Glucose-lowering medication initiation in people with newly diagnosed type 2 diabetes in Scotland: a mixed-methods study

Background: Worldwide, clinical guidelines recommend the reduction of glucose levels in people with type 2 diabetes mellitus (T2DM) as necessary in order to reduce risk of complications. In Scotland, the national guidelines suggest a target of glycated haemoglobin (HbA1c) of 53 mmol/mol (7.0%) and recommend an individualised treatment approach that may include lifestyle and/or pharmacological interventions. For most patients, the initial treatment is recommended to be lifestyle changes: diet and physical activity. However, when glycaemic targets are not achieved by lifestyle changes, pharmacological treatment should be added, drug choices should be based on patient characteristics and preferences. The literature review showed that the period after diagnosis is one of the critical points for optimal management for T2DM. However, it also showed that there is a lack of studies, which have focused on the initiation of pharmacological treatment in people with newly diagnosed T2DM. Thus, this study aimed to describe factors associated with the initiation of glucose-lowering medication (GLM) in people with newly diagnosed T2DM and the underlying reasons for starting pharmacological treatment in a Scottish primary healthcare context. Methods: This study employed a convergent parallel mixed-methods design, comprising two strands: one quantitative and one qualitative. The quantitative strand comprised a retrospective cohort study design; participants were drawn from an extract of the SCI-Diabetes dataset, which included people who had been diagnosed with T2DM in Scotland between 2004 and 2012 and were followed up for at least two years after diagnosis. This strand explored factors associated with time to initiation of GLM amongst people with newly diagnosed T2DM. For the qualitative strand, interviews were undertaken with 16 healthcare professionals (HCPs) recruited from 12 practices in Scotland to identify and explore factors and considerations that might influence clinical decision-making in relation to initiation of GLM in people with T2DM in a Scottish primary healthcare context, data were analysed thematically.Results: The cohort, for the quantitative strand, consisted of 154,660 people with newly diagnosed T2DM. More than half of people (54.9%) received GLM prescription within two years after T2DM diagnosis. The results indicated that increased age, male sex, the least deprived Scottish Index of Multiple Deprivation (SIMD) quintiles and receiving antihypertensive medication were associated with longer time to drug treatment. Conversely, HbA1c >53 mmol/mol, body mass index (BMI) >30 Kg/m2 and receiving antihypertensive medication were associated with shorter time to drug treatment. The findings from the qualitative strand revealed that a variety of interwoven factors and considerations influenced HCPs’ decision-making about initiating medication to lower blood glucose. These fell into three main categories: individual-patient related considerations, HCP-patient related factors, and contextual factors. Individual patient-related considerations included physiological aspects such as patient’s age and HbA1c, and psychological aspects, for instance, whether they were perceived to be motivated, their needs and expectations and cultural/ethnic background. HCP-patient related factors included historical contact with patients and, negotiation with patients. Contextual factors included time resources, division of labour within their practices, clinical guidelines (including the recent decommissioning of the Quality and Outcomes Framework; QOF), and HCPs’ perceptions of how their own roles fitted in with those of other colleagues involved in delivering diabetes care.Conclusions: The cohort showed that patients’ baseline HbA1c, age, sex, and SIMD quintile were among the factors associated with the timing of GLM initiation in Scotland from 2004 to 2012. However, the interviews with HCPs highlighted the complex factors, which can influence and inform HCPs’ decision-making. Thus, offering important insights into why prescription patterns for treatment of early type 2 diabetes vary across patients, practices and over time

Reviewing the impact of indoor air quality management and asthma education on asthmatic children's health outcomes – A pilot study

Indoor air quality (IAQ) impacts asthmatic children's health. Previous research suggests that individual interventions such as home-based education and IAQ management positively impact health outcomes for asthma and other respiratory diseases. This study aims to evaluate the impact of the combination of homebased education and IAQ management with an air purifier as a single intervention, rather than individual interventions, to improve health outcomes of asthmatic children. This study was conducted between June and November 2019 in McAllen, Texas. Foobot devices were used to monitor the temperature, relative humidity, particulate matter 2.5μm (PM2.5), and total Volatile Organic Compounds (tVOC) in the bedroom, kitchen, and living room of 13 homes. The monitoring was carried into phases of equal length of pre- and post-intervention. Families received asthma education together with recommendations on how to manage and improve IAQ. The children's health outcomes were evaluated at the beginning and end of the study using certified surveys. Comparison of the PM2.5 and tVOC levels and the scores for health outcomes were made between pre-and post-intervention. The results showed that PM2.5 and tVOC levels reduced significantly after intervention. The health outcomes were improved in asthmatic children. However, only the difference in the health-related quality of life was statistically significant. The results cannot be generalised; however, they provide evidence of the combined intervention's impact, including asthma education and IAQ management, with an air purifier to improve asthmatic children's health outcomes

