Diabetes management in Guinea Bissau: a situational analysis.

INTRODUCTION: There is an increasing commitment in the African Region towards diabetes care, following acknowledgement that it is an important public health issue which needs to be addressed in order to improve population health. We conducted a situational analysis of diabetes care in Guinea Bissau in order to identify the main issues faced in the management of the disease in this country. METHODS: The study design was qualitative and data collection was done using semi directive interviews and focus groups with participants involved in primary diabetes care and management in Guinea Bissau (health care professionals, non-governmental organization staff, traditional healers) and patients. The data was analyzed using the five-phase approach of the thematic analysis framework. RESULTS: The major themes identified included: the lack of specialists and properly trained healthcare personnel; no standardized care protocol for diagnosis, treatment, follow up and proper management for diabetic patients; resources poor primary health care settings; no validated epidemiological dataset on prevalence and the lack of awareness about diabetes (in general population and also in medical staff). CONCLUSION: This first situational analysis can serve as a baseline to develop an action plan to address the main issues identified.

Interventions targeting hypertension and diabetes mellitus at community and primary healthcare level in low- and middle-income countries:a scoping review.

BACKGROUND: Hypertension (HTN) and diabetes mellitus (DM) are highly prevalent in low- and middle-income countries (LMIC) and a leading cause of morbidity and mortality. Recent evidence on effectiveness of primary care interventions has attracted renewed calls for their implementation. This review aims to synthesize evidence pertaining to primary care interventions on these two diseases, evaluated and tested in LMICs. METHODS: Two reviewers conducted an electronic search of three databases (Pubmed, EMBASE and Web of Science) and screened for eligible articles. Interventions covering health promotion, prevention, treatment, or rehabilitation activities at the PHC or community level were included. Studies published in English, French, Portuguese and Spanish, from January 2007 to January 2017, were included. Key extraction variables included the 12 criteria identified by the Template for Intervention Description and Replication (TIDieR) checklist and guide. The Innovative Care for Chronic Conditions Framework (ICCCF) was used to guide analysis and reporting of results. RESULTS: 198 articles were analyzed. The strategies focused on healthcare service organization (76.5%), community level (9.7 %), creating a positive policy environment (3.6%) and strategies covering multiple domains (10.2%). Studies included related to the following topics: description or testing of interventions (n=81; 41.3%), implementation or evaluation projects (n=42; 21.4%), quality improvement initiatives (n=15; 7.7%), screening and prevention efforts (n=26; 13.2%), management of HTN or DM (n=13; 6.6%), integrated health services (n=10; 5.1%), knowledge and attitude surveys (n=5; 2.5%), cost-effective lab tests (n=2; 1%) and policy making efforts (n=2; 1%). Most studies reported interventions by non-specialists (n=86; 43.4%) and multidisciplinary teams (n=49; 25.5%). CONCLUSION: Only 198 articles were found over a 10 year period which demonstrates the limited published research on highly prevalent diseases in LMIC. This review shows the variety and complexity of approaches that have been tested to address HTN and DM in LMICs and highlights the elements of interventions needed to be addressed in order to strengthen delivery of care. Most studies reported little information regarding implementation processes to allow replication. Given the need for multi-component complex interventions, study designs and evaluation techniques will need to be adapted by including process evaluations versus simply effectiveness or outcome evaluations.

Biomarkers of oxidative stress and its association with the urinary reducing capacity in bus maintenance workers.

