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ABSTRACT Objective Methods Results Conclusions To explore the causal relationship between cystatin C levels and different stages of diabetic retinopathy through Mendelian randomization (MR).The MRC Integrative Epidemiology Unit provided the Genome‐wide association studies (GWAS) data related to cystatin C (exposure). GWAS data for outcomes [DR, proliferative diabetic retinopathy (PDR), severe non‐proliferative background diabetic retinopathy (SNPBDR)] were sourced from the FinnGen. Adopted Inverse Variance Weighting (IVW), MR‐Egger regression MR‐PRESSO, Weighted Median, Constrained Maximum Likelihood and Model Averaging (cML‐MA), Weighted model, Radial MR, and MR‐Lasso to estimate the causal relationship between cystatin C and diabetic retinopathy. We conducted multivariable MR analysis to evaluate the independent causal effects of cystatin C levels on diabetic retinopathy.Based on the IVW method, we observed a causal relationship between cystatin C and diabetic retinopathy [odds ratio (OR)random effect = 1.137, 95% confidence interval (CI): 1.035–1.250]/PDR (ORrandom effect = 1.123, 95%CI: 1.004–1.255)/SNPBDR (ORfixed effect = 2.002, 95%CI: 1.343–2.986). Consistent findings were obtained through the cML‐MA method. Cochran's Q test suggested the presence of heterogeneity between the cystatin C level and instrumental variables in relation to diabetic retinopathy and proliferative diabetic retinopathy, respectively. After adjusting for outliers using MR‐PRESSO and Radial MR, it was observed that the statistical significance of the association between cystatin C level and diabetic retinopathy persists. Reverse MR analysis indicated that genetically related SNPBDR may influence the cystatin C level. In multivariable MR analysis, there were indications suggesting a causal relationship of cystatin C with the risk of DR/PDR/SNPBDR adjusting for confounders.This study utilizes Mendelian randomization analyses to establish a causal relationship between cystatin C and diabetic retinopathy, and reveals the impact of cystatin C on the risk of diabetic retinopathy, thus providing new evidence for clinical intervention of diabetic retinopathy. [ABSTRACT FROM AUTHOR]

A non‐exercise method equation using seismocardiography for estimating V̇O2peak (SCG V̇O2peak) has previously been validated in healthy subjects. However, the performance of the SCG V̇O2peak within a trained population is unknown, and the ability of the model to detect changes over time is not well elucidated. Forty‐seven sub‐elite football players were tested at the start of pre‐season (SPS) and 36 players completed a test after eight weeks at the end of the pre‐season (EPS). Testing included an SCG V̇O2peak estimation at rest and a graded cardiopulmonary exercise test (CPET) on a treadmill for determination of V̇O2peak. Agreement between SCG V̇O2peak and CPET V̇O2peak showed a large underestimation at SPS (bias ± 95% CI: −9.9 ± 1.8, 95% Limits of Agreement: 2.2 to −22.0 mL·min−1 kg−1). At EPS no interaction (p = 0.3590) but a main effect of time (p < 0.0001) and methods (p < 0.0001) was observed between SCG and CPET V̇O2peak. No correlation in V̇O2peak changes was observed between SCG and CPET (r = −20.0, p = 0.2484) but a fair agreement in classifying the correct directional change in V̇O2peak with the SCG method was found (Cohen's κ coefficient = 0.28 ± 0.25). Overall, the SCG V̇O2peak method lacks accuracy and despite being able to estimate group changes, it was incapable of detecting individual changes in V̇O2peak following a pre‐season period in sub‐elite football players. The SCG algorithm needs to be further adjusted and the accuracy and precision improved for the method to be applicable for use within a trained population. Highlights: This is the first time a non‐exercise method using seismocardiography for the estimation of V̇O2peak has been validated in sub‐elite football players.The seismocardiography V̇O2peak method lacks accuracy within a trained population as it underestimates V̇O2peak compared to the gold standard measurement in sub‐elite football players.The seismocardiography V̇O2peak method can estimate the group changes in V̇O2peak following the pre‐season training period in sub‐elite football players. However, it is incapable of detecting individual changes.Adjustment of the seismocardiography V̇O2peak algorithm is needed and the accuracy and precision improved for the method to be applicable for use within a trained population. [ABSTRACT FROM AUTHOR]

Background: Patients who have recurrent atrial fibrillation (AF) following redo catheter ablation may eventually be managed with a pace-and-ablate approach, involving pacemaker implant followed by atrioventricular nodal ablation (AVNA). We sought to determine which factors would predict subsequent AVNA in patients undergoing redo AF ablation. Methods: We analyzed patients undergoing redo AF ablations between 2013 and 2019 at our institution. Follow-up was censored on December 31, 2021. Patients with no available follow- up data were excluded. Time-to-event analysis with Cox proportional hazard regression was used to compare those who underwent AVNA to those who did not. Results: A total of 467 patients were included, of whom 39 (8.4%) underwent AVNA. After multivariable adjustment, female sex (aHR 4.68 [95% CI 2.30-9.50]; p < 0.001), ischemic heart disease (aHR 2.99 [95% CI 1.25-7.16]; p = 0.014), presence of a preexisting pacemaker (aHR 3.25 [95% CI 1.10-9.60]; p = 0.033), and persistent AF (aHR 2.22 [95% CI 1.07-4.59]; p = 0.032) were associated with increased risk of subsequent AVNA requirement. Conclusion: Female sex, ischemic heart disease, and persistent AF may be useful clinical predictors of the requirement for subsequent AVNA and may be considered as part of shared clinical decision making. [ABSTRACT FROM AUTHOR]

Background: Immunotherapy has revolutionized cancer treatment. Recent studies have suggested that the efficacy of immunotherapy can be further enhanced by the influence of gut microbiota. In this study, we aimed to investigate the impact of bacteria on the effectiveness of cancer immunotherapy by combining analysis of clinical samples with validation in animal models. Methods: In order to characterize the diversity and composition of microbiota and its relationship with response to immune checkpoint inhibitors (ICIs), 16S ribosomal RNA (rRNA) and GC–MS sequencing was performed on 71 stool samples from patients with advanced non‐small cell lung cancer (NSCLC) prior to treatment with immune checkpoint blockade (ICB). Furthermore, fecal microbiota transplantation (FMT) was performed from different patients into mice and a subcutaneous tumor model established using the Lewis lung cancer cell line to evaluate the therapeutic effect of PD‐1 on mice with varying gut microbiota. Results: The results demonstrated a significant association between elevated gut microbiota diversity and response to treatment with ICIs, p < 0.05. Faecalibacterium was markedly increased in the gut microbiota of responders (R), accompanied by increased short‐chain fatty acid (SCFA) levels, especially butanoic acid, acetic acid and hexanoic acid, p < 0.05. Additionally, FMT from R and nonresponders (NR) could promote an anticancer effect and reduce the expression of Ki‐67 cells in tumors in mice, p < 0.05. Moreover, R and NR FMT did not alter PD‐L1 expression in the tumor tissues of mice, p > 0.05. The diversity of gut microbiota consistently correlated with an optimistic prognosis in NSCLC patients with immunotherapy, which could be functionally mediated by SCFAs. Conclusion: The findings of the present study indicated that the diversity of gut microbiota and SCFAs is related to the efficacy of immunotherapy. FMT can effectively delay tumor progression, and enhance the effect of immunotherapy, thus providing evidence for improving the efficacy of immunotherapy in NSCLC patients. [ABSTRACT FROM AUTHOR]

