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Child undernutrition persists in Cambodia despite recent progress. As Cambodia undergoes a shift in dietary consumption that coincides with economic, demographic, and epidemiologic changes, there is risk of ultra-processed foods and sugar-sweetened beverages displacing nutrient-dense foods during the critical period of infant growth in the first 24 months. The aim of this study was to assess the introduction and intake of foods of low nutritional value and sugar-sweetened beverages and their association with undernutrition among children 24 months of age in rural and semi-urban Cambodia. Cross-sectional analyses of a 24-h dietary recall from a sample (n = 377) of 24-month-olds found that the majority of infants had been introduced to packaged salty snacks and sweets by 12 months of age and to sugar-sweetened beverages by 15 months. By 24 months of age, 78% of children had consumed foods of low nutritional value and 57% consumed a sugar-sweetened beverage on the previous day. Multivariate logistic regression analyses demonstrated that infant intake of a flavored sugary drink on the previous day was associated with over two times the odds of both stunting and wasting, and consumption of packaged sweets on the previous day was associated with over two times the odds of wasting, but no association was found with stunting. These findings underscore the need to improve educational and policy interventions to support healthy feeding practices for infants and young children.

BACKGROUND: The global nutrition transition is associated with increased consumption of ultra-processed snack foods and sugar-sweetened beverages (UPF/SSB), contributing to the double burden of child obesity and undernutrition. METHODS: This cross-sectional study describes the prevalence of maternal and child UPF/SSB consumption and the factors associated with frequent consumption in a convenience sample of 749 children ages 6 months through 6 years and their mothers participating in a community-based child oral health program in five informal settlement communities in Mumbai, India. Mothers were interviewed regarding maternal and child oral health and nutrition characteristics, including consumption of beverages and foods associated with tooth decay-milk, soda, tea with sugar, sweets, and chips/biscuits-using standardized questionnaires. Spearman correlations were used to assess for associations between various social factors and the frequency of maternal and child consumption of the five food categories. Chi-square tests were used to assess differences in child consumption patterns by age groups. RESULTS: Though reported soda consumption was low among both mothers and children, nearly 60% of children consumed sweets and chips/biscuits daily, four to five times the rate of mothers. Factors associated with childrens frequent consumption of UPF/SSB included lower maternal education level, frequent maternal consumption of UPF/SSB, greater number of household members, greater amount of money given to the child, and closer proximity to a store. CONCLUSION: Our findings demonstrate social factors that may promote UPF/SSB consumption. The nutritional dangers of sugary drinks and non-nutritious snacks for mothers and young children should be addressed across maternal-child health, education, and social service programs. Early childhood nutrition interventions should involve the entire family and community and emphasize the need to limit childrens consumption of unhealthy foods and beverages from an early age.

Research has recognized that enhancing pre-service teachers' attitudes, efficacy, and decreasing concerns about inclusive education are essential factors in teacher preparation. However, no research has compared the relative ability of online courses to affect these factors when compared to traditional face-to-face instruction. The current study used pre-post survey methods to measure the effects of the online versus face-to-face formats of teaching inclusive education content to Canadian pre-service teachers. Moreover, we studied the relationships between these variables and the participants' intentions for inclusive teaching practices. Results showed that while the face-to-face format influenced pre-service teachers' attitudes and efficacy, it did not foster lower concerns or higher intentions. In contrast, the online course made no significant difference in any of the dependent variables. Given the well-established importance of affective as well as practical variables to effective inclusion, implications and limitations are discussed.

Type 2 diabetes mellitus (T2DM) is one of the most common modern “disease of affluence”, characterized by hyperglycemia resulting from defective insulin secretion by pancreatic β cells and/or impaired tissue sensitivity to insulin. In Poland, the incidence of this metabolic disease is 5–8% and is still increasing. The consequences of the development of T2DM include, among others: changes in cardiovascular system, retinopathy, nephropathy and neuropathy. Due to medical progress, it is easier to control glycemia, as well as to predict the occurrence of this disease or the dynamics of its development and consequences. The molecules discussed in the article: growth differentiation factor 15 (GDF-15), mesencephalic astrocyte-derived neurotrophic factor (MANF) and fetuin-A, represent great promise both in the diagnosis and treatment of not only T2DM, but also obesity, which often accompanies T2DM. Most of the studies reported in the literature were performed on animal models, mainly mouse. This article presents arguments supporting the potential usefulness of the above-mentioned paracrine factors for prognostic, diagnostic and therapeutic purposes.

