ABSTRACT
BACKGROUND AND AIMS: In this study, we aimed to refer eligible (patients with stable blood sugar and without any history of cardiovascular events or proliferative retinopathy) and willing persons with diabetes (PwDs) to primary healthcare centers (PHCs) from tertiary care and to compare the care indicators. METHODS: This before-after interventional study was conducted among PwDs aged ≥18 years at a tertiary care hospital in South India. Care indicators (regularity to the clinic, waiting time, and blood sugar control status) were assessed before down referral and after three months of follow-ups at PHCs. RESULTS: Of 204 PwDs referred to PHCs. Among them, 88% (n = 180) registered at PHCs for care and 46% (n = 94, 95% CI 39.1-53.2%) were lost to follow-ups at PHCs. The main reason for loss to follow-ups was the unavailability of medicines at PHCs(n = 41, 44%). Among those who were on regular follow-ups at PHCs, there was no significant difference in fasting blood glucose (FBG) control status compared to tertiary (52%-64.6%, p = 0.083). However, there was a significant improvement in the regularity of clinic visits (75% vs. 100%, p < 0.001), consultation waiting time (90 vs. 60 min, p = 0.028), and waiting time at pharmacy queues (120 vs. 30 min, p < 0.001) between tertiary care and PHCs. However, among those registered at PHCs, only 40.6% (n = 73, 95% CI 33.3-48.1) were willing to continue care at PHCs for their diabetes management. CONCLUSION: Primary care was better than tertiary care in terms of PwD's regularity of clinic visits and waiting time for care.
Subject(s)
Diabetes Mellitus , Operations Research , Humans , Adolescent , Adult , Blood Glucose , Referral and Consultation , Primary Health Care , IndiaABSTRACT
Successful reproductive management in buffaloes depends on effective estrus detection. Urinary pheromones identified from natural estrous cycle have been reported to decipher estrus phase. However, its presence has not been analyzed in the urine after synchronization. Thus, our present investigation was to investigate the influence of synchronized estrus urine in bulls and to examine the presence of estrus-specific compounds ascertained in natural estrus in synchronized buffaloes. Mid-stream urine was collected from six synchronized buffaloes during various phases of estrous cycle and volatiles were examined using GC-MS. Sexual provocation in bulls was established by displaying persistent flehmen and frequent mounting towards estrus urine from synchronized animals. Totally forty-two volatile compounds were identified from three phases of estrous cycle, more specifically 4-methyl phenol (p-cresol) and 9-octadecenoic acid (oleic acid) in estrus urine of synchronized animal as similar to natural estrus. Hence, these chemical cues in buffalo urine might be employed as potential marker candidates for the development of an estrus detection aid.
ABSTRACT
The present study was carried out to identify the urinary sex pheromones of buffaloes and their role in relation to bull reproductive behaviour. Urinary samples were collected from 12 buffalo heifers at four different phases of estrous cycles. Fourteen compounds were identified throughout the cycle, which included phenol, ketone, alkane, alcohol, amide, acid and aldehyde. Among the 14 chemical profiles, three compounds were only found on the day of estrus, viz. 1-chlorooctane, 4-methylphenol and 9-octadecenoic acid. Behavioural investigation clearly showed that bulls were attracted and exhibited repeated flehmen behaviour towards the 4-methyl phenol. The bulls displayed penile erection and mounting behaviour while exposed to 9-octadecenoic acid. However, the other compound, 1-chlorooctane, did not influence such sexual behaviours. The present results provide evidence that the estrus-specific urinary volatile compounds appear to be sex pheromones which initiate the bull's reproductive behaviour.