The Household Water Insecurity Experiences (HWISE) Scale: comparison scores from 27 sites in 22 countries

Abstract Household survey data from 27 sites in 22 countries were collected in 2017–2018 in order to construct and validate a cross-cultural household-level water insecurity scale. The resultant Household Water Insecurity Experiences (HWISE) scale presents a useful tool for monitoring and evaluating water interventions as a complement to traditional metrics used by the development community. It can also help track progress toward achievement of Sustainable Development Goal 6 ‘clean water and sanitation for all’. We present HWISE scale scores from 27 sites as comparative data for future studies using the HWISE scale in low- and middle-income contexts. Site-level mean scores for HWISE-12 (scored 0–36) ranged from 1.64 (SD 4.22) in Pune, India, to 20.90 (7.50) in Cartagena, Colombia, while site-level mean scores for HWISE-4 (scored 0–12) ranged from 0.51 (1.50) in Pune, India, to 8.21 (2.55) in Punjab, Pakistan. Scores tended to be higher in the dry season as expected. Data from this first implementation of the HWISE scale demonstrate the diversity of water insecurity within and across communities and can help to situate findings from future applications of this tool

Ciencias de la Biología y Agronomía

Este volumen I contiene 17 capítulos arbitrados que se ocupan de estos asuntos en Tópicos Selectos de Ciencias de la Biología y Agronomía, elegidos de entre las contribuciones, reunimos algunos investigadores y estudiantes. Se presenta un Estudio Comparativo de los Recursos Hidrológico-Forestales de la Microcuenca de la Laguna de Epatlan, Pue. (1993 a 2014); la Situación Actual de la Mancha de Asfalto en Maíz (Zea mays L.) en los Municipios de Jiquipilas y Ocozocoautla, Chiapas, México; las poblaciones sobresalientes de maíz de la raza Zapalote Chico, en la Región Istmeña de Oaxaca; Se indica el índice de área foliar de cultivo de Chile Poblano mediante dos métodos en condiciones protegidas; Esquivel, Urzúa y Ramírez exploran el efecto de la biofertilización con Azospirillum en el crecimiento y producción de Jitomate; esbozan su artículo sobre la determinación del nivel de Heterosis en híbridos de Maíz para la Comarca Lagunera; una investigación sobre la estabilización de semilla de Solanum lycopersicum durante el almacenamiento y estimulación de la germinación; acotan sobre el CTAB como una nueva opción para la detección de Huanglongbing en cítricos, plantean su evaluación sobre el aluminio y cómo afecta la vida de florero de Heliconia psittacorum; indican sobre el impacto del H-564C, como un híbrido de maíz con alta calidad de proteina para el trópico húmedo de México; presetan su investigación sobre la producción de Piña Cayena Lisa y MD2 (Ananas comosus L.) en condiciones de Loma Bonita, en Oaxaca; acotan sobre el efecto de coberteras como control biológico por conservación contra áfidos en Nogal Pecanero; esbozan sobre la caracterización de cuatro genotipos de Frijol Negro en Martínez de la Torre, Veracruz, México; presentan una caracterización hidroecológica de la microcuenca de Arroyo Prieto, Yuriría, Gto., y alternativas para su restauración ambiental; presentan su investigación sobre el efecto del hongo Beauveria bassiana sobre solubilización de fosfatos y la disponibilidad de fósforo en el suelo; plantean su investigación sobre la Germinación y regeneración in vitro de Epidendrum falcatum LINDL; esbozan su artículo sobre genotipos de frijol negro y su tolerancia a sequía terminal en Veracruz, México

The Household Water Insecurity Experiences (HWISE) Scale: Comparison scores from 27 sites in 22 countries

Household survey data from 27 sites in 22 countries were collected in 2017–2018 in order to construct and validate a cross-cultural household-level water insecurity scale. The resultant Household Water Insecurity Experiences (HWISE) scale presents a useful tool for monitoring and evaluating water interventions as a complement to traditional metrics used by the development community. It can also help track progress toward achievement of Sustainable Development Goal 6 ‘clean water and sanitation for all’. We present HWISE scale scores from 27 sites as comparative data for future studies using the HWISE scale in low-and middle-income contexts. Site-level mean scores for HWISE-12 (scored 0–36) ranged from 1.64 (SD 4.22) in Pune, India, to 20.90 (7.50) in Cartagena, Colombia, while site-level mean scores for HWISE-4 (scored 0–12) ranged from 0.51 (1.50) in Pune, India, to 8.21 (2.55) in Punjab, Pakistan. Scores tended to be higher in the dry season as expected. Data from this first implementation of the HWISE scale demonstrate the diversity of water insecurity within and across communities and can help to situate findings from future applications of this tool

