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People socially connected with each other often share health risks, possibly due to shared environments and behaviors. In a retrospective cohort study, we examined whether incidence of diabetes was different for individuals with recently diagnosed partners compared to individuals similar on other characteristics but whose partners were never diagnosed with diabetes. We analyzed 2007–11 data from Kaiser Permanente Northern California (KNPC), an integrated health system with >3.5 million members. We estimated annual diabetes incidence controlling for demographic, socio-economic, behavioral, and health characteristics. Using propensity score matching and multivariate logistic regression, we compared odds of incident diabetes among co-residing partners ages 18–89 years of people who had been diagnosed with diabetes during the previous year (in robustness checks up to the previous three years) and people who had never been diagnosed but were similar on observed characteristics. Partners of newly-diagnosed people had annual diabetes incidence of 16.4/1,000, equivalent to10.8 times higher (95%CI: 9.2–12.6) than people whose spouses had never been diagnosed (1.5/1,000). Odds remained higher three years after a spouses’ diagnosis (45.4 vs. 11.7/1,000). Adjusting for other characteristics, odds of diabetes for those with a partner diagnosed in the previous year were 8.7 times higher CI: 7.4–10.2) than among those whose partner had never been diagnosed. Partners of persons with recently-diagnosed diabetes developed diabetes at much higher rates than partners of persons with similar characteristics who were never diagnosed with diabetes. Individuals with a recently diagnosed partner could be considered a high-risk population for screening and prevention.

Background The COVID-19 pandemic has required clinicians to pivot to offering services via telehealth; however, it is unclear which patients (users of care) are equipped to use digital health. This is especially pertinent for adults managing chronic diseases, such as obesity, hypertension, and diabetes, which require regular follow-up, medication management, and self-monitoring. Objective The aim of this study is to measure the trends and assess factors affecting health information technology (HIT) use among members of the US population with and without cardiovascular risk factors. Methods We used serial cross-sectional data from the National Health Interview Survey for the years 2012-2018 to assess trends in HIT use among adults, stratified by age and cardiovascular risk factor status. We developed multivariate logistic regression models adjusted for age, sex, race, insurance status, marital status, geographic region, and perceived health status to assess the likelihood of HIT use among patients with and without cardiovascular disease risk factors. Results A total of 14,304 (44.6%) and 14,644 (58.7%) participants reported using HIT in 2012 and 2018, respectively. When comparing the rates of HIT use for the years 2012 and 2018, among participants without cardiovascular risk factors, the HIT use proportion increased from 51.1% to 65.8%; among those with one risk factor, it increased from 43.9% to 59%; and among those with more than one risk factor, it increased from 41.3% to 54.7%. Increasing trends in HIT use were highest among adults aged >65 years (annual percentage change [APC] 8.3%), who had more than one cardiovascular risk factor (APC 5%) and among those who did not graduate from high school (APC 8.8%). Likelihood of HIT use was significantly higher in individuals who were younger, female, and non-Hispanic White; had higher education and income; were married; and reported very good or excellent health status. In 2018, college graduates were 7.18 (95% CI 5.86-8.79), 6.25 (95% CI 5.02-7.78), or 7.80 (95% CI 5.87-10.36) times more likely to use HIT compared to adults without high school education among people with multiple cardiovascular risk factors, one cardiovascular risk factor, or no cardiovascular risk factors, respectively. Conclusions Over 2012-2018, HIT use increased nationally, with greater use noted among younger and higher educated US adults. Targeted strategies are needed to engage wider age, racial, education, and socioeconomic groups by lowering barriers to HIT access and use.

Nocturia, waking from sleep at night to void, is a common, bothersome symptom for which many older adults seek treatment. In 2017, the US FDA approved the first of two desmopressin analogues indicated for nocturia. While efficacious, these drugs can potentially cause severe hyponatremia that can be fatal, particularly if older adults have comorbid conditions (e.g., congestive heart failure, uncontrolled hypertension), laboratory abnormalities (e.g., low sodium, reduced renal function) and concomitant medications (e.g., diuretics, analgesics). Using secondary data from the National Health and Nutrition Examination Survey (NHANES) to identify a sample of U.S. adults 50 years and older with 2 or more nightly nocturia episodes, we determined the prevalence of contraindications, warnings, and need for more frequent monitoring indicated by the product label. Among the sample of 1,521 older respondents, 70.0% of those with nocturia had contraindications or a need for frequent sodium monitoring. Contraindications to desmopressin analogues were more prevalent with older age (27.6%, 34.5%, and 38.8%, for ages 50-64, 65-79, and 80+, respectively, p

The COVID-19 pandemic created numerous barriers to the implementation of participant-facing research. For most, the pandemic required rapid transitioning to all virtual platforms. During this pandemic, the most vulnerable populations are at highest risk of falling through the cracks of engagement in clinical care and research. Nonetheless, we argue that we should reframe the discussion to consider how this transition may create opportunities to engage extensively to reach populations. Here, we present our experience in Atlanta (Georgia, United States) in transitioning a group visit model for South Asian immigrants to a virtual platform and the pivotal role community members in the form of community health workers can play in building capacity among participants. We provide details on how this model helped address common barriers to group visit models in clinical practice and how our community health worker team innovatively addressed the digital challenges of working with an elderly population with limited English proficiency.

ObjectivePeople with chronic conditions are known to be vulnerable to the COVID-19 pandemic. This study aims to describe patients’ lived experiences, challenges faced by people with chronic conditions, their coping strategies, and the social and economic impacts of the COVID-19 pandemic.Design, setting and participantsWe conducted a qualitative study using a syndemic framework to understand the patients’ experiences of chronic disease care, challenges faced during the lockdown, their coping strategies and mitigators during the COVID-19 pandemic in the context of socioecological and biological factors. A diverse sample of 41 participants with chronic conditions (hypertension, diabetes, stroke and cardiovascular diseases) from four sites (Delhi, Haryana, Vizag and Chennai) in India participated in semistructured interviews. All interviews were audio recorded, transcribed, translated, anonymised and coded using MAXQDA software. We used the framework method to qualitatively analyse the COVID-19 pandemic impacts on health, social and economic well-being.ResultsParticipant experiences during the COVID-19 pandemic were categorised into four themes: challenges faced during the lockdown, experiences of the participants diagnosed with COVID-19, preventive measures taken and lessons learnt during the COVID-19 pandemic. A subgroup of participants faced difficulties in accessing healthcare while a few reported using teleconsultations. Most participants reported adverse economic impact of the pandemic which led to higher reporting of anxiety and stress. Participants who tested COVID-19 positive reported experiencing discrimination and stigma from neighbours. All participants reported taking essential preventive measures.ConclusionPeople with chronic conditions experienced a confluence (reciprocal effect) of COVID-19 pandemic and chronic diseases in the context of difficulty in accessing healthcare, sedentary lifestyle and increased stress and anxiety. Patients’ lived experiences during the pandemic provide important insights to inform effective transition to a mixed realm of online consultations and ‘distanced’ physical clinic visits.

