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Background/Aim: Patients with rifampicin resistant-tuberculosis (RRTB) may remain a source of infection longer than patients with rifampicin sensitive-tuberculosis (RS-TB). This study aimed to detect active cases of RS-TB and RR-TB through systematic screening among household contacts of RR-TB patients in Dhaka, Bangladesh. Methods: This cross-sectional study was conducted among the 355 household contacts (HHCs) of 93 RR-TB primary cases identified from various centres in Dhaka, diagnosed between November 2020 and October 2021. For the identification of active cases of tuberculosis (TB), systematic screening among HHCs was done, where verbal screening was performed to check the presence of symptoms of TB. Those who had at least one symptoms of TB were considered as symptomatic contacts. Later GeneXpert analysis of sputum was done among the screened symptomatic contacts. Data was collected using a pretested, semi-structured, interviewer-administered questionnaire. Results: An estimated 30.4 % of respondents were ≤ 15 years of age. TBlike symptoms were prevalent among 9.9 % of respondents. Loss of appetite (45.7 %), unexplained weight loss (40.0 %) and cough (37.1 %) were the most common symptoms. Among the contacts with TB-like symptoms, 6.7 % were diagnosed as a case of TB (3.35 % were RR-TB and 3.35 % were RS-TB). The number needed to be screened to find an active case of TB was established at 178 among the HHCs of RR-TB. Conclusions: About one in ten RR-TB HHCs showed TB-like symptoms. One in fifteen HHCs with TB-like symptoms was an active case of TB. Regular, effective screening of RR-TB contacts is needed to stop the transmission.

ABSTRACTFrench fries (FF) and fried chicken (FC) are known contributors to overweight and obesity among adolescents worldwide. Top selling five brands for both FF and FC were analyzed to determine their health compromising contents, which were sampled from the markets of Dhaka, Bangladesh. Sodium (Na) was determined by flame photometry, trans fatty acids (TFAs) by gas chromatography and heavy metals like arsenic (As), lead (Pb), cadmium and chromium by graphite furnace atomic absorption spectrophotometry. The median concentration of Na, TFA, As and Pb in FF was 0.45 gm/100 gm, 0.11 gm/100 gm, 0.93 mg/kg and 0.03 mg/kg, respectively. Similarly, in FC the median concentration of Na, TFA, As and Pb was 0.46 gm/100 gm, 0.13 gm/100 gm, 0.053 mg/kg and 0.06 mg/kg, respectively. The study findings suggests that consuming FF and FC impose a health risk among the exposed population.

# Background The application of a gender lens enables the identification of gendered power dynamics that are deeply embedded within structures and institutions. This study delved into a comprehensive analysis of gender norms of male and female adolescents in terms of their health needs, the type of health services offered to them, the barriers and facilitators for utilization of health services at the adolescent-friendly health services (AFHS) across different tiers of government health facilities through a gender lens. # Methods The study was conducted at 23 health facilities across four districts of Bangladesh from February 2022 to June 2022. The study design was cross-sectional with a mixed methods approach. A total of 304 adolescents completed the survey, and 28 adolescents participated in in-depth interviews (IDI). Key-informant interviews (KII) were conducted with 48 key stakeholders, including parents, teachers, health service providers, facility managers, and health managers. Quantitative data were analyzed using descriptive statistics, and qualitative data was analyzed using thematic analysis. # Results Adolescents have different needs for information about services, types of services provided, and use based on gender. There was a significant association between the marital status of adolescents and the need for different types of health services (*P*\

Background: Information on the mortality causes of goldsmiths in Bangladesh is limited. This study aimed to find out the mortality causes in a selected group of goldsmiths. Methods: A World Health Organization recommended questionnaire was adapted to conduct verbal autopsy of 20 deceased goldsmiths. Death-related information was gathered from the family members present during deceased’s illness preceding death. The mortality causes were determined by the interview outcomes and medical records-review. Results: The mean age of the goldsmiths at death was 59.2± 9.3 years. Among then, 70.0% were smokers and 50.0% were alcohol consumers. Cardiovascular diseases (CVD) were the most common immediate and underlying cause of death (60.0% and 45.0%, respectively). Conclusion: The life expectancy of goldsmiths was much lower than the average life expectancy of Bangladeshi population, where CVD was the primary cause of death. Smoking and alcohol consumption were prevalent among them. Awareness about healthy lifestyles should be prioritized for highly CVD prevention among the goldsmiths. Bangabandhu Sheikh Mujib Medical University Journal 2023;16(2): 87-90

