Self-management practices among type 2 diabetes patients attending physicians and pharmacists: An exploratory study from Lahore, Pakistan

Background: Globally, Pakistan is among the top 10 countries in terms of the proportion of the population living with diabetes. Type 2 diabetes cannot be cured permanently, but complications and premature deaths can be prevented by adopting healthy lifestyles. Self-management is the key to controlling diabetes. Besides rational therapeutic approaches, patient counseling by physicians and pharmacists is crucial because self-management practices are generally influenced by the patient’s knowledge of their disease. Objectives: The objectives of this study were to explore self-management practices among type 2 diabetes patients visiting physicians and pharmacists, and to assess the differences in the self-management practices of patients who visit physicians and those who visit pharmacists concerning type 2 diabetes in the past two years. Methods: This exploratory study recruited 363 established type 2 diabetes patients using a simple random sampling technique. The patients had consulted either a physician or pharmacist (but not both) over the past two years in relation to their type 2 diabetes, and physically visited a branch of a private-chain retail pharmacy in Lahore, Pakistan. Face-to-face interviews and structured questionnaires with a few open-ended questions were adopted as methods of data collection, focusing on socio-demographic and clinical factors, and the standard self-management practices of patients. Data were analyzed using frequencies, percentages, means and standard deviations. The difference between categorical variables, i.e. self-management practices and visits to healthcare professionals, were determined using chi-square tests. Results: The results showed that none of the standard diabetes self-management practices were fully adhered to by the patients. The use of the HbA1C test to monitor diabetes was the least used test among diabetic patients visiting a physician (29.60%) or pharmacist (25.70%). Patients visiting pharmacists adhered to medication use (88.50%, p<0.001), eating a well-balanced diet (75.22%, p=0.050), blood glucose level check (88.50%, p<0.001) and regular blood pressure monitoring (81.42%, p<0.001), whereas patients visiting physicians adhered better to daily feet checking (69.20%, p<0.001) and regular exercise (74.80%, p<0.001). Conclusions: Our study indicates that there is a significant fluctuation in adherence to key self-management practices among type 2 diabetes patients who visit physicians and those who visit pharmacists. Increasing the numbers of pharmacists in the healthcare system who have a special focus on diabetes may improve self-management practices among diabetic patients. [Ethiop. J. Health Dev. 2020; 34(3):165-170] Key words: Pharmacists, physicians, consultation, type 2 diabetes, self-managemen

Students’ perceptions of the role of pharmacists in the healthcare system in Lahore, Pakistan

Purpose: To explore the role of pharmacists in the healthcare system of Lahore, Pakistan; and to determine association between students’ socio-demographic indicators and the likelihood of consulting with a pharmacist.Methods: In this exploratory study, data were collected from 589 students at a private sector university in Lahore, Pakistan, using a convenient sampling design. Information was collected using a semistructured questionnaire. Descriptive statistics (i.e., mean, standard deviation, percentages) and chi square were employed.Results: Of 621 questionnaires, a total of 589 were returned, giving a response rate of 94.85 %. The results showed that 289 students (49.06 %) have interacted with pharmacists; however, the majority of the students (98.64 %) agreed there is a strong need for pharmacists who can provide guidance on medication safety. Furthermore, there was a statistically significant association between family system (x2 (1) = 4.046, p = 0.004), age of family head (x2 (1) = 11.755, p = 0.001), education level of family head (x2 (1) = 10.473, p = 0.001), and consulting a pharmacist.Conclusion: There are important roles for pharmacists to play in order to improve the healthcare system of Lahore, Pakistan. Some social demographics affect the likelihood that a person will seek professional counseling from a pharmacist.Keywords: Medication safety, Healthcare system, Pharmacist consultation, Students’ perceptio

Self-care Practices of Type 2 Diabetes Patients by Socio-demographic and Clinical Factors: An Ordered Probit Model

Background: Diabetes prevalence has risen more rapidly in middle- and low-income countries and has emerged as the seventh highest cause of death in such countries. Socio-demographics, patient knowledge and clinical factors, such as family history of diabetes, have a vital effect on the disease outcomes. This study assessed self-care practices among patients with type 2 diabetes to determine the probability of self-care by predictor variables, including socio-economic and clinical factors, and quantify the marginal effects of these independent variables on different self-care practices among diabetic patients. Methods: This exploratory study collected data from 200 type 2 diabetes patients at a branch of private pharmacy in Pakistan using a convenient sampling technique and a semi-structured questionnaire. An ordered probit regression model was used to analyze the different self-care practices among diabetic patients. With self-practices ordered in four classes from poor to good, the marginal effects of each socio-economic and clinical factors were also calculated on the likelihood of aforesaid self-care practices among diabetic patients. Results: Results showed that the relationships of household income, patient’s choice of private or public hospital for treatment, and patient’s weight with self-care probability were statistically significant. These socio-demographics and clinical indicators significantly influenced each category of self-care practices. Conclusion: Socio-demographic and clinical factors played a decisive role in the healthcare practices among type-2 diabetes patients. Monthly household income, patient’s choice of private or public hospital for treatment, and patient’s weight influenced different levels of self-care practices. Income had a negative contribution in poor and fair self-care levels of practices, whereas it had a positive role in average and good self-care levels of practices. Keywords: type 2 diabetes; self-care practices; socio-economic factors; developing countr

