Prevalence and correlates of pre-diabetes in Sub-Saharan Africa using Demographic and Health Survey Data: a cross-sectional study.

OBJECTIVE: The objective is to investigate the prevalence of pre-diabetes in Namibia and South Africa and to determine sociodemographic correlates of disease using population data. DESIGN: Cross-sectional study. SETTING: Demographic and Health Survey for emerging (Namibia) and established (South Africa) economies in Sub-Saharan Africa collected laboratory data that allowed determination of pre-diabetes status. PARTICIPANTS: 3141 adults over age 18 from the 2013 Namibia survey, weighted to a population of 2176, and 4964 adults over age 18 from the 2016 South Africa survey, weighted to a population of 4627 had blood glucose/glycated haemoglobin (HbA1c) and diabetes information were included in the analysis. OUTCOME MEASURES: Pre-diabetes was defined as not being diagnosed with diabetes and having a blood sugar measurement of 100-125 mg/dL in Namibia or an HbA1c measurement of 5.7%-6.4%. Logistic models were run for each country separately, with pre-diabetes as the outcome and a series of sociodemographic variables (age, gender, urban/rural residence, number of children, employment status, wealth index, education level, and ethnicity (in South Africa) or religion (in Namibia)) entered as variables to investigate the independent relationship of each. RESULTS: The weighted prevalence of pre-diabetes was 18.7% in Namibia and 70.1% in South Africa. Rural residence was independently associated with higher odds of pre-diabetes in Namibia (1.47, 95% CI 1.05 to 2.06), while both younger age (0.98, 95% CI 0.97 to 0.99) and urban residence (0.80, 95% CI 0.66 to 0.99) were independently associated with odds of pre-diabetes in South Africa. CONCLUSIONS: The prevalence of pre-diabetes was 18.7% in Namibia and 70.1% in South Africa. Correlates of pre-diabetes differed between the two countries with rural residents having higher odds of pre-diabetes in Namibia and urban residents with higher odds in South Africa. Aggressive interventions, including population level education and awareness programmes, and individual level education and lifestyle interventions that account for country-specific contextual factors are urgently needed to prevent progression to diabetes.

Incidence of Esophageal Adenocarcinoma, Mortality, and Esophagectomy in Barrett's Esophagus Patients Undergoing Endoscopic Eradication Therapy.

INTRODUCTION: Endoscopic eradication therapy (EET) is the preferred treatment for Barrett's esophagus (BE)-related neoplasia patients. However, the impact of EET on critical outcomes, outside of clinical trials and registry data, remains scarcely studied. We aimed to assess real-world practice patterns and clinical outcomes among BE patients undergoing EET. METHODS: TriNetX is a large research network comprising linked inpatient and outpatient electronic-health record-derived data from over 80,000,000 patients. Patients with a diagnosis of BE from 2015 to 2020 were identified and included if they underwent EET during the study period. The primary outcome was the progression to EAC after index EET. Secondary outcomes included rate of esophagectomy, and all-cause mortality. All outcomes were stratified by baseline histology. The incidence of EAC and all-cause mortality were reported in person-years and adjusted for age and sex. RESULTS: A total of 4114 patients were analyzed. Distribution of baseline histology was as follows: NDBE (11.8%), LGD (21.4%), HGD (26.4%), EAC (20.8%), and unspecified (19.6%). The total incidence of EAC after index EET was 6.01 per 1000 person-years (PY) for the entire cohort with the highest rate in HGD patients (12.9/1000 PY). The incidence of all-cause mortality was 13.23 per 1000 PY with the highest rates in EAC patients (25.1 per 1000 PY). Rates of esophagectomy were < 1% for all grades of dysplasia. CONCLUSION: The results of this study provide "real-world" data on critical outcomes for BE patients undergoing EET, demonstrating a low risk of incident EAC, all-cause mortality, and need for esophagectomy.

Blood pressure monitoring in zoologically managed bonobos (Pan paniscus).

In response to the growing evidence that hypertension may play a significant role in the development of cardiovascular disease (CVD) in bonobos, the Great Ape Heart Project established a finger blood pressure (BP) monitoring protocol for zoo-housed bonobos. The ability to monitor BP without the use of anesthesia provides more opportunities to detect potential hypertension in its early stages allowing for therapeutic intervention that may slow the progression of CVD. No BP reference ranges exist for bonobos due to the lack of an established protocol, the difficulty of measuring BP in animals, and small sample size of zoo-housed bonobos. By working with all 8 institutions in North America that care for bonobos, it was possible to (1) investigate the feasibility of using finger BP devices, and (2) establish BP trends for male and female bonobos. Data were collected from May 2016 to March 2019. Zoos were asked to train for and collect BP measurements from any bonobos willing to participate, regardless of age, sex, or health status as well as to report on the quality of the training and measurements obtained. At the start of the study, the North American bonobo population consisted of 74 bonobos ages 5 years and older at 8 institutions. All 8 institutions submitted at total of 3656 BP readings from 50 bonobos (n = 23 females, n = 27 males; ages 5-51 years) representing 67.57% of the trainable population ages 5 years and older. Of the readings submitted, 2845 were determined to be good quality, reliable BP readings (77.81% useful BP measurements) for 36 of the 50 adult bonobos submitted for this study (59.01% of the adult population ages 10-51 years) but showed limitations in the protocol for the younger population. BP trend analysis showed significant differences between bonobos that were not on medication versus those treated with cardiac medications, with those on cardiac mediations having significantly higher systolic arterial pressure, diastolic arterial pressure, and mean arterial pressure (p ≤ 0.001 for all comparisons). Systolic BP generally increased over age classes (10-19, 20-29, 30-39, 40+ years).