High rates of suicide continue to plague the modern world, with clinicians, researchers, and policymakers working urgently to ameliorate what has been recognized as a worldwide public health crisis. Under American Law, individuals‐ including health care providers, could generally not be held liable for causing the suicide of another person. This article presents a review of suicide law in the United States in the context of a recent civil case in which a physician with expertise in mental health was sued for the death of an ex‐partner who committed suicide in his home. Historical events and landmark legal cases spanning the 15th century to now are examined and presented as a narrative review to inform society and mental health clinicians a‐like towards interpreting the changing medical‐legal landscape. As modern advances in science continue to discern the critical biopsychosocial factors that contribute to the act of suicide, there is an inevitably growing concern that suicide may no longer be an incomprehensible nor irrational event as has been assumed for centuries. Thus, it may be considered that individual with expertise and qualification to treat a group of individuals at higher risk of suicide (severe mental illness) may be subject to a different standard than the average individual. This article seeks to present a complex matter where no simple or broad‐sweeping conclusions can yet be drawn, however remains a critically important matter for mental health clinicians. [ABSTRACT FROM AUTHOR]

Abstract Since child sexual abuse (CSA) is one of the most serious public health issues, how CSA cases and victims are portrayed in the daily newspapers is a major concern to the public health and communication specialists. The purpose of this study was to evaluate the degree of the ethical standard of reporting CSA in Bangladeshi newspapers, as well as to identify the potential risk factors associated with unethical reporting. From January to December 2017, a total of 1093 news stories on CSA were collected from four top circulated Bengali newspapers and two English newspapers of Bangladesh. Berelson’s quantitative content analysis approach (only manifest content) was used to analyze these stories. For the coding and analysis purpose, news items (texts and news with photos) of spot news, editorials, and commentaries were included. Chi-square tests were used to evaluate the bivariate association of different case characteristics with unethical reporting, and multivariate logistic regression models were performed to assess the potential risk factors of disclosing the victim’s identity and needless detail in the news description. This study revealed that more than 40% of news stories on CSA cases did not follow the ethical standard of reporting. Episodic CSA cases were more unethically reported in newspapers, compared to the thematic stories (42.8% vs. 11.6%). Approximately 37% of news stories disclosed at least one identifying information of victims (i.e., name, parents’ name, family member’s name, or school name), and 23% of stories included sensual and/or excessive description of the event. Our adjusted model showed that victim identifiers were most likely to be reported in news stories when the victim was 13–17 years old (AOR 1.86; P = 0.027), the alleged perpetrator held influential social status (AOR 2.44, P = 0.005), the victim was familiar to the perpetrator (AOR 6.85, P

Bangladesh, similar to other countries is experiencing an increased burden of cancer. Absence of a national cancer registry has created a gap in the information regarding the presentation of cancer statistics of the country. The objective of this study was to assess the types and distribution of the cancer patients attending a tertiary academic medical center hospital in Bangladesh. A cross-sectional study was conducted among all the confirmed cancer patients attending the in-patient and out-patient, and daycare facilities in Bangabandhu Sheikh Mujib Medical University in October, 2019. A validated questionnaire, recommended by International Agency for the Cancer Registry was used to collect data. Written informed consent was obtained from every respondent. This study had received its ethical clearance from Institutional Review Board of BSMMU. Among the 1656 respondents, 78.8% were adult and 25.2% were from paediatric age groups. Leading cancer for adult males were lung cancer (9.6%), leukaemia (9.4%) and lymphoma (9.0%); and breast cancer (28.1%), thyroid cancer (16.1%), and cervical cancer (12.2%) for females. Leukaemia was the most frequent cancer in the paediatric group for both males (71.5%) and females (66.5%). Establishing a hospital-based cancer registry with high quality data in an academic medical center setting is feasible and can set the stage for establishing nationwide hospital-based as well as establishing a popula- tion-based cancer registry in Bangladesh, which is necessary to identify and tackle the rising burden of cancer in this country. BSMMU J 2022; 15(1): 43-49

