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BackgroundDiabetes is a growing concern in South Asia but few nationally representative studies identify factors behind this rising disease burden. We studied the nationwide change in diabetes prevalence in Bangladesh, subpopulations disproportionately affected, and the contribution of rising unhealthy weight to the change in diabetes prevalence. Methods Based on a sample of 13,959 adults aged 35 years and older with biomarker measurements from the 2011 and 2017/2018 Bangladesh Demographic and Health Surveys, we estimated how the prevalence of diabetes changed nationally and across socioeconomic/geographic groups. Using counterfactual decomposition, we assessed how much the prevalence of diabetes would have grown if BMI had not changed between 2011 and 2017.ResultsDiabetes prevalence increased from 12.1 (11.1, 13.1) to 14.4% (13.3, 15.5) between 2011 and 2017/2018. Diabetes grew disproportionately quickly among population groups with higher household wealth, more education, and in three regions. Over this same period, mean BMI increased from 20.9 (20.8, 21.1) to 22.5 kg/m^2 (22.4, 22.7) and overweight from 25.8 (24.4, 27.3) to 42.1% (40.4, 43.7). Under the counterfactual scenario of constant BMI, diabetes would have risen by only 1.0 (-0.4, 2.4) instead of 2.3 percentage points (0.8, 3.7) nationally, corresponding to a contribution of 58% (-106.3, 221.7). Similarly, group-specific trends were largely attributable to increasing BMI.ConclusionsDiabetes prevalence in Bangladesh has increased rapidly between 2011 and 2017/2018. Decomposition analysis estimates have wide confidence intervals but are consistent with the hypothesis that this change was driven by the dramatic rise in body weights.

BackgroundCardiovascular diseases (CVDs) are the leading cause of death in most low- and middle-income countries (LMICs). CVDs and their metabolic risk factors have historically been concentrated among urban residents with higher socioeconomic status (SES) in LMICs such as India. However, as India develops, it is unclear whether these socioeconomic and geographic gradients will persist or change. Understanding these social dynamics in CVD risk is essential for mitigating the rising burden of CVDs and to reach those with the greatest needs.MethodsUsing nationally representative data with biomarker measurements from the fourth (2015-16) and fifth (2019-21) Indian National Family and Health Surveys, we investigated trends in the prevalence of four CVD risk factors: tobacco consumption (self-reported, any type), unhealthy weight, idiabetes (random plasma glucose concentration ≥200mg/dL or self-reported diabetes), and hypertension (one of: average systolic blood pressure ≥ 140mmHg, average diastolic blood pressure ≥ 90mmHg, self-reported past diagnosis, or self-reported current antihypertensive medication use) among adults aged 15-49 years. We first described changes at the national level and then trends stratified by place of residence (urban versus rural), geographic region (northern, northeastern, central, eastern, western, southern), regional level of development (Empowered Action Group member state or not), and two measures of socioeconomic status: level of education (no education, primary incomplete, primary complete, secondary incomplete, secondary complete, higher) and wealth (quintiles).FindingsUnhealthy weight increased among all social and geographic groups but both the absolute and the relative changes were substantially higher among people with low SES (as measured by education or wealth) and in rural areas. For diabetes and hypertension, the prevalence increased for those from disadvantaged groups while staying constant or even decreasing among the wealthier and more educated. In contrast, tobacco consumption declined for all social and geographic groups.InterpretationIn 2015-16, CVD risk factors were higher among more advantaged subpopulations in India. However, between 2015-16 and 2019-21, the prevalence of these risk factors grew more rapidly for less wealthy and less educated subpopulations and those living in rural areas. These trends have resulted in CVD risk becoming far more widespread throughout the population; CVD can no longer be characterized as a wealthy urban phenomenon.FundingThis work was supported by the Alexander von Humboldt Foundation [NS]; the Stanford Diabetes Research Center [PG], and the Chan Zuckerberg Biohub [PG].Research in ContextEvidence before this studyWe searched PubMed for work published between Jan 1, 1990, and Sep 23, 2022, with variations of the search terms “reversal hypothesis”, “social gradient”, “socioeconomic gradient”, “social difference”, “socioeconomic difference”, “socioeconomic status”, “change”, “trend”, “cardiovascular disease”, “cardiovascular risk factor”, “diabetes”, “hypertension”, “overweight”, “obesity”, “smoking”, “tobacco”, “low-income”, “lower-middle-income”, and “India” in the title or abstract. Existing studies on changes in the socioeconomic patterning of cardiovascular disease (CVD) risk factors mostly compared the size of social gradients in obesity cross-sectionally between countries at different levels of national income or development. These studies generally found higher obesity among higher socioeconomic status (SES) populations but opposite gradients for countries at higher levels of development. However, because these studies use cross-sectional comparisons, whether these patterns reflect the influence of development or other contextual factors associated with countries at different levels of development is unclear. Both for obesity and for other CVD risk factors, we found few nationally-representative studies that traced how gradients within countries changed over time as they developed. Importantly, most of these studies did not focus on India and those that did only considered single risk factors such as obesity using older data. Existing nationally representative research on India is thus predominantly cross-sectional and has only focused on the size of social gradients at single points in time. This work generally finds higher levels of unhealthy weight, diabetes, and hypertension among wealthy and educated subpopulations but lower levels of tobacco consumption. Subnational and smaller non-representative studies from India that traced changes in CVD risk factors over time provide some evidence of reversing or flattening gradients but it is unclear whether these patterns hold at regional and national levels.Added value of this studyUsing data from the 2015-16 and 2019-2021 National Family and Health Surveys, we provide some of the first nationally representative evidence for trends in the prevalence of major CVD risk factors in India and how these trends have changed across social and geographic groups. Both absolute and relative increases in prevalence were far more pronounced among relatively poor and less educated populations. As a result of these trends, most CVD risk factors became more equal across population groups, or in some cases, became higher among the less compared to more educated.Implications of all the available evidenceIndians with lower SES – as measured by wealth and education – experienced considerable adverse trends in unhealthy weight, diabetes, and hypertension between 2015-16 and 2019-21. Our results reveal that CVDs can no longer be considered a problem of the affluent parts of society and suggest that CVD prevention efforts that reach less advantaged subpopulations are urgently needed.