Obesity is a chronic disease that constitutes a global problem and a serious challenge to public health. In the course of this disease, excessive accumulation of fat tissue occurs in the body, which not only leads to an increased risk of health complications, but also negatively affects the quality of life. Fat cells – adipocytes – are responsible for the biosynthesis and release of adipokines, among others, leptin, visfatin, chemerin and omentin-1. They are active biological substances, including mediators of inflammation, which may lead to the development of metabolic disorders in the body. The above-mentioned properties of the described adipokines make it possible to potentially use them as diagnostic and therapeutic factors in the course of obesity and its accompanying disorders such as insulin resistance, type 2 diabetes mellitus, and cardiometabolic complications. Despite significant progress in understanding the role played by the discussed adipokines, further research is necessary to precisely describe the mechanisms of action and to determine the precise relationship between their plasma concentrations and state of diseases.

Currently, steatohepatitis has been designated as metabolic dysfunction-associated steatohepatitis (MASLD). MASLD risk factors mainly include metabolic disorders but can also include genetic, epigenetic, and environmental factors. Disease entities such as obesity, diabetes, cardiovascular disease, and MASLD share similar pathomechanisms and risk factors. Moreover, a bidirectional relationship is observed between the occurrence of certain chronic diseases and MASLD. These conditions represent a global public health problem that is responsible for poor quality of life and high mortality. It seems that paying holistic attention to these problems will not only help increase the chances of reducing the incidence of these diseases but also assist in the prevention, treatment, and support of patients.

Paweł Sokal,1 Damian Palus,1 Magdalena Jabłońska,2 Oskar Puk,2 Sara Kieronska-Siwak1 1Department of Neurosurgery and Neurology, Faculty of Health Sciences, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, 85-168, Poland; 2Doctoral School Collegium Medicum Nicolaus Copernicus University, Bydgoszcz, 85-168, PolandCorrespondence: Paweł Sokal, Department of Neurosurgery and Neurology, Faculty of Health Sciences, Collegium Medicum Nicolaus Copernicus University, Ujejskiego 75, Bydgoszcz, 85-168, Poland, Email pawel.sokal@cm.umk.plPurpose: Central neuropathic pain (CNP) following spinal cord injury (SCI) presents a formidable therapeutic challenge, affecting over 50% of the patients post-SCI. For those who experience CNP, conventional treatments often prove insufficient. Spinal cord stimulation (SCS) emerges as a potential intervention for chronic pain after SCI that is unresponsive to pharmacotherapy and supportive measures. However, the efficacy of SCS in alleviating CNP is notably limited. The objective of our study was to evaluate novel stimulation paradigms in SCS for patients with severe CNP after SCI, based on our extensive experience.Patients and Methods: From a pool of 112 patients treated with SCS for chronic neuropathic pain in the Department of Neurosurgery and Neurology, we selected eight individuals (4 males and 4 females) with CNP for our case series. Burst and high frequency SCS was applied. The assessment involved utilizing the Numeric Rating Scale (NRS), the Neuropathic Pain Symptom Inventory (NPSI), and the EQ-5D quality of life scale before surgery and during a 12-month follow-up period.Results: Over the course of the one-year follow-up, only two patients experienced satisfactory relief from pain, demonstrating the effectiveness of the stimulation. Moreover, high-frequency and burst SCS failed to show improvement in the remaining six patients.Conclusion: Our findings suggest that, despite the incorporation of new stimulation paradigms such as burst stimulation and high-frequency stimulation, SCS does not exhibit significant effectiveness in treating neuropathic pain in patients after SCI. These findings highlight the ongoing challenge of treating CNP and emphasize the importance of investigating alternative therapeutic strategies for this group.Keywords: spinal cord stimulation, central neuropathic pain, spinal cord injury, burst stimulation, high-frequency stimulation

During the initial wave of the COVID-19 pandemic, 1,930 Canadian teachers were surveyed about their burnout and resilience levels, as well as their job demands and resources. Latent profile analysis revealed that teachers were responding to their experiences in five distinct patterns, or profiles, of burnout or resilience. Survey data were then used to match each profile group with their salient demands and resources. A continuum model of recommendations is offered to support teacher resilience as they navigate and recover from the pandemic.