Background: Any public health emergency demands adequate risk communication with the vulnerable population along with their optimized perception about the impending risk to ensure proper risk management and crisis control. Hence, we conducted this study to explore healthcare providers’ perceptions regarding risks of coronavirus disease 2019 (COVID-19), as well as how they are being communicated to about the risk, and how they practice risk reduction measures. Methods: We conducted a two-phased explanatory sequential mixed-method study among physicians and nurses from randomly selected tertiary healthcare facilities in Dhaka, the capital of Bangladesh. In the first phase, we assessed the general pattern and quantifiable measures of risk perception, risk communication, and infection prevention practices quantitatively. We performed multiple linear regression analyses to explore how much variability of risk perception was predicted by risk communication methods and contents. In the second phase, we collected qualitative data for in-depth understanding and exploration of participants’ experiences and insights regarding COVID-19 risk through interviews and document reviews. We manually performed thematic content analysis of the qualitative data. Finally, we triangulated findings from both phases to illustrate the research objectives. Discussion: Based on the psychometric dimensions of risk perception and psycho-social theory of the health belief model, perceptions of COVID-19 risk among healthcare providers were evaluated in this study. The relationship between risk perception and infection prevention and control practices among healthcare providers were also investigated. The explanatory sequential design of this study is expected to generate hypotheses on how risk perception is being shaped in a time of uncertainty and, thus, will help to build a proper risk communication strategy for the healthcare providers

Abstract Background Globally, older population (aged ≥60 years) comprise 11% of the total population, and 23% of them are malnourished. Lack of knowledge and education, adverse dietary habits, depression or psychological disorders, poor oral and dental health, disability, and diseases are the reported factors responsible for malnutrition among them. Geriatric people comprise 7.5% of the total population of Bangladesh, and almost a quarter are malnourished. But there is scarce data on the factors associated with the nutritional status of the older population in Bangladesh. Methods A cross-sectional study was conducted among 125 older individuals (male 59, female 66) living in three villages of Uttarkhan, Dhaka, Bangladesh, to identify the factors associated with their nutritional status. The Mini Nutritional Assessment scale, Geriatric Depression Scale-Short Form, and Geriatric Oral Health Assessment Index were used for assessing the nutritional status, mental health status, and oral health quality of the respondents, respectively. Information on socio-demographic characteristics, comorbidities and dietary factors, and food behaviors were gathered by a pretested semi-structured questionnaire. Ethical approval was obtained from the Institutional Review Board of Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. Results The participants’ mean age was 67.9 ± 7.1 years. Most of them (53.6%) had no formal education. Among the respondents, 22.0% male and 28.8% female were malnourished. The proportion of malnourished and at risk of malnutrition among the respondents living without a partner were 28.6 and 65.3%, respectively. A significantly (p

Background: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age. PCOS is characterized by the presence of polycystic ovaries, menstrual dysfunction, infertility, and biochemical and clinical hyperandrogenism. The objective of this study was to evaluate the serum vitamin D Level and Insulin Resistance in Obese Adolescents with polycystic ovary syndrome (PCOS). The study was a cross-sectional study conducted among 94 PCOS women of reproductive age coming to the Department of Endocrinology & Metabolism of Bangabandhu Sheikh Mujib Medical University (BSMMU). The women with polycystic ovary syndrome were considered as the study population. Among the participants, around 91% had vitamin D deficiency and 4% had vitamin D insufficiency, no participants had a sufficiency. Among PCOS patients underweight was 42.10%, Healthy Weight 45.27%, pre-obese 9.63%, and obese 3.0%. Regarding fasting insulin levels (<20uIU/ml) among 14.9% of PCOS. In the comparison of clinical characteristics of the participants, less than half (37.2%) had painful menstruation and 67% had hirsutism. Adolescent girls with PCOS are mostly vitamin D deficient and the rate of obesity is also high. The results of this study brought the true picture of insulin resistance and metabolic syndrome among different phenotypes of women with PCOS in Bangladesh, very likely contributing to a better understanding of the management of PCOS, and patients will benefit individually in their management. Estimation of vitamin D levels & and examination the obesity may help the clinician to manage obesity cases with PCOS adolescents more efficiently. [ABSTRACT FROM AUTHOR]

