In Transition

Precarious circumstances within our environment galvanizes our feelings towards an uncertain and unknown future. In Transition is a series of work that responds to transitional urban landscapes that fluctuate between collapse and renewal. Through the exploration of oil paint medium, application and formal devices, each painting becomes a pursuit in reorganizing cluttered and unresolved urban scenes while maintaining ambiguous qualities relating to the initial source. Contradictions and opposition arise in reaction to conceptual strategies and undergoing processes, however, implement emotive responses to stimulate and challenge the viewer

Estimating the prevalence and incidence of type 2 diabetes using population level pharmacy claims data: A cross-sectional study

Objective: To estimate the prevalence and incidence of type 2 diabetes using a national pharmacy claims database. Research design and methods: We used data from the Health Service Executive-Primary Care Reimbursement Service database in Ireland for this cross-sectional study. Prevalent cases of type 2 diabetes were individuals using an oral hypoglycemic agent, irrespective of insulin use, in 2012. Incident cases were individuals using an oral hypoglycemic agent in 2012 who had not used one in the past. Population level estimates were calculated and stratified by age and sex. Results: In 2012, there were 114 957 prevalent cases of type 2 diabetes giving a population prevalence of 2.51% (95% CI 2.49% to 2.52%). Among adults (≥15yrs), this was 3.16% (95% CI 3.15% to 3.18%). The highest prevalence was in those aged 70+ years (12.1%). 21 574 people developed type 2 diabetes in 2012 giving an overall incidence of 0.48% (95% CI 0.48% to 0.49%). In adults, this was 0.60% (95% CI 0.60% to 0.61%). Incidence rose with age to a maximum of 2.08% (95% CI 2.02% to 2.15%) in people aged 65-69 years. Men had a higher prevalence (2.96% vs 2.04%) and incidence (0.54% vs 0.41%) of type 2 diabetes than women. Conclusions: Pharmacy claims data allow estimates of objectively defined type 2 diabetes at the population level using up-to-date data. These estimates can be generated quickly to inform health service planning or to evaluate the impact of population level interventions

Fractionation of soil phosphorus in a long-term phosphate fertilization

The changes in inorganic and organic phosphorus (P) fractions of soil resulting from long-term fertilization (40 years) were investigated. In order to improve understanding of the sink and sources of phosphorus, P-fractions were extracted from soil samples of 0-30 and 30-60 cm depth with different amounts of monoammonium-phosphate (MAP) and then determined. Stagnosol was the type of the studied soil. Phosphate fertilizer was applied in 26, 39 and 52 kgP/ha amounts during the period of 40 years. Samples were subjected to sequential extraction according to the modified Chang and Jackson method and BCR (Community Bureau of Reference) sequential extraction procedure in order to extract different forms of phosphorus. The Certified Reference material CRM 684 (River Sediment Extractable Phosphorus) was used to provide accuracy of the instrument and both used methods. Furthermore, the association of phosphorus with substrates was provided by comparison of the results of sequential methods of phosphorus species with the sequential extraction of metals (Fe, Al, Mn and Ca). Results of continuous fertilization during 40 years indicated the increase of all the phosphorus forms in the soil except of phosphorus bound to calcium and organic phosphorus. Application of higher amounts of P-fertilizer resulted in dominance of Al-P fraction in studied soil which indicated that this fraction was the most responsible for the migration of phosphorus along the soil profile

A comparative analysis of scientific outputs of countries formed from former Yugoslav republics and some other countries for the period 2008-2012

Scientific outputs of six countries (republics of the former Yugoslavia - the Socialist Federal Republic of Yugoslavia): Serbia, Croatia, Slovenia, Bosnia and Herzegovina, Former Yugoslav Republic of Macedonia and Montenegro were discussed in this paper. For the purpose of comparison, the data for seven neighbouring countries of the former Yugoslavia (Albania, Greece, Bulgaria, Romania, Hungary, Austria and Italy) were given as well. Also, the data for the Group of Eight (G8) countries (the United States, Canada, the United Kingdom, France, Italy, Germany, Japan and the Russian Federation) and some European countries similar in population to ex-Yugoslav republics were included. To gain a more complete picture on the outputs in scientific production (e.g., publications and patents), data on several developed European countries, as well as the countries from other continents were given. The analysis, which included 33 countries, was made based on different bibliometric indicators for the period of five years (2008-2012). The data were collected from international databases

Diabetes is a Strong Predictor of Mortality During Tuberculosis Treatment: A Prospective Cohort Study Among Tuberculosis Patients from Mwanza, Tanzania.