Genetic Mapping in Cotton

The genus Gossypium provides natural fiber for textile industry worldwide. Genetic improvement in cotton for traits of interest is not up to mark due to scarcity of adequate information about fiber production and quality. Use of DNA markers for overcoming the issues of selection associated with complex traits is the ultimate choice which may lead to initiate breeding by design. Numerous marker-trait associations have been identified for economical traits using linkage analysis in cotton. Currently there is need for developing high-density genetic maps using next-generation sequencing approaches together with genome-wide association studies (GWAS). Efforts have been started in this direction and several QTLs including fiber quality, yield traits, plant architecture, stomatal conductance and verticillium wilt resistance were identified. This chapter narrates genetic diversity, QTL mapping, association mapping and QTLs related to fiber quality traits. The incorporation of various genomic approaches and previously described marker strategies will pave the way for increase in fiber production

Genome-wide association for heat tolerance at seedling stage in historical spring wheat cultivars

Increasing global temperature has adverse effects on crop health and productivity at both seedling and reproductivity stages. It is paramount to develop heat tolerant wheat cultivars able to sustain under high and fluctuating temperature conditions. An experiment was conducted to characterize 194 historical wheat cultivars of Pakistan under high temperature at seedling stage to identify loci associated with heat tolerance using genome-wide association studies (GWAS). A quantitative trait locus, TaHST1, on chr4A was also characterized to identify the haplotypes at this locus associated with heat tolerance in wheat from Pakistan. Initially, the diversity panel was planted under control conditions (25°C/20°C day and night temperature) in a glass house. At three leaf stage, plants were subjected to heat stress (HS) by increasing temperature (40°C/35°C day and night), while one treatment was kept at control condition. After 7 days of HS, data were collected for seedling morphology. Heat stress reduced these traits by 25% (root weight) to 40% (shoot weight), and shoot biomass was largely affected by heat stress. A GWAS model, fixed and random model circulating probability unification (FarmCPU), identified 43 quantitative trait nucleotides (QTNs) on all chromosomes, except chr7B, were associated under both HS and control conditions. Thirteen QTNs were identified in control, while 30 QTNs were identified in HS condition. In total, 24 haplotypes were identified at TaHST1 locus, and most of the heat tolerant genotypes were assigned to Hap-20 and Hap-21. Eleven QTNs were identified within 0.3–3.1 Mb proximity of heat shock protein (HSP). Conclusively, this study provided a detailed genetic framework of heat tolerance in wheat at the seedling stage and identify potential genetic regions associated with heat tolerance which can be used for marker assisted selection (MAS) in breeding for heat stress tolerance

Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and developm nt investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens

Global age-sex-specific fertility, mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950-2019 : a comprehensive demographic analysis for the Global Burden of Disease Study 2019