Energy-Efficient Homes: A Heaven for Respiratory Illnesses

The built environment has changed dramatically due to the increased interest in mitigating climate change. Homes are becoming more energy-efficient, responding to energy issues, and reducing carbon emissions primarily. Nevertheless, we started to realize the unintended consequences of these changes that impact a home’s indoor environment and occupants’ health. Indoor air quality is a critical aspect as indoor pollutants are increasing in homes. More than ever, it is crucial to adhere to the best ventilation practices, building materials, and cleaning products. Additionally, behaviour changes, such as those for Healthy Homes, can prevent their health impact. Interdisciplinary research between public health and building professionals needs to educate citizens and present evidence for legislative changes and recommendations to spur change to reduce indoor air pollution and protect vulnerable populations preventing harmful effects on future generations’ healt

Reviewing the impact of indoor air quality management and asthma education on asthmatic children's health outcomes – A pilot study

Indoor air quality (IAQ) impacts asthmatic children's health. Previous research suggests that individual interventions such as home-based education and IAQ management positively impact health outcomes for asthma and other respiratory diseases. This study aims to evaluate the impact of the combination of homebased education and IAQ management with an air purifier as a single intervention, rather than individual interventions, to improve health outcomes of asthmatic children. This study was conducted between June and November 2019 in McAllen, Texas. Foobot devices were used to monitor the temperature, relative humidity, particulate matter 2.5μm (PM2.5), and total Volatile Organic Compounds (tVOC) in the bedroom, kitchen, and living room of 13 homes. The monitoring was carried into phases of equal length of pre- and post-intervention. Families received asthma education together with recommendations on how to manage and improve IAQ. The children's health outcomes were evaluated at the beginning and end of the study using certified surveys. Comparison of the PM2.5 and tVOC levels and the scores for health outcomes were made between pre-and post-intervention. The results showed that PM2.5 and tVOC levels reduced significantly after intervention. The health outcomes were improved in asthmatic children. However, only the difference in the health-related quality of life was statistically significant. The results cannot be generalised; however, they provide evidence of the combined intervention's impact, including asthma education and IAQ management, with an air purifier to improve asthmatic children's health outcomes.publishedVersio

Demographic and Health Indicators in Correlation to Interstate Variability of Incidence, Confirmation, Hospitalization, and Lethality in Mexico: Preliminary Analysis from Imported and Community Acquired Cases during COVID-19 Outbreak

This study’s objective is to analyze the incidence, lethality, hospitalization, and confirmation of COVID-19 cases in Mexico. Sentinel surveillance for COVID-19 cases in Mexico began after the confirmation of the first patient with community transmission. Methods: This epidemiologic, cross-sectional study includes all clinically suspected, and laboratory-confirmed cases nationwide from the beginning of the outbreak to 21 April 2020. State-cluster demographic data and health indicators were analyzed in reference to epidemiologic measures, with logistic regressions for the dependent variables of incidence, confirmation, and lethality. Results: The national incidence was 13.89/100,000 inhabitants with a 6.52% overall lethality and a confirmed-case mortality of 11.1%. The incidence variation significantly correlated with migration, but not urbanization. Pediatric patients were less prone to be tested (OR = −3.92), while geriatric individuals were a priority. State lethality positively correlated with the proportion of the population assisted at public hospitals and correlated inversely to the number of hospitals and clinics in the state. Conclusions: Migration strongly correlated with incidence; elderly patients had lower odds of being hospitalized but were likely to die. Patients aged <15 were less prone to be laboratory-confirmed. Case confirmation was not performed in all hospitalized patients, but 72.15% of hospitalized patients had favorable outcomes to date

Assessing Impact of Household Intervention on Indoor Air Quality and Health of Children with Asthma in the US-Mexico Border:A Pilot Study

Few studies have investigated household interventions to enhance indoor air quality (IAQ) and health outcomes in relatively low-income communities. This study aims to examine the impact of the combined intervention with asthma education and air purifier on IAQ and health outcomes in the US-Mexico border area. An intervention study conducted in McAllen, Texas, between June and November 2019 included 16 households having children with asthma. The particulate matter (PM2.5) levels were monitored in the bedroom, kitchen, and living room to measure the IAQ for 7 days before and after the intervention, respectively. Multiple surveys were applied to evaluate changes in children's health outcomes. The mean PM2.5 levels in each place were significantly improved. Overall, they significantly decreased by 1.91 μg/m3 on average (). All surveys showed better health outcomes; particularly, quality of life for children was significantly improved (). This pilot study suggests that the combined household intervention might improve IAQ in households and health outcomes for children with asthma and reduce health disparities in low-income communities. Future large-scale studies are needed to verify the effectiveness of this household intervention to improve IAQ and asthma management