BACKGROUND: Exposure to particles (PM) induces adverse health effects (cancer, cardiovascular and pulmonary diseases). A key-role in these adverse effects seems to be played by oxidative stress, which is an excess of reactive oxygen species relative to the amount of reducing species (including antioxidants), the first line of defense against reactive oxygen species. The aim of this study was to document the oxidative stress caused by exposure to respirable particles in vivo, and to test whether exposed workers presented changes in their urinary levels for reducing species. METHODS: Bus depot workers (n = 32) exposed to particles and pollutants (respirable PM4, organic and elemental carbon, particulate metal content, polycyclic aromatic hydrocarbons, NOx, O3) were surveyed over two consecutive days. We collected urine samples before and after each shift, and quantified an oxidative stress biomarker (8-hydroxy-2'-deoxyguanosine), the reducing capacity and a biomarker of PAH exposure (1-hydroxypyrene). We used a linear mixed model to test for associations between the oxidative stress status of the workers and their particle exposure as well as with their urinary level of reducing species. RESULTS: Workers were exposed to low levels of respirable PM4 (range 25-71 µg/m3). However, urinary levels of 8-hydroxy-2'-deoxyguanosine increased significantly within each shift and between both days for non-smokers. The between-day increase was significantly correlated (p < 0.001) with the concentrations of organic carbon, NOx, and the particulate copper content. The within-shift increase in 8OHdG was highly correlated to an increase of the urinary reducing capacity (Spearman ρ = 0.59, p < 0.0001). CONCLUSIONS: These findings confirm that exposure to components associated to respirable particulate matter causes a systemic oxidative stress, as measured with the urinary 8OHdG. The strong association observed between urinary 8OHdG with the reducing capacity is suggestive of protective or other mechanisms, including circadian effects. Additional investigations should be performed to understand these observations.

Efficacy of therapeutic patient education in chronic diseases and obesity.

OBJECTIVE: To evaluate the clinical, methodological and reporting aspects of systematic reviews and meta-analyses in order to determine the efficacy of therapeutic patient education (TPE). METHODS: A thorough search of the medical and nursing literature recorded in MedLine database from 1999 to August 2009 was conducted using the keywords: patient education, efficacy, diabetes, asthma, COPD, hypertension, cardiology, obesity, rheumatology, and oncology. RESULTS: Thirty five relevant meta-analyses were identified and initially selected for critical analyses (598 studies concerning approximately 61,000 patients). The detailed description of the educative intervention was present in 4% of articles whereas in 23% the interventions were briefly described. In the majority of studies, the educative interventions were only named (49%) or totally absent (24%). The majority of studies reported improvement of patient outcomes due to the TPE (64%), 30% of studies reported no effect of TPE and 6% of the analysed reviews and meta-analyses reported worsening of measured outcomes. CONCLUSION: Patient education could improve patient outcomes. The high benefit from TPE was shown by articles with detailed description of educational intervention as well as by those who report multidimensional and multidisciplinary educational intervention. PRACTICE IMPLICATIONS: The impact of therapeutic patient education on health outcomes is 50-80%.

[Efficiency of therapeutic education]. / Ficacité de l'education thérapeutique.

Therapeutic patient education has been developed over more than 30 years, to better treat chronic patients. The purpose of this article is to summarize its efficiency, based on recent meta-analysis publications. This analysis reflects more than 500 studies concerning ten diseases. It appears that the educative interventions are poorly described and that it is frequent that the control group also received some basic education. Despite these biases, the efficiency of the therapeutic patient education is clearly demonstrated in the majority of the studies (60%), whatever the pathologies or indicators are. Concerning obesity, one can find exactly the same tendency, with consequent and long lasting weight losses.

Amperometric tape ion sensors for cadmium(II) ion analysis.

This paper describes a novel tape platform ion sensing methodology specific to the detection of cadmium(II) ions in aqueous solution based on assisted ion transfer reactions across a polarized water/organic gel micro-interface. The tape ion sensors were constructed to incorporate the micro-water/polyvinylchloride-2-nitrophenylethyl ether (PVC-NPOE) gel interfaces referred to as ionodes. The sensors have overall thicknesses less than 300 microm, allowing their packaging in a disposable tape format. The detection methodology is based on the selective assisted transfer of the cadmium ion in aqueous phase by ETH 1062 present in the PVC-NPOE gel layer and was first investigated using cyclic voltammetry. Quantitative analysis of cadmium(II) ions in aqueous solution using the tape sensors was then conducted under stop-flow conditions. Detection limits as low as 20 ppb (178 nM) for Cd(II) ions in very small volumes as low as a single 20 microl droplet without any sample preconcentration was achieved in an analysis time of approximately 20s, which could be easily employed for the direct measurement of Cd(II) ion levels in various field applications. The tape ion sensor can also be used in a flow-cell geometry to preconcentrate Cd(II) ions from aqueous samples and further improve the detection limit.