Objective: The tapering of biologic disease‐modifying antirheumatic drug (b‐DMARD) therapy for patients with rheumatoid arthritis (RA) in stable remission is frequently undertaken, but specific guidance on how to successfully taper is lacking. The objective of this study is to identify predictors of flare in patients in stable b‐DMARD–induced clinical remission, who did or did not follow structured b‐DMARD tapering. Methods: Patients with RA receiving b‐DMARD treatment who had achieved sustained remission according to a Disease Activity Score in 28 joints using the C‐reactive protein level (DAS28‐CRP) <2.6 for ≥6 months were offered tapering. Clinical, ultrasound (US) (total power Doppler [PD]/grayscale abnormalities), CD4+ T cell subsets, and patient‐reported outcomes (PROs) were collected at inclusion. The primary endpoint was the occurrence of flare (loss of DAS28‐CRP remission) over 12 months. Logistic regression analyses identified predictors of flare. Dichotomization into high/low‐risk groups was based on 80% specificity using the area under the receiving operator curve (AUROC). Results: Of 63 patients choosing tapering, 23 (37%) flared compared with 12 of 60 (20%) on stable treatment (P = 0.043). All patients who flared regained remission upon reinstating treatment. In the tapering group, flare was associated with lower regulatory T cell (Treg) (P < 0.0001) and higher CRP levels (P < 0.0001), erythrocyte sedimentation rate (P < 0.035), and inflammation‐related cells (IRCs) (P = 0.054); stepwise modeling selected Tregs (odds ratio [OR] = 0.350, P = 0.004), IRCs (OR = 1.871, P = 0.007), and CRP level (OR = 1.577, P = 0.004) with 81.7% accuracy and AUROC = 0.890. In the continued therapy group, modeling retained the tender joint count, total PD, and visual analog scale pain score, with 82.1% accuracy and AUROC = 0.899. Most patients in the study were considered low risk of flare (80 of 123 patients [65%]). Only 5 of 37 (13.5%) of the low‐risk patients who tapered flared, which was notable compared with the continued therapy group (20% flare). Conclusion: Flare on tapering b‐DMARDs was predicted by lower Tregs and elevated inflammation biomarkers (IRCs/CRP level); flare on continued b‐DMARDs was associated with raised pain parameters and US inflammation. Knowledge of these biomarkers should improve outcomes by targeted selection for tapering, and by increased monitoring of those on continued therapy predicted to flare. [ABSTRACT FROM AUTHOR]

Rheumatoid arthritis (RA) is an autoimmune disorder with a varying range of organs involved leading to adverse outcomes. However, very little is known, with conflicting results about the association between RA and atrial fibrillation (AF). We aim to evaluate the association between RA and AF, and other clinical outcomes. We performed a systematic literature search using PubMed, Embase, and Scopus for relevant articles from inception until September 10, 2023. Primary clinical outcomes were AF. Secondary outcomes were acute coronary syndrome (ACS), stroke, and all-cause mortality (ACM). A total of 4 679 930 patients were included in the analysis, with 81 677 patients in the RA group and 4 493 993 patients in the nonrheumatoid arthritis (NRA) group. The mean age of the patients was 57.2 years. Pooled analysis of primary outcomes shows that RA groups of patients had a significantly higher risk of AF (odds ratios [OR], 1.53; 95% confidence interval [CI]: [1.16-2.03], p < .001) compared with NRA groups. Secondary Outcomes show that the RA group of patients had significantly higher odds of ACS (OR, 1.39; 95% CI: [1.26-1.52], p < .001), and ACM (OR, 1.19; 95% CI: [1.03-1.37], p = .02) compared with the NRA groups. However, the likelihood of stroke (OR, 1.02; 95% CI: [0.94-1.11], p = .61) was comparable between both groups of patients. Our study shows that RA groups of patients are at increased risk of having AF, ACS, and ACM. [ABSTRACT FROM AUTHOR]

The size and shape of niche spaces or trait spaces are often analysed using hypervolumes estimated from data. The hypervolume R package has previously supported such analyses via descriptive but not inferential statistics. This gap has limited the use of hypothesis testing and confidence intervals when comparing or analysing hypervolumes.We introduce a new version of this R package that provides nonparametric methods for resampling, building confidence intervals and testing hypotheses. These new methods can be used to reduce the bias and variance of analyses, and well as provide statistical significance for hypervolume analysis.We illustrate usage on real datasets for the climate niche of tree species and the functional diversity of penguin species. We analyse the size and overlap of the respective niche or trait spaces.These statistical inference methods improve the interpretability and robustness of hypervolume analyses. [ABSTRACT FROM AUTHOR]

Aim: To explore the mediating role of psychological capital between authentic leadership and innovative behaviour among Chinese nurses. Design: A cross‐sectional study. Methods: In December 2021, online surveys were delivered among nurses from 37 hospitals in Anhui Province by convenience sampling approach. The data was collected using the Chinese version of the Authentic Leadership Questionnaire, Nurse Psychological Capital Questionnaire and Nurse Innovative Behaviour Scale. The structural equation model and bootstrap test examined the mediating role of psychological capital between authentic leadership and innovative behaviour. Results: 3495 Chinese nurses from 37 Anhui Province hospitals participated in this study. The mean item score of authentic leadership was 3.25 (SD 0.83), psychological capital was 4.85 (SD 0.89), and innovative behaviour was 2.82 (SD 0.84). Authentic leadership perceived by nurses, psychological capital, and innovative behaviour were statistically significant and positively correlated with each other (r = 0.524 ~ 0.806, p < 0.01). Psychological capital significantly mediated the association between authentic leadership and innovative behaviour (β = 0.449, p < 0.001), and its mediating effect accounted for 76.75% of the total effect. Conclusion: Results suggest the importance of developing nurse managers' authentic leadership to foster nurses' psychological capital and innovation behaviour. [ABSTRACT FROM AUTHOR]

