BackgroundTanzania has recently experienced a significant rise in the burden of diabetes, and it is estimated that more than 400,000 people are living with diabetes. A major concern in the management of diabetes is the occurrence of diabetic complications that occur as a result of poor glycemic control. Identification of the factors associated with poor glycemic control is important in order to institute appropriate interventions for the purpose of improving glycemic control and prevention of chronic complications.AimThe aim of this study was to determine the level of glycemic control and explore the factors associated with poor glycemic control among patients with type 2 diabetes mellitus (T2DM).MethodologyA cross-sectional study was carried out at the diabetic clinics for T2DM patients at the national and municipal hospitals in Dar es Salaam. A total of 469 patients were enrolled over a period of 8 weeks from March 2013 to May 2013. Patients’ information such as sociodemographic characteristics, self-care management behaviors, and medication adherence were obtained through interviews. Blood pressure, weight, and height were measured during the day of the interview. All available last readings for fasting blood glucose (FBG) measurements, lipid profile, and other clinical characteristics were obtained from patients’ records.ResultsThe mean age of patients was 54.93 years. The majority (63.5%) of patients were females and only eight patients had records of lipid profile measurements. Out of 469 patients, 69.7% had FBG of ≥7.2 mmol/L, indicating poor glycemic control. Females aged between 40 years and 59 years had significantly higher poor glycemic control (76.1%) as compared with their male counterparts. Thirty-eight percent of patients had poor medication adherence, which was associated with poor glycemic control. The proportion of poor glycemic control increased with age. A significantly high proportion of poor glycemic control was observed in patients who had had the disease for more than 20 years since diagnosis. Factors associated with poor glycemic control included lack of health insurance, using more than one oral hypoglycemic agent, normal body mass index, obesity, and nonadherence to diabetic medications.ConclusionPatients in this study had generally poor glycemic control. From these findings it is recommended that diabetic patients should be routinely screened for lipid profile to determine levels of cholesterol, triglycerides, and low-density lipoproteins, which are risk factors for cardiovascular events. An education program should be developed to educate patients on the importance of medication adherence and weight management for better glycemic control.

No abstract

No abstract

No abstract

A comprehensive hydro-ecological investigation was conducted to determine the ecological response of increased groundwater withdrawals from the Kirkwood-Cohansey aquifer system, an important source of water supply in southern New Jersey, USA. Collocated observations were made of aquatic-macroinvertebrate assemblages and stream hydrologic attributes to develop flow-ecology response relations. A sub-regional transient groundwater flow model (MODFLOW) was used to simulate three plausible high-stress groundwater-withdrawal scenarios which resulted in stream baseflow reductions of approximately 0.12, 0.20, and 0.26 m 3 s -1 . These reduction scenarios were used to construct flow-alteration ecological response models to evaluate aquaticmacroinvertebrate response to streamflow reduction. For example, flow-alteration ecological response models indicate that if groundwater withdrawals diminish mean annual streamflow from 1.1 to 0.6 m 3 s -1 , the abundance of intolerant taxa could be reduced by as much as 20%. These flow-alteration ecological response modelling results could be used by resource professionals to evaluate alternative water management strategies to determine maximum basin withdrawal rates that meet ongoing human water demand while protecting biological integrity.Key words hydro-ecology; streamflow alteration; aquatic macroinvertebrates; flow-ecology relations; groundwater model; MODFLOW; withdrawal scenarios Effets de la réduction des débits sur les macro-invertébrés aquatiques: relier les prélèvements d'eaux souterraines et la réponse des communautés dans les cours d'eaux du Sud du New Jersey, Etats-Unis Résumé Une enquête hydro-écologique globale a été menée pour déterminer la réponse écologique de l'augmentation des prélèvements d'eau souterraine de l'aquifère Kirkwood-Cohansey, une importante source d'approvisionnement en eau du Sud du New Jersey, Etats-Unis. Des observations co-localisées de communautés de macro-invertébrés aquatiques et d'attributs hydrologiques des cours d'eau ont été réalisées pour établir les relations de la réponse débit-écologie. Un modèle sous-régional transitoire de l'écoulement des eaux souterraines (MODFLOW) a été utilisé pour simuler trois scénarios plausibles de prélèvements importants des eaux souterraines qui ont abouti à une réduction du débit de base des cours d'eau de l'ordre de 0,12, 0,20 et 0,26 m3/s. Ces scénarios de réduction ont été utilisés pour élaborer des modèles de réponse écologique à l'altération du débit, pour évaluer la réponse des macro-invertébrés aquatiques à la réduction des débits. Par exemple, les modèles de réponse écologique à l'altération du débit indiquent que si les prélèvements d'eaux souterraines provoquent la diminution de l'écoulement annuel moyen de 1,1 m3/s à 0,6 m3/s, l'abondance des taxons intolérants pourrait être réduite de près de 20%. Ces résultats de la modélisation de la réponse écologique pourraient être utilisés par les professionnels des ressources pour évaluer des stratégies alternatives de gestion de l'eau afin de dé...