[Fighting heart attacks and atherosclerosis: a therapeutical challenge]. / Combattre l'infarctus du myocarde et l'athérosclérose: un défi thérapeutique.

Myocardial infarction is a frequent, serious and recurrent complication of a chronic disease: atherosclerosis. Therapeutic advances have improved the clinical outcome of affected patients and have shortened the hospital length of stay. However, to decrease the recurrence of cardiovascular events, it is essential to increase adherence to therapeutic projects by improving information given to coronary patients during the short initial hospitalization. This can be achieved by using tools that have been developed for the management of chronic disease: therapeutic education and motivational interviews. Moreover, these information tools have to perform well and have to be used at appropriate times to ensure a positive effect on patients.

[Representations, behavior and obesity]. / Représentations, comportements et obésité.

Dealing with a long term chronic disease necessarily implies changes of behaviour. In the field of obesity, these behaviours concern habits which are very often firmly fixed in patients' lives. The study of patients' representations is of great interest in the medical field. Representations guide behaviours and therefore build up an important factor which determines the adherence to the treatment. Representations always have a foundation and making them rise up induces a non-judge-mental attitude. The health care provider can help the patient make them evolve. It must be highlighted that health care providers' representations are also important, particularly in the therapeutic relationship. This article proposes a reflection on the obese patients follow-up situation as well as some clinical implications.

Antioxidant redox sensors based on DNA modified carbon screen-printed electrodes.

Antioxidant redox sensors based on DNA modified carbon screen-printed electrodes were developed. The carbon ink was doped with TiO2 nanoparticles, onto which double-strand DNA was adsorbed. A redox mediator, namely, tris-2,2'-bipyridine ruthenium(II) [Ru(bpy)3(2+)] was electrooxidized on the electrode surface to subsequently oxidize both the adsorbed ds-DNA and the antioxidants in solution. The resulting oxidation damage of the adsorbed ds-DNA was then detected by square wave voltammetry in a second solution containing only Ru(bpy)3Cl2 at a low concentration (microM). A kinetic model was developed to study the protecting role of antioxidants in aqueous solutions. The electrochemical sensor has been applied to evaluate the redox antioxidant capacity of different molecules.

Antioxidant sensors based on DNA-modified electrodes.

TiO2/ITO modified electrodes were developed to quantitatively photooxidize adsorbed ds-DNA and to study the effect of antioxidants as ds-DNA protecting agents. TiO2 films are used for efficient ds-DNA immobilization, for ds-DNA oxidation through photogenerated hydroxyl radicals, and as electrodes for amperometric sensing. The films, prepared by a sol-gel process, are deposited on ITO glass electrodes. Damages occurring after ds-DNA oxidation by ROS are detected by adding MB as an intercalant probe and by monitoring the electrochemical reduction current of the intercalated redox probe. The MB electrochemical signal is found to be sensitive enough to monitor ds-DNA structure changes, and the electrochemical sensor has been applied to the evaluation of the antioxidant properties of glutathione and gallic acid.

Plasma etched polymer microelectrochemical systems.

This paper presents a novel technique based on plasma etching for the mass production of polymer microchip devices. The method consists of the patterning of a photo-resist by a high resolution printer on a foil composed of three layers (5 microm copper/50 microm polyimide/5 microm copper). After this step, both copper layers are chemically etched in order to serve as a contact mask on the polyimide surface so as to produce the desired microstructure pattern. The foil is placed into a reactive plasma chamber in order to etch the exposed polyimide by means of an oxidizing plasma. The method enables holes, lines or larger areas to be etched, thereby generating either microholes, microchannels or electrodes in the plastic material. The copper can then be chemically removed or further patterned to produce conductive pads which are further electroplated with gold. The microchannel is then covered with a polyethylene terephthalate/polyethylene (PET/PE) lamination. The strength of this technology is that access holes for the fluid inlet and outlet, as well as gold coated electrodes can be fabricated without post-processing in a batch process. Demonstration of the application of such microelectrochemical systems is shown here by voltammetric detection inside a 60 nL microchannel, which presents the special feature of linear depletion of the analytes in the direction parallel to the microchannel.