Abstract Background Little is known regarding the effect of exposure to biomass fuel smoke inhalation on respiratory symptoms in the Bangladeshi population which is a major health hazard in most of the developing countries. This study aims to explore the association between respiratory symptoms and biomass fuel smoke exposure among children under 5 years of age. Methods Data were extracted from the Bangladesh Urban Health Survey conducted in 2013. A total of 10,575 mothers with at least one surviving children were selected. Respiratory symptoms among children under 5 years of age were considered as the primary outcome. Sequential multiple logistic regression models were used to observe the association between respiratory symptoms and biomass fuel smoke exposure adjusting the effect of residential factors and mother and child characteristics. Results Around 40% of the mothers exclusively used biomass fuel irrespective of the kitchen location and 54% of them were habituated in indoor cooking. The prevalence of respiratory symptoms of under-five children among in-house and outdoor biomass fuel users was 23.0% and 21.9%, respectively. Results of fitted multiple logistic regression models showed that the odds of having respiratory symptoms among children under 5 years of age were increased due to in-house biomass fuel use [OR = 1.18; 95% CI, 1.04–1.36] compared with the non-biomass user. An increased risk of respiratory symptoms was also significantly associated with mother’s birth complication [OR = 1.51; 95% CI, 1.36–1.67], non-government organization (NGO) membership of mothers [OR = 1.32; 95% CI, 1.16–1.51], age of the child (6–23m) [OR = 1.29; 95% CI, 1.10–1.52], and nutritional status (stunting) [OR = 1.18; 95% CI, 1.06–1.31]. Conclusion This study found the use of in-house biomass fuel as a significant risk factor associated with respiratory symptoms of children under 5 years of age. More longitudinal studies should be designed to establish a causal relationship between HAP (household air pollution) and respiratory symptoms among children with more direct measures of HAP and clinical procedure.

Despite the enormous disruption of tuberculosis (TB) services reported globally, Bangladesh’s impact is not well documented. We aimed to assess the effect of the COVID-19 pandemic on the TB control program in Bangladesh from patients’ and service providers’ perspectives. We conducted a cross-sectional study from November–December 2021 at six conveniently selected Upazila Health Complexes (UHC) of the Dhaka division, Bangladesh. We conducted face-to-face interviews among 180 pulmonary TB service recipients and all TB service providers working in the selected UHC. We also reviewed TB registries from each UHC. All data were summarized using descriptive statistics tools. We found a 31% reduction in presumptive TB cases during 2021 compared to 2020. Other TB services, such as testing, were reduced by 16–36% during the same period. Service receivers reported a lack of transportation (95%), and a lack of adequate human resources (89%) as critical barriers to receiving and providing TB service, respectively. The findings of our study showed substantial interruption of TB service delivery during the COVID-19 pandemic, threatening the recent progress and pushback from achieving the 2035 End TB targets. Early mitigation of TB service delivery through adopting remote follow-ups using digital health technology and integrating COVID-19 and TB screening is essential for the continuity of essential TB services and achieving global TB targets.

# Background Bangabandhu Sheikh Mujib Medical University (BSMMU) is a postgraduate medical university in Bangladesh, where health research is an institutional mission. To improve the institutional research culture that contributes to better research capabilities, an assessment of BSMMU’s research output, challenges faced while conducting research, feasible actions to overcome them, and indicators for evaluating the research capacity were identified. # Methods Published manuscripts from BSMMU for the year 2018, registered with PubMed and BanglaJOL, were reviewed to assess the status of research output. Key informant interviews and in-depth interviews were conducted with various members of the academic departments, central library, institutional review board and University journals, to identify research-related challenges, strategies to overcome, and indicators to evaluate the research capacity. # Results In 2018, the total number of scientific articles published was 364, among which 68.4% of the articles were published in local journals and 31.6% in international journals. Journals published by the University lacked indexation into international medical databases and had no impact factor. The majority of the interviewees mentioned about the lack of dedicated time for research, prioritized research agendas and need for research-related trainings to improve research performance as challenges. Establishing policies for research support, development of University’s research infrastructure and better mechanisms to disseminate research findings, were identified as key opportunities for improvement. For future evaluation of research capacity strengthening, individual levels indicators (publication outputs, research grants, awards, number of collaborations) were emphasized. # Conclusions Preference for publishing in the local journals was observed rather than in international peer-reviewed journals. The key challenges for undertaking research included the absence of dedicated time and trainings for skill development. Publication outputs, research grants, awards, number of collaborations were identified as notable indicators for evaluating improvements in research capacity at an individual level. Establishing policies and guidelines for research support, along with the development of appropriate research infrastructure in the University, will enable it to guide national policies and programs.

