8,573 research outputs found

    Image_2_Gestational diabetes mellitus in Cameroon: prevalence, risk factors and screening strategies.jpeg

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    BackgroundThe burden of gestational diabetes (GDM) and the optimal screening strategies in African populations are yet to be determined. We assessed the prevalence of GDM and the performance of various screening tests in a Cameroonian population.MethodsWe carried out a cross-sectional study involving the screening of 983 women at 24-28 weeks of pregnancy for GDM using serial tests, including fasting plasma (FPG), random blood glucose (RBG), a 1-hour 50g glucose challenge test (GCT), and standard 2-hour oral glucose tolerance test (OGTT). GDM was defined using the World Health Organization (WHO 1999), International Association of Diabetes and Pregnancy Special Group (IADPSG 2010), and National Institute for Health Care Excellence (NICE 2015) criteria. GDM correlates were assessed using logistic regressions, and c-statistics were used to assess the performance of screening strategies.FindingsGDM prevalence was 5路9%, 17路7%, and 11路0% using WHO, IADPSG, and NICE criteria, respectively. Previous stillbirth [odds ratio: 3路14, 95%CI: 1路27-7路76)] was the main correlate of GDM. The optimal cut-points to diagnose WHO-defined GDM were 5路9 mmol/L for RPG (c-statistic 0路62) and 7路1 mmol/L for 1-hour 50g GCT (c-statistic 0路76). The same cut-off value for RPG was applicable for IADPSG-diagnosed GDM while the threshold was 6路5 mmol/L (c-statistic 0路61) for NICE-diagnosed GDM. The optimal cut-off of 1-hour 50g GCT was similar for IADPSG and NICE-diagnosed GDM. WHO-defined GDM was always confirmed by another diagnosis strategy while IADPSG and GCT independently identified at least 66路9 and 41路0% of the cases.InterpretationGDM is common among Cameroonian women. Effective detection of GDM in under-resourced settings may require simpler algorithms including the initial use of FPG, which could substantially increase screening yield.</p

    The Design and Use of Digital Technologies in the Context of South鈥揝outh Migration

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    The use and design of digital technologies plays an important role in South-South migration, from migrant decision making, orientation and route planning, to integration into host communities and connecting with those left behind. Digital technologies can be leveraged to increase access to opportunities and rights for migrants, thereby boosting migration鈥檚 developmental benefits at the interface between migrants and host communities. Yet structural inequalities in migration contexts mean that access and use are almost always socially contingent, often leading to further inequalities. This chapter outlines key themes from the existing literature on migrant use of digital technologies in the context of South-South migration drawing also on new data generated through the MIDEQ Hub

    Table_1_Gestational diabetes mellitus in Cameroon: prevalence, risk factors and screening strategies.pdf

    No full text
    BackgroundThe burden of gestational diabetes (GDM) and the optimal screening strategies in African populations are yet to be determined. We assessed the prevalence of GDM and the performance of various screening tests in a Cameroonian population.MethodsWe carried out a cross-sectional study involving the screening of 983 women at 24-28 weeks of pregnancy for GDM using serial tests, including fasting plasma (FPG), random blood glucose (RBG), a 1-hour 50g glucose challenge test (GCT), and standard 2-hour oral glucose tolerance test (OGTT). GDM was defined using the World Health Organization (WHO 1999), International Association of Diabetes and Pregnancy Special Group (IADPSG 2010), and National Institute for Health Care Excellence (NICE 2015) criteria. GDM correlates were assessed using logistic regressions, and c-statistics were used to assess the performance of screening strategies.FindingsGDM prevalence was 5路9%, 17路7%, and 11路0% using WHO, IADPSG, and NICE criteria, respectively. Previous stillbirth [odds ratio: 3路14, 95%CI: 1路27-7路76)] was the main correlate of GDM. The optimal cut-points to diagnose WHO-defined GDM were 5路9 mmol/L for RPG (c-statistic 0路62) and 7路1 mmol/L for 1-hour 50g GCT (c-statistic 0路76). The same cut-off value for RPG was applicable for IADPSG-diagnosed GDM while the threshold was 6路5 mmol/L (c-statistic 0路61) for NICE-diagnosed GDM. The optimal cut-off of 1-hour 50g GCT was similar for IADPSG and NICE-diagnosed GDM. WHO-defined GDM was always confirmed by another diagnosis strategy while IADPSG and GCT independently identified at least 66路9 and 41路0% of the cases.InterpretationGDM is common among Cameroonian women. Effective detection of GDM in under-resourced settings may require simpler algorithms including the initial use of FPG, which could substantially increase screening yield.</p

    Image_1_Gestational diabetes mellitus in Cameroon: prevalence, risk factors and screening strategies.jpeg