Background: Endobronchial ultrasound‐guided (EBUS) transbronchial needle aspiration (TBNA) has significantly improved the diagnostic workup for intrathoracic lymphadenopathies. More recently, EBUS intranodal forceps biopsy (IFB) has been developed in an attempt to maximize diagnostic yield by providing additional tissue. In this study, we aimed to assess the improvement of diagnostic yield with EBUS‐TBNA combined with EBUS‐IFB, compared to EBUS‐TBNA alone. Methods: Consecutive patients who had 19‐G EBUS‐TBNA and EBUS‐IFB from August 30, 2018, to September 28, 2021, were included. Four senior pathologists retrospectively analyzed, independently and blindly, first, only the EBUS‐TBNA samples (cell block), then, at least 1 month later, both samples from EBUS‐TBNA and from EBUS‐IFB together. Results: Fifty patients were included in the study and 52 lymph nodes were analyzed. Diagnostic yield was 77% (40/52) for EBUS‐TBNA alone and 94% (49/52) when combined with EBUS‐IFB (p = 0.023). Malignancy was diagnosed with EBUS‐TBNA combined with EBUS‐IFB in 25/26 cases (96%), versus 22/26 (85%) with EBUS‐TBNA alone (p = 0.35); and 4/5 (80%) versus 2/5 (40%) for lymphoma specifically. Kappa interobserver agreement was 0.92 for EBUS‐IFB and 0.87 for EBUS‐TBNA alone. Nonmalignant condition was diagnosed with EBUS‐TBNA combined with EBUS‐IFB in 24/26 cases (92%), versus 18/26 (69%) for EBUS‐TBNA alone (p = 0.07). Conclusion: The use of EBUS‐IFB combined with 19‐G EBUS‐TBNA improves the mediastinal lymph node diagnostic yield However the benefit appears to be mainly restricted to nonmalignant histology. [ABSTRACT FROM AUTHOR]

Background: The best choice between first‐line aspiration and stent retriever for acute basilar artery occlusion remains controversial. This study aims to perform a systematic review and meta‐analysis comparing the stent retriever and direct aspiration about reported recanalization rates and periprocedural complications. Method: PubMed, Embase, Web of Science, Cochrane, and Clinical Trials were searched for the studies evaluating the efficacy and safety of first‐line aspiration versus stent retriever for acute basilar artery occlusion. A standard software program (Stata Corporation) was used for end‐point analyses. Statistical significance was defined as a p‐value less than.05. Results: A total of 11 studies were involved in the current study, including 1014 patients. Regarding postoperative recanalization, the pooled analysis identified a significant difference in successful recanalization (odds ratio [OR] = 1.642; 95% confidence interval (95% CI): 1.099–2.453; p =.015) and complete recanalization (OR = 3.525; 95% CI: 1.306–2.872; p =.001) between the two groups in favor of the first‐line aspiration. Concerning the complications, the first‐line aspiration could achieve a lower rate of total complication (OR =.359; 95% CI:.229–.563; p <.001) and hemorrhagic complication (OR =.446, 95% CI:.259–.769; p =.004) than stent retriever. No significant difference was observed in postoperative mortality (OR =.966; p =.880), subarachnoid hematoma (OR =.171; p =.094), and parenchymal hematoma (OR =.799; p =.720). In addition, the pooled results revealed a significant difference in procedure duration between the two groups in favor of aspiration (WMD = −27.630, 95% CI: −50.958 to −4.302; p =.020). However, there was no significant difference in favorable outcome (OR = 1.149; p =.352) and rescue therapy (OR = 1.440; p =.409) between the two groups. Conclusion: Given that the first‐line aspiration was associated with a higher rate of postoperative recanalization, a lower risk of postoperative complication, and a faster duration of the procedure, these findings support the aspiration may be more secure than a stent retriever. [ABSTRACT FROM AUTHOR]

Acta Obstetricia et Gynecologica Scandinavica (AOGS) has updated its guidelines for authors to report methods and statistical analyses. The guidelines reflect recent advancements in research methodology and address concerns about the misuse of statistical hypothesis testing. The guidelines aim to promote transparency and best practices in scholarly publishing by encouraging consistent and standardized reporting. They also emphasize the interpretation of effect sizes and confidence intervals, rather than relying solely on statistical significance. The guidelines cover various aspects of experimental and observational studies and are aligned with the EQUATOR network's guidelines for health research. AOGS encourages authors to adhere to these guidelines to enhance the credibility and understanding of their research. [Extracted from the article]

This study aimed to examine the perceived stress and body image in burn patients and the relationship between these two variables. This is a descriptive and cross‐sectional study. The study included total of 144 patients who had burn injuries, received treatment in a research and training hospital and were scheduled to be discharged. The data were collected prospectively by the researchers, using descriptive methods, Kruskal Wallis test, paired samples t test, and Pearson's correlation analysis. Of the patients, 59% were between the ages of 18 and 35 years, 68.1% were male, 65.3% had second‐degree burns, 77.1% had burn surfaces ranging between 10% and 20% of their body, and 54.9% had autograft surgery. The burn patients aged 51 years and over had higher perceived stress than younger patients, and the difference between them was statistically significant (P < 0.05). As the percentage of burn surface increased, the perceived stress increased, and the perceived body image weakened (P < 0.05). The burn patients with autograft surgery had lower perceived stress and higher perceived body image than those without autograft surgery, and the difference between them was statistically significant (P < 0.01). This study found an inverse relationship between perceived stress and body image in burn patients, which was affected by the percentage of burn surface and autograft surgery. Relevant interventions are suggested to increase perceived body image in burn patients and reduce their perceived stress. [ABSTRACT FROM AUTHOR]

