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Scotland G.S.,University of Aberdeen | McNamee P.,University of Aberdeen | Cheyne H.,University of Stirling | Hundley V.,University of Stirling | Barnett C.,Directorate of Public Health
Birth | Year: 2011

Background: The latent phase of labor can vary greatly in duration, and many women are uncertain about when to contact the maternity unit. The aim of this study was to elicit and value women's preferences for some aspects of labor management. Methods: A questionnaire was sent to 1,251 women who had recently given birth to their first child at one of 14 maternity units in Scotland. Discrete choice questions were used to measure women's preferences for five attributes of care: number of visits (assessments) before admission to the labor ward, time spent on the labor ward before delivery, mobility during labor, pain relief required, and mode of delivery. Responses were analyzed for the sample as a whole and for subgroups defined by recent experiences of labor. Results: A total of 730 (58.4%) questionnaires were returned and analyzed. Women expressed a preference for fewer visits before admission, shorter times on the labor ward before delivery, mobility during labor, normal vaginal deliveries, and moderate forms of pain relief (Entonox and opiates). Subgroup analysis suggests that women's preferences for pain relief are influenced by their recent labor experience. The elicited preference values provide a means for estimating the tradeoffs women are willing to make between attributes of labor management. Conclusions: Women appear to dislike being turned away from the labor ward before admission for delivery. Extra visits before admission only appear to be a price worth paying if they result in reductions in the duration of time spent on the labor ward, reductions in the chance of being immobilized in hospital during labor, or a lower chance of requiring an instrumental or operative delivery. © 2010, Copyright the Authors. Journal compilation © 2010, Wiley Periodicals, Inc.


Forster A.S.,King's College London | Forbes A.,King's College London | Dodhia H.,Directorate of Public Health | Connor C.,Guys and St Thomas Foundation Trust | And 4 more authors.
Diabetologia | Year: 2013

Aims/hypothesis: This study evaluated whether repeated non-attendance for diabetic eye screening is associated with the risk of sight-threatening diabetic retinopathy (STDR). Methods: This was a cohort study of 6,556 residents with diabetes who were invited for screening between 2008 and 2011 in a population-based eye screening programme in inner London and who attended for their first-ever screen in 2008. The proportion of participants with STDR was evaluated in relation to the number of years in which screening was missed. Results: The proportion of participants who did not attend screening decreased between 2009 and 2011 (annual reduction 1.6% [95% CI 0.9%, 2.3%]). The adjusted relative odds of STDR for 210 participants who did not attend two consecutive years of screening were 3.76 (95% CI 2.14, 6.61; p < 0.001), compared with participants who were screened annually. In 605 participants with mild non-proliferative retinopathy at the first screen, the adjusted relative odds of developing proliferative or moderate to severe non-proliferative retinopathy were 5.72 (95% CI 7.43, 22.83; p = 0.013) for 53 participants who missed two screens. Conclusions/interpretation: Patients who do not attend diabetic eye screening are at increased risk of developing STDR. Tracing of non-attenders with evidence of established retinopathy should be an important fail-safe procedure. © 2013 Springer-Verlag Berlin Heidelberg.


Forster A.S.,King's College London | Forbes A.,King's College London | Dodhia H.,Directorate of Public Health | Connor C.,Guys and St Thomas NHS Foundation Trust | And 4 more authors.
Diabetes Care | Year: 2013