The global nutrition transition has increased the prevalence of childhood dental caries. Greater understanding is needed of the impact of social determinants—including maternal education—on child oral health. This is a cross-sectional analysis of a convenience sample of families of 458 indigenous Ecuadorian children aged 6 months through 6 years from 2011−2013. Data was collected by mother interviews and child dental and anthropometric examinations. Multivariate logistic and Zero-Inflated-Poisson regression analyses assessed associations between years of maternal education and maternal-child oral health practices and child oral health outcomes. Each additional year of maternal education was significantly (p < 0.05) associated with some healthier practices including greater likelihood of mothers and children drinking milk daily (OR 1.20; 95% CI 1.08, 1.34); and less healthy practices including greater likelihood of bottle-feeding children with sugary liquids (OR 1.14; 95% CI 1.06, 1.22) and to older age, giving children sweets daily, calming children with a bottle or sweets, and less likelihood of helping brush their children’s teeth (OR 0.93; 95% CI 0.88, 0.98). Each year of maternal education had a small but statistically non-significant influence on increasing the odds of children being among those who are cavity-free (OR 1.03; 95% CI 0.92, 1.16). Interventions to improve health outcomes should focus not just on maternal education but also address social and commercial determinants of health through nutrition and oral health education, as well as policies to reduce sugar and ensure universal access to oral health care.

BackgroundThere is growing evidence to suggest that exposure to a high concentration of nitrogen dioxide (NO2) can lead to a higher incidence of Acute Respiratory Infections (ARIs) in children; however, such an association remains understudied in Sub-Saharan Africa due to the limited availability of exposure data. This study explored this association by using the satellite-detected tropospheric NO2 concentrations measured by Sentinel-5 Precursor and ARI symptoms in children under age five collected in the Demographic and Health Survey (DHS) in Senegal.MethodsWe matched the daily tropospheric NO2 exposure with the individual ARI symptoms according to the DHS survey clusters spatially and temporally and conducted a logistic regression analysis to estimate the association of exposure to NO2 with ARI symptoms in two preceding weeks.ResultsWe observed a positive association between exposure to continuous levels of NO2 and ARI symptoms after adjusting for confounders (OR 1.27 per 10 mol/m2, 95% CI: 1.06 - 1.52). When the association was further examined by quartile exposure categories, the 4th quartile category was positively associated with symptoms of ARI after adjusting for confounders (OR 1.71, 95% CI: 1.08-2.69). This suggests that exposure to certain high levels of NO2 is associated with the increased risk of children having symptoms of ARI in Senegal.ConclusionsThis study highlights the need for increased research on the effects of ambient NO2 exposure in Africa as well as the need for more robust, ground-based air monitoring in the region. For a country like Senegal, where more than 90% of the population lives in areas that do not meet the national air quality standards, it is urgently required to implement air pollution prevention efforts to protect children from the health hazards of air pollution.

Background & Aims: Tacrolimus has been associated with recurrence of primary biliary cholangitis (PBC) after liver transplantation (LT), which in turn may reduce survival. This study aimed to assess the association between the type of calcineurin inhibitor used and long-term outcomes following LT in patients with PBC. Methods: Survival analyses were used to assess the association between immunosuppressive drugs and graft or patient survival among adult patients with PBC in the European Liver Transplant Registry. Patients who received a donation after brain death graft between 1990 and 2021 with at least 1 year of event-free follow-up were included. Results: In total, 3,175 patients with PBC were followed for a median duration of 11.4 years (IQR 5.9–17.9) after LT. Tacrolimus (Tac) was registered in 2,056 (64.8%) and cyclosporin in 819 (25.8%) patients. Following adjustment for recipient age, recipient sex, donor age, and year of LT, Tac was not associated with higher risk of graft loss (adjusted hazard ratio [aHR] 1.07, 95% CI 0.92-1.25, p = 0.402) or death (aHR 1.06, 95% CI 0.90-1.24, p = 0.473) over cyclosporin. In this model, maintenance mycophenolate mofetil (MMF) was associated with a lower risk of graft loss (aHR 0.72, 95% CI 0.60-0.87, p