Objectives: Veteran persons living with dementia (PLWDs) have high acute care utilization. We aim to understand why PLWDs seek care in the emergency department (ED) and how their utilization differs from older Veterans with no dementia diagnosis. We demonstrate the use of a novel national chief complaint data set in the Veteran Affairs Health Care System. Methods: This was a retrospective observational study of ED users 65 years or older as of FY2017. The primary outcome is presence of one or more ED visits in FYs 2017–2018 using a logistic regression model controlling for dementia and other variables. Secondary outcomes include counts of ED visits by disposition, Emergency Severity Index, chief complaints defined by a natural language processing program, and ED encounter diagnoses defined by primary International Statistical Classification of Diseases, Tenth Revision (ICD‐10‐CM) code. Results: Our cohort of Veterans comprised 3,115,263 patients. Of those, 255,372 (8.2%) had a diagnosis of dementia. Logistic regression modeling demonstrated that dementia is a significant predictor of ED use (p < 0.0001), with PLWDs more likely to have an ED visit (odds ratio 1.96, 95% confidence interval 1.94–1.98). PLWDs were admitted at higher rates when accounting for age and acuity. Chief complaints that were more common among PLWDs included falls (6.7% dementia vs. 3.3% without dementia), weakness (3.6% vs. 2.2%), and abnormal mental state (2.2% vs. 0.4%). ICD‐10‐CM codes were largely similar between the two groups. Conclusions: Our results reinforce that the ED is a common access point for Veterans with dementia. These patients require special consideration as they are more likely to visit the ED and be admitted. Our use of a novel national chief complaint data set suggests that they more commonly present with certain geriatric syndromes and nonspecific complaints. Further work is needed to determine whether these would warrant targeted interventions to improve quality of acute care. [ABSTRACT FROM AUTHOR]

The abdominal skin is not a common area for keloid formation. The knowledge of laparoscopically induced keloids (LIK) remains little. This article aimed to review the case series of LIK and analyse the characteristics. A retrospective and descriptive study was conducted. Patients' clinical records in the database were collected, including the demographics, medical history, laparoscopic surgery information, keloid information, and the severity of LIKs recorded using the Patient and Observer Scar Assessment Scale. Twenty‐four LIK patients were enrolled. 18 patients were female and 10 had chronic diseases. 11 patients had non‐LIKs. 91.6% patients received laparoscopic cholecystectomy. LIKs were mainly located under the xiphoid process (N = 20), followed by the umbilicus (N = 16). 41.7% patients developed keloids at all trocha sites. The severity of the LIK was significantly negatively associated with the presence of the non‐LIK. Laparoscopic procedures could lead to the formation of keloids. Two types of LIKs were noticed: extended incisions induced long "spreading" type and trocha induced round bulging type. The presence of non‐LIKs could significantly reduce the severity of LIKs. [ABSTRACT FROM AUTHOR]

Background: Although T factor is defined as the size of invasive area rather than total tumor size in the eighth edition of the TNM classification, whether the pathological invasive area to tumor ratio (ITR) is a prognostic factor has not yet been evaluated. Methods: In total, 432 lung adenocarcinoma patients were analyzed, among which 266 patients with pathological stage IA were used to perform a subanalysis. Results: Smoking status (odds ratio [OR]: 0.43, p = 0.01), neutrophil‐to‐lymphocyte ratio (NLR) (OR: 1.97, p = 0.03), maximum standardized uptake value (SUVmax) (OR: 3.62, p < 0.01), and ITR (OR: 6.76, p < 0.01) were significantly different in univariate analysis. Smoking status (OR: 0.34, p < 0.01), SUVmax (OR: 3.05, p < 0.01), and ITR (OR: 5.44, p < 0.01) were risk factors for recurrence in multivariate analysis. In patients with pathological stage IA disease, smoking status (OR: 0.34, p = 0.03), NLR (OR: 2.30, p = 0.04), SUVmax (OR: 3.63, p < 0.01), pathological invasive area (OR: 4.00, p < 0.01), and ITR (OR: 6.03, p < 0.01) were significantly different in univariate analysis. Smoking status (OR: 0.27, p = 0.02), SUVmax (OR: 3.93, p < 0.01), and ITR (OR: 4.38, p < 0.01) were significant risk factors for recurrence in multivariate analysis. Conclusions: SUVmax and ITR are risk factors for recurrence. These results suggest that SUVmax is important for deciding the indication for limited resection or adjuvant chemotherapy, and ITR is an adaptation criterion for adjuvant chemotherapy for early‐stage lung adenocarcinoma patients. [ABSTRACT FROM AUTHOR]

Racial diversity among faculty, students, and administrators is increasing at universities in the United States. These changes have been uneven, with growth in underrepresented students exceeding that of faculty diversity. To address these and other inequities, a growing number of universities have established an executive‐level chief diversity officer (CDO). Our study offers a first empirical examination of this effort at selected 4‐year U.S. universities from 2001 to 2019 using unique data on the initial hiring date of a CDO and publicly available demographic data. We provide a comprehensive overview of demographic trends within our data and find confidence intervals around the estimated instantaneous average treatment effect for an executive‐level CDO on diverse hiring tightly contain zero. Estimated treatment effects are small and lack statistical significance within 4 years of a CDO position being established. We discuss other possible factors that explain trends toward higher diversity on campus and several possible constraints. [ABSTRACT FROM AUTHOR]

Background: Patient activation describes the knowledge, skills and confidence in managing one's own health. Promoting patient activation is being prioritized to reduce costs and adverse outcomes such as cardiovascular disease (CVD). The increasing prevalence of chronic kidney disease (CKD) presents a need to understand the characteristics that influence patient activation and the effect on health outcomes. Design: Cross‐sectional study. Setting and participants: Patients with non‐dialysis CKD recruited from 14 sites (general nephrology and primary care) in England, UK. Outcome measures: Patient activation was measured using the PAM‐13. Demographic and health‐related variables, self‐reported symptom burden, health‐related quality of life (HRQOL), socioeconomic status (SES), were assessed as determinants of patient activation. Major CVD risk factors included hypertension, dyslipidaemia, obesity and hyperkalaemia. Results: 743 patients were included (eGFR: 32.3 (SD17.1) mL/min/1.73 m2, age 67.8 (SD13.9) years, 68% male). The mean PAM score was 55.1 (SD14.4)/100. Most patients (60%) had low activation. Those with low activation were older (P<.001), had lower eGFR (P =.004), greater number of comorbidities (P =.026) and lower haemoglobin (P =.025). Patients with low activation had a 17% greater number of CVD risk factors (P <.001). Risk factors in those with low activation were being older (P <.001) and having diabetes (P <.001). Conclusion: This study showed that only a minority of CKD patients are activated for self‐management. Our findings help better understand the level of activation in these patients, particularly older individuals with multimorbidity, and further the knowledge regarding the characteristics that influence activation. Patient or Public Contribution: Patients were involved in the design of main study. [ABSTRACT FROM AUTHOR]