Background: Accurate and up-to-date assessment of demographic metrics is crucial for understanding a wide range of social, economic, and public health issues that affect populations worldwide. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 produced updated and comprehensive demographic assessments of the key indicators of fertility, mortality, migration, and population for 204 countries and territories and selected subnational locations from 1950 to 2019. Methods: 8078 country-years of vital registration and sample registration data, 938 surveys, 349 censuses, and 238 other sources were identified and used to estimate age-specific fertility. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate age-specific fertility rates for 5-year age groups between ages 15 and 49 years. With extensions to age groups 10–14 and 50–54 years, the total fertility rate (TFR) was then aggregated using the estimated age-specific fertility between ages 10 and 54 years. 7417 sources were used for under-5 mortality estimation and 7355 for adult mortality. ST-GPR was used to synthesise data sources after correction for known biases. Adult mortality was measured as the probability of death between ages 15 and 60 years based on vital registration, sample registration, and sibling histories, and was also estimated using ST-GPR. HIV-free life tables were then estimated using estimates of under-5 and adult mortality rates using a relational model life table system created for GBD, which closely tracks observed age-specific mortality rates from complete vital registration when available. Independent estimates of HIV-specific mortality generated by an epidemiological analysis of HIV prevalence surveys and antenatal clinic serosurveillance and other sources were incorporated into the estimates in countries with large epidemics. Annual and single-year age estimates of net migration and population for each country and territory were generated using a Bayesian hierarchical cohort component model that analysed estimated age-specific fertility and mortality rates along with 1250 censuses and 747 population registry years. We classified location-years into seven categories on the basis of the natural rate of increase in population (calculated by subtracting the crude death rate from the crude birth rate) and the net migration rate. We computed healthy life expectancy (HALE) using years lived with disability (YLDs) per capita, life tables, and standard demographic methods. Uncertainty was propagated throughout the demographic estimation process, including fertility, mortality, and population, with 1000 draw-level estimates produced for each metric. Findings: The global TFR decreased from 2·72 (95% uncertainty interval [UI] 2·66–2·79) in 2000 to 2·31 (2·17–2·46) in 2019. Global annual livebirths increased from 134·5 million (131·5–137·8) in 2000 to a peak of 139·6 million (133·0–146·9) in 2016. Global livebirths then declined to 135·3 million (127·2–144·1) in 2019. Of the 204 countries and territories included in this study, in 2019, 102 had a TFR lower than 2·1, which is considered a good approximation of replacement-level fertility. All countries in sub-Saharan Africa had TFRs above replacement level in 2019 and accounted for 27·1% (95% UI 26·4–27·8) of global livebirths. Global life expectancy at birth increased from 67·2 years (95% UI 66·8–67·6) in 2000 to 73·5 years (72·8–74·3) in 2019. The total number of deaths increased from 50·7 million (49·5–51·9) in 2000 to 56·5 million (53·7–59·2) in 2019. Under-5 deaths declined from 9·6 million (9·1–10·3) in 2000 to 5·0 million (4·3–6·0) in 2019. Global population increased by 25·7%, from 6·2 billion (6·0–6·3) in 2000 to 7·7 billion (7·5–8·0) in 2019. In 2019, 34 countries had negative natural rates of increase; in 17 of these, the population declined because immigration was not sufficient to counteract the negative rate of decline. Globally, HALE increased from 58·6 years (56·1–60·8) in 2000 to 63·5 years (60·8–66·1) in 2019. HALE increased in 202 of 204 countries and territories between 2000 and 2019

Resource distribution and productivity analysis within Pakistan's agriculture

Land ist eine entscheidende Ressource in der landwirtschaftlichen Produktion, aber seine ungleiche Verteilung verzögert das Wohlergehen der Entwicklungsländer. Diese Studie wurde hauptsächlich entwickelt, um die Verteilung von land und die damit verbundenen Problemen der landwirtschaftlichen Produktivität in den zugehörigen Ländern zu erforschen. Darüber hinaus wurde die unterschiedliche Ebene der Verteilung von land auf die Beziehungen zu anderen betriebs und sozio-ökonomischen Indikatoren analysiert. Ebenso wurde die vollständige oder teilweise Faktor-produktivität, Bruttoergebnisse, Ernteintensität, Ernte-Vielfalt, die Unterschiede der Einkommensverteilung und die institutionelle Kredit Verfügbarkeit untersucht. Alle der genannten Indikatoren wurden für kleine, mittlere und große Kategorien der Betriebsgrößen bewertet. Drei verschiedene Standorte wurden differenziert nach ihrem zugang zu bewässerung aus gesucht z.B. ständig bewässerte. Flächen m0it ganzjährigen Dauerkulturen, nicht dauerhaft bewässerten Flächen mit sechsmonatiger Bewässerbarkeit durch die öffentliche Infrastruktur und Flächen mit dene bewässerungs-infrastrukture (vor allem durch Brunnen bewässert). Verschiedene statistische (zB. Gini-Koeffizient, Lorenz-Kurve, Herfindahl-Index etc.) und ökonometrische Maßnahmen (log-log-Funktion) wurden zu messung verschiedener Indikatoren zur Erreichung der Ziele der Studie verwendet. Der Ergebnisse belegen eine gleichmäßige Landverteilung in nicht dauerhaft bewässerten Gebieten, während die Landverteilung in regenbewässerten Gebieten zersplittert ist. Die Leistung der meisten der Indikatoren, d.h. die Rendite, Bruttoergebnisse, die landwirtschaftlichen Einkommen, Arbeitsproduktivität, Einkommensverteilung, Anbauintensität und Anbaudiversität war im Vergleich zu anderen Gebieten höher. Während die Faktorproduktivität, Bewässerungsproduktivität und die institutionelle Kreditverfügbarkeit in dauerhaft bewässerten Gebieten höher war. Allerdings wiesen regenbewässerung-gebiete immer die geringste Effizienz in Bezug auf alle der genannten Indikatoren auf. Die genannten Indikatoren waren bei kleinen Betrieben stärker ausgeprägt als bei größeren betrieben. Darüber hinaus bestätigten regressive Ergebnisse der Studie die Existenz der inversen Beziehung zwischen Betriebsgröße und Produktivität an allen Standorten der Studie. Daher wird der Schluss gezogen, dass eine bessere Verteilung von Land und kleine Betriebsstrukturen der Landwirtschaft dazu beitragen können, mehr zu produzieren. Es wird dringend empfohlen, dass die Umverteilungen der Land reformen notwendig sind, in Entwicklungs ländern mit Landknappheit und reichlichen Arbeitskräften wie Pakistan. Es kann auch zur Linderung von Armut beitragen und als Hilfe zür Ernährungssicherung in den benachteiligten Regionen dienen.Land is a pivotal resource in agriculture production but its uneven distribution retards the welfare of developing nations. This study was, mainly, devised to address land distribution problems and consequent farm productivity in the study area. Furthermore, level of land distribution disparities was focused on to observe its relationship with different on-farm and socio-economic indicators including total and partial factor productivities, gross margins, cropping intensity, crop diversity, income distribution disparities and institutional credit availability etc. All of the aforesaid indicators were also assessed for small, medium and large farm size categories. Three distinct locations were chosen on the basis of varying irrigation endowments i.e. irrigated perennial area with year round, irrigated non-perennial area with six months irrigation availability through public infrastructure and rainfed area was mainly tubewell irrigated (without public irrigation infrastructure). Various statistical (i.e. Gini coefficient, Lorenz curve, Herfindahl Index etc) and econometric measures (i.e. log-log function) were employed to quantify different indicators to achieve objectives of the study. Land was observed evenly distributed in irrigated non-perennial area as compared to other areas while land distribution was found most skewed in rainfed area. The performance of most of the indicators i.e. yield, gross margins, farm income, labour productivity, income distribution, cropping intensity and crop diversity was found better as compared to other areas. While total factor productivity, irrigation productivity and rate of institutional credit availability was higher in irrigated perennial area. However, rainfed area was always least efficient with respect to all of the quantified indicators. The aforesaid indicators were observed better at small farms than larger ones. Moreover, regression results of the study also confirmed the existence of inverse relationship between farm size and productivity in all of the study locations. Therefore, it is concluded that better land distribution and small farms agriculture can help to produce more. So, it is strongly suggested that redistributive land reforms are necessary in land scarce and labour abundant developing countries like Pakistan. It can also alleviate poverty and help to bring food security in the deprived regions

