Diabetic foot is challenging progressive disease which requires multisystemic control. Neuropathy, arteriopathy, and cellular responses should treated collaboratively. Despite all medical advances, diabetic foot can highly resulted with amputation and also re-amputation can be required because of failed wound healing. In this study, we aimed to investigate the relation between blood parameters and amputation events. Diabetic 323 patients include to the study who referred to orthopaedic clinic for amputation. Amputation levels (amputation levels phalanx, metatarsal, lisfranc, syme, below knee, knee-disarticulation, above-knee amputation) and re-amputations recorded and compared with routine blood parameters. Re-amputation was observed at 69 patients. The significant difference detected between lower albumin, higher HbA1c, higher CRP levels (P < 0.05) in regards to gross amputation levels, and increased wound depth. Furthermore, lower albumin levels and higher levels of WBC, HbA1c, CRP, and Creatinine were detected in re-amputation levels. Especially, HbA1c, CRP, and Creatinine levels were found as upper bound of reference line for re-amputation. The statistically optimal HbA1c cutoff point for diabetes was ≥7.05%, with a sensitivity of 86% and a specificity of 59%. In according to our results, simple blood parameters can be useful for observing the progress of amputation in diabetic foot. Particularly, lower albumin, and higher HbA1c, CRP, and Creatinine levels detected as related with poor prognosis. Besides, screening of HbA1c level seems to be highly sensitive for detecting of re-amputation possibility.

Analysis of routine blood markers for predicting amputation/re-amputation risk in diabetic foot

Abstract Background The proportion of women with family planning needs increased from 74 to 76% between 2000 and 2019, and this improvement has not transcended to a fertility rate stall or decrease in sub-Saharan Africa (SSA). In the face of a continuous increase in the fertility rate in SSA, population experts agreed that the efficient use of reliable family planning methods such as long-acting reversible and permanent contraceptive methods (LARC/PMs) could help reduce the high fertility rate and associated adverse reproductive health outcomes in the region. However, despite the effectiveness of LARC/PMs, its use remains elusive in SSA. Thus, this study examines the prevalence and factors associated with the use of LARC/PMs among women who desire no more children in high-fertility countries in SSA. Methods Secondary datasets from the demographic health surveys conducted in 20 countries in SSA between 2010 and 2019 were included in the study. A total sample size of 46,290 sexually active women of reproductive age who desire no more children and who met the study inclusion criteria was pooled and analysed. Prevalence of LARC/PMs use was displayed using a graph whilst binary logistic regression was used to determine the associated factors, and results were presented as unadjusted odds ratio and adjusted odds ratio with a statistical significance of p &lt; 0.05. Results The prevalence of LARC/PMs use among women who desire no more children was 7.5%. Ranging from 20.9% in Senegal and as low as 0.4% in Congo. Women within the richest wealth index [aOR = 1.18, 95% CI = 1.03–1.36] and those exposed to mass media [aOR = 1.54, 95% CI = 1.41–1.68] had higher odds of LARC/PMs use among sexually active women of reproductive age who desire no more children compared to those within poorest wealth index and women with no mass media exposure. Conclusion The study concluded that LARC/PMs use among sexually active women who desire no more children was very low, and women within the richest wealth index and those with mass media exposure were likely to use LARC/PMs. Interventions that will encourage using LARC/PMs should be prioritised to reduce fertility rates in SSA. 

/pdf/prevalence-and-factors-associated-with-the-use-of-long-gs49le6a.pdf

Prevalence and factors associated with the use of long-acting reversible and permanent contraceptive methods among women who desire no more children in high fertility countries in sub-saharan Africa

Abstract Background Owing to an increase in life expectancy, it is common for the older adults to suffer from chronic diseases that can result in disability and a low quality of life. This study aimed to explore the influence of chronic diseases and multimorbidities on activities of daily living (ADLs) and instrumental ADLs (IADLs) in an older Chinese population. Methods Based on the Chinese Longitudinal Healthy Longevity Survey (2018), 9,155 older adults aged 65 years and above were included in the study. A self-administered questionnaire was used to collect information on demographic characteristics, chronic diseases, ADLs, and IADLs. The impact of factors affecting ADL and IADL impairment in older adults was analysed using binary logistic regression. Results In total, 66.3% participants had chronic diseases. Hypertension, heart disease, arthritis, diabetes and cerebrovascular disease were among the top chronic diseases. Of these, 33.7% participants had multimorbidities. The most common combination of the two chronic diseases was hypertension and heart disease (11.2%), whereas the most common combination of the three chronic diseases was hypertension, heart disease, and diabetes (3.18%). After categorising the older adults into four age groups, dementia, visual impairment, and hearing impairment were found to be more prevalent with increasing age. The prevalence of hypertension, heart disease, cerebrovascular disease, gastrointestinal ulcers, arthritis and chronic nephritis gradually increased with age until the age of 75 years, peaked in the 75–84 years age group, and then showed a decreasing trend with age. Multimorbidity prevalence followed a similar pattern. Regression analysis indicated that the increase in age group and the number of chronic diseases independently correlated with impairments in ADL as well as IADL. Additionally, gender, physical activity, educational background, obesity, depressive symptoms, and falls also had an impact on ADLs or IADLs. Conclusion Chronic diseases and multimorbidities are common in older adults, and it is important to note that aging, multimorbidity, obesity, and unhealthy lifestyle choices may interfere with ADLs or IADLs in older adults. Therefore, it is imperative that primary healthcare providers pay special attention to older adults and improve screening for multimorbidity and follow-up needs. 

Chronic disease and multimorbidity in the Chinese older adults’ population and their impact on daily living ability: a cross-sectional study of the Chinese Longitudinal Healthy Longevity Survey (CLHLS)

Abstract Background Empty nesters are older people who live alone or an older couple without children to care for them. In China, empty nesters make up a significant community and are more likely to experience emotional issues, particularly depression. This study investigated the prevalence of depression and the factors influencing depression among Chinese home-bound empty nesters using meta-analysis. Methods Based on previous studies, we used search terms relating to empty nesters and depression in English and Chinese. Databases, including China Journal Full Text Database (CNKI), Wanfang, Wipu, China Biomedical Literature Database (CBM), PubMed, Web of Science, Embase, The Cochrane Library, and UptoDate, were searched in April 2022, for relevant articles. Details including names of authors, year of publication, region of investigation, study type, sample size, depression detection scale, depression detection rate, and influencing factors were captured. The heterogeneity of the studies was assessed based on the I 2 index, and data analysis was performed using Stata 16.0 software. Results A total of ten research articles involving 5337 Chinese empty nesters were evaluated in the present meta-analysis. The overall prevalence of depression among empty nesters in China was 43%. The prevalence of depression among urban empty nesters was 38% (95% CI: 0.24,0.52), and 36% (95% CI: 0.18,0.55) among rural empty nesters. Many factors, including female, income, marital status, chronic illness, relationship with children, and social support were linked to depression among urban empty nesters. Conclusion The prevalence of depression among empty nesters was 43%. Therefore, based on the factors influencing depression, government departments can intervene early to improve the mental health of empty nesters. Limitations The meta-analysis only included cross-sectional studies. Therefore, there is a need for more future original studies investigating depression among empty nesters in China. 

/pdf/prevalence-and-factors-influencing-depression-among-empty-n5vvrhuu.pdf

Prevalence and factors influencing depression among empty nesters in China: A meta-analysis

With a population of about 1.1 billion, sub-Saharan Africa is projected to overtake Eastern, Southern and Central Asia to become the most populous region by 2060. One effective approach for slowing this rapid population growth is the use of modern contraception and this may be short-acting or long acting. Previous studies have explored the association between women empowerment indicators contraception use, however, there is limited evidence on how women empowerment indicators associate with type of contraception. Hence the present study investigated the association between women empowerment indicators and type of contraception used by women in 11 sub-Saharan African countries.We utilised Demographic and Health Survey data of 22,637 women from 11 countries, collected between 2018 and 2021. The outcome variable was type of contraception used. Descriptive and inferential analyses were executed. The descriptive analysis reflected women empowerment indicators and the proportion of women using contraceptives. Multinomial logistic regression was considered for the inferential analysis. The results for the multinomial logistic regression were presented as adjusted odds ratios (aORs) along with the respective 95% confidence intervals (CIs) signifying precision. The sample weight (wt) was used to account for the complex survey (svy) design. All the analyses were done with Stata version 13 and SPSS version 25.The study showed that on the average, 15.95% of the women do not use modern contraceptives, whilst 30.67% and 53.38% use long-acting and short-acting contraceptives respectively. The adjusted models showed that women who were working had higher odds of using long-acting (aOR = 1.44, CI 1.28-1.62) and short-acting (aOR = 2.00, CI 1.79-2.24) methods compared with those who were not working. The analysis revealed higher likelihood of long-acting method use among women with high decision-making capacity (aOR = 1.27, CI 1.09-1.47) compared with women with low decision-making capacity. Women with medium knowledge level had a higher likelihood (aOR = 1.54, 1.09-2.17) of using long-acting methods than their counterparts with low knowledge level.Our findings show that most women in the 11 countries use modern contraceptives, however, different empowerment indicators align with different contraceptive type. It therefore behoves governments of the studied countries to review current interventions and embrace new ones that are more responsive to the peculiar contraception needs of empowered and non-empowered women.By 2060, sub-Saharan Africa is expected to have more population than Southern, Eastern, and Central Asia. Modern contraception is identified to be effective in reducing population growth. There is limited evidence on the association between women empowerment indicators and the type of contraception used by women in sub-Saharan Africa, either short or long-acting methods. Hence, this study investigated the relationship between women empowerment indicators and the type of contraception used by women in 11 sub-Saharan African countries. We performed both descriptive and inferential analyses. The descriptive analysis, being frequencies and percentages, focused on women empowerment indicators and the proportion of women who use contraception. The inferential analysis was multinomial logistic regression. The findings showed that 15.95% of women do not use modern contraception, however, 30.67% and 53.38% were using long-acting and short-acting contraception, respectively. Women who worked had higher odds of using long-acting and short-acting methods than those who did not work. Women with high decision-making capacity had high likelihood of using long-acting methods than women with low decision-making capacity. Women with medium knowledge level had a higher likelihood of using long-acting methods than their counterparts with low knowledge level. The study highlights the need for governments in the studied countries to review current interventions and adopt new ones to make the interventions more responsive to the contraception needs of women, irrespective of their empowerment status. 

/pdf/womens-empowerment-indicators-and-short-and-long-acting-biyslrfx.pdf

Women’s empowerment indicators and short- and long-acting contraceptive method use: evidence from DHS from 11 countries

Researchers have long been concerned about the association between depression and the prevalence of multiple chronic diseases or multimorbidity in older persons. However, the underlying pathway or mechanism in the multimorbidity-depression relationship is still unknown. Data were extracted from a baseline survey of the Longitudinal Ageing Survey of India (LASI) conducted during 2017–18 (N = 31,464; aged ≥ 60 years). Depression was assessed using the 10-item Centre for Epidemiological Studies Depression Scale (CES-D-10). Multivariable logistic regression was used to examine the association. The Karlson–Holm–Breen (KHB) method was adopted for mediation analysis. The prevalence of depression among older adults was nearly 29% (men: 26% and women 31%). Unadjusted and adjusted estimates in binary logistic regression models suggested an association between multimorbidity and depression (UOR = 1.28; 95% CIs 1.27–1.44 and AOR = 1.12; 95% CIs 1.12–1.45). The association was particularly slightly strong in the older men. In addition, the association was mediated by functional health such as Self Rated Health (SRH) (proportion mediated: 40%), poor sleep (35.15%), IADL disability (22.65%), ADL disability (21.49%), pain (7.92%) and by behavioral health such as physical inactivity (2.28%). However, the mediating proportion was higher among older women as compared to older men. Physical inactivity was not found to be significant mediator for older women. The findings of this population-based study revealed that older people with multimorbidity are more likely to suffer depressive symptoms in older ages, suggesting the need for more chronic disease management and research. Multimorbidity and depression may be mediated by certain functional health factors, especially in older women. Further longitudinal research is needed to better understand the underlying mechanisms of this association so that future preventive initiatives may be properly guided.

/pdf/multimorbidity-and-depression-among-older-adults-in-india-m9h13dqb.pdf

Multimorbidity and depression among older adults in India: Mediating role of functional and behavioural health

Abstract Background In India, the usage of modern contraception methods among women is relatively lower in comparison to other developed economies. Even within India, there is a state-wise variation in family planning use that leads to unintended pregnancies. Significantly less evidence is available regarding the determinants of modern contraception use and the level of inequalities associated with this. Therefore, the present study has examined the level of inequalities in modern contraception use among currently married women in India. Methods This study used the fourth round of National Family Health Survey (NFHS-4) conducted in 2015-16. Our analysis has divided the uses of contraception into three modern methods of family planning such as Short-Acting Reversible Contraception (SARC), Long-Acting Reversible Contraception (LARC) and permanent contraception methods. SARC includes pills, injectable, and condoms, while LARC includes intrauterine devices, implants, and permanent contraception methods (i.e., male and female sterilization). We have employed a concentration index to examine the level of socioeconomic inequalities in utilizing modern contraception methods. Results Our results show that utilization of permanent methods of contraception is more among the currently married women in the higher age group (40–49) as compared to the lower age group (25–29). Women aged 25–29 years are 3.41 times (OR: 3.41; 95% CI: 3.30–3.54) more likely to use SARC methods in India. Similarly, women with 15 + years of education and rich are more likely to use the LARC methods. At the regional level, we have found that southern region states are three times more likely to use permanent methods of contraception. Our decomposition results show that women age group (40–49), women having 2–3 children and richer wealth quintiles are more contributed for the inequality in modern contraceptive use among women. Conclusions The use of SARC and LARC methods by women who are marginalized and of lower socioeconomic status is remarkably low. Universal free access to family planning methods among marginalized women and awareness campaigns in the rural areas could be a potential policy prescription to reduce the inequalities of contraceptive use among currently married women in India. 

/pdf/inequalities-in-short-acting-reversible-long-acting-1zorjntt.pdf

Inequalities in short-acting reversible, long-acting reversible and permanent contraception use among currently married women in India

Changes in Socioeconomic Inequalities in Unintended Pregnancies Among Currently Married Women in India

INTRODUCTION: 
The term diabetes was coined by Aretaeus of Cappadocia.it was derived from the greek word “diabainein”. Diabetes means one that straddles. Diabetes was recorded first in English as Diabete around 1425. 
In 1675, the word mellitus was added by Thomas willis. Matthew Dobson in 1776, confirmed the excess sugar in urine and blood. 
Sushrutha named diabetes as Madumeha (sweet urine disease) in 6th century. Avicenna Persian (980–1037) described diabetic gangrene. 
The role of pancreas in diabetes was first by Joseph von Mering and Minkowski. 1910 sir Edward albert Sharpey Shafer suggested that diabetic people were deficient in insulin. 
Banting and Best purified insulin from bovine pancreas for which he was awarded noble price. Banting is honoured by worlds diabetes day which is held on his birthday, November, 14. 
Amputations surgical principals was first given by Ambrose Pare. 
AIMS AND OBJECTIVES: 
The purpose of the present study is 
To analyze the level of CRP and adequacy of glycemic control
To correlate the level of CRP with sequelae of diabetic foot.
MATERIALS AND METHODS:
Setting: Department of General Surgery, Government Stanley Hospital, Chennai.
Study Design: Prospective Observational. 
Study Period: 1 years. 
Materials: Approx. 100 patients. 
Inclusion Criteria: All type 2 DM on treatment and diabetic foot. 
Exclusion Criteria: Patients with clinical or biochemical evidence sepsis other than diabetes foot. Patients with active auto immune disease (RA, SLE, systemic sclerosis).
Admission sugar values, CRP values are obtained. Blood and estimation done by standard method. Grading of diabetic foot is as per wagner classification. As the protocol all patients treated with medical surgical care available in institution. Throughout admission serial measurements blood documented. Weekly obtained till discharge. Using statistical analysis correlated grade treatment outcome. The study after sign informed consent form.
OBSERVATION AND RESULTS:
From January 2012 to November 2012, a total of 100 patients who was admitted with diabetic foot in the Department Of General Surgery ,Government Stanley Hospital was studied.
After admission routine blood investigations radiological evaluation. Wound swab culture and sensivity were done.
Blood sugar values both fasting and post prandial and c reactive protein levels were checked in all patients.
Both oral and intravenous antibiotics were prescribed according to the pus culture and sensitivity report. 
Initial through surgical debridement was done.
Daily dressings were done. 
The fasting blood sugar value ranges from 127 to 225 .minimum value is presentation 127 and the maximum value 225.patients are categorized into five groups to find the distribution.
CONCLUSION: 
From our study it is concluded that glycemic control and CRP has definitive correlation with outcome which is proved by patients with persistently elevated blood sugar levels and CRP went in for amputation in our study. 
It is also concluded that 33.33% ( 9 patients out of 27) patients with elevated CRP above the critical value of 40 have went in for amputation. Rest of the patients with CRP < 40 went in for wound healing with appropriate surgical management.

/pdf/correlation-of-crp-level-with-glycemic-control-in-diabetic-41j0ivaevr.pdf

Correlation of CRP Level with Glycemic Control in Diabetic Foot Patients and Its Sequelae

The present study aimed to examine the association of multimorbidity status with food insecurity among disadvantaged groups such as Scheduled Castes (SCs), Scheduled Tribes (STs), and Other Backward Class (OBCs) in India.The data for this study was derived from the first wave of the Longitudinal Ageing Study in India (LASI),2017-18, focusing on 46,953 individuals aged 45 years and over who belong to SCs, STs, and OBCs groups. Food insecurity was measured based on the set of five questions developed by the Food and Nutrition Technical Assistance Program (FANTA). Bivariate analysis was performed to examine the prevalence of food insecurity by multimorbidity status along with socio-demographic and health-related factors. Multivariable logistic regression analysis and interaction models were used.The overall prevalence of multimorbidity was about 16% of the study sample. The prevalence of food insecurity was higher among people with multimorbidity compared to those without multimorbidity. Unadjusted and adjusted models suggested that people with multimorbidity were more likely to be food insecure than people without multimorbidity. While middle-aged adults with multimorbidity and men with multimorbidity had a higher risk of food insecurity.The findings of this study suggest an association between multimorbidity and food insecurity among socially disadvantaged people in India. Middle-aged adults experiencing food insecurity tend to reduce the quality of their diet and consume a few low-cost, nutritionally deficient meals to maintain caloric intake, putting them again at risk for several negative health outcomes. Therefore, strengthening disease management could reduce food insecurity in those facing multimorbidity. 

/pdf/exploring-food-insecurity-and-multimorbidity-in-indian-1sme6i6o.pdf

Exploring food insecurity and multimorbidity in Indian socially disadvantaged people: cross-sectional findings from LASI, 2017–18

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