    No full text
    BackgroundThe burden of gestational diabetes (GDM) and the optimal screening strategies in African populations are yet to be determined. We assessed the prevalence of GDM and the performance of various screening tests in a Cameroonian population.MethodsWe carried out a cross-sectional study involving the screening of 983 women at 24-28 weeks of pregnancy for GDM using serial tests, including fasting plasma (FPG), random blood glucose (RBG), a 1-hour 50g glucose challenge test (GCT), and standard 2-hour oral glucose tolerance test (OGTT). GDM was defined using the World Health Organization (WHO 1999), International Association of Diabetes and Pregnancy Special Group (IADPSG 2010), and National Institute for Health Care Excellence (NICE 2015) criteria. GDM correlates were assessed using logistic regressions, and c-statistics were used to assess the performance of screening strategies.FindingsGDM prevalence was 5路9%, 17路7%, and 11路0% using WHO, IADPSG, and NICE criteria, respectively. Previous stillbirth [odds ratio: 3路14, 95%CI: 1路27-7路76)] was the main correlate of GDM. The optimal cut-points to diagnose WHO-defined GDM were 5路9 mmol/L for RPG (c-statistic 0路62) and 7路1 mmol/L for 1-hour 50g GCT (c-statistic 0路76). The same cut-off value for RPG was applicable for IADPSG-diagnosed GDM while the threshold was 6路5 mmol/L (c-statistic 0路61) for NICE-diagnosed GDM. The optimal cut-off of 1-hour 50g GCT was similar for IADPSG and NICE-diagnosed GDM. WHO-defined GDM was always confirmed by another diagnosis strategy while IADPSG and GCT independently identified at least 66路9 and 41路0% of the cases.InterpretationGDM is common among Cameroonian women. Effective detection of GDM in under-resourced settings may require simpler algorithms including the initial use of FPG, which could substantially increase screening yield.</p

    Effectiveness assessment of non-pharmaceutical interventions: lessons learned from the COVID-19 pandemic

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    Numerous studies have assessed the effectiveness of non-pharmaceutical interventions (NPIs), such as school closures and stay-at-home orders, during the COVID-19 pandemic. Such assessments can inform public health policy and contribute to evidence-based choices of NPIs during subsequent waves or future epidemics. However, methodological issues and a lack of common standards have limited the practical value of the existing evidence. Based on our work and literature review, we discuss lessons learned from the COVID-19 pandemic and make recommendations for standardizing and improving assessment, data collection, and modeling. These recommendations can contribute to more reliable and policy-relevant assessments of NPI effectiveness during future epidemics

    The exposed Mule Creek vent deposits record the structure of a volcanic conduit during a hybrid explosive鈥揺ffusive eruption

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    Silicic volcanic eruptions commonly begin with the explosive ejection of pyroclastic material, before transitioning to gentler effusion-dominated activity. Well-exposed dissected silicic systems are scarce and poorly studied, hindering the advances in our understanding of the explosive鈥揺ffusive transition needed to improve interpretations of volcanic unrest and hazard forecasting. The Mule Creek vent (New Mexico, USA) is a dissected silicic conduit that records the processes controlling conduit formation and evolution, and the role tuffisites (fractures filled with variably welded pyroclasts) play in conduit dynamics. Here, we use decimeter-scale photo-mapping of lithostratigraphic units and thin section analysis to differentiate and interpret three dominant emplacement styles during vent evolution. First, there was repeated deposition and erosion of pyroclastic material at the conduit walls, recorded by erosive surfaces in pyroclastic breccia and agglomerates at the conduit margins. Second, sub-vertical domains of dense melt-dominated magma were emplaced and preserved as glass-dominated vitrophyre and brecciated vitrophyre, with the textural hallmarks of assembly from welding of pyroclasts. Finally, the sub-horizontal fracturing of previously deposited lithologies produced laterally cross-cutting tuffisites. The vent deposits track the widening and then narrowing of the conduit through time and reflect progressive insulation and generally higher temperatures towards the conduit center as pyroclasts accumulate. Welding of pyroclastic fill and the formation of dense vitrophyres towards the conduit center lowers deposit porosity and effective wall permeability. This drives localized gas pressure increases and results in gas-driven fracturing, generating tuffisites, which act as transient outgassing pathways. The structure of the Mule Creek vent records an explosive鈥揺ffusive transition, constraining the processes controlling conduit evolution and aiding our interpretation of volcanic unrest

    Associations with age and glomerular filtration rate in a referred population with chronic kidney disease: Methods and baseline data from a UK multicentre cohort study (NURTuRE-CKD)

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    BACKGROUND: Chronic kidney disease (CKD) is common but heterogenous and is associated with multiple adverse outcomes. The National Unified Renal Translational Research Enterprise (NURTuRE)-CKD cohort was established to investigate risk factors for clinically important outcomes in persons with CKD referred to secondary care. METHODS: Eligible participants with CKD stages G3-4 or stages G1-2 plus albuminuria > 30聽mg/mmol were enrolled from 16 nephrology centres in England, Scotland and Wales from 2017 to 2019. Baseline assessment included demographic data, routine laboratory data and research samples. Clinical outcomes are being collected over 15 years by the UK Renal Registry using established data linkage. Baseline data are presented with subgroup analysis by age, sex and estimated GFR (eGFR). RESULTS: 2996 participants were enrolled. Median (interquartile range) age was 66 (54 to 74) years, 58.5% were male, eGFR 33.8 (24.0 to 46.6) ml/min/1.73m2 and UACR 209 (33 to 926) mg/g. 1883 participants (69.1%) were in high-risk CKD categories. Primary renal diagnosis was CKD of unknown cause in 32.3%, glomerular disease in 23.4% and diabetic kidney disease in 11.5%. Older participants and those with lower eGFR had higher systolic blood pressure and were less likely to be treated with renin-angiotensin system inhibitors (RASi) but were more likely to receive a statin. Female participants were less likely to receive a RASi or statin. CONCLUSIONS: NURTuRE-CKD is a prospective cohort of persons who are at relatively high risk of adverse outcomes. Long-term follow-up and a large biorepository create opportunities for research to improve risk prediction and investigate underlying mechanisms to inform new treatment development
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