Setting HbA1c targets for patients with type 2 diabetes

Therapeutic strategies to optimize glycaemic control are an important part of clinical decision for management of patients with type 2 diabetes (T2DM). Several guidelines provide a target value of HbA1c for all T2DM patients. However, a "one-size-fits-all" goal might not be the best strategy for all T2DM patients

Prevalence of depression and its associated factors in patients with type 2 diabetes: A cross-sectional study in Dhaka, Bangladesh

Depression is a common feature in patients with type 2 diabetes and often remains undetected and untreated, causing increased morbidity and mortality. We explored the prevalence of co-morbid depression and its associated factors, including major life-events among patients with type 2 diabetes in Bangladesh. We conducted a cross-sectional study among 515 patients with type 2 diabetes between September 2013 and July 2014 in a tertiary hospital in Dhaka city. We assessed depression using Patient Health Questionnaire-9 (PHQ-9) with predefined cut-off scores of 5, 10, 15 and 20 to indicate minimal, mild, moderate, moderately-severe, and severe depression. Associations between depression and its associated factors were explored using univariate and multivariate regression. Overall, 61.9% participants had depressive symptoms, and the prevalence was higher among females (70.9%) compared to males (50.6%). One-third (35.7%) of participants had mild depression and 36.2% had moderate to severe depression. In the multivariate analysis, factors significantly associated with depression were: age ≤ 60 years (OR: 2.1, 95% CI = 1.2–3.6; p ≤ 0.006), female gender (OR = 1.9, 95% CI = 1.3–3.0; p ≤ 0.002), those having 1–3 complications (OR = 2.3, 95% CI = 1.2–4.3; p = 0.010), experienced loss of business or crop failure (OR = 2.1, 95% CI = 1.2–3.6; p = 0.006), major family conflicts (OR = 2.2, 95% CI = 1.4–3.5; p ≤ 0.001), separation or deaths of family members or divorce (OR = 2.2, 95% CI = 1.4–3.5; p ≤ 0.001), and those who experienced unavailability of food or medicines (OR = 2.2, 95% CI = 1.0–4.5; p = 0.038). Patients with diabetes, especially females, those having other complications, and major life-events should routinely be screened for symptoms of depression with adequate management of these conditions

Diabetes knowledge and utilization of healthcare services among patients with type 2 diabetes mellitus in Dhaka, Bangladesh

Diabetes is a significant global public health concern. Poor knowledge of disease and healthcare utilization is associated with worse health outcomes, leading to increasing burden of diabetes in many developing countries. This study aimed to determine diabetes related knowledge and factors affecting utilization of healthcare services among patients with type 2 diabetes mellitus in Bangladesh

Clinical profile of patients with diabetic nephropathy in a tertiary level hospital in Dhaka, Bangladesh

Background: Diabetic nephropathy (DN) is one of the major causes of morbidity and mortality among patients with diabetes worldwide. Data on DN patients in Bangladesh are scarce. Objectives: The aim of this study was to determine the clinical status of patients with DN and its associated factors in Bangladesh. Materials and Methods: A cross-sectional study was conducted among 130 DN patients admitted in Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) hospital in Dhaka from May to July 2010. We collected data using structured questionnaires, anthropometric, biochemical, and clinical measurements. Multiple regression analyses were performed to examine the relationships between independent variables and factors associated with DN. Results: The mean age of the patients was 56.50 ± 14.2 years. The mean duration of hypertension, diabetes, and DN was 7.32 ± 5.42, 10.08 ± 6.8, and 3.24 ± 3.67 years, respectively. The mean HbA1c was 10.07 ± 3.27%, and mean serum creatinine 2.91 ± 1.98 mg/dl. The correlation coefficient matrix suggests relationships between many of the patients' characteristics and clinical outcomes. Multiple logistic regression analysis shows that the duration of DN (>3 years) is associated with female sex (odds ratio [OR] 1.01, 95% confidence interval [CI] 0.97-2.12), systolic blood pressure (OR 1.04, 95% CI 0.78-1.53), serum creatinine (OR 1.04, 95% CI 0.96-1.87), HbA1c (OR 1.12, 95% CI 0.89-2.01), and duration of hypertension (OR 1.06, 95% CI 0.83-2.37). Conclusion: The results show that among the study participants DN develops earlier with a shorter duration of hypertension and diabetes, providing a strong case for promoting effective strategies for optimum management of diabetes and hypertension in the clinics

