</p> <p>In the Tunisian population, <it>TCF7L2</it>-rs7903146 T allele confers an increased risk of developing T2D as previously reported in the European population and many other ethnic groups. In contrast, none of the other tested SNPs that influence T2D risk in the European population was associated with T2D in the Tunisian Arabic population. An insufficient power to detect minor allelic contributions or genetic heterogeneity of T2D between different ethnic groups can explain these findings.</p

The association of levels of physical activity with metabolic syndrome in rural Australian adults

Background:&nbsp; Physical activity (PA) reduces risk factors related to metabolic syndrome. Rurality influences the way people incorporate physical activity into daily life. The aim of this study is to determine the association of PA level with metabolic syndrome in a rural Australian population. The influence of adiposity on these associations is also investigated.Methods: Three cross-sectional population health surveys were conducted in south-east Australia during 2004&ndash;2006 using a random population sample (n = 1563, participation rate 49%) aged 25&ndash;74 years. PA was assessed via a self-administered questionnaire, and components of the metabolic syndrome via anthropometric measurements taken by specially trained nurses and laboratory tests.Results: Approximately one-fifth of participants were inactive in leisure-time and over one-third had metabolic syndrome (men 39%, women 33%; p = 0.022). There was an inverse association between level of PA and metabolic syndrome (p &lt; 0.001). Men who were inactive in leisure-time were more than twice as likely and women more than three times as likely to have metabolic syndrome compared with those having high PA. Body mass index (BMI) is a mediating factor in the association between level of PA and metabolic syndrome.Conclusion: Some PA is better than none if adults, particularly women, are to reduce their risk of metabolic syndrome and associated vascular diseases. Specialised interventions that take rurality into consideration are recommended for adults who are inactive.<br /

Goal-Directed Reasoning and Cooperation in Robots in Shared Workspaces: an Internal Simulation Based Neural Framework

From social dining in households to product assembly in manufacturing lines, goal-directed reasoning and cooperation with other agents in shared workspaces is a ubiquitous aspect of our day-to-day activities. Critical for such behaviours is the ability to spontaneously anticipate what is doable by oneself as well as the interacting partner based on the evolving environmental context and thereby exploit such information to engage in goal-oriented action sequences. In the setting of an industrial task where two robots are jointly assembling objects in a shared workspace, we describe a bioinspired neural architecture for goal-directed action planning based on coupled interactions between multiple internal models, primarily of the robot’s body and its peripersonal space. The internal models (of each robot’s body and peripersonal space) are learnt jointly through a process of sensorimotor exploration and then employed in a range of anticipations related to the feasibility and consequence of potential actions of two industrial robots in the context of a joint goal. The ensuing behaviours are demonstrated in a real-world industrial scenario where two robots are assembling industrial fuse-boxes from multiple constituent objects (fuses, fuse-stands) scattered randomly in their workspace. In a spatially unstructured and temporally evolving assembly scenario, the robots employ reward-based dynamics to plan and anticipate which objects to act on at what time instances so as to successfully complete as many assemblies as possible. The existing spatial setting fundamentally necessitates planning collision-free trajectories and avoiding potential collisions between the robots. Furthermore, an interesting scenario where the assembly goal is not realizable by either of the robots individually but only realizable if they meaningfully cooperate is used to demonstrate the interplay between perception, simulation of multiple internal models and the resulting complementary goal-directed actions of both robots. Finally, the proposed neural framework is benchmarked against a typically engineered solution to evaluate its performance in the assembly task. The framework provides a computational outlook to the emerging results from neurosciences related to the learning and use of body schema and peripersonal space for embodied simulation of action and prediction. While experiments reported here engage the architecture in a complex planning task specifically, the internal model based framework is domain-agnostic facilitating portability to several other tasks and platforms

Smectite clay KSF as effective catalyst for oxidation of m-tyrosol with H 2 O 2 to hydroxytyrosol

A successful procedure to demonstrate the ability to produce high-added value phenolic hydroxytyrosol by oxidation of m-tyrosol was developed, using clay KSF/H 2 O with peroxide hydrogen to afford excellent yields (more than 60%). Three different operating parameters, including m-tyrosol, H 2 O 2 concentration and amount of catalyst were performed using an experimental design methodology “Box–Behnken” for hydroxytyrosol production. All derivative compounds in reaction mixture during reaction time were identified using mass spectrometry. Hydroxytyrosol 3,4-dihydroxystyrene; 3-hydroxyphenyl acetic acid and 2.5-dihydroxyphenylethanol were the major compounds. By means of 2,2-diphenyl-1-picrylhydrazyl DPPH method, the antioxidant activity was realized, indicating that the strongest antiradical activity (IC 50% = 21.57 mg/mL) was detected when the concentration of hydroxytyrosol is higher. The developed synthesis, investigated for the first time, is operationally simple and could find application for industrial purposes. © 2019, Akadémiai Kiadó, Budapest, Hungary