Introduction: Nutritional vulnerability of adolescents living in slums is more compare to general adolescents. Adolescent girls are disproportionately impacted by nutritional deficiency due to gender norms, many adolescent boys are malnourished as well. This study sought to assess gender differences in nutritional status among adolescents living with family in selected slums of Bangladesh. Methods: The study used cross-sectional design with mixed method approach. Male and female adolescents between 10 to 19 years living in the Bauniabadh slum and 'Ta' Block Jhil Par slum of Dhaka were study population. Quantitative data was collected through pre -tested structured Bangla questionnaire by household survey of 115 adolescents. Qualitative interviews were sought through 12 In-depth interviews. BMI was categorized and 24-hour dietary recall was used to obtain dietary information by dietary diversity score. Results: Around 40.0% male adolescents and 46.6% female adolescents were underweight. Approximately 5% male adolescents and 3.4% female adolescents were overweight. Almost 67% male adolescents and 63.8% female adolescents had lowest dietary diversity score. One-fourth of male adolescents and 36.2% female adolescents had medium dietary diversity Score. There is observed association between sex of respondents and eating vegetables, and eating fish (p<0.05). Dietary behavior and eating more foods for female adolescents had significant observed association with sex of respondents (p<0.05). The qualitative result revealed that females were expected to learn cooking since they had to feed other members of her in laws house. Females made food sacrifices so that other family members could eat more. Conclusion: There were gender differences in nutritional status, dietary behaviour and nutritional knowledge among male and female adolescents living with family in selected slums of Dhaka, Bangladesh. [ABSTRACT FROM AUTHOR]

BackgroundAlthough child physical abuse (CPA) is considered as a major global public health problem, it has not yet been recognized as such in Bangladesh. Very few studies have assessed the prevalence and victims' characteristics of multiple forms of CPA.ObjectiveThis population-based study assessed the prevalence of CPA committed by adults in a rural area of Bangladesh and examined its association with demographic and socio-contextual factors.MethodsData were obtained using ISPCAN Child Abuse Screening Tool for Children (ICAST-C) in a random sample of 1416 children (49% girls, 51% boys) aged 11 to 17 years by face-to-face interviews during March-April 2017. The response rate was 91.5%. To estimate predictors of CPA, physical abuse was categorized into frequent and less frequent groups.ResultsThe prevalence of at least one form (≥ 1), two forms (≥2) and three or more forms (≥ 3) of CPA were estimated approximately to 99%, 95% and 83% in their lifetime and 93%, 79%, and 57% in the past year respectively. Hitting (except on buttocks), standing/kneeling and slapping were the most common physical abuse whereas given drugs or alcohol, pinched, burned or scalded, beaten-up and locked up were less reported. Female children were faced severe forms of CPA more than that of males. Male children, younger age groups, witnessing adults using weapons at home, bullied by siblings and low level of maternal education were found to be significant risk factors for both ≥ 1 form and ≥ 2 forms of frequent CPA whereas adding also adult shouting in a frightening way was found as a significant risk factor for ≥ 2 forms of frequent CPA.ConclusionSelf-reported prevalence of CPA is extremely common in the Bangladeshi rural society. The prevalence was associated with demographic and socio-contextual characteristics of the children such as being younger, witnessing domestic violence and maternal low education. The findings provide evidence to support parents and policy-makers to take effective measures to implement policy and programme on alternative up-bringing methods and creating awareness of negative effects of CM which in turn help Bangladesh to line up with UN Convention on the Rights of the Child, which the country signed in 1990.