Strong evidence suggests diabetes may be associated with tuberculosis (TB) and could influence TB treatment outcomes. We assessed the role of diabetes on sputum culture conversion and mortality among patients undergoing TB treatment. A total of 1250 Tanzanian TB patients were followed prospectively during TB treatment with sputum culture after 2 and 5 months. Survival status was assessed at least 1 year after initiation of treatment. At baseline, all participants underwent testing for diabetes and HIV, and the serum concentration of the acute phase reactant alpha-1 glycoprotein (AGP) was determined. There were no differences between participants with and without diabetes regarding the proportion of positive cultures at 2 (3.8% vs. 5.8%) and 5 (1.3% vs. 0.9%) months (P > 0.46). However, among patients with a positive TB culture, relatively more patients with diabetes died before the 5-month follow-up. Within the initial 100 days of TB treatment, diabetes was associated with a fivefold increased risk of mortality (RR 5.09, 95% CI 2.36; 11.02, P < 0.001) among HIV uninfected, and a twofold increase among HIV co-infected patient (RR 2.33 95% CI 1.20; 4.53, P = 0.012), while diabetes was not associated with long-term mortality. Further adjustment with AGP did not change the estimates. Diabetes considerably increases risk of early mortality during TB treatment. The effect may not be explained by increased severity of TB, but could be due to impaired TB treatment response. Research is needed to clarify the mechanism and to assess whether glycaemic control improves survival

Diabetes and tuberculosis: the impact of the diabetes epidemic on tuberculosis incidence.

BACKGROUND: Tuberculosis (TB) remains a major cause of mortality in developing countries, and in these countries diabetes prevalence is increasing rapidly. Diabetes increases the risk of TB. Our aim was to assess the potential impact of diabetes as a risk factor for incident pulmonary tuberculosis, using India as an example. METHODS: We constructed an epidemiological model using data on tuberculosis incidence, diabetes prevalence, population structure, and relative risk of tuberculosis associated with diabetes. We evaluated the contribution made by diabetes to both tuberculosis incidence, and to the difference between tuberculosis incidence in urban and rural areas. RESULTS: In India in 2000 there were an estimated 20.7 million adults with diabetes, and 900,000 incident adult cases of pulmonary tuberculosis. Our calculations suggest that diabetes accounts for 14.8% (uncertainty range 7.1% to 23.8%) of pulmonary tuberculosis and 20.2% (8.3% to 41.9%) of smear-positive (i.e. infectious) tuberculosis. We estimate that the increased diabetes prevalence in urban areas is associated with a 15.2% greater smear-positive tuberculosis incidence in urban than rural areas - over a fifth of the estimated total difference. CONCLUSION: Diabetes makes a substantial contribution to the burden of incident tuberculosis in India, and the association is particularly strong for the infectious form of tuberculosis. The current diabetes epidemic may lead to a resurgence of tuberculosis in endemic regions, especially in urban areas. This potentially carries a risk of global spread with serious implications for tuberculosis control and the achievement of the United Nations Millennium Development Goals.RIGHTS : This article is licensed under the BioMed Central licence at http://www.biomedcentral.com/about/license which is similar to the 'Creative Commons Attribution Licence'. In brief you may : copy, distribute, and display the work; make derivative works; or make commercial use of the work - under the following conditions: the original author must be given credit; for any reuse or distribution, it must be made clear to others what the license terms of this work are