OBJECTIVE-Annual diabetic eye screening has been implemented in England since 2008. This study aimed to estimate changes in the detection of retinopathy in the first 4 years of the program. RESEARCH DESIGN AND METHODS-Participants included 32,340 patients with type 2 diabetes resident in three London boroughs with one or more screening records between 2008 and 2011. Data for 87,570 digital images from 2008 to 2011 were analyzed. Frequency of sight-threatening diabetic retinopathy (STDR) was estimated by year of screen for first screens and for subsequent screens according to retinopathy status at first screen. RESULTS-Among 16,621 first-ever screens, the frequency of STDR was 7.1% in 2008, declining to 6.4%in 2011 (P = 0.087). The proportion with a duration of diabetes of 1< 1 year at first screen increased from 18.7%in 2008 to 48.6% in 2011. Second or later screens were received by 26,308 participants. In participants with mild nonproliferative retinopathy at first screen, the proportion with STDR at second or later screen declined from 21.6% in 2008 to 8.4% in 2011 (annual change -2.2% [95% CI -3.3 to -1.0], P < 0.001). In participants with no retinopathy at first screen, STDR declined from 9.2% in 2008 to 3.2% in 2011 (annual change-1.8% [-2.0 to -1.7], P < 0.001). Declining trends were similar in sociodemographic subgroups. CONCLUSIONS-After the inception of population-based diabetic eye screening, patients at lower risk of STDR contribute an increasing proportion to the eligible population, and the proportion detected with STDR at second or subsequent screening rounds declines rapidly. © 2013 by the American Diabetes Association.


Hoetjes P.C.,Directorate of Public Health | Carpenter K.E.,United International University Dhanmondi
PLoS ONE | Year: 2010

Saba Bank has always been an area of special importance to the neighboring island of Saba in the Netherlands Antilles. Sabans traditionally fished on the Bank as far back as 1907, but increasing foreign fishing pressures on the Bank in the 1970s and 1980s forced many Saban fishermen out. Concerns were compounded by the suspicion that shipping was also damaging the benthic habitat of the bank. Fishery legislation, enacted in 1996, brought an end to unlicensed fishing and established Coast Guard enforcement on the Bank, but also led to protests from neighboring countries that previously fished on the Bank. Research was necessary to support the need for protection. Review of available research of Saba Bank and rapid biological assessments and fisheries surveys since 1996 emphasized the richness of Saba Bank's biodiversity and the need for protection of fisheries stocks. The national nature policy plan recognized this and encouraged further research to base conservation measures on. - Recent biological surveys of corals, fishes, and algae presented in this collection of articles emphasized habitat heterogeneity and the relative richness of the marine flora and fauna. These assessments formed the basis for a management plan to protect Saba Bank's biodiversity and a draft proposal to the International Maritime Organization (IMO) seeking Particularly Sensitive Sea Area (PSSA) status for the Bank. The intention of the PSSA proposal is to protect the benthic habitat on Saba Bank from anchor damage. This paper serves to provide the context for the results of the recent biodiversity surveys of Saba Bank. It is hoped that this collection will serve as a knowledge baseline and engender further research in the area. © 2010 Hoetjes, Carpenter.


Guariguata L.,International Diabetes Federation | Whiting D.R.,Directorate of Public Health | Hambleton I.,University of the West Indies | Beagley J.,International Diabetes Federation | And 2 more authors.
Diabetes Research and Clinical Practice | Year: 2014

Introduction: Diabetes is a serious and increasing global health burden and estimates of prevalence are essential for appropriate allocation of resources and monitoring of trends. Methods: We conducted a literature search of studies reporting the age-specific prevalence for diabetes and used the Analytic Hierarchy Process to systematically select studies to generate estimates for 219 countries and territories. Estimates for countries without available source data were modelled from pooled estimates of countries that were similar in regard to geography, ethnicity, and economic development. Logistic regression was applied to generate smoothed age-specific prevalence estimates for adults 20-79 years which were then applied to population estimates for 2013 and 2035. Results: A total of 744 data sources were considered and 174 included, representing 130 countries. In 2013, 382 million people had diabetes; this number is expected to rise to 592 million by 2035. Most people with diabetes live in low- and middle-income countries and these will experience the greatest increase in cases of diabetes over the next 22 years. Conclusion: The new estimates of diabetes in adults confirm the large burden of diabetes, especially in developing countries. Estimates will be updated annually including the most recent, high-quality data available. © 2013.