OBJECTIVES: To compare dietary intake and patterns among adults with and without depression in South Asia. METHODS: Baseline survey data from the 2015–16 Centre for cArdiometabolic Risk Reduction in South-Asia study, representative of three urban South Asian cities (n = 13 588), were analyzed. Non-pregnant adults ≥ 20 years completed interviewer-administered surveys including a semi-quantitative Food Frequency Questionnaire (FFQ) and Patient Health Questionnaire-9 (PHQ-9) to assess depression. Participants were categorized as having moderate/severe depression (PHQ-9 = 10–27), mild depression (PHQ-9 = 5–9), and no depression (PHQ-9 = 0–4). FFQ data were transformed into daily food (g/d) and beverage (ml/d) intake. Among adults with and without depression, we compared differences in socio-demographic characteristics and daily food and nutrient intake (energy and macronutrients and their distributions) using Students t tests and chi-sq tests and determined diet patterns using exploratory factor analysis. RESULTS: Overall,16% (95% CI 14.7, 17.5) had mild depression and 6% (95% CI 5.1, 7.1) had moderate/severe depression. Compared with adults with no or mild depression, adults with moderate/severe depression had lower intake of energy (2196 ± 804 [no] vs. 2408 ± 852 [mild] vs. 2751 ± 902 [moderate/severe] kcal/d), carbohydrates (284 ± 102 vs. 318 ± 117 vs. 366 ± 125 g/d)), protein (77 ± 35 vs. 81 ± 36 vs. 87 ± 33g/d)), fat (81 ± 36 vs. 88 ± 37 vs. 101 ± 39 g/d), and all food groups except meat (41 ± 83 vs. 41 ± 97 vs. 28 ± 73 g/d) and poultry (132 ± 146 vs. 107 ± 143 vs. 76 ± 113 g/d). Across groups, diets comprised 51–53% carbohydrates, 12–14% protein, and 32–33% fat. Four distinct diet patterns were seen among adults without depression (traditional, modern, non-vegetarian, vegetarian), with mild depression (traditional, western, vegetarian, non-vegetarian), and with moderate/severe depression (traditional, energy-dense, western, non-vegetarian). CONCLUSIONS: Diets of South Asian adults with depression were poorer in quality and quantity than those without depression. Efforts are needed to better study the direction of these associations and ways to improve diets of South Asians. FUNDING SOURCES: NHLBHI, NIH, Oxford Health Alliance Vision 2020 of the UnitedHealth Group, Fogarty International Center and the Eunice Kennedy Shriver NIDDK, NIH and the Emory Global Health Institute.

Objective: The present study examines the hypothesis that the clinical and ultrasonography data reported at baseline visit can predict the responsiveness of ibuprofen in controlling heavy menstrual bleeding with Cu-IUDs at 3 months follow-up visit.

Depression and diabetes are highly prevalent worldwide and often co-exist, worsening outcomes for each condition. Barriers to diagnosis and treatment are exacerbated in low and middle-income countries with limited health infrastructure and access to mental health treatment. The INtegrating DEPrEssioN and Diabetes treatmENT (INDEPENDENT) study tests the sustained effectiveness and cost-effectiveness of a multi-component care model for individuals with poorly-controlled diabetes and depression in diabetes clinics in India.Adults with diabetes, depressive symptoms (Patient Health Questionnaire-9 score≥10), and ≥1 poorly-controlled cardiometabolic indicator (either HbA1c≥8.0%, SBP≥140mmHg, and/or LDL≥130mg/dl) were enrolled and randomized to the intervention or usual care. The intervention combined collaborative care, decision-support, and population health management. The primary outcome is the between-arm difference in the proportion of participants achieving combined depression response (≥50% reduction in Symptom Checklist score from baseline) AND one or more of: ≥0.5% reduction in HbA1c, ≥5mmHg reduction in SBP, or ≥10mg/dl reduction in LDL-c at 24months (12-month intervention; 12-month observational follow-up). Other outcomes include control of individual parameters, patient-centered measures (i.e. treatment satisfaction), and cost-effectiveness.The study trained seven care coordinators. Participant recruitment is complete - 940 adults were screened, with 483 eligible, and 404 randomized (196 to intervention; 208 to usual care). Randomization was balanced across clinic sites.The INDEPENDENT model aims to increase access to mental health care and improve depression and cardiometabolic disease outcomes among complex patients with diabetes by leveraging the care provided in diabetes clinics in India (clinicaltrials.gov number: NCT02022111).

National surveillance data show a sustained decline in the incidence rate of diagnosed diabetes, which has been heralded as a success in the battle against diabetes in the U.S. In this Perspective, we take a closer look at these data and provide additional insights to help interpret these trends. We examine multiple sources of data on the prevalence and incidence of diabetes in the U.S. as well as data on trends in diabetes risk factors to provide context for these national surveillance findings. Although some of the incidence decline may represent real progress against diabetes, it is likely that there are also nonbiological factors at play, especially changes in diagnostic criteria for diabetes. We present and discuss data that suggest improved detection and changes in screening and diagnostic practices may have resulted in the depletion of the “susceptible population.” Providing this context for the recent declines in new diabetes diagnoses observed in national data is critical to help avoid misinterpretation. We argue that it is premature to declare victory against the epidemic of diabetes in the U.S. and discuss how we might better focus current public health efforts, including a specific emphasis to address prediabetes.

OBJECTIVE To assess participant-level results from the first 4 years of implementation of the National Diabetes Prevention Program (National DPP), a national effort to prevent type 2 diabetes in those at risk through structured lifestyle change programs. RESEARCH DESIGN AND METHODS Descriptive analysis was performed on data from 14,747 adults enrolled in year-long type 2 diabetes prevention programs during the period February 2012 through January 2016. Data on attendance, weight, and physical activity minutes were summarized and predictors of weight loss were examined using a mixed linear model. All analyses were performed using SAS 9.3. RESULTS Participants attended a median of 14 sessions over an average of 172 days in the program (median 134 days). Overall, 35.5% achieved the 5% weight loss goal (average weight loss 4.2%, median 3.1%). Participants reported a weekly average of 152 min of physical activity (median 128 min), with 41.8% meeting the physical activity goal of 150 min per week. For every additional session attended and every 30 min of activity reported, participants lost 0.3% of body weight (P < 0.0001). CONCLUSIONS During the first 4 years, the National DPP has achieved widespread implementation of the lifestyle change program to prevent type 2 diabetes, with promising early results. Greater duration and intensity of session attendance resulted in a higher percent of body weight loss overall and for subgroups. Focusing on retention may reduce disparities and improve overall program results. Further program expansion and investigation is needed to continue lowering the burden of type 2 diabetes nationally.

Various hemostatic agents are currently available for routine laparoscopic procedures, avoiding thermal lesions due to energy devices.