Background: Stress and depression have each been associated with relapse risk. In clinical practice, chronic alcohol use is often accompanied by poor emotional and self‐regulatory processes. Tonic and phasic changes in stress responsivity impact an individual's relapse risk to alcohol. A further complicating factor is the pervasive coexistence of depressive symptoms in those with Alcohol Use Disorder (AUD), where the contribution of depressive symptomatology to these processes is not well understood. Individuals with AUD (AD) (21 with and 12 without sub‐clinical depressive symptoms) and 37 social drinking controls (16 with and 21 without sub‐clinical depressive symptoms) as part of a more extensive study (Fox et al., 2019). All participants were exposed to two 5‐min personalized guided imagery conditions (stress and neutral) in a randomized and counterbalanced order across consecutive days. Alcohol craving, negative mood, Stroop performance, and plasma measures (cortisol, adrenocorticotrophic hormone, and salivary alpha‐amylase) were collected before and after imagery exposure. Results: Elevations in autonomic response (heart rate) to imagery (stress and neutral) were observed as a function of drinking (in both depressed and non‐depressed individuals with alcohol use disorder compared with depressed and non‐depressed social drinkers). Conversely, suppressed cortisol following stress was observed as a function of depressive symptomatology across both drinking groups. Individuals with comorbid AD and depressive symptoms demonstrated attenuated Adrenocorticotropic Hormone and poor Stroop performance compared with the other groups, indicating an interactive effect between drinking and depression on pituitary and inhibitory systems. Conclusion: Sub‐clinical depressive pathophysiology may be distinct from drinking severity and may alter relapse‐related stress adaptations during protracted abstinence from alcohol. [ABSTRACT FROM AUTHOR]

Background: Evidence suggests that serotonergic psychedelics (e.g. psilocybin), have rapid-acting and long-lasting antidepressant effects after a single dose. However, the mechanism underlying these effects remain unclear. One proposed mechanism is that these drugs promote neuroplasticity. However, this has not been conclusively demonstrated in humans. Aims: We hypothesized that relative to placebo, psilocybin would: (1) increase electroencephalographic (EEG) correlates of neuroplasticity, (2) reduce depression symptoms, and (3) changes in EEG would correlate with improvements in depression. Methods: In this double-blind, placebo-controlled, within-subject study, individuals with major depressive disorder (MDD; n = 19) were administered placebo followed by psilocybin (0.3 mg/kg) in a fixed order (placebo, followed by psilocybin 4 weeks later). EEG indices of neuroplasticity (tetanus-induced long-term potentiation) as assessed via auditory evoked theta (4–8 Hz) power and measures of depression (GRID Hamilton Rating Scale for Depression-17 (GRID-HAM-D-17)) were measured at several time-points after placebo and psilocybin (24 h and 2 weeks after each session). Results: EEG theta power doubled in amplitude 2 weeks after a single psychedelic dose of psilocybin but not after placebo. Further, improvements in depression symptoms 2 weeks after psilocybin were correlated with increases in theta power. Conclusions: The increased theta power observed represents evidence of sustained changes in the brain following psilocybin. Given the correlation with enhancement in depressive symptoms, changes in theta may represent an EEG biomarker of the sustained effects of psilocybin, and may shed light on potential mechanisms of psilocybin's antidepressant effect. Taken together, these results complement the emerging notion that psilocybin, and perhaps other psychedelics, can produce long-term alterations in neuroplasticity. [ABSTRACT FROM AUTHOR]

Background: Several early phase studies have demonstrated that psilocybin-assisted therapy has rapid-acting and persisting antidepressant effects from just one or two doses. However, methodological limitations (e.g., placebo-control, blinding) limit interpretability of the existing literature. Methods: In an exploratory placebo-controlled, within-subject, fixed-order study, individuals with moderate to severe major depressive disorder were administered placebo (n = 19) followed by psilocybin (0.3 mg/kg) (n = 15) 4 weeks later. Dosing sessions were embedded within an manualized course of psychotherapy. Enhanced blinding procedures were used. Depression, anxiety, and quality of life were measured over a 16-week study period. Results: Depression and anxiety significantly improved following both placebo and psilocybin with no significant difference in the degree of change between the two conditions. However, antidepressant effect sizes were larger after psilocybin (d ′ = 1.02–2.27) than after placebo (d ′ = 0.65–0.99) and there were high rates of response (66.7%) and remission (46.7%) following psilocybin administration. Antidepressant effects following psilocybin persisted, on average, for 2 months and there were persisting improvements in mood-related quality of life domains. The strength of mystical-type experience during psilocybin dosing was not correlated with subsequent antidepressant effects. Conclusions: The results of this exploratory study highlight the complex interplay between expectancy, therapy effects, and drug/placebo effects in psychedelic-assisted psychotherapy studies. Nonetheless, the acute and persisting clinical improvements observed following psilocybin support further study of its potential in the treatment of major depression. Future studies should more explicitly mitigate and measure expectancy effects and assess the impact of repeated dosing and different forms of psychotherapeutic support. [ABSTRACT FROM AUTHOR]