Summary: Background: Healthcare-associated infections (HAI) and antimicrobial use (AMU) are drivers for antimicrobial resistance, and robust data are required to inform interventions and track changes. We aimed to estimate the prevalence of HAI and AMU at Port Moresby General Hospital (PMGH), the largest hospital in Papua New Guinea. Methods: We did a point prevalence survey (PPS) on HAI and AMU at PMGH in May 2023 using the European Centre for Disease Prevention and Control (ECDC) PPS protocol. We included all critical care patients and randomly sampled half of the patients in other acute-care wards. We calculated weighted HAI and AMU prevalence estimates to account for this sampling strategy. Weighted HAI estimates were also calculated for an expanded definition that included physician diagnosis. Findings: Of 361 patients surveyed in 18 wards, the ECDC protocol identified 28 HAIs in 26 patients, resulting in a weighted HAI prevalence of 6.7% (95% CI: 4.6, 9.8). Surgical site infections (9/28, 32%) were the most common HAI. When adding physician diagnosis to the ECDC definitions, more skin and soft tissue, respiratory, and bloodstream HAIs were detected, and the weighted HAI prevalence was 12.4% (95% CI: 9.4, 16.3). The prevalence of AMU was 66.5% (95%CI: 61.3, 71.2), and 73.2% (263/359) of antibiotics were from the World Health Organization Access group. Interpretation: This is the first reported hospital PPS of HAI and AMU in Papua New Guinea. These results can be used to prioritise interventions, and as a baseline against which future point prevalence surveys can be compared. Funding: Australian Government Department of Foreign Affairs and Trade and Therapeutic Guidelines Limited Australia.

In late 2019 and early 2020, governments around the world closed educational institutions due to the COVID-19 pandemic. A similar response occurred in Canada and resulted in a sudden pivot by teachers from classroom-based instruction to remote teaching. During and shortly after this time, we undertook a survey study of over 2000 Canadian teachers, as well as follow-up interviews with a representative sub-set of those who took part in the initial round of the survey, to gain perspectives on teaching during the pandemic crisis. We summarize the foundations of the entire study and focus on the analysis and discussion of interview data to provide enhanced understanding of initial survey results. This study presents five lessons from the voices of teachers in the initial stages of COVID-19 in Canadian K-12 schools. Each lesson addresses a reality of teaching that was magnified by the pandemic and is highlighted for future consideration of educators in times of uncertainty and change.

Background: Formative assessment of the rollout process of the California Oral Health Literacy (OHL) toolkit uses a mixed-methods approach. The OHL toolkit is an educational resource for dental professionals to improve communication with patients. This study was intended to obtain user feedback and suggestions for improvement. Methods: This mixed-methods assessment of the OHL toolkit rollout included anonymous post-training surveys distributed at regional dental societies in California and 1:1 interviews with dental champions who would work with the research team on toolkit rollout. Anonymous and deidentified data were analyzed using R and Dedoose. Results: From surveys (n = 37), the OHL toolkit components of highest interest to respondents were teach-back, increasing health literacy awareness among staff and learning to use plain language communication. Perceived implementation barriers were time constraints, insufficient staffing and a need for more training on communication techniques. Impressions, implementation prospects and recommendations for the OHL toolkit were obtained from qualitative interviews (n = 6). Overall, participants had positive impressions of the training presentation, OHL toolkit and implementation prospects. Conclusion: This study identified interest areas and implementation barriers, data that can be used to further improve the OHL toolkit and reduce barriers faced by practitioners. Further assessments at clinician and patient levels will be helpful for outcomes evaluation. Practical implications: The OHL toolkit is perceived positively by dental practitioners in California. Facilitators and barriers identified by dental providers and champions can be addressed through changes to the OHL toolkit and training. Rollout at the national level is being considered.