Aim: To highlight the grave complications among teenage mothers in Assiut Woman's Health Hospital compared with the adult mothers. Methods: This study was a prospective case control study, conducted at the Labor Ward of Assiut Woman's Health Hospital from 1st of January 2016 to 30th of June 2016. We included teenage pregnant women (13-19 completed years at delivery) as case and adult mothers (20-29 years) formed the control group. The primary outcome of the study is the rate of pregnancy complications among teenage mothers. Results: Obstetric complications were higher among the teenage mothers (p=0.0001). The teenage mothers had a higher proportion of normal vaginal delivery (p=0.005). The adult mothers reported a higher rate of elective cesarean section (CS) and operative vaginal delivery (p=0.0001, p=0.002; respectively). The infants of teenage mothers tended to have a lower birth weight and Apgar score than the adult ones. Conclusion: This study clearly states that the teenage mothers and their infants were more liable to complications during pregnancy and labor compared to adult mothers.

To assess the efficacy and safety of condom-loaded Foley's catheter versus Bakri Balloon in the management of primary atonic post partum hemorrhage (PPH) secondary to vaginal delivery.This study was single blinded randomized controlled trial conducted at Assiut Woman's Health Hospital, Egypt in the period between October 2014 and December 2015. It Comprised 66 women with primary atonic PPH following vaginal delivery. Eligible participants were randomly assigned to Bakri balloon (group A) or condom-loaded Foley's catheter (group B). The primary outcome was the success of tamponade to stop the uterine bleeding without additional surgical interventions. Secondary outcomes included time between insertion and stoppage of the bleeding, the amount of blood transfusion and maternal complications.Both treatment modalities successfully controlled the primary atonic PPH without a statistically significant difference [30/33(91.0%) and 28/33(84.84%), p = .199; respectively]. However; Bakri balloon required shorter time to stop the uterine bleeding (9.09 min vs. 11.76 min, p = .042; respectively). There was no statistically significant difference between both groups regarding postpartum maternal complications, the vital signs, urine output, hemoglobin and hematocrit levels from before to after tamponade insertion.Condom-loaded Foley's catheter is as effective as Bakri balloon in the management of primary atonic PPH following vaginal delivery but requires a significant bit longer time to stop the attack.

To test the effect of aspirin and omega 3 on fetal weight as well as feto-maternal blood flow in asymmetrical intrauterine growth restriction (IUGR).This study is a clinically registered (NCT02696577), open, parallel, randomized controlled trial, conducted at Assiut Woman's Health Hospital, Egypt including 80 pregnant women (28-30 weeks) with IUGR. They were randomized either to group I: aspirin or group II: aspirin plus omega 3. The primary outcome was the fetal weight after 6 weeks of treatment. Secondary outcomes included Doppler blood flow changes in both uterine and umbilical arteries, birth weight, time and method of delivery and admission to NICU. The outcome variables were analyzed using paired and unpaired t-test.The estimated fetal weight increased significant in group II more than group I (p=0.00). The uterine and umbilical arteries blood flow increased significantly in group II (p0.05). The birth weight in group II was higher than that observed in group I (p0.05).The using of aspirin with omega 3 is more effective than using aspirin only in increasing fetal weight and improving utero-placental blood flow in IUGR.

Objectives: To assess the safety and feasibility of a novel technique, External Pop-out (EPO), for supporting the loweruterine segment during fetal head extraction in cesarean section (CS).Study design: Prospective cohort study.Patients and Methods: The current research is a registered (NCT02755168) study compassing the new technique, EPO,for head extraction during CS. The technique was performed on single, living, cephalic, elective cesarean deliveries atWomen's Health Hospital, Assiut University, Egypt. The primary study outcomes were; the feasibility and the rate ofincision extensions with the External Pop-out technique. The secondary outcomes included the easiness score and thelearning curve of this technique on five senior obstetricians’ trainee.Results: The EPO technique was successful in 845/877 cases (96.3%) but impossible in the remaining 32 case because ofextensive pelvic adhesions. The rate of occurrence of minor extensions associated with EPO was 8/845 (0.95%) with nomajor extensions in succeeded cases. There was a statistically significant difference between the mean of easiness score in the early 5 cases and the next 5 cases in 4 out of 5 trainees. The remaining trainee reported a higher easiness score earlier from his 4th case. The mean of total scores in the late cases was also significantly higher than the early cases (p=0.0001).Conclusions: External Pop-out technique is feasible with low rates of uterine incisions extensions. Moreover; thistechnique is easily learned and performed by obstetricians

Uterine rupture is a catastrophic obstetrical emergency with serious effects on both women and fetuses. Operative hysteroscopic procedures can add more risk factor for occurrence of this tragedy. Here, we report a case of spontaneous recurrent rupture uterus at 33 weeks of gestation in a 32 years old woman with previous history of hysteroscopic resection of submucous myoma after development of acute abdomen. Uterine repair of fundal rupture was performed through emergency exploratory laparotomy. Surgeons should explain to their patients the hazards of probable risk of recurrent and multiple uterine rupture in the future pregnancy and to document this discussion in the medical records before proceeding to operative hysteroscopic procedures.

There is little data on the incidence of diabetes complications in young onset type 1 diabetes (T1DM) and type 2 diabetes (T2DM) in non European populations.From a tertiary diabetes centre, Chennai, India, we recruited 108 T1DM (defined by abrupt onset of symptoms or diabetic ketoacidosis, absent insulin reserve requiring insulin treatment) and 90 T2DM participants (defined by absence of ketosis, good beta-cell reserve, and good response to oral agents) who were diagnosed between the ages of 10 and 25years, and without any evidence of diabetes complications at diagnosis. We estimated the incidence of various complications (median follow up of five years); retinopathy was defined by presence of at least one definite microaneurysm by retinal photography, nephropathy by urinary albumin excretion ⩾30μg/mg of creatinine, neuropathy by vibration perception threshold ⩾20V on biothesiometry, peripheral vascular disease by an ankle-brachial index0.9, and ischemic heart disease (IHD) by history of myocardial infarction or coronary revascularization or Q waves on ECG or on drug treatment for IHD.The mean ages at diagnosis of T1DM and T2DM participants were 17.1±4.2vs. 21.6±3.6years respectively. The incidence of various complications reported in numbers/1000 person years of follow up of T1DM and T2DM were: retinopathy 77.4vs. 78.0/1000 person years, nephropathy, 62.0vs. 58.8, neuropathy 7.8 vs. 13.9 and ischemic heart disease 1.2vs. 5.4. In Cox regression analysis, after adjustment for age, glycated hemoglobin, systolic blood pressure and serum cholesterol, T2DM participants had 2.11 times (95%CI: 1.27-3.51) higher risk of developing any diabetes complication, compared to T1DM.Young-onset T2DM have a more aggressive disease course than T1DM.

Objective This study compares the efficacy of sublingual misoprostol versus intravenous oxytocin in reducing bleeding during and after cesarean delivery. Materials and methods A randomized clinical trial conducted on 120 pregnant women at term (37–40 weeks) gestation scheduled for elective cesarean delivery, who were assigned to either sublingual misoprostol 400 μg or intravenous infusion of 20 units of oxytocin after delivery of the neonate. The main outcome measures were blood loss at and 2 hours after cesarean delivery, change in hematocrit value, need for any additional oxytocic drugs, and drug-related side effects. Results The overall mean blood loss was significantly lower in the misoprostol group compared to the oxytocin group (490.75 ± 159.90 mL vs. 601.08 ± 299.49 mL; p = 0.025). However, changes in hematocrit level (pre- and postpartum) was comparable between both groups. There was a need for additional oxytocic therapy in 16.7% and 23.3% after use of misoprostol and oxytocin, respectively ( p = 0.361). Incidence of side effects such as shivering and metallic taste were significantly higher in the misoprostol group compared to the oxytocin group ( p Conclusions Sublingual misoprostol is more effective than intravenous infusion of oxytocin in reducing blood loss during and after cesarean delivery. However, occurrence of temporary side effects such as shivering and metallic taste was more frequent with the use of misoprostol.

