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The state of diabetes care and obstacles to better care in Aceh, Indonesia: a mixed-methods study
No full textAbstract
Background
Cardio-metabolic diseases are a major cause of death worldwide, including in Indonesia, where diabetes is one of the most critical diseases for the health system to manage.
Methods
We describe the characteristics, levels of control, health behavior, and diabetes-related complications of diabetes patients in Aceh, Indonesia. We use baseline data and blood testing from a randomized-controlled trial. We conducted semi-structured interviews with eight health providers from Posbindu and Prolanis programs that target diabetes and other non-communicable diseases (NCDs). We also conducted three focus group discussions with 24 diabetes patients about their experiences of living with diabetes and the existing support programs.
Results
The blood tests revealed average HbA1c levels indicative of poor glycemic control in 75.8 percent of patients and only 20.3 percent were free from any symptoms. Our qualitative findings suggest that patients are diagnosed after diabetes-related symptoms manifest, and that they find it hard to comply with treatment recommendations and lifestyle advice. The existing programs related to NCDs are not tailored to their needs.
Conclusion
We identify the need to improve diabetes screening to enable earlier treatment and achieve better control of the disease. Among diagnosed patients, there are widespread beliefs about diabetes medication and alternative forms of treatment that need to be addressed in a respectful dialogue between healthcare professionals and patients. Current diabetes screening, treatment and management programs should be revised to meet the needs of the affected population and to better respond to the increasing burden of this disease.Open-Access-Publikationsfonds 202
Real-world smartphone-based point-of-care diagnostics in primary health care to monitor HbA1c levels in people with diabetes
No full textBackgroundThe lack of accurate and affordable monitoring of glycated hemoglobin (HbA1c) is a common issue among patients with diabetes in low- and middle-income countries. We aimed to test a tablet- and smartphone-based point-of-care (TSB POC) device against a local laboratory-based measure of HbA1c for monitoring diabetes under real-world conditions.MethodsFor this cross-sectional clinical method applicability study, capillary and venous blood was collected in duplicate and analyzed at local primary health care centers. For a heterogeneity test, the tests were performed by an expert, and by a team of local nurses. The study was conducted in a multicenter design in rural and urban Aceh, Indonesia in 2019, and included a total of 533 adults. We mainly used Bland-Altman plots to assess the number of readings within the 95%-limits of agreement (LoA) and Deming regressions.ResultsThe results show a mean difference between capillary HbA1c on the test device and the reference method of −0.54 [CI0.95 = −1.6933; 0.6048] with 5.21% of measurements outside the LoA and a Pearson’s r = 0.91 in the Deming Regression. There is no significant difference in test concordance between local nurses and the expert (4.23% versus 5.13% results outside the LoA [CI0.95 = −0.0331; 0.0511]).ConclusionsTSB POC for analysis of HbA1c is an acceptable alternative for accessible monitoring of diabetes patients under these conditions. This method could provide access to high-quality diagnostic decisions through regular and cost-effective HbA1c monitoring directly in healthcare facilities, thus providing better access to essential health services.Plain language summary People with diabetes in low- and middle-income countries often lack access to reliable and affordable tests to monitor their long-term blood sugar levels, known as HbA1c. This study tested a simple tablet- or smartphone-based device to measure HbA1c directly at primary health centers. The study was conducted in urban and rural areas of Indonesia with 533 participants. The results showed that the device’s measurements were almost identical to laboratory tests. There was hardly any difference in the results, regardless of whether the tests were carried out by experienced experts or by nurses in the field. This method could provide a basis for regular and affordable HbA1c testing to improve diabetes care and access to basic health services for patients in these regions.Rhode et al. investigate the applicability of smartphone-based point-of-care diagnostics for monitoring HbA1c levels of diabetes patients under real-world conditions in a lower-middle income setting. They discover that the method offers an acceptable alternative for accessible monitoring under these conditions
The economics of type 2 diabetes in middle-income countries
Full text linkThis thesis researches the economics of type 2 diabetes in middle-income countries
(MICs). Given the high prevalence of type 2 diabetes in MICs, in-depth
country specific analysis is key for understanding the economic consequences of
type 2 diabetes. The thesis consists of four studies with the unifying theme of
improving the understanding of the causal impact of diabetes on economic outcomes.
Study (1) provides an updated overview, critically assesses and identifies
gaps in the current literature on the economic costs of type 2 diabetes using
a systematic review approach; study (2) investigates the effects of self-reported
diabetes on employment probabilities in Mexico, using cross-sectional data and
making use of a commonly used instrumental variable approach; study (3) revisits
and extends these results via the use of a fixed effects panel data analysis,
also considering a broader range of outcomes, including wages and working
hours. Further, it makes use of cross-sectional biomarker data that allow for the
investigation of undiagnosed diabetes. Study (4) researches the effect of a diabetes
diagnosis on employment as well as behavioural risk factors in China, using
longitudinal data and applying an alternative identification strategy, marginal
structural models estimation, while comparing these results with fixed effects estimation
results. The thesis identifies a considerable economic burden of diabetes
in middle-income countries and uncovers several inequities affecting women, the
poor and the uninsured. Biomarker results indicate that the adverse effects are
limited to those aware of their diabetes. Finally, women are also found to achieve
fewer positive changes of their behavioural risk factors after a diabetes diagnosis
than men, offering a potential explanation for their more adverse employment
outcomes compared to men. To reduce the economic burden, the groups most
affected by the identified inequities should be targeted. Further, the underlying
reasons for the found sex differences need to be identified
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Full text linkWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
koamabayili/VECTRON-author-checklist: VECTRON author checklist
No full textWe have done our best to complete the author checklist relating to the use of animals in the hut study. Note that the objective for the hut study was to evaluate the IRS treatment applications for residual efficacy against Anopheles mosquitoes, including the local An. coluzzii mosquito population. Cows were only used to attract mosquitoes into the huts and no tests were carried out directly on the cows. The author checklist is intended for use with studies where experiments are carried out on animals, which is why we have had such difficulty in completing this for the hut study, as many of the questions do not relate to how the cows were used
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