One of the branches of traditional Chinese medicine (TCM) is herbal medicine. In this paper, we focus on the biological activity of substances belonging to flavonoids and specific examples of their impact on various body systems. Flavonoids are a group of chemical compounds included in plant materials, honey, propolis or mushrooms used in TCM. Chrysin, galangin, kaempferol and fisetin are examples of flavonoids showing, among others, antioxidant, anti-inflammatory or antibacterial properties, which are the subject of various scientific studies aimed at examining their potential therapeutic effect.

Abstract Background The global nutrition transition is associated with increased consumption of ultra-processed snack foods and sugar-sweetened beverages (UPF/SSB), contributing to the double burden of child obesity and undernutrition. Methods This cross-sectional study describes the prevalence of maternal and child UPF/SSB consumption and the factors associated with frequent consumption in a convenience sample of 749 children ages 6 months through 6 years and their mothers participating in a community-based child oral health program in five informal settlement communities in Mumbai, India. Mothers were interviewed regarding maternal and child oral health and nutrition characteristics, including consumption of beverages and foods associated with tooth decay—milk, soda, tea with sugar, sweets, and chips/biscuits—using standardized questionnaires. Spearman correlations were used to assess for associations between various social factors and the frequency of maternal and child consumption of the five food categories. Chi-square tests were used to assess differences in child consumption patterns by age groups. Results Though reported soda consumption was low among both mothers and children, nearly 60% of children consumed sweets and chips/biscuits daily, four to five times the rate of mothers. Factors associated with children’s frequent consumption of UPF/SSB included lower maternal education level, frequent maternal consumption of UPF/SSB, greater number of household members, greater amount of money given to the child, and closer proximity to a store. Conclusion Our findings demonstrate social factors that may promote UPF/SSB consumption. The nutritional dangers of sugary drinks and non-nutritious snacks for mothers and young children should be addressed across maternal–child health, education, and social service programs. Early childhood nutrition interventions should involve the entire family and community and emphasize the need to limit children’s consumption of unhealthy foods and beverages from an early age.

Teachers have demonstrated a wide range of responses to the challenges of teaching within a pandemic. The current study investigated the relationship between resilience and post-traumatic growth in teachers during the COVID-19 pandemic. Based on administration of the Maslach Burnout Inventory in 2022, four teachers demonstrated high levels of resilience, indicating the potential that they had experienced post-traumatic growth. Follow-up interviews were therefore conducted to investigate whether these teachers demonstrated all seven characteristics of post-traumatic growth. Although all four resilient teachers indicated experiencing several characteristics, only two teachers demonstrated post-traumatic growth. The findings support a clear distinction between resilience and post-traumatic growth. Implications related to future research using both qualitative and quantitative methods to further illuminate the processes and conditions of post-traumatic growth are discussed.

Teacher preparation in Canada benefits from innovative programming that supports vibrant, inclusive classrooms. We examine two Canadian-made programmes: The Three-Block Model of Universal Design for Learning, with particular focus on the social emotional learning block, and the Teaching Continuum, a model for inclusive physical education settings. We use the 3H Model of inclusive teacher education to analyze the fit of these two approaches to pre-service teacher inclusive education preparation and suggest ways they can become more entrenched within Canadian schools.

An appreciative inquiry approach oriented eight semi-structured interviews conducted with teachers from Australia, New Zealand, Austria, Italy, Spain, Canada, Bangladesh and India to identify their intrinsic and extrinsic strengths and understand how they were able to translate them into practice during the first COVID-19 lockdown in 2020. Commitment and determination, collegial support and solidarity were some of the common driving forces identified, despite the differences in teachers' backgrounds, education systems, policies and cultures. Our research sheds light on opportunity solving in times of crisis as well as on the way education systems worldwide can renew themselves to ensure innovative and inclusive quality education.