Systems Thinking, Mapping and Change in Food and Agriculture

Societal actors across scales and geographies increasingly demand visual applications of systems thinking – the process of understanding and changing the reality of a system by considering its whole set of interdependencies – to address complex problems affecting food and agriculture. Yet, despite the wide offer of systems mapping tools, there is still little guidance for managers, policy-makers, civil society and changemakers in food and agriculture on how to choose, combine and use these tools on the basis of a sufficiently deep understanding of socio-ecological systems. Unfortunately, actors seeking to address complex problems with inadequate understandings of systems often have limited influence on the socio-ecological systems they inhabit, and sometimes even generate unintended negative consequences. Hence, we first review, discuss and exemplify seven key features of systems that should be – but rarely have been – incorporated in strategic decisions in the agri-food sector: interdependency, level-multiplicity, dynamism, path dependency, self-organization, non-linearity and complex causality. Second, on the basis of these features, we propose a collective process to systems mapping that grounds on the notion that the configuration of problems (i.e., how multiple issues entangle with each other) and the configuration of actors (i.e., how multiple actors relate to each other and share resources) represent two sides of the same coin. Third, we provide implications for societal actors - including decision-makers, trainers and facilitators - using systems mapping to trigger or accelerate systems change in five purposive ways: targeting multiple goals; generating ripple effects; mitigating unintended consequences; tackling systemic constraints, and collaborating with unconventional partners

A cost effectiveness analysis of salt reduction policies to reduce coronary heart disease in four Eastern Mediterranean countries.

BACKGROUND: Coronary Heart Disease (CHD) is rising in middle income countries. Population based strategies to reduce specific CHD risk factors have an important role to play in reducing overall CHD mortality. Reducing dietary salt consumption is a potentially cost-effective way to reduce CHD events. This paper presents an economic evaluation of population based salt reduction policies in Tunisia, Syria, Palestine and Turkey. METHODS AND FINDINGS: Three policies to reduce dietary salt intake were evaluated: a health promotion campaign, labelling of food packaging and mandatory reformulation of salt content in processed food. These were evaluated separately and in combination. Estimates of the effectiveness of salt reduction on blood pressure were based on a literature review. The reduction in mortality was estimated using the IMPACT CHD model specific to that country. Cumulative population health effects were quantified as life years gained (LYG) over a 10 year time frame. The costs of each policy were estimated using evidence from comparable policies and expert opinion including public sector costs and costs to the food industry. Health care costs associated with CHDs were estimated using standardized unit costs. The total cost of implementing each policy was compared against the current baseline (no policy). All costs were calculated using 2010 PPP exchange rates. In all four countries most policies were cost saving compared with the baseline. The combination of all three policies (reducing salt consumption by 30%) resulted in estimated cost savings of $235,000,000 and 6455 LYG in Tunisia;$39,000,000 and 31674 LYG in Syria; $6,000,000 and 2682 LYG in Palestine and$1,3000,000,000 and 378439 LYG in Turkey. CONCLUSION: Decreasing dietary salt intake will reduce coronary heart disease deaths in the four countries. A comprehensive strategy of health education and food industry actions to label and reduce salt content would save both money and lives

Insulin resistance in type 1 diabetes: what is ‘double diabetes’ and what are the risks?

In this review, we explore the concept of ‘double diabetes’, a combination of type 1 diabetes with features of insulin resistance and type 2 diabetes. After considering whether double diabetes is a useful concept, we discuss potential mechanisms of increased insulin resistance in type 1 diabetes before examining the extent to which double diabetes might increase the risk of cardiovascular disease (CVD). We then go on to consider the proposal that weight gain from intensive insulin regimens may be associated with increased CV risk factors in some patients with type 1 diabetes, and explore the complex relationships between weight gain, insulin resistance, glycaemic control and CV outcome. Important comparisons and contrasts between type 1 diabetes and type 2 diabetes are highlighted in terms of hepatic fat, fat partitioning and lipid profile, and how these may differ between type 1 diabetic patients with and without double diabetes. In so doing, we hope this work will stimulate much-needed research in this area and an improvement in clinical practice