Macleod M.,University of Dundee | Gregor A.,University of Dundee | Barnett C.,Directorate of Public Health | Magee E.,Directorate of Public Health | And 2 more authors.
Maternal and Child Nutrition | Year: 2013

A semi-structured, web-based questionnaire was developed to survey midwives (n=241) employed by NHS Tayside, UK, to identify current practice and views on weight management of obese women during pregnancy and the puerperium. A total of 78 (32%) midwives submitted responses following email invitation. Most respondents (79%) reported always calculating women's body mass index (BMI) at booking, with 73% routinely explaining the BMI category. In terms of future practice for obese women, although few respondents (15%) currently offer personalised advice regarding weight management based on a woman's diet and physical activity levels, 77% of respondents thought such advice would be appropriate and 69% thought it could possibly be feasible to offer such advice. The respondents viewed weight management to be of importance and felt that universal advice is appropriate, but confidence in discussing weight management and knowledge of the subject was low. Strategies to improve midwife confidence and weight management services should include training, ongoing support and definition of the midwife's role within the multidisciplinary team to support practice in the future. © 2012 John Wiley & Sons Ltd.


Guariguata L.,International Diabetes Federation | Linnenkamp U.,International Diabetes Federation | Beagley J.,International Diabetes Federation | Whiting D.R.,Directorate of Public Health | Cho N.H.,Ajou University
Diabetes Research and Clinical Practice | Year: 2014

Aims: We estimated the number of live births worldwide and by IDF Region who developed hyperglycaemia in pregnancy in 2013, including total diabetes in pregnancy (known and previously undiagnosed diabetes) and gestational diabetes. Methods: Studies reporting prevalence of hyperglycaemia first-detected in pregnancy (formerly termed gestational diabetes) were identified using PubMed and through a review of cited literature. A simple scoring system was developed to characterise studies on diagnostic criteria, year study was conducted, study design, and representation. The highest scoring studies by country with sufficient detail on methodology for characterisation and reporting at least three age-groups were selected for inclusion. Forty-seven studies from 34 countries were used to calculate age-specific prevalence of hyperglycaemia first-detected in pregnancy in women 20-49 years. Adjustments were then made to account for heterogeneity in screening method and blood glucose diagnostic threshold in studies and also to align with recently published diagnostic criteria as defined by the WHO for hyperglycaemia first detected in pregnancy. Prevalence rates were applied to fertility and population estimates to determine regional and global prevalence of hyperglycaemia in pregnancy for 2013. An estimate of the proportion of cases of hyperglycaemia in pregnancy due to total diabetes in pregnancy was calculated using age- and sex-specific estimates of diabetes from the IDF Diabetes Atlas and applied to age-specific fertility rates. Results: The global prevalence of hyperglycaemia in pregnancy in women (20-49 years) is 16.9%, or 21.4 million live births in 2013. An estimated 16.0% of those cases may be due to total diabetes in pregnancy. The highest prevalence was found in the South-East Asia Region at 25.0% compared with 10.4% in the North America and Caribbean Region. More than 90% of cases of hyperglycaemia in pregnancy are estimated to occur in low- and middle-income countries. Conclusion: These are the first global estimates of hyperglycaemia in pregnancy and conform to the new WHO recommendations regarding diagnosis and also include estimates of live births in women with known diabetes. They indicate the importance of the disease from a public health and maternal and child health perspective, particularly in developing countries. © 2013 Elsevier Ireland Ltd.


Linnenkamp U.,International Diabetes Federation | Guariguata L.,International Diabetes Federation | Beagley J.,International Diabetes Federation | Whiting D.R.,Directorate of Public Health | Cho N.H.,Ajou University
Diabetes Research and Clinical Practice | Year: 2014

