Patients' opinion on the barriers to diabetes control in areas of conflicts: The Iraqi example

<p>Abstract</p> <p>Background</p> <p>The health system in Iraq has undergone progressive decline since the embargo that followed the second gulf war in 1991. The aim of this study is to see barriers to glycemic control form the patient perspective, in a diabetic clinic in the south of Iraq.</p> <p>Methods</p> <p>A cross sectional study from the diabetes out-patient clinic in Al-Faiha general hospital in Basrah, South Iraq for the period from January to December 2007. The study includes diabetic patients whether type 1 or 2 if they have at least one year of follow up in the same clinic. Those with A1C ≥ 7% were interviewed by special questionnaire, that was filled in by the medical staff of the clinic. The subjects analyzed in this study were adults (≥ 18 years old) with previously diagnosed diabetes (n = 3522). The duration of diabetes range from 1 to 30 years.</p> <p>Results</p> <p>Mean A1C was 8.4 ± 2 percent, with 835(23.7%) patients with A1C less than 7% and 2688(76.3%) equal to or more than 7%. Of 3522 studied patients, 46.6% were men and 51.5% were women, with mean age of 53.78 ± 12.81 year and age range 18–97 years. Patient opinion for not achieving good glycemic control among 2688 patients with HbA1C ≥ 7% included the following. No drug supply from primary health care center (PHC) or drug shortage is a cause in 50.8% of cases, while drugs and or laboratory expense were the cause in 50.2%. Thirty point seven percent of patients said that they were unaware of diabetics complications and 20.9% think that diabetes is an untreatable disease. Thirty percent think that non-control of their diabetes is due to migration after the war. No electricity or erratic electricity, self-monitoring of blood glucose (SMBG) is not available, or strips were not available or could not be used, and illiteracy as a cause was seen in 15%, 10.8% and 9.9% respectively.</p> <p>Conclusion</p> <p>Our patients with diabetes mellitus declared that of the causes for poor glycemic control most of them related to the current health situation in Iraq.</p

Fossils from Mille-Logya, Afar, Ethiopia, elucidate the link between Pliocene environmental changes and Homo origins

Several hypotheses posit a link between the origin of Homo and climatic and environmental shifts between 3 and 2.5 Ma. Here we report on new results that shed light on the interplay between tectonics, basin migration and faunal change on the one hand and the fate of Australopithecus afarensis and the evolution of Homo on the other. Fieldwork at the new Mille-Logya site in the Afar, Ethiopia, dated to between 2.914 and 2.443 Ma, provides geological evidence for the northeast migration of the Hadar Basin, extending the record of this lacustrine basin to Mille-Logya. We have identified three new fossiliferous units, suggesting in situ faunal change within this interval. While the fauna in the older unit is comparable to that at Hadar and Dikika, the younger units contain species that indicate more open conditions along with remains of Homo. This suggests that Homo either emerged from Australopithecus during this interval or dispersed into the region as part of a fauna adapted to more open habitats.info:eu-repo/semantics/publishedVersio

Off-rift volcanism in rift zones determined by crustal unloading

When continents are stretched over a long period of time, deep elongated rift valleys form at Earth’s surface and zones of ponded magma, centred beneath the rift, form at the crust–mantle boundary1, 2. Ascending magma sometimes erupts within the rift valley3, 4 or, counterintuitively, at volcanic fields away from the rift valley that are offset by tens of kilometres from the source of magma at depth5, 6, 7, 8. The controls on the distribution of this off-rift volcanism are unclear. Here we use a numerical model of magmatic dyke propagation during rifting to investigate why some dykes reach the surface outside the rift valley, whereas others are confined to the valley. We find that the location of magmatism is governed by the competition between tectonic stretching and gravitational unloading pressure, caused by crustal thinning and faulting along the rift borders. When gravitational unloading dominates over tectonic stretching forces, dykes ascending from the ponded magma are steered towards the rift sides, eventually causing off-rift eruptions. Our model also predicts the formation of stacked magma sills in the lower crust above the magma-ponding zone, as well as the along-rift propagation of shallow dykes during rifting events, consistent with observations of magmatism and volcanism in rift zones globally. We conclude that rift topography-induced stress changes provide a fundamental control on the transfer of magma from depth to the surface