Background Hypertension is an established risk factor for the development of atrial fibrillation (AF). We evaluated the association and population impact of hypertension, defined using the new 2017 guidelines, on risk of AF. Methods In this analysis, we included 14,915 participants in the Atherosclerosis Risk in Communities study without history of AF. Participants underwent blood pressure measurements at baseline and their antihypertensive medication use was assessed. Incident AF was ascertained from study electrocardiograms, hospital records and death certificates. Cox proportional models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) of AF among individuals with hypertension based on the JNC7 and 2017 ACC/AHA guidelines. Poisson models were used to obtain risk ratios and calculate population-attributable fractions (PAFs). Results We identified 2891 cases of incident AF during 21.4 years of mean follow-up. Prevalence of hypertension was 34 and 48% under the JNC7 and 2017 ACC/AHA definitions, respectively. HRs (95%CI) of AF in hypertensives versus non-hypertensives were 1.44 (1.32, 1.56) and 1.37 (1.26, 1.48) after multivariable adjustment under the old and new guidelines, respectively. The corresponding PAF (95%CI) using the old and new guidelines were 11% (8, 13%) and 13% (9, 16%), respectively. Conclusions Overall, our analysis shows that even though the prevalence of hypertension using the new criteria is 40% higher than with the old criteria, this does not translate into meaningful increases in AF attributable to hypertension. These results suggest that prevention or treatment of hypertension based on the new (versus old) guidelines may have limited impact on AF incidence.

OBJECTIVE To evaluate the effect of adjunctive use of vaginal progesterone after McDonald cerclage on the rate of second-trimester abortion in singleton pregnancy. METHODS A randomized controlled trial at Woman's Health Hospital, Assiut University, Egypt, between April 2017 and March 2019 enrolled women eligible for McDonald cerclage. After cerclage, participants were randomly assigned to receive progesterone (400 mg pessary) once daily until 37 weeks or no progesterone. The primary outcome was rate of abortion before 28 weeks. Secondary outcomes included gestational age at delivery, preterm delivery, mean birthweight, Apgar score, and admission to the neonatal intensive care unit (NICU). RESULTS The rate of spontaneous abortion was higher in the no-progesterone group (P=0.016). Mean gestational age and mean birthweight was higher in the progesterone group (P

IntroductionAlthough deaths due to chronic kidney disease (CKD) have doubled over the past two decades, few data exist to inform screening strategies for early detection of CKD in low-income and middle-income countries.MethodsUsing data from three population-based surveys in India, we developed a prediction model to identify a target population that could benefit from further CKD testing, after an initial screening implemented during home health visits. Using data from one urban survey (n=8698), we applied stepwise logistic regression to test three models: one comprised of demographics, self-reported medical history, anthropometry and point-of-care (urine dipstick or capillary glucose) tests; one with demographics and self-reported medical history and one with anthropometry and point-of-care tests. The ‘gold-standard’ definition of CKD was an estimated glomerular filtration rate 2 or urine albumin-to-creatinine ratio ≥30 mg/g. Models were internally validated via bootstrap. The most parsimonious model with comparable performance was externally validated on distinct urban (n=5365) and rural (n=6173) Indian cohorts.ResultsA model with age, sex, waist circumference, body mass index and urine dipstick had a c-statistic of 0.76 (95% CI 0.75 to 0.78) for predicting need for further CKD testing, with external validation c-statistics of 0.74 and 0.70 in the urban and rural cohorts, respectively. At a probability cut-point of 0.09, sensitivity was 71% (95% CI 68% to 74%) and specificity was 70% (95% CI 69% to 71%). The model captured 71% of persons with CKD and 90% of persons at highest risk of complications from untreated CKD (ie, CKD stage 3A2 and above).ConclusionA point-of-care CKD screening strategy using three simple measures can accurately identify high-risk persons who require confirmatory kidney function testing.

AIMS: To evaluate whether and what combinations of diabetes quality metrics were achieved in a multicentre trial in South Asia evaluating a multicomponent quality improvement intervention that included non-physician care coordinators to promote adherence and clinical decision-support software to enhance physician practices, in comparision with usual care. METHODS: Using data from the Centre for Cardiometabolic Risk Reduction in South Asia (CARRS) trial, we evaluated the proportions of trial participants achieving specific and combinations of five diabetes care targets (HbA(1c)

Background Studies in high-income countries have reported associations between oral health and diabetes. There is however a lack of evidence on this association from low and middle-income countries, especially India. The current study aimed to assess the prevalence of common oral diseases and their association with diabetes. Methods This cross-sectional study was nested within the second Cardiometabolic Risk Reduction in South Asia Surveillance Study. A subset of study participants residing in Delhi were administered the World Health Organization’s Oral Health Assessment Questionnaire and underwent oral examination for caries experience and periodontal health assessment using standard indices. Diabetes status was ascertained by fasting blood glucose, glycosylated hemoglobin values or self-reported medication use. Information was captured on co-variates of interest. The association between oral health and diabetes was investigated using Multivariable Zero-Inflated Poisson (ZIP) regression analysis. Results Out of 2045 participants, 47% were women and the mean age of study participants was 42.17 (12.8) years. The age-standardised prevalence (95% confidence interval) estimates were 78.9% (75.6–81.7) for dental caries, 35.9% (32.3–39.6) for periodontitis. Nearly 85% participants suffered from at least one oral disease. Compared to diabetes-free counterparts, participants with diabetes had more severe caries experience [Mean Count Ratio (MCR) = 1.07 (1.03–1.12)] and attachment loss [MCR = 1.10 (1.04–1.17)]. Also, the adjusted prevalence of periodontitis was significantly higher among participants with diabetes [42.3%(40.0–45.0)] compared to those without diabetes [31.3%(30.3–32.2)]. Conclusion We found that eight out of ten participants in urban Delhi suffered from some form of oral disease and participants with diabetes had worse oral health. This highlights the need for public health strategies to integrate oral health within the existing Non-Communicable Disease control programs. Electronic supplementary material The online version of this article (10.1186/s12903-019-0884-4) contains supplementary material, which is available to authorized users.