Introduction: Hyperglycaemia is one of the most prevalent metabolic disorders occurring during pregnancy. Limited data are available on the global prevalence of hyperglycaemia in pregnancy. The International Diabetes Federation (IDF) has developed a methodology for generating estimates of the prevalence of hyperglycaemia in pregnancy, including hyperglycaemia first detected in pregnancy and live births to women with known diabetes, among women of childbearing age (20-49 years). Methods: A systematic review of the literature for studies reporting the prevalence of gestational diabetes was conducted. Studies were evaluated and scored to favour those that were representative of a large population, conducted recently, reported age-specific estimates, and case identification was based on blood test. Age-specific prevalence data from studies were entered to produce estimates for five-year age groups using logistic regression to smooth curves, with age as the independent variable. The derived age-specific prevalence was adjusted for differences in diagnostic criteria in the underlying data. Cases of hyperglycaemia in pregnancy were derived from age-specific estimates of fertility and age-specific population estimates. Country-specific estimates were generated for countries with available data. Regional and global estimates were generated based on aggregation and extrapolation for 219 countries and territories. Available fertility rates and diabetes prevalence estimates were used to estimate the proportion of hyperglycaemia in pregnancy that may be due to total diabetes in pregnancy - pregnancy in women with known diabetes and diabetes first detected in pregnancy. Results: The literature review identified 199 studies that were eligible for characterisation and selection. After scoring and exclusion requirements, 46 studies were selected representing 34 countries. More than 50% of selected studies came from Europe and North America and Caribbean. The smallest number of identified studies came from sub-Saharan Africa. The majority of studies were for high-income countries, although low- and middle-income countries were also represented. Conclusion: Prevalence estimates of hyperglycaemia in pregnancy are sensitive to the data from which they are derived. The IDF methodology is a transparent, reproducible, and modifiable method for estimating the burden of hyperglycaemia in pregnancy. More data are needed, in particular from developing countries, to strengthen the methodology. © 2013 Elsevier Ireland Ltd.


Joseph V.,Directorate of Public Health | Joseph V.,University of Leeds | West R.M.,University of Leeds | Shickle D.,University of Leeds | And 2 more authors.
Journal of Telemedicine and Telecare | Year: 2011

A literature review was carried out to identify the key challenges in the implementation of telehealth. This was followed by a survey of organisations in England involved in telehealth projects in order to understand the challenges they faced. Ten of the 13 health or local authority organisations surveyed had telehealth projects and three were at the planning stage. The analysis revealed seven key challenges facing implementers of telehealth in England. Based on the findings from the literature review and the survey, a model was constructed and a checklist drawn up. The model contained the following elements: identifying issues, needs and partners; producing a strategy; securing funding; implementing changes; and monitoring and evaluating a telehealth project. The checklist was validated by using key informants from the organisations originally surveyed. The checklist may be useful to guide telehealth development and implementation in the future.


Ali A.A.,Directorate of Public Health | Al Lami F.H.,Directorate of Public Health
Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia | Year: 2016

Microalbuminuria (MAU) is an early marker of diabetic nephropathy (DN), which accounts for a significant reduction in life expectancy of diabetic patients. The progression of DN from the appearance of clinical proteinuria to end stage renal failure is usually irreversible. Increased levels of urinary albumin secretion may represent a more generalized vascular damage. This is the first study conducted in Iraq to determine the prevalence and potential risk factors of MAU among Type 2 diabetes mellitus (T2DM) patients. A cross-sectional study was conducted on a systematic random sample of 224 eligible T2DM patients aged 25-64 years attending a DM clinic in Baghdad. A questionnaire was developed to gather basic and clinical data, besides anthropometric measurements, and laboratory assessment of lipid profile, HbA1c, serum creatinine, albumin, and microalbumin/creatinin in urine. MAU was defined as albumin/creatinine ratio 30-300 mg/g on two occasions. Only 36 cases (16.1%) had MAU. A statistical significant association found between MAU and educational level (P = 0.009), family history of hypertension (P = 0.024) and DN (P = 0.013), history of hypertension (P = 0.001), duration of angiotensin-converting-enzyme inhibitor drug intake in hypertensive patients (P = 0.001), body mass index (BMI) (P = 0.014), and waist to hip ratio (P = 0.006). Logistic regression analyses revealed two independent risk factors influencing MAU: diastolic blood pressure [odds ratio (OR) = 1.08, 95% confidence interval (CI): 1.007-1.118] and BMI (OR = 1.17, 95% CI: 1.037-1.220). The prevalence of MAU is not low among DM patients. Mandatory screening of all DM patients and amelioration of the assigned significant risk factors are recommended.

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