Spatial distribution of agricultural resources and food security: A case of Punjab Pakistan

Agriculture is Pakistan’s most vital sector and backbone of the economy, whose productivity depends upon several agricultural and natural resources. 19.8% of GDP of Pakistan’s economy is come from the agriculture sector and it employs 42.3% of the total work force. There are several agricultural resources which enhance the food production and helps in efficient production. Different regions of Pakistan have different type and amount of resources, these agricultural resources include land, water, livestock, agricultural credit, agricultural machinery, fertilizers and farm workers. The purpose of this study is to provide geographical intensity, district wise mapping of Punjab province of Pakistan. These maps illustrated the spatial distribution of districts in terms of crucial agricultural stocks which are important for higher food security. Then further econometric analysis is used to see the impact of various agricultural resources on food security. The study concluded that in overall availability of agricultural resources, Muzzafargarh, Sahiwal and Vehari districts are having abundance agricultural resources. With the increase in agricultural resources, more food will be produced which leads to increase the level of food security. Empirical investigation shows that Gini of Operational Farm Holding, Irrigated Area and Agricultural Machinery (Tractors) are significantly affecting the food security. The regression coefficients will direct the policy makers about what is the optimal combination of resources in terms of their importance for the food security, commercial importance of these input variables and assist them to prioritize their district wise spending using the geographical representations

Ranking and relationship of agricultural credit with food security: A district level analysis

Agriculture sector is back bone of agrarian economies and it is the primary source of food in these economies like Pakistan. Current situation of Pakistan’s economy highlighted that agriculture sector contributes the 19.8% share to GDP and provides 42.3% of the total work force. There is a lot of empirical work which focus on consistent expansion of agriculture output. Food production in agricultural economy require bundle of resources but credit is one of the factor which help in risk aversion and risk Management. The one of the major problem faced by the farmers is the shortage of credit availability. Therefore, this study has been devised to observe the impact of institutional and non-institutional agricultural credit on the level of food security in the districts of Punjab province of Pakistan. In this regard multiple linear regression models are rendered to quantify the relationship between food security (i.e. Food Insecure Population, Food Availability, Food Access and Food Absorption) and Agricultural Credit (i.e. Overall Agricultural Credit, Institutional Agricultural Credit and Non-Institutional Agricultural Credit). The study find that Institutional Agricultural Credit is significantly helping in combating food insecurity while Non-Institutional Agricultural Credit shows unexpected results. Therefore it is strongly recommended to cates institutional credit to reduce food insecurity issues in the country