Developing effective policy strategies to retain health workers in rural Bangladesh: A policy analysis

Retention of human resources for health (HRH), particularly physicians and nurses in rural and remote areas, is a major problem in Bangladesh. We reviewed relevant policies and provisions in relation to HRH aiming to develop appropriate rural retention strategies in Bangladesh

Human resources for mental health in low and middle income countries: Evidence from Bangladesh

Mental disorders are a major public health challenge globally, contributing to 40% of the global burden of disease. Nevertheless, it remains highly neglected by health planners and policy makers, particularly in low and middle income countries (LMIC). Bangladesh, one of the low-income countries, suffers from a severe shortage of appropriately trained and an adequate number of human resources to provide mental health care. The authors reviewed available evidence on the dynamics of mental health services in LMIC like Bangladesh, with a view to help develop appropriate policies on human resources. This chapter critically examines the current situation of human resources for mental health in Bangladesh, and explores ways to further strengthen human resources so as to enhance mental health services in the country

Human resources for mental health in low and middle income countries: Evidence from Bangladesh

Mental disorders are a major public health challenge globally, contributing to 40% of the global burdenof disease. Nevertheless, it remains highly neglected by health planners and policy makers, particularlyin low and middle income countries (LMIC). Bangladesh, one of the low-income countries, suffers froma severe shortage of appropriately trained and an adequate number of human resources to providemental health care. The authors reviewed available evidence on the dynamics of mental health servicesin LMIC like Bangladesh, with a view to help develop appropriate policies on human resources. Thischapter critically examines the current situation of human resources for mental health in Bangladesh,and explores ways to further strengthen human resources so as to enhance mental health services inthe country. © 2017 by IGI Global. All rights reserved

Training mid-level health cadres to improve health service delivery in rural Bangladesh

Introduction In recent years, the government of Bangladesh has encouraged private sector involvement in producing mid-level health cadres including Medical Assistants (MAs). The number of MAs produced has increased significantly. We assessed students' characteristics, educational services, competencies and perceived attitudes towards health service delivery in rural areas. Methods We used a mixed method approach using quantitative (questionnaire survey) and qualitative (key informant interviews and roundtable discussion) methods. Altogether, five public schools with 238 students and 30 private schools with 732 students were included. Statistical analyses were performed using STATA v-12. Qualitative data were analyzed thematically. Findings The majority of the students in both public (66%) and private medical assistant training schools (MATS) (61%) were from rural backgrounds. They spent the majority of their time in classroom learning (public 45% versus private 42%) and the written essay exam was the common form of a students' performance assessment. Compared with students of public MATS, students of private MATS were more confident in different aspects of educational areas, including managing emerging health needs (P<0.001); evidence-based practice (P=0.002); critical thinking and problem solving (P=0.02), and use of IT/computer skills (P<0.001). Students were aware of not having adequate facilities in rural areas (public 71%, private 65%), but they perceived working in rural areas will offer several benefits, including use of learnt skills; friendly rural people; and opportunities for real-life problem solving, etc. Conclusion This study provides a current picture of MATS students' characteristics, educational services, competencies and perception towards working in rural areas. The MA students in both private and public sectors showed a greater level of willingness to serve in rural health facilities. The results are promising to improve health service delivery, particularly in rural and hard-to-reach areas of Bangladesh. © Cambridge University Press 2016

Device-based physical activity and late-life depressive symptoms: An analysis of influential factors using share data