Aims Type 2 diabetes is a heterogeneous disease and may manifest from multiple disease pathways. We examined insulin secretion and insulin resistance across two ethnicities with particularly high risk for diabetes yet with widely different distributions of weight class. Materials and methods In this population-based, cross-sectional study, Pima Indians from Southwestern United States (n = 865) and Asian Indians from Chennai, India (n = 2374) had a 75-g oral glucose tolerance test. We analysed differences in plasma glucose, plasma insulin, insulin resistance (HOMA-IR), and insulin secretion (ΔI0-30 /ΔG0-30 ) across categories of body mass index (BMI) and glycemic status per American Diabetes Association criteria. Results Pima Indians were younger (mean 27.4 ± SD 6.6, Asian: 33.9 ± 6.7 years) and had higher BMI (33.6 ± 8.1, Asian: 25.7 ± 4.9 kg/m2 ). Among normal weight participants (mean BMI: Pima 22.4 SE 0.2; Asian 22.2 SE 0.06 kg/m2 ), fasting glucose was higher in Asian Indians (5.2 vs Pima: 4.8 mmol/L, P = .003), adjusted for age and sex. Pima Indians were three times as insulin resistant as Asian Indians (HOMA-IR: 7.7 SE 0.1, Asian: 2.5 SE 0.07), while Asian Indians had three times less insulin secretion (Pima: 2.8 SE 1.0 vs Asian: 0.9 SE 1.0 pmol/mmol), a pattern evident across age, BMI, and glycemic strata. Conclusions Metabolic differences between Pima and Asian Indians suggest heterogeneous pathways of type 2 diabetes in the early natural history of disease, with emphasis of insulin resistance in Pima Indians and emphasis of poor insulin secretion in Asian Indians.

The last 2–3 decades have witnessed a decline in age-standardized cardiovascular mortality rates in high-income regions, whereas this has only slightly decreased or even increased in most of the low- and middle-income countries. A systematic comparison of global CVD mortality by regions attributable to various modifiable risk factors such as diabetes, obesity, hypertension, poor diet, and physical inactivity is not available. We present a summary of time trends and heterogeneity in the distribution of global CVD mortality and the attribution of risk factors between 1990 and 2017 using the Global Burden of Disease (GBD) 2017 study. Globally, an estimated ~ 17.8 million (233.1 per 100,000) people died of CVD in 2017. The rate of CVD death was decreased in high-income countries (1990: 271.8 (95% UI (uncertainty interval), 270.9–273.5); 2017: 128.5 (95% UI, 126.4–130.7) per 100,000)) whereas it remained the same in lower- and middle-income countries (1990: 368.2 (95% UI, 335.6–383.3); 2017: 316.9 (95% UI, 307.0–325.5) per 100,000). Among the various traditional risk factors, high systolic blood pressure, unhealthy diet, high fasting plasma glucose, and high low-density lipoprotein levels were attributed to most of the CVD death and disability-adjusted life year lost. We also observed gender variations in tobacco and increased alcohol consumption. In addition to the traditional risk factors, poor air quality is associated with increased CVD burden in developing countries. Surveillance, country-specific guidelines, evidence-based policies, reinforcement of multisectoral health systems, and innovative solutions are urgently needed in resource-challenged settings to curb CVD risk factors and overall burden.

Although it is hypothesized that rural American adults with diabetes (DM) have poorer control of ABCS risk factors [glycohemoglobin (A1c), Blood pressure (BP), Cholesterol, and Smoking], there are no empiric data comparing diabetes care in rural versus urban areas. We examined rural and urban differences in proportions of U.S. adults with DM achieving A1c Disclosure C. Mercado: None. K.M. Bullard: None. M.K. Ali: None. G. Imperatore: None. S. Saydah: None. E. Gregg: None.

The impact of social and environmental circumstances on success in an intensive behavioral intervention to lose weight and reduce risk of type 2 diabetes is unknown. We examined the association of social and environmental circumstances such as provisions of social relations and support, home and work environment, and adverse life events on weight loss and diabetes incidence in the Diabetes Prevention Program (DPP) randomized controlled trial. We included data on 650 female and 319 male adults from the DPP lifestyle intervention group with information on social circumstances and body weight at baseline and follow-up after 6 months (24 weeks of lifestyle intervention), 1, and 2 years. We applied Cox proportional hazards model to obtain hazard ratios (HRs), with social circumstances as the exposures and body weight gain (>7%) or development of diabetes as outcome, adjusting for baseline age, sex, marital status, and number of individuals in the home of the participant. Life style intervention participants who experienced events or changes at work during the DPP trial had a 44% higher risk of developing diabetes [HRR=1.44, 95% CI:1.02;2.04] as compared to lifestyle intervention participants who did not have such experiences at work. Adjustment of body weight gain after the intervention period explained a small component of this risk: 1.38 [95% CI:0.94;2.03]. Negative changes in the home environment [HRR=1.09, 95% CI:0.76;1.56], low provision of social relations [HRR=1.15, 95% CI:0.81;1.65] or adverse life events [HRR=1.14, 95% CI:0.81;1.62] did not increase the HR of developing diabetes. Social circumstances were not associated with >7% body weight increase between the end of the intervention period and 1 or year 2. Thus, our results suggest that work changes and stresses may worsen the possibility of lowering diabetes risk through intensive lifestyle interventions. Disclosure J. NIelsen: None. M.K. Ali: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases; General Clinical Research Center; Eunice Kennedy Shriver National Institute of Child Health and Human Development; National Institute on Aging; Office of Research on Women's Health; Office of Research on Minority Health; Centers for Disease Control and Prevention

Background: The burden of diabetes is overwhelming worldwide and more important in low- and middle-income countries (LMICs). Preventing cardiovascular morbidity and mortality by providing essential medicines for diabetes and its associated risk factors is a major concern in a context of scarcity of resources and weak health systems. We conducted a systematic review from the recent literature to assess and synthesize the gap and needs for access to essential diabetes medicines in LMICs. Methods: We selected the recently published literature on essential medicines for diabetes in LMICs using the PubMed database. Articles were found using the following keywords: "Diabetes AND Essential Medicines" and "Diabetes AND Access to Insulin." Relevant studies conducted in one or more LMICs, as defined by the World Bank, were selected for analysis. Results: Availability and affordability of essential medicines for diabetes is poor in LMICs. Availability of insulin was as low as 10.3% in low income countries while 63% of households could not afford insulin in the PURE study conducted in 22 countries (18 LMICs). In two national surveys conducted in Uganda and Zambia, none of the heathcare facilities was meeting the WHO Standards for essential tools and medicines in Uganda and few (6 out of 46) in Zambia, with only 11% availability of insulin in rural area. Conclusions: The LMICs include a wide range of countries with varying levels of health care resources and quality. To meet the challenge of access to essential medicines for diabetes and other noncommunicable diseases, it is necessary to categorize needs by region and by country in order to prioritize interventions. Disclosure A.M. Diallo: None. M.K. Ali: None. K. Narayan: None.

Clinical guidelines and national programs recommend control of ABCS risk factors [glycohemoglobin (A1c), Blood pressure, Cholesterol, and Smoking] to reduce diabetes-related comorbidities and mortality. We investigated changes in meeting the ABCS goals (A1c Disclosure C. Mercado: None. K.M. Bullard: None. M.K. Ali: None. G. Imperatore: None. S. Saydah: None. E. Gregg: None.