Background: Nutrition has a significant impact on the health of post-menopausal women. An appropriate dietary plan provides women with the necessary nutrients to maximize their activity and help minimize chronic diseases that may arise after menopause. The objective of the study was to assess the nutritional knowledge and dietary diversity of post-menopausal women in the rural area of Bangladesh. Materials and methods: A cross-sectional study was conducted among post-menopausal women aged 45 to 60. A sampling frame of 167 post-menopausal women was created by visiting each household, and 101 participants were chosen randomly from this frame. Face-to-face interviews were used to gather data. The body mass index (BMI) was used to evaluate nutritional status. To gather dietary data and calculate dietary diversity scores, a 24-hour dietary recall questionnaire was used. Knowledge score was used to gauge nutrition-related knowledge. Result: The average nutrition knowledge score was 8.55 out of 13. Knowledge has a statistically significant effect on the dietary diversity of post-menopausal women (P< 0.015). In this study, BMI was 41 percent, within the normal range, 35 percent were overweight, and 22 percent were obese. Around 45 percent of the respondents had a low dietary diversity score. There was a weak association between BMI and dietary diversity (P> 0.077). Almost 90 percent of women experienced menopausal problems, and 25 percent had inadequate knowledge about menopause. Conclusion: Knowledge of nutrition is associated with post-menopausal women's dietary diversity. Nutrition knowledge can improve the dietary diversity of post-menopausal women. [ABSTRACT FROM AUTHOR]

French fries (FF) and fried chicken (FC) are known contributors to overweight and obesity among adolescents worldwide. Top selling five brands for both FF and FC were analyzed to determine their health compromising contents, which were sampled from the markets of Dhaka, Bangladesh. Sodium (Na) was determined by flame photometry, trans fatty acids (TFAs) by gas chromatography and heavy metals like arsenic (As), lead (Pb), cadmium and chromium by graphite furnace atomic absorption spectrophotometry. The median concentration of Na, TFA, As and Pb in FF was 0.45 gm/100 gm, 0.11 gm/100 gm, 0.93 mg/kg and 0.03 mg/kg, respectively. Similarly, in FC the median concentration of Na, TFA, As and Pb was 0.46 gm/100 gm, 0.13 gm/100 gm, 0.053 mg/kg and 0.06 mg/kg, respectively. The study findings suggests that consuming FF and FC impose a health risk among the exposed population. [ABSTRACT FROM AUTHOR]

In Bangladesh, postpartum hemorrhage (PPH) is the leading cause of maternal mortality accounting for 31% of all blood transfusions in the country. Although safe blood transfusion is one of the 8 signal functions of Comprehensive Emergency Obstetric Care (CEmOC) strategy, most of the designated public sector CEmOC facilities do not have on-site blood storage system. Emergent blood is mainly available from external blood banks. As a result, emergent patients are to rely on an unregulated network of brokers for blood which may raise question about blood safety. This study explored lived experiences of patients' attendants, managers, providers, and blood brokers before and after the implementation of an on-line Blood Information and Management Application (BIMA) in regards to barriers and facilitators of blood transfusion for emergent patients.Data were collected at Dhaka Medical College Hospital (DMCH), a tertiary-level teaching hospital before (January 2014) and after (March 2015) the introduction of an online BIMA system. Data collection methods included 24 key informant interviews (KIIs) and 40 in-depth interviews (IDIs). KIIs were conducted with formal health service providers, health managers and unlicensed blood brokers. IDIs were conducted with the relatives and husbands of women who suffered PPH, and needed emergency blood.Patients' attendants were unaware of patients' blood type and availability of blood in emergency situation. Newly introduced online BIMA system could facilitate blