Risk of Foot Ulcer and Lower-Extremity Amputation Among Participants in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study

Objective: Intensive glycemic control reduces risk of kidney, retinal, and neurologic complications in type 1 diabetes (T1D), but whether it reduces risk of lower extremity complications is unknown. We examined whether former intensive versus conventional glycemic control among Diabetes Control and Complications Trial (DCCT) participants with T1D reduced the long-term risk of diabetic foot ulcers (DFU) and lower extremity amputations (LEA) in the subsequent Epidemiology of Diabetes Interventions and Complications (EDIC) study. <p>Research Design and Methods: DCCT participants [n=1441] completed 6.5 years on average of intensive vs conventional diabetes treatment, after which 1408 were enrolled in EDIC and followed annually over 23 years for DFU and LEA occurrences by physical examination. Multivariable Cox models estimated associations of DCCT treatment assignment and time-updated exposures with DFU or LEA. </p> <p>Results: Intensive versus conventional glycemic control was associated with a significant risk reduction for all DFU (Hazard Ratio [HR] 0.77, 95% CI 0.60 to 0.97), and a similar magnitude but nonsignificant risk reduction for first recorded DFU (HR 0.78, 95% CI 0.59 to 1.03) and first LEA (HR 0.70, 95% CI 0.36 to 1.36). In adjusted Cox models, clinical neuropathy, lower sural nerve conduction velocity and cardiovascular autonomic neuropathy were associated with higher DFU risk; eGFR < 60 mL/min/1.73 m², albuminuria, and macular edema with higher LEA risk; and any retinopathy and greater time-weighted mean DCCT/EDIC HbA1c with higher risk of both outcomes (p<0.05).</p> <p>Conclusions: Early intensive glycemic control decreases long-term DFU risk, the most important antecedent in the causal pathway to LEA.</p>

Challenges Associated with Creeping Disasters in Disaster Risk Science and Practice: Considering Disaster Onset Dynamics

In this article, we set out to reconcile a general conceptualization of disaster temporalities by drawing on the epitome example of a creeping disaster, namely famine. Our argument is driven by the recognition that slowly manifesting disaster impacts pose distinct challenges for decision makers and researchers while there is a tendency for the disaster literature to overlook the role of disaster onset dynamics. More specifically and as a starting point, we identify four key themes that merit particular attention when dealing with creeping disasters: (1) our understanding of disaster as a phenomenon; (2) measurement and operationalization; (3) early warning and response; and (4) disaster management and termination. By integrating conceptual discussions of disaster with famine scholarship—a phenomenon often excluded from mainstream disaster research—this article provides fresh perspectives on disaster science as well as a number of implications for how we think about disaster risk reduction.

Risk of Foot Ulcer and Lower-Extremity Amputation Among Participants in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study

Objective: Intensive glycemic control reduces risk of kidney, retinal, and neurologic complications in type 1 diabetes (T1D), but whether it reduces risk of lower extremity complications is unknown. We examined whether former intensive versus conventional glycemic control among Diabetes Control and Complications Trial (DCCT) participants with T1D reduced the long-term risk of diabetic foot ulcers (DFU) and lower extremity amputations (LEA) in the subsequent Epidemiology of Diabetes Interventions and Complications (EDIC) study. <p>Research Design and Methods: DCCT participants [n=1441] completed 6.5 years on average of intensive vs conventional diabetes treatment, after which 1408 were enrolled in EDIC and followed annually over 23 years for DFU and LEA occurrences by physical examination. Multivariable Cox models estimated associations of DCCT treatment assignment and time-updated exposures with DFU or LEA. </p> <p>Results: Intensive versus conventional glycemic control was associated with a significant risk reduction for all DFU (Hazard Ratio [HR] 0.77, 95% CI 0.60 to 0.97), and a similar magnitude but nonsignificant risk reduction for first recorded DFU (HR 0.78, 95% CI 0.59 to 1.03) and first LEA (HR 0.70, 95% CI 0.36 to 1.36). In adjusted Cox models, clinical neuropathy, lower sural nerve conduction velocity and cardiovascular autonomic neuropathy were associated with higher DFU risk; eGFR < 60 mL/min/1.73 m², albuminuria, and macular edema with higher LEA risk; and any retinopathy and greater time-weighted mean DCCT/EDIC HbA1c with higher risk of both outcomes (p<0.05).</p> <p>Conclusions: Early intensive glycemic control decreases long-term DFU risk, the most important antecedent in the causal pathway to LEA.</p>

Attentiveness to Early Warning Drought Information: Implications for Policy Support and Climate Risk Reduction in Ghana

Successful drought planning is dependent on the generation of timely and accurate early warning information. Yet there is little evidence to explain the extent to which crop farmers pay attention to and assimilate early warning drought information that aids in the policy formulation in support of drought risk reduction. A socioecological survey, using a structured questionnaire administered to 426 crop farming households, was carried out in the Talensi District of the Upper East Region, Ghana. The data analytic techniques used were frequency tables, relative importance index, and multinomial logistics embedded in SPSS v.20 software. The results show that crop farmers predominantly rely on agricultural extension officers for early warning drought information, with an estimated 78% of them paying little to very much attention to the information. The likelihood ratio Chi-square test showed that there is a significant improvement in fit as X2 (20) = 96.792, p < 0.000. Household status, average monthly income, and age were the significant predictors for crop farmers paying no attention at all to early warning drought information, while household status was the only significant factor among those paying a little attention. The drive to build a climate-resilient society with effective early warning centers across Ghana will receive 60% lower support from crop farmers paying no to a little attention as compared to farmers paying very much attention to early warning drought information. Broader stakeholder engagements should be carried out to harness inclusive support from crop farmers to build a climate-resilient society in Ghana.

It’s not the batteries! Smoke alarm presence and functionality 5-7 years post installation of sealed lithium battery alarms

Smoke alarms with lithium batteries have been marketed as long life or “10 Year Alarms.” Previous work has drawn into question the actual term of functionality for lithium battery alarms. This paper reports on observed smoke alarm presence and functionality in a sample of 158 homes which had participated in a fire department smoke alarm installation program 5-7 years prior to the observations. A total of 394 alarms were originally installed in the 158 homes that completed the revisit. At the time of the revisit, 214 of those alarms were working (54%), 26 were non-working (7%), and 154 were missing (39%). Of the 158 homes that completed the revisit, n=62 (39%) had all their originally installed project alarms up at working at the revisit. Respondents who reported owning their homes and who reported living in their home for 6 or more years were significantly more likely than renters and those living in their homes for 5 or fewer years were more likely to maintain all of their project alarms. Smoke alarm installation programs should consider revisiting homes within 5-7 years post installation to inspect and replace any missing or non-functioning alarms. We recommend programs conducting community risk reduction programs track and plan installations and revisits to improve smoke alarm coverage.

Reducing the Risk of Cognitive Decline and Dementia: WHO Recommendations

With population ageing worldwide, dementia poses one of the greatest global challenges for health and social care in the 21st century. In 2019, around 55 million people were affected by dementia, with the majority living in low- and middle-income countries. Dementia leads to increased costs for governments, communities, families and individuals. Dementia is overwhelming for the family and caregivers of the person with dementia, who are the cornerstone of care and support systems throughout the world. To assist countries in addressing the global burden of dementia, the World Health Organisation (WHO) developed the Global Action Plan on the Public Health Response to Dementia 2017–2025. It proposes actions to be taken by governments, civil society, and other global and regional partners across seven action areas, one of which is dementia risk reduction. This paper is based on WHO Guidelines on risk reduction of cognitive decline and dementia and presents recommendations on evidence-based, multisectoral interventions for reducing dementia risks, considerations for their implementation and policy actions. These global evidence-informed recommendations were developed by WHO, following a rigorous guideline development methodology and involved a panel of academicians and clinicians with multidisciplinary expertise and representing geographical diversity. The recommendations are considered under three broad headings: lifestyle and behaviour interventions, interventions for physical health conditions and specific interventions. By supporting health and social care professionals, particularly by improving their capacity to provide gender and culturally appropriate interventions to the general population, the risk of developing dementia can be potentially reduced, or its progression delayed.