South Asians have a high burden of diabetes at younger ages. We compared diabetes risk in South Asians aged 20-44 years living in India (Delhi and Chennai) and Pakistan (Karachi) with Pima Indians, a population with the world’s highest incidence of diabetes. We analyzed prospective cohort data from the Pima Indian Study (Pima, n=1852), and the Center for Cardiometabolic Risk Reduction in South Asia Study (CARRS, South Asians, n=6676). We defined diabetes as fasting glucose ≥126 mg/dl, HbA1c ≥ 6.5%, or medication use. At baseline, on average, the South Asians were less obese than Pima (BMI, kg/m2: 24.4 vs. 33.8; Waist, cms 82.5 vs.107). Age-standardized diabetes incidence (cases/1000 person-years, 95% CI) was lower in South Asians than in Pima (Men: 14.2, 12.2-16.2 vs. 37.3, 31.8-42.8; Women: 14.8, 13.0-16.5 vs. 46.1, 41.2-51.1). Incidence among 20-24 year old were 80% and 87% lower, respectively, among South Asian men and women, but the risk differential narrowed at older ages (Table). In those with BMI Disclosure K. Narayan: None. D. Kondal: None. S. Kobes: None. M. Deepa: None. N.R. Daya: None. S.A. Patel: None. R. Anjana: None. L.R. Staimez: None. M.K. Ali: None. U. Gujral: None. D. Prabhakaran: None. R. Shivashankar: None. M. Kadir: None. E. Selvin: None. V. Mohan: None. R.L. Hanson: None. N. Tandon: None. Funding National Heart, Lung, and Blood Institute; Department of Health and Human Services (HHSN268200900026C); United Health Group, Minneapolis, MN; National Institute of Diabetes and Digestive and Kidney Diseases (P30DK111024)

Populations in economic transition have a high diabetes prevalence even at lower body mass indices (BMI). We compared diabetes incidence in South Asians ≥45 years in urban India (Delhi and Chennai) and Pakistan (Karachi) with blacks and whites in U.S. Prospective analyses were done using data from the Center for Cardiometabolic Risk Reduction in South Asia Study (CARRS, South Asians, n=3,136), and the Atherosclerosis Risk in Communities Study (ARIC, blacks, n=3,059; whites, n=9,924). We defined diabetes as fasting glucose ≥126 mg/dl, HbA1c ≥ 6.5%, or medication use. South Asians were less obese than blacks and whites (BMI, kg/m2: 24.9 vs. 28.2 vs. 26.0; Waist, cms 87.5 vs.97.5 vs. 95.2). Age-standardized diabetes incidence (cases/1000 person-years, 95% CI) in South Asian men was similar to blacks and 1.6 times than whites (26.0, 22.2-29.8 vs. 26.2, 22.7-29.7 vs. 16.1, 14.8-17.4); and in South Asian women slightly higher than blacks and 3 times than whites (31.9, 27.5-36.2 vs. 28.6, 25.7-31.6 vs. 11.3, 10.2-12.3). In those with BMI Adults in urban India/Pakistan have higher diabetes incidence than U.S. whites. Even nonobese South Asian adults have markedly higher risk of diabetes compared to whites. Disclosure K. Narayan: None. D. Kondal: None. N.R. Daya: None. S.A. Patel: None. M. Deepa: None. R. Anjana: None. L.R. Staimez: None. U. Gujral: None. S. Kobes: None. R. Shivashankar: None. M.K. Ali: None. M. Kadir: None. D. Prabhakaran: None. R.L. Hanson: None. V. Mohan: None. E. Selvin: None. N. Tandon: None. Funding National Heart, Lung, and Blood Institute; Department of Health and Human Services (HHSN268200900026C); United Health Group, Minneapolis, MN; National Institute of Diabetes and Digestive and Kidney Diseases (P30DK111024)

Key Points Question What number and proportion of US adults are referred to and use diabetes preventive services? Findings In this nationally representative cross-sectional analysis of 50 912 survey respondents, 73.5% of those with diagnosed prediabetes and 50.6% of those with risk factors reported receiving any advice or referrals to reduce risk; of those advised, 35.0% to 75.8% of those with diagnosed prediabetes and 33.5% to 75.2% with risk factors reported engaging in various risk-reducing activities or programs in the past year. Those with a formal prediabetes diagnosis were more likely to receive advice or referrals by health care professionals, and those advised were more likely to engage in risk-reducing activities and/or programs. Meaning To improve reach and use of diabetes preventive services, expansion of some combination of programs (supply), awareness (demand), and access and referrals by health care professionals (linkage) appears to be needed., This nationally representative cross-sectional analysis of data from the US National Health Interview Survey findings assesses the reach and use of diabetes prevention services among US adults with diagnosed prediabetes or risk factors for type 2 diabetes., Importance Coordinated efforts by national organizations in the United States to implement evidence-based lifestyle modification programs are under way to reduce type 2 diabetes (hereinafter referred to as diabetes) and cardiovascular risks. Objective To provide a status report on the reach and use of diabetes prevention services nationally. Design, Setting, and Participants This nationally representative, population-based cross-sectional analysis of 2016 and 2017 National Health Interview Survey data was conducted from August 3, 2017, through November 15, 2018. Nonpregnant, noninstitutionalized, civilian respondents 18 years or older at high risk for diabetes, defined as those with no self-reported diabetes diagnosis but with diagnosed prediabetes or an elevated American Diabetes Association (ADA) risk score (>5), were included in the analysis. Analyses were conducted for adults with (and in sensitivity analyses, for those without) elevated body mass index. Main Outcomes and Measures Absolute numbers and proportions of adults at high risk with elevated body mass index receiving advice about diet, physical activity guidance, referral to weight loss programs, referral to diabetes prevention programs, or any of these, and those affirming engagement in each (or any) activity in the past year were estimated. To identify where gaps exist, a prevention continuum diagram plotted existing vs desired goal achievement. Variation in risk-reducing activities by age, sex, race/ethnicity, educational attainment, insurance status, history of gestational diabetes mellitus, hypertension, or body mass index was also examined. Results This analysis included 50 912 respondents (representing 223.0 million adults nationally) 18 years or older (mean [SE] age, 46.1 [0.2] years; 48.1% [0.3%] male) with complete data and no self-reported diabetes diagnosis by their health care professional. Of the represented population, 36.0% (80.0 million) had either a physician diagnosis of prediabetes (17.9 million), an elevated ADA risk score (73.3 million), or both (11.3 million). Among those with diagnosed prediabetes, 73.5% (95% CI, 71.6%-75.3%) reported receiving advice and/or referrals for diabetes risk reduction from their health care professional, and, of those, 35.0% (95% CI, 30.5%-39.8%) to 75.8% (95% CI, 73.2%-78.3%) reported engaging in the respective activity or program in the past year. Half of adults with elevated ADA risk scores but no diagnosed prediabetes (50.6%; 95% CI, 49.5%-51.8%) reported receiving risk-reduction advice and/or referral, of whom 33.5% (95% CI, 30.1%-37.0%) to 75.2% (95% CI, 73.4%-76.9%) reported engaging in activities and/or programs. Participation in diabetes prevention programs was exceedingly low. Advice from a health care professional, age range from 45 to 64 years, higher educational attainment, health insurance status, gestational diabetes mellitus, hypertension, and obesity were associated with higher engagement in risk-reducing activities and/or programs. Conclusions and Relevance Among adults at high risk for diabetes, major gaps in receiving advice and/or referrals and engaging in diabetes risk-reduction activities and/or programs were noted. These results suggest that risk perception, health care professional referral and communication, and insurance coverage may be key levers to increase risk-reducing behaviors in US adults. These findings provide a benchmark from which to monitor future program availability and coverage, identification of prediabetes, and referral to and retention in programs.

Introduction Strong evidence shows that lifestyle change and weight loss stimulated by counseling improve glycemic control and lower comorbidities for patients with diabetes, but it is unclear whether diet or physical activity counseling for patients with diabetes in ambulatory settings has actually been responsive to this evidence. Methods Data from the 2005–2015 National Ambulatory Medical Care Surveys were used to assess trends in provider-reported diet or exercise counseling during ambulatory care visits. The data were pooled and multivariate logistic regression models were built, adjusting for patient-, provider-, and practice-level characteristics to examine whether the provision of counseling varied by these characteristics. Data were analyzed from September 2018 to December 2018. Results There were 42,234 adults with diabetes and 272,094 adults without diabetes. The proportions of patients with provider-reported Type 2 diabetes who received any diet or exercise counseling were no different over time, 30% in 2005 (95% CI=25%, 35%) and 25% in 2015 (95% CI=18%, 31%). Lower proportions of those without diabetes received any counseling, 17% in 2005 (95% CI=14%, 19%) and 15% in 2015 (95% CI=11%, 18%). Adjusted models showed that Hispanic patients had a higher likelihood of receiving diet or exercise counseling, compared with whites (OR=1.38, 95% CI=1.09, 1.75). Those aged 30–49 years were more likely to receive diet or exercise counseling than those aged >75 years (OR=1.51, 95% CI=1.27, 1.80). Compared with rural areas and other providers, visits in a metropolitan area (OR=1.27, 95% CI=1.09, 1.47) or with an advanced practice provider (OR=1.66, 95% CI=1.00, 2.75) had a higher likelihood of any diet or exercise counseling delivery. Conclusions Less than 30% of Americans with diabetes receive diet or exercise counseling in ambulatory visits, and this proportion has not changed significantly in a decade. Future interventions should focus on addressing this gap in counseling.

PURPOSE AND OBJECTIVES: Low‐ and middle‐income countries (LMICs) have a large burden of noncommunicable diseases and confront leadership capacity challenges and gaps in implementation of proven interventions. To address these issues, we designed the Public Health Leadership and Implementation Academy (PH-LEADER) for noncommunicable diseases. The objective of this program evaluation was to assess the quality and effectiveness of PH-LEADER. INTERVENTION APPROACH: PH-LEADER was directed at midcareer public health professionals, researchers, and government public health workers from LMICs who were involved in prevention and control of noncommunicable diseases. The 1-year program focused on building implementation research and leadership capacity to address noncommunicable diseases and included 3 complementary components: a 2-month online preparation period, a 2-week summer course in the United States, and a 9-month, in-country, mentored project. EVALUATION METHODS: Four trainee groups participated from 2013 through 2016. We collected demographic information on all trainees and monitored project and program outputs. Among the 2015 and 2016 trainees, we assessed program satisfaction and pre–post program changes in leadership practices and the perceived competence of trainees for performing implementation research. RESULTS: Ninety professionals (mean age 38.8 years; 57% male) from 12 countries were trained over 4 years. Of these trainees, 50% were from India and 29% from Mexico. Trainees developed 53 projects and 9 publications. Among 2015 and 2016 trainees who completed evaluation surveys (n = 46 of 55), we saw pre–post training improvements in the frequency with which they acted as role models (Cohen’s d = 0.62, P

Objective To assess the effectiveness of prophylactic bilateral uterine artery ligation (BUAL) in reducing the incidence of postpartum hemorrhage (PPH) during cesarean delivery among women at risk of uterine atony. Methods A randomized clinical trial at Cairo University Maternity Hospital, Egypt, from December 2017 to December 2018. Women at risk of uterine atony undergoing scheduled or emergency cesarean were randomized to two groups. In the BUAL group, women underwent BUAL before placental delivery; in the control group, women had cesarean delivery without BUAL. The primary outcome was the estimated blood loss during cesarean. Results Intraoperative blood loss during cesarean was significantly lower in the BUAL group than in the control group (523.4 ± 41.0 vs 619.6 ± 36.1 mL; P=0.003). Blood loss in the first 6 hours after cesarean was also significantly lower in the BUAL group than in the control group (246.1 ± 21.4 vs 326.1 ± 18.5 mL; P=0.006). There was no difference in operative time between the two groups (52.1 ± 6.1 vs 52.2 ± 6.8, P=0.880). Conclusion BUAL during cesarean was found to be an effective method for decreasing blood loss during and after cesarean delivery among women at risk of uterine atony and subsequent PPH. CLINICALTRIALS.GOV: NCT03591679.

Background Economic dimensions of implementing quality improvement for diabetes care are understudied worldwide. We describe the economic evaluation protocol within a randomised controlled trial that tested a multi-component quality improvement (QI) strategy for individuals with poorly-controlled type 2 diabetes in South Asia. Methods/design This economic evaluation of the Centre for Cardiometabolic Risk Reduction in South Asia (CARRS) randomised trial involved 1146 people with poorly-controlled type 2 diabetes receiving care at 10 diverse diabetes clinics across India and Pakistan. The economic evaluation comprises both a within-trial cost-effectiveness analysis (mean 2.5 years follow up) and a microsimulation model-based cost-utility analysis (life-time horizon). Effectiveness measures include multiple risk factor control (achieving HbA1c

Aims To develop and pilot test a taxonomy that empirically estimates health intervention effectiveness from efficacy data. Methods We developed a taxonomy to score health interventions across 11 items on a scale from 0–100. The taxonomy was pilot-tested in efficacy and effectiveness diabetes prevention studies identified in two separate systematic reviews; here, the face validity, inter-rater reliability and factor structure of the taxonomy were established. Random effects meta-analyses were used to obtain weight loss and diabetes incidence pooled effects across studies. These effects and taxonomy scores were used to down calibrate efficacy estimates to effectiveness estimates as follows: Efficacy effect*[Efficacy score/highest possible score]. Results We scored 82 effectiveness lifestyle modification studies (mean score 49.2), 32 efficacy lifestyle modification studies (mean score 69.8) and 20 efficacy studies testing medications (mean score 77.4). The taxonomy had face validity and good inter-rater reliability (ICC = 0.9 [0.87, 0.93]). The between-groups down calibrated weight loss estimate was similar to that observed in the effectiveness meta-analysis (1.7 and 1.8 kg, respectively). The down calibrated diabetes relative risk reduction was also similar to that observed in the effectiveness meta-analysis (30.6% over 2.7 years and 29% over 2 years, respectively). Conclusions The taxonomy is a promising tool to estimate the real-world impact of health interventions.

Diabetes lifestyle self-management is a 24/7, lifelong effort that takes place in homes, families, neighborhoods, workplaces, clinics, and organizations in the community. From an ecological perspective, patients are not isolated but part of a complex, multilayered system where barriers in each layer and their interaction may hinder effective lifestyle management. As such, responsibility for effective lifestyle management is shared among patients, families, providers, communities, and healthcare systems and payers. This chapter discusses barriers to lifestyle management that can be encountered at each of these levels and proposes strategies that can be used to address these barriers and promote effective patient self-management.

In the United States, diabetes affects approximately 10% of the population, and in 2017, this equated to an estimated 30.3 million Americans with diabetes. Type 2 or insulin-independent diabetes accounts for the majority (~90–95%) of cases in the United States. Furthermore, approximately one-third of US adults have prediabetes, an identifiable precursor phase in which blood glucose levels are above normal but not yet in the diagnostic range for diabetes, and one’s risk of developing type 2 diabetes increases five to twelvefold.

This paper presents high efficiency, high integration, and wideband low-IF radio frequency transceiver for multi-standard applications using 130 ​nm CMOS technology. The proposed low-IF transceiver includes receiver, transmitter, and quadrature voltage-controlled power oscillator (QVCO). The proposed receiver consists of a low-noise driver stage designed using Capacitive Cross-Coupling (CCC) common-gate configuration, and I/Q demodulator. While, the proposed transmitter composes of an I/Q modulator and an RF power amplifier, where the I/Q modulator consists of two up-conversion mixers, a five ports transformer along with switched capacitors bank for reconfigurable RF output matching. The proposed receiver has a frequency band of 0–10 ​GHz, while the operating frequency of the proposed transmitter equals 1.5–4 ​GHz. The proposed RF transceiver design is suitable for multi-band LTE, IOT, WSN, and multi-standard applications. The proposed receiver achieves a power gain of 15.4 ​dB, noise figure (NF) equals 3.8 ​dB, sensitivity equals −100.2 dBm and a dynamic range of 92.2 dBm. On the other hand, the proposed transmitter has a saturated output power of 23 dBm, power added efficiency (PAE) equals 41%, the power gain of 25 ​dB, and adjacent channel power ratio (ACPR) of equals −31.8dBc. The proposed receiver and transmitter consume 10.85 ​mW, and 180.95 ​mW, respectively, including the QVCO. The receiver and transmitter Figures of Merit (FoM) equal 191.5 ​dB and 2.45 ​dB respectively. The active areas of the proposed receiver and transmitter equal 0.56 m m 2 and 1.6 m m 2 , respectively while the chip areas are 1.6 m m 2 and 2.4 m m 2 , respectively.

IntroductionWe compared diabetes incidence in South Asians aged ≥45 years in urban India (Chennai and Delhi) and Pakistan (Karachi), two low-income and middle-income countries undergoing rapid transition, with blacks and whites in the US, a high-income country.Research design and methodsWe computed age-specific, sex-specific and body mass index (BMI)-specific diabetes incidence from the prospective Center for Cardiometabolic Risk Reduction in South Asia Study (n=3136) and the Atherosclerosis Risk in Communities Study (blacks, n=3059; whites, n=9924). We assessed factors associated with incident diabetes using Cox proportional hazards regression.ResultsSouth Asians have lower BMI and waist circumference than blacks and whites (median BMI, kg/m2: 24.9 vs 28.2 vs 26.0; median waist circumference, cm 87.5 vs 96.0 vs 95.0). South Asians were less insulin resistant than blacks and whites (age-BMI-adjusted homeostatic model assessment of insulin resistance, µIU/mL/mmol/L: 2.30 vs 3.45 vs 2.59), and more insulin deficient than blacks but not whites (age-BMI-adjusted homeostasis model assessment of β-cell dysfunction, µIU/mL/mmol/L: 103.7 vs 140.6 vs 103.9). Age-standardized diabetes incidence (cases/1000 person-years (95% CI)) in South Asian men was similar to black men and 1.6 times higher (1.37 to 1.92) than white men (26.0 (22.2 to 29.8) vs 26.2 (22.7 to 29.7) vs 16.1 (14.8 to 17.4)). In South Asian women, incidence was slightly higher than black women and 3 times (2.61 to 3.66) the rate in white women (31.9 (27.5 to 36.2) vs 28.6 (25.7 to 31.6) vs 11.3 (10.2 to 12.3)). In normal weight (BMI 2), diabetes incidence adjusted for age was 2.9 times higher (2.09 to 4.28) in South Asian men, and 5.3 times (3.64 to 7.54) in South Asian women than in white women.ConclusionsSouth Asian adults have lower BMI and are less insulin resistant than US blacks and whites, but have higher diabetes incidence than US whites, especially in subgroups without obesity. Factors other than insulin resistance (ie, insulin secretion) may play an important role in the natural history of diabetes in South Asians.

We examined factors responsible for variation in cardiovascular disease (CVD) mortality across US counties in 2009-2013. We linked county-level census, survey, administrative, and vital statistics data to examine 4 sets of features: demographic factors, social and economic factors, health-care utilization and features of the environment, and population health indicators. County-level associations of these features (standardized to a mean of 0 with a standard deviation of 1) with cardiovascular deaths per 100,000 person-years among adults aged 45-74 years was modeled using 2-level hierarchical linear regression with random intercept for state. The percentage of CVD mortality variation (intercounty disparity) modeled by each set of features was quantified. Demographic composition accounted for 36% of county CVD mortality variation, and another 32% was explained after inclusion of economic/social conditions. Health-care utilization, features of the environment, and health indicators explained an additional 6% of CVD mortality variation. The largest contributors to CVD mortality levels were median income (-23.61 deaths/100,000 person-years, 95% CI: -26.95, -20.26) and percentage without a high school education (20.71 deaths/100,000 person-years, 95% CI: 16.48, 24.94). In comparison, the largest health-related contributors were health-care utilization (19.35 deaths/100,000 person-years, 95% CI: 16.36, 22.34) and CVD risk factors (4.80 deaths/100,000 person-years, 95% CI: 2.14, 7.46). Improving health-care access and decreasing the prevalence of traditional CVD risk factors may reduce county CVD mortality levels, but improving socioeconomic circumstances of disadvantaged counties will be required in order to reduce CVD mortality disparities across counties.

Objectives: to evaluate the effect of oral ginkgo biloba extract (GB)) on asymmetrical intrauterine growth restriction (IUGR). Study Design: A randomized trial conducted at Assiut Women Health on 226 pregnant women with asymmetrical IUGR. The patients randomly received GB extract or placebo for 6 weeks. The main outcome measures were improvement in fetal weight and feto-maternal blood flow. The data were analyzed by Student’s t- test and chi-squared tests. Result: There was a significant increase in the estimated fetal weight in the GB group (3047+ 127 gm) when compared to the placebo group (2734+ 127 gm) (p= Conclusions: GB extract improves placental functions, Doppler indices and fetal weight in pregnancies complicated with IUGR fetuses.