Background: Regular physical activity is effective for preventing and managing depression; however, only a few studies have assessed physical activity using device-based measures. We aimed to examine the association between device-based total physical activity and late-life depressive symptoms and explore which factors may explain this relationship. Methods: Data from 10 European countries who participated in wave 8 of the Survey of Health, Ageing and Retirement in Europe (SHARE) were analyzed. Triaxial accelerometers (Axivity AX3; Axivity, Newcastle UK) were used to assess total physical activity. Depressive symptoms were assessed through the EURO-D scale. Possion regression models and mediation analysis were performed. Results: The final sample included 785 older adults (70 participants had missing data in one or more variables and were excluded from the analysis) [mean (SD): age 68.6 (8.8) years; 59.2 % female]. After adjusting for several confounders, a 10 % increase in the mean acceleration was associated with lower depressive symptoms (B = −0.0228; 95%CI = −0.0395, −0.0061). This association was partly explained by limitations in activities of daily living and quality of life. Limitations: Cross-sectional design, convenience sample, bi-directionality, lack of cutoff points for classification of the Axivity AX3 placed in the thigh, into intensities. Conclusions: Higher device-based total physical activity was linked with lower depressive symptoms in older European adults. Future studies employing device-based measures that allow to better capture important physical activity dimensions (i.e., intensity) will better inform about dose-response relationships

Global, regional, and national burden of chronic kidney disease, 1990–2017: A systematic analysis for the Global Burden of Disease Study 2017

Background: Health system planning requires careful assessment of chronic kidney disease (CKD) epidemiology, but data for morbidity and mortality of this disease are scarce or non-existent in many countries. We estimated the global, regional, and national burden of CKD, as well as the burden of cardiovascular disease and gout attributable to impaired kidney function, for the Global Burden of Diseases, Injuries, and Risk Factors Study 2017. We use the term CKD to refer to the morbidity and mortality that can be directly attributed to all stages of CKD, and we use the term impaired kidney function to refer to the additional risk of CKD from cardiovascular disease and gout. Methods: The main data sources we used were published literature, vital registration systems, end-stage kidney disease registries, and household surveys. Estimates of CKD burden were produced using a Cause of Death Ensemble model and a Bayesian meta-regression analytical tool, and included incidence, prevalence, years lived with disability, mortality, years of life lost, and disability-adjusted life-years (DALYs). A comparative risk assessment approach was used to estimate the proportion of cardiovascular diseases and gout burden attributable to impaired kidney function. Findings: Globally, in 2017, 1·2 million (95% uncertainty interval [UI] 1·2 to 1·3) people died from CKD. The global all-age mortality rate from CKD increased 41·5% (95% UI 35·2 to 46·5) between 1990 and 2017, although there was no significant change in the age-standardised mortality rate (2·8%, −1·5 to 6·3). In 2017, 697·5 million (95% UI 649·2 to 752·0) cases of all-stage CKD were recorded, for a global prevalence of 9·1% (8·5 to 9·8). The global all-age prevalence of CKD increased 29·3% (95% UI 26·4 to 32·6) since 1990, whereas the age-standardised prevalence remained stable (1·2%, −1·1 to 3·5). CKD resulted in 35·8 million (95% UI 33·7 to 38·0) DALYs in 2017, with diabetic nephropathy accounting for almost a third of DALYs. Most of the burden of CKD was concentrated in the three lowest quintiles of Socio-demographic Index (SDI). In several regions, particularly Oceania, sub-Saharan Africa, and Latin America, the burden of CKD was much higher than expected for the level of development, whereas the disease burden in western, eastern, and central sub-Saharan Africa, east Asia, south Asia, central and eastern Europe, Australasia, and western Europe was lower than expected. 1·4 million (95% UI 1·2 to 1·6) cardiovascular disease-related deaths and 25·3 million (22·2 to 28·9) cardiovascular disease DALYs were attributable to impaired kidney function. Interpretation: Kidney disease has a major effect on global health, both as a direct cause of global morbidity and mortality and as an important risk factor for cardiovascular disease. CKD is largely preventable and treatable and deserves greater attention in global health policy decision making, particularly in locations with low and middle SDI. Funding: Bill & Melinda Gates Foundation