Combined hepatocellular‐cholangiocarcinoma (cHCC‐CC) and intrahepatic cholangiocarcinoma (ICC) are classified into one category, but comparison of prognosis of the two carcinomas remains controversial. The aim of the current study was to investigate surgical outcomes for patients with ICC or cHCC‐CC who underwent resection in order to elucidate whether the classification of ICC and cHCC‐CC is justified. Subjects were 61 patients with ICC and 29 patients with cHCC‐CC who underwent liver resection from 2001 to 2017. Clinic‐pathological data from the two groups were compared. Tumor number and vascular invasion were independent risk factors for recurrence‐free survival (RFS) in both groups (P < .001 for both). Of note, for patients with ICC, tumor cut‐off size of 5 cm showed statistical significance in median RFS (>5 cm vs ≤5 cm, 0.5 years vs 4.0 years, P = .003). For patients with cHCC‐CC, tumor cut‐off size of 2 cm showed statistical significance in median RFS (>2 cm vs ≤2 cm, 0.6 years vs 2.6 years, P = .038). The median RFS of patients with cHCC‐CC was 0.9 years (95% confidence interval: 0.3‐1.6), which was poorer than that of patients with ICC (1.3 years, 0.5‐2.1) (P = .028); the rate of RFS at 5 years was 0% and 37.7% respectively. Our study supports the concept of classifying ICC and cHCC‐CC into different categories because of a significant difference in RFS between the two. [ABSTRACT FROM AUTHOR]

The association of biomedical sciences with mathematics is inextricable and undeniable. It should be considered that gaining confidence or strong belief within the framework of a scientific experiment – in the 'compulsory' marriage with statistics – does not mean total and undisturbed certainty. The null hypothesis significance testing (NHST) has been the kernel of statistical data analysis for a long period. Medicine is making use of it in a very wide range. The main problem in NHST arises out of a dichotomic perception of reality. Scientific reasoning was biased in the aftermath of the uncritical, almost dogmatic, trust in a level of statistical significance, namely a p‐value, defined as 'the dictating paradigm of p‐value'. The level of statistical significance (p‐value) is not completely plausible and objective; it cannot be equated with the nature of a phenomenon or population characteristics. The p‐value refers directly to a formulated hypothesis only, that is the probability of observing a given outcome under the condition posited by a specific null hypothesis and given a specific model of the distribution of outcomes under the null hypothesis. Experts claim that unjustified conclusions and guidelines have become the bane of many scientific journals. Investigators should be able to interpret study results in a broad context and look at them critically. Statistics indeed is a leaven to further scientific discussion, not its conclusion. It is not easy to abandon the p‐value. Lots of researchers recommended an ecumenical approach to the statistical analysis of research data, for example analyses of the same results using a variety of statistical procedures. Many of them express the view that a threshold level of statistical significance should be lower than p < 0.05. To enhance the plausibility and true scientific value of research works, investigators should also take into consideration the effect size along with its confidence limits. The effect size is a kind of added value and should be determined a priori. Account must be taken of their origin, conditioning (medical knowledge), as well as specific implications in clinical practice. The effect size makes possible to compare results of various research works. It is argued that to the rescue for modern science can come research works that bear the stamp of reproducibility, for example studies conducted in several independent centres, based on coherent and meticulous methodology, or data from various centres typed in one spotless big database and submitted to rigorous and deliberate multilevel statistical analyses. [ABSTRACT FROM AUTHOR]

Abstract: Improving infant and young child feeding practices is critical for improving growth and reducing child mortality and morbidity. This paper aims to compare predictors of minimum dietary diversity, an important indicator of adequate complementary feeding practices, in Bangladesh in 2011 and 2014. The 2011 and 2014 Bangladesh Demographic and Health Survey were used to examine predictors of minimum dietary diversity among 6–23 months. An additional analysis was conducted for the 18–23‐month group, because a significant increase in meeting minimum dietary diversity recommendations was seen in this age group only. Factors found to be associated with practices were compared across time points. In 2011, minimum dietary diversity was 23.8% and increased to 28.8% in 2014. Among children 18–23 months, in 2011, minimum dietary diversity was 32.5% and increased to 42.8% in 2014. Among all children, wealth, education, exposure to media, and antenatal care were significant predictors of dietary diversity. In the 18–23‐month age group, significant predictors in 2011 were wealth and decision making. In 2014, significant predictors were education and exposure to media. Demographic trends indicated a significant increase in education and exposure to media between 2011 and 2014. As these were significant for minimum dietary diversity in 2014 overall and for 18–23 months, they might be important targets of future interventions, specifically utilizing media channels and tailoring special strategies for women with low education and limited exposure to media. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the incidence and risk factors of deep surgical site infection (DSSI) during hospitalisation after closed tibial plateau fractures treated with open reduction and internal fixation (ORIF). We performed this retrospective study at a university‐affiliated hospital with an advanced trauma centre. The data of adult patients with closed tibial plateau fractures treated with ORIF from January 2012 to February 2017 were extracted from the electronic medical records. Demographics, injury‐related and surgery‐related variables of DSSI and non‐DSSI groups were compared by univariate test. Multivariate logistic analysis models were used to investigate the independent risk factors. In total, 676 patients with complete data met the inclusion criteria and were included, and of them, 17 developed DSSI (2.51%) during hospitalisation. Approximately 60% (9/17) of DSSI was caused by Staphylococcus aureus. Compared to the non‐DSSI group, DSSI patients had a significantly longer stay in hospital (25.8 vs 15.2 days). Independent risk factors of DSSI identified by multivariate analysis were higher BMI (>26.0) (OR, 1.58; 95% CI, 1.09 to 3.27; P = 0.032), prolonged surgical duration (>138 min) (OR, 4.26; 95% CI, 1.54 to 11.19; P = 0.005) and current smoking (OR, 3.42; 95% CI, 1.47 to 8.62; P = 0.01). A relatively low incidence rate of DSSI (2.51%) was found in this study, and several significant risk factors were identified. Smoking cessation programmes should be implemented immediately after hospitalisation, especially for obesity and morbid obesity patients. Detailed and comprehensive preoperative assessment and a considerate operative plan should be guaranteed to reduce surgical duration. [ABSTRACT FROM AUTHOR]

Preventing intraoperatively acquired pressure ulcers (IAPUs) in patients undergoing spinal surgery in the prone position using a Relton‐Hall frame is challenging. We investigated the efficacy of soft silicone foam dressings in preventing IAPUs. A prospective dual‐center sham study was conducted among patients undergoing elective spinal surgery in a general hospital and a university hospital in Japan. The incidence of IAPUs that developed when soft silicone foam dressings and polyurethane film dressings were used was compared on two sides in the same patient. IAPUs developed on the chest in 11 of 100 patients (11%). Polyurethane film dressings were associated with a significantly higher rate of IAPUs than soft silicone foam dressings (11 versus 3, P = 0·027). A multivariate logistic regression analysis revealed that a diastolic blood pressure of <50 mmHg (P = 0·025, OR 3·74, 95% confidence interval [CI] 1·18–13·08) and the length of surgery (by 1 hour: P = 0·038, OR 1·61, 95% CI 1·03–2·64) were independently associated with the development of IAPUs. The use of soft silicone foam dressings reduced the risk of IAPUs (P = 0·019, OR 0·23, 95% CI 0·05–0·79) and was more effective than film dressings for preventing IAPUs in spinal surgery patients. [ABSTRACT FROM AUTHOR]

Maternal capabilities-qualities of mothers that enable them to leverage skills and resources into child health-hold potential influence over mother's adoption of child caring practices, including infant and young child feeding. We developed a survey ( n = 195) that assessed the associations of 4 dimensions of maternal capabilities (social support, psychological health, decision making, and empowerment) with mothers' infant and young child feeding practices and children's nutritional status in Uganda. Maternal responses were converted to categorical subscales and an overall index. Scale reliability coefficients were moderate to strong (α range = 0.49 to 0.80). Mothers with higher social support scores were more likely to feed children according to the minimum meal frequency (odds ratio [OR] [95% confidence interval (CI)] = 1.38 [1.10, 1.73]), dietary diversity (OR [95% CI] = 1.56 [1.15, 2.11]), iron rich foods, (OR [95% CI] = 1.47 [1.14, 1.89]), and minimally acceptable diet (OR [95% CI] = 1.55 [1.10, 2.21]) indicators. Empowerment was associated with a greater likelihood of feeding a minimally diverse and acceptable diet. The maternal capabilities index was significantly associated with feeding the minimum number of times per day (OR [95% CI] = 1.29 [1.03, 1.63]), dietary diversity (OR [95% CI] = 1.44 [1.06, 1.94]), and minimally acceptable diet (OR [95% CI] = 1.43 [1.01, 2.01]). Mothers with higher psychological satisfaction were more likely to have a stunted child (OR [95% CI] = 1.31 [1.06, 1.63]). No other associations between the capabilities scales and child growth were significant. Strengthening social support for mothers and expanding overall maternal capabilities hold potential for addressing important underlying determinants of child feeding in the Ugandan context. [ABSTRACT FROM AUTHOR]

The study aims to examine the individual and combined association of early life factors (birth weight, birth length, and any and exclusive breastfeeding) with attention capacity in adolescents. The study included 421 European adolescents (243 girls), aged 12.5-17.5 years, who participated in the Healthy Lifestyle in Europe by Nutrition in Adolescence Study. Body weight and length at birth of adolescents were collected from parental records. The duration of any and exclusive breastfeeding were self-reported. The d2 Test of Attention was administered to assess attention capacity. The main results showed that birth weight, birth length, breastfeeding, and exclusive breastfeeding were related to attention capacity in boys ( β ranging from 0.144 to 0.196; all p < .05) after adjustment for age, centre, gestational age, maternal education, family affluence scale, and body mass index. Among boys, differences in attention capacity were found according to tertiles of birth weight and birth length ( p < .05), as well as borderline significant differences across groups of any and exclusive breastfeeding ( p = 0.055 and p = 0.108, respectively) after adjusting for potential confounders. In addition, boys with 3 early life risk factors (low birth weight, low birth length, and <3 months of breastfeeding) had significantly lower scores in attention capacity compared with boys with 0 risk factors (percentile score − 15.88; p = 0.009). In conclusion, early life factors, both separately and combined, may influence attention capacity in male European adolescents. Importantly, the combination of the 3 early life risk factors, low birth weight, low birth length, and <3 months of breastfeeding, even in normal ranges, may provide the highest reduction in attention capacity. [ABSTRACT FROM AUTHOR]

Adding amylase to fortified blended foods can improve energy density, and increase child's energy and nutrient intake. The efficacy of this strategy is unknown for the World Food Programme's Super Cereal Plus (SC+) and Super Cereal (SC) blends. The primary goal of this study was to investigate the increased energy intake from amylase-containing SC+ and SC compared to control porridges in Burkinabe children. Secondly, energy intake from amylase-containing porridges compared to CERELAC®, Vitazom, and eeZeeBAR™ was studied. Thirdly, caregivers' ( n = 100) porridge acceptability was investigated. The design was a randomized double-blind controlled cross-over trial studying the effect of amylase addition to SC+ and SC flours on porridge energy and nutrient intake in healthy Burkinabe children aged 12-23 ( n = 80) and 24-35 months ( n = 40). Amylase added to porridges increased energy density from 0.68 to 1.16 kcal/g for SC+ and from 0.66 to 1.03 kcal/g for SC porridges. Among children aged 12-23 months, mean energy intake from all porridges with amylase (135-164 kcal/meal) was significantly higher compared to control SC+ porridges (84-98 kcal/meal; model-based average). Among children aged 24-35 months, mean energy intakes were also significantly higher from all porridges with amylase added (245-288 kcal/meal) compared to control SC porridges (175-183 kcal/meal). Acceptability of the porridges among caregivers was rated neutral to good, both for amylase-added and non-amylase-containing porridges. These findings suggest that, among 12-35-month-old, adding amylase to fortified blended foods significantly increased energy and consequently nutrient intake per meal by 67% for SC+ and 47% for SC. Moreover, amylase-containing porridges were well accepted by the caregivers. [ABSTRACT FROM AUTHOR]

In formula-fed infants, rapid weight gain during the first week of life is associated with later obesity. To examine the association between weight gain during the first week and overweight at age 2 among infants with various feeding practices and the relationship between exclusive breastfeeding in early infancy and overweight, we enrolled a prospective cohort of healthy mother-infant dyads and followed them for 2 years. We enrolled 450 mother/infant pairs and obtained information on 306 infants at year 2. Weight change during the first week of life and detailed feeding information were collected during the first month of life. Anthropometric measures were collected at 2 years. Overweight was defined as body mass index (BMI) ≥85th percentile for age. At 2 years, 81% had normal weights and 19% were overweight. Maternal pre-pregnancy BMI; infant birth weight; maternal education; and Women, Infants, and Children status were associated with the risk of overweight at age 2. Children who gained more than 100 g during the first week were 2.3 times as likely after adjustment ( p = .02) to be overweight at age 2 compared to infants who lost weight. There was no association between feeding type and BMI, but feeding type was significantly associated with change in weight at week 1 and anthropometric measurements at age 2. Infant weight gain in the first week of life is related to overweight at age 2, and exclusively breastfed infants are least likely to gain ≥100 g. [ABSTRACT FROM AUTHOR]

Early childhood development plays a key role in a child's future health, educational success, and economic status. However, suboptimal early development remains a global challenge. This study examines the influences of quality of the home learning environment (HOME) and child stunting in the first year of life on child development. We used data collected from a randomized controlled trial of preconceptional micronutrient supplementation in Vietnam ( n = 1,458). The Bayley Scales of Infant Development-III were used to assess cognition, language, and motor development domains at 2 years. At 1 year, 14% of children were stunted, and 15%, 58%, and 28% of children lived in poor, medium, and high HOME environments, respectively. In multivariate generalized linear regression models, living in a high HOME environment was significantly associated with higher scores (0.10 to 0.13 SD) in each of the developmental domains. Stunted children scored significantly lower for cognitive, language, and motor development (−0.11 to −0.18), compared to nonstunted children. The negative associations between stunting on development were modified by HOME; the associations were strong among children living in homes with a poor learning environment whereas they were nonsignificant for those living in high-quality learning environments. In conclusion, child stunting the first year of life was negatively associated with child development at 2 years among children in Vietnam, but a high-quality HOME appeared to attenuate these associations. Early interventions aimed at improving early child growth as well as providing a stimulating home environment are critical to ensure optimal child development. [ABSTRACT FROM AUTHOR]

The Baby-Friendly Hospital (BFH) Initiative has led to an increase in breastfeeding rates and duration worldwide. But little is known about whether the beneficial effects persist beyond a facility's designation as a BFH. To investigate the association of BFH designation (current, former, and never) and compliance with Baby-Friendly (BF) practices on breastfeeding in Switzerland, this study combined nationwide survey data on breastfeeding with BFH monitoring data. In this cross-sectional study, 1,326 children were born in 34 current ( N = 508), 28 former ( N = 425), and 34 never designated BFHs ( N = 393). We compared exclusive and any breastfeeding according to BFH designation over the first year of life, using Kaplan-Meyer Survival curves. Logistic regression models were applied to analyse breastfeeding prevalence, and Cox-regression models were used for exclusive (0-6 months) and continued (6-12 months) breastfeeding duration. Average duration of exclusive breastfeeding (13.1 weeks, 95% confidence interval [12.0, 17.4]) and any breastfeeding (32.7 weeks, 95% confidence interval [30.5, 39.2]) were the longest for babies born in currently accredited BFHs. Exclusive breastfeeding was associated with high compliance with monitored BF practices in current BFHs and with the number of BF practices experienced in all hospitals. Continued breastfeeding was significantly longer when babies were born in current BFHs (cessation hazard ratio 0.60, 95% confidence interval [0.42, 0.84]) or in former BFHs (cessation hazard ratio 0.68, 95% confidence interval [0.48, 0.97]). Overall, the results support continued investment into BFHs, because babies born in current BFHs are breastfed the most and the longest, whereas a former BFH designation shows a sustained effect on continued breastfeeding. [ABSTRACT FROM AUTHOR]

Socioeconomic inequalities in child undernutrition remain one of the main challenges in Bangladesh. The social determinants of health are mostly responsible for such inequalities across different population groups. However, no study has examined the relative contribution of different social determinants to the socioeconomic inequality in child undernutrition in Bangladesh. Our objective is to measure the extent of socioeconomic-related inequalities in childhood stunting and identify the key social determinants that potentially explain these inequalities in Bangladesh. We used data for children younger than 5 years of age for this analysis from 2 rounds of Bangladesh Demographic and Health Surveys conducted in 2004 and 2014. We examined the socioeconomic inequality in stunting using the concentration curve and concentration index. We then decomposed the concentration index into the contributions of individual social determinants. We found significant inequality in stunting prevalence. The negative concentration index of stunting indicated that stunting was more concentrated among the poor than among the well-off. Our results suggest that inequalities in stunting increased between 2004 and 2014. Household economic status, maternal and paternal education, health-seeking behavior of the mothers, sanitation, fertility, and maternal stature were the major contributors to the disparity in stunting prevalence in Bangladesh. Equity is a critical component of sustainable development goals. Health policymakers should work together across sectors and develop strategies for effective intersectoral actions to adequately address the social determinants of equity and reduce inequalities in stunting and other health outcomes. [ABSTRACT FROM AUTHOR]

Although iron deficiency (ID) is considered the most frequent micronutrient deficiency in industrialized countries and is associated with impaired neurodevelopment when occurring in early years, accurate recent estimations of its prevalence are lacking. Our objective was to estimate ID prevalence and associated sociodemographic markers in young children in France. The Saturn-Inf national cross-sectional hospital-based survey recruited 3,831 French children <6 years old between 2008 and 2009 to assess lead poisoning prevalence and to establish a biobank. This secondary analysis measured serum ferritinemia (SF) in sera kept frozen at −80 °C for children with sufficient serum aliquots and C-reactive protein <10 mg/L. For the 657 participating children (17% of the Saturn-Inf study), the median age was 3.9 years (interquartile range: 2.2-5.1); 52% were boys. The median SF was 44 μg/L (interquartile range: 28-71). ID prevalence was 2.8% (95% confidence interval [1.7, 4.7]) and 3.2% (95% confidence interval [2.0, 5.1]) with an SF threshold of 10 and 12 μg/L, respectively. Low SF was significantly associated ( p < .05) with mother being a migrant (32 vs. 45 μg/L for a mother born in France) or unemployed (37 vs. 50 μg/L for a mother employed). In this first national cross-sectional hospital-based study in France, ID prevalence was much lower than that in other French and European studies performed in underprivileged populations but close to the lowest values observed in other population-based studies in Europe. [ABSTRACT FROM AUTHOR]

We investigated the long-term implications of infantile thiamine (vitamin B1) deficiency on motor function in preschoolers who had been fed during the first 2 years of life with a faulty milk substitute. In this retrospective cohort study, 39 children aged 5-6 years who had been exposed to a thiamine-deficient formula during infancy were compared with 30 age-matched healthy children with unremarkable infant nutritional history. The motor function of the participants was evaluated with The Movement Assessment Battery for Children (M-ABC) and the Zuk Assessment. Both evaluation tools revealed statistically significant differences between the exposed and unexposed groups for gross and fine motor development ( p < .001, ball skills p = .01) and grapho-motor development ( p = .004). The differences were especially noteworthy on M-ABC testing for balance control functioning ( p < .001, OR 5.4; 95% CI 3.4-7.4) and fine motor skills ( p < .001, OR 3.2; 95% CI 1.8-4.6). In the exposed group, both assessments concurred on the high rate of children exhibiting motor function difficulties in comparison to unexposed group (M-ABC: 56% vs. 10%, Zuk Assessment: 59% vs. 3%, p < .001). Thiamine deficiency in infancy has long-term implications on gross and fine motor function and balance skills in childhood, thiamine having a crucial role in normal motor development. The study emphasizes the importance of proper infant feeding and regulatory control of breast milk substitutes. [ABSTRACT FROM AUTHOR]

Objective To assess the therapeutic efficacy of local injections of botulinum toxin type A (Btx-A) in improving blood flow to the hands of patients with Raynaud's phenomenon (RP) secondary to scleroderma. Methods In this randomized, double-blind, placebo-controlled clinical trial, patients with scleroderma-associated RP received Btx-A (50 units in 2.5 ml sterile saline) in one randomly selected hand and sterile saline (2.5 ml) in the opposite hand. Follow-up at 1 and 4 months postinjection included laser Doppler imaging of hands, patient-reported outcomes, and physical examination. We compared outcomes using paired t-tests and population-average generalized models with generalized estimating equations. Results Of 40 patients enrolled, 25 had limited scleroderma and 15 had diffuse scleroderma. From baseline to 1-month follow-up, there was a greater reduction in average blood flow in Btx-A-treated hands compared to placebo-treated hands. The model estimated that this difference was statistically significant (average difference −30.08 flux units [95% confidence interval −56.19, −3.98], P for interaction = 0.024). This difference was mainly influenced by patients with longstanding RP and diffuse scleroderma. Change in blood flow at 4-month follow-up was not significantly different between groups. Clinical measures (QuickDASH, McCabe Cold Sensitivity Score, pain on a visual analog scale, and Raynaud's Condition Score) improved slightly for Btx-A-treated hands. Conclusion Our laboratory-based laser Doppler imaging flow data do not support using Btx-A to treat RP in all scleroderma patients. The secondary clinical outcomes suggest some positive effect, but its clinical meaningfulness is questionable. The role of Btx-A in treating RP should be further studied with more homogeneous patient populations and in unique clinical situations such as acute digital ischemia. [ABSTRACT FROM AUTHOR]

Despite improvements over the past 20 years, high burdens of child mortality and undernutrition still coexist in Afghanistan. Global evidence indicates that complementary feeding (CF) practices predict child survival and nutritional status. Our study aims to describe CF practices in Afghanistan and to discern underlying predictors of CF by analysing data from Afghanistan's 2015 Demographic and Healthy Survey. Multilevel models were constructed comprising potential predictors at individual, household, and community levels and four CF indicators: timely introduction of solid, semi‐solid, or soft foods (INTRO), minimum meal frequency (MMF), minimum dietary diversity (MDD), and minimum acceptable diet (MAD) among breastfed children. INTRO prevalence among children aged 6–8 months was 56%, whereas the prevalence of MMF, MDD, and MAD among children aged 6–23 months was 55%, 23%, and 18%, respectively. Of the seven food groups considered, four were consumed by 20% or fewer children: eggs (20%), legumes and nuts (18%), fruits and vegetables (15%), and flesh foods (14%). Increasing child age and more antenatal care visits were significantly and positively associated with greater odds of meeting all CF indicators. Lower household wealth and lower community‐level access to health care services were associated with lower odds of MDD and MAD. Disparities in achieving recommended CF practices were observed by region. CF practices in Afghanistan are poor and significant socioeconomic inequities in CF are observed across the country. Our study calls for urgent policy and programme attention to improve complementary feeding practices as an intrinsic part of the national development agenda. [ABSTRACT FROM AUTHOR]

Evidence on the management of acute malnutrition in infants aged less than 6 months (infants <6mo) is scarce. To understand outcomes using current protocols, we analysed a sample of 24 045 children aged 0-60 months from 21 datasets of inpatient therapeutic care programmes in 10 countries. We compared the proportion of admissions, the anthropometric profile at admission and the discharge outcomes between infants <6mo and children aged 6-60 months (older children). Infants <6mo accounted for 12% of admissions. The quality of anthropometric data at admission was more problematic in infants <6mo than in older children with a greater proportion of missing data (a 6.9 percentage point difference for length values, 95% CI: 6.0; 7.9, P < 0.01), anthropometric measures that could not be converted to indices (a 15.6 percentage point difference for weight-for-length z-score values, 95% CI: 14.3; 16.9, P < 0.01) and anthropometric indices that were flagged as outliers (a 2.7 percentage point difference for any anthropometric index being flagged as an outlier, 95% CI: 1.7; 3.8, P < 0.01). A high proportion of both infants <6mo and older children were discharged as recovered. Infants <6mo showed a greater risk of death during treatment (risk ratio 1.30, 95% CI: 1.09; 1.56, P < 0.01). Infants <6mo represent an important proportion of admissions to therapeutic feeding programmes, and there are crucial challenges associated with their care. Systematic compilation and analysis of routine data for infants <6mo is necessary for monitoring programme performance and should be promoted as a tool to monitor the impact of new guidelines on care. [ABSTRACT FROM AUTHOR]

While literature describing immigrant's breastfeeding practices exists, especially among those living within developed countries, there is a significant gap in knowledge on how the host culture may influence the EBF behaviors of refugees, especially those living in protracted situations within sub-Saharan Africa. A cross-sectional study was conducted in the Buduburam Refugee Settlement in Ghana from July-August 2008 to explore the association between the amount of time living in Ghana and exclusive breastfeeding practices among Liberian refugees and Ghanaians in surround villages. The study included 480 women: 239 Liberians living in 12 settlement zones (in two of which Liberians and Ghanaians co-exist), 121 Ghanaians living in two settlement zones, and 120 Ghanaians living in nearby urban village of Awutu. Liberian mothers who lived in Ghana at least eight years were significantly more likely to exclusively breastfeed (OR: 1.78, 95% CI: 1.02, 3.09) compared to Ghanaian mothers living in Awutu. These findings suggest that increased time living in Buduburam improved the chances of EBF success among Liberians, perhaps as a result of unique EBF education/support opportunities offered in the settlement to Liberian refugees that were not readily available to Ghanaians. Further research to understand the 'mechanisms' explaining exclusive breastfeeding differences as a function of time spent in host country is needed for improving breastfeeding support in refugee settlements and host communities. [ABSTRACT FROM AUTHOR]