The aim of the study was to analyse health-related quality of life (HRQoL) and its determinants in individuals with an increased risk of developing type 2 diabetes mellitus (T2D). We used pseudonymized baseline data collected between 2018 and 2020 as part of the Dimini project in Hesse and Schleswig–Holstein. HRQoL was measured by the mental and the physical component score of the validated instrument Short Form 12 and descriptively analysed followed by multiple linear regression analysis. The Dimini population (n = 662) showed an average physical component score of 42.12 (SD 10.56) and a mental component score of 47.12 (SD 11.13). While men demonstrated both significantly higher physical and mental component scores than women, differences based on migration background were not observed. Younger age was associated with a higher level of the physical component score, whereas mental component scores linearly increased with age. Regarding indicators of T2D-risk, a significant influence of HbA1c on HRQoL was not confirmed. However, physical component scores are negatively related to Findrisk scores and BMI. Finally, study participants living alone and those with a handicap reported lower levels of HRQoL. Compared with a representative sample of the general German population (DEGS1), Dimini participants were characterized by a lower average HRQoL. The analysis showed a higher vulnerability to an impaired HRQoL within certain subgroups of the population and among participants with relatively higher levels of T2D-risk. As a result, tailored healthcare interventions are required to reach these target groups. Trial Registration Number: ClinicalTrials.gov ID NCT03482674.

Information is lacking on how older adults are coping during the pandemic. We explored coping strategies including outdoor activities among community-dwelling older adults (N = 115) 65 and older (mean age 76.45, 71.3% female). Using conventional content analysis, we analyzed responses to: 1) How are you coping with COVID-19? and 2) How often are you going outside during the pandemic and for what reasons? Most common activities are connecting with family and friends (some in person, others on the phone or virtually), reading, tv, game playing, and learning something new (e.g. webinars, online classes). The majority are going outside every day, with walking being the most common activity. Only a few are restricting their out of home activities to essential tasks (e.g. going to the doctors, pharmacy, getting groceries). Findings suggest that many older adults are engaging in positive coping activities. Assessing coping strategies can give insight into wellbeing.

We present three adolescents with focal lesions of the distal femur that were shown to be benign aggregates of small lymphocytes and plasma cells of unknown origin. The patients were within the age of 12 and 14 years. All lesions presented with similar MRI findings and provided the same histopathological findings in the biopsy. Although all lesions increased in size, only one patient remained symptomatic and underwent subsequent tumor resection. To our best knowledge, tumor or pseudotumoral epiphyseal lymphoid infiltrates as seen in these three patients have not previously been described. We recommend a biopsy to rule out a malignant tumor or an infection. Observation, without further invasive testing in asymptomatic patients, is recommended until the resolution of the lesions. However, if a lesion becomes symptomatic, surgical resection should be considered.

In 2002, for the first time, in Atkins v. Virginia, 536 U.S. 304 (2002), the United States Supreme Court found that it violated the Eighth Amendment to subject persons with intellectual disabilities to the death penalty. Since that time, it has returned to this question multiple times, clarifying that inquiries into a defendant’s intellectual disability (for purposes of determining whether he is potentially subject to the death penalty) cannot be limited to a bare numerical “reading” of an IQ score, and that state rules based on superseded medical standards created an unacceptable risk that a person with intellectual disabilities could be executed in violation of the Eighth Amendment. Atkins provides a blueprint, but the question remains as to whether it will, in the long run, be more than a “paper victory.” Until these issues are carefully considered, the true legacy of Atkins and its progeny will not be at all clear, and it will similarly not be clear if the case’s revolutionary potential will be fulfilled. In this paper, we seek to answer this question: to what extent has the Fifth Circuit given meaningful life to Atkins and its progeny? Our research reveals that, in the universe of 70 “Atkins cases” (that is, cases in the Fifth Circuit in which colorable Atkins-based arguments had been raised by defendants on habeas corpus applications), in only nine cases (12%) was any actual and meaningful relief granted to defendants (their sentences being commuted to life in prison, with one of those defendants having a parole hearing scheduled). In 40 of the 70 cases (57%), the Circuit affirmed a decision below, in most cases, denying applications for writs of habeas corpus. Eight cases (11%) are still pending, that is, there was a remand from the Fifth Circuit or a grant of a certificate of appealability, and further proceedings are currently taking place or being scheduled. In 13 cases (18.5%), although preliminary relief had been granted, defendants were ultimately unsuccessful; as of the writing of this paper, ten have been executed, one defendant’s execution has been stayed because of Covid-related reasons, one died in prison and one remains on death row. In short, if every one of the defendants in pending cases is successful (an outcome that, based on the Fifth Circuit’s global track record, is certainly not likely), that will mean that Atkins’ claims were successful in just 24% of all cases. Our findings also revealed important patterns of why certain defendants were successful, and the majority were unsuccessful. It was more likely that at least preliminary relief was granted in those cases in which defendants were able to rebut allegations that they were “malingering,” in which effort to raise the so-called “Flynn effect” were prevalent, and in which the WAIS IQ test was relied upon; if all three were present, that seemed to heighten the likelihood of success. On the other hand, the findings also revealed that it was less likely that a defendant would be successful if the WISC IQ test were used, if there was no rebuttal for malingering claims or if the subsequently-discredited testimony of one forensic psychologist was used by the state. Our roadmap is this: First, we discuss the Atkins case and the significance of how post-Atkins cases modified and reinforced some of Atkins’ most salient points. Following this, we will examine the universe of Fifth Circuit cases applying (often, misapplying) Atkins, explaining our methodology and revealing our findings. We then consider this entire area of law and policy through the lens and filter of therapeutic jurisprudence, and then subsequently apply that doctrine’s principles to the database of the cases in question. We conclude by offering some modest suggestions focusing on how we can finally, some 17 years after one of us used this phrase in a title of another law review article about Atkins, “giv[e] life” to this case.

Objectives The purpose of this study was to solicit and compile data from practicing veterinary specialists regarding their use of toceranib in cats with mast cell neoplasia and to provide initial assessment of possible clinical benefit and adverse events. Methods The American College of Veterinary Internal Medicine and Oncology listservs were used to solicit data pertaining to cases in which toceranib was used in the treatment of feline mast cell neoplasia. Cases were included if the following data were received: signalment (age, sex, breed), diagnosis of mast cell neoplasia by either cytology or histopathology, anatomic classification of disease (cutaneous, splenic/hepatic, gastrointestinal, other), previous and concurrent treatment, toceranib dose (mg/kg) and schedule, duration of therapy, best response and documentation of adverse events. Results Case data from 50 cats with cutaneous (n = 22), splenic/hepatic (visceral) (n = 10), gastrointestinal (n = 17) or other (n = 1) mast cell neoplasia were received. Clinical benefit was seen in 80% (40/50), including 86% (19/22) with cutaneous, 80% (8/10) with visceral and 76% (13/17) with gastrointestinal involvement. A majority of cats (n = 35) received glucocorticoids during toceranib treatment. Median duration of treatment in cats experiencing clinical benefit was 36 weeks (range 4–106 weeks), 48 weeks (range 12–199 weeks) and 23 weeks (range 13-81 weeks) for cutaneous, visceral and gastrointestinal cases, respectively. Toceranib was administered at a median dose of 2.5 mg/kg (range 1.6–3.5 mg/kg); in 90% (45/50) the drug was given three times per week. Treatment was generally well tolerated with 60% (30/50) of cats experiencing adverse events. The majority of these events were low-grade (grade 1 or 2) gastrointestinal or hematologic events that resolved with treatment break and/or dose adjustment. Conclusions and relevance Toceranib appears to be well tolerated in feline patients with mast cell neoplasia. Biologic activity of this drug is evident in the studied cats; however, further prospective studies are needed to elucidate fully its role in treatment of this disease.

Sturge-Weber syndrome (SWS) is a vascular neurocutaneous disorder that results from a somatic mosaic mutation in GNAQ, which is also responsible for isolated port-wine birthmarks. Infants with SWS are born with a cutaneous capillary malformation (port-wine birthmark) of the forehead or upper eyelid which can signal an increased risk of brain and/or eye involvement prior to the onset of specific symptoms. This symptom-free interval represents a time when a targeted intervention could help to minimize the neurological and ophthalmologic manifestations of the disorder. This paper summarizes a 2015 SWS workshop in Bethesda, Maryland that was sponsored by the National Institutes of Health. Meeting attendees included a diverse group of clinical and translational researchers with a goal of establishing research priorities for the next few years. The initial portion of the meeting included a thorough review of the recent genetic discovery and what is known of the pathogenesis of SWS. Breakout sessions related to neurology, dermatology, and ophthalmology aimed to establish SWS research priorities in each field. Key priorities for future development include the need for clinical consensus guidelines, further work to develop a clinical trial network, improvement of tissue banking for research purposes, and the need for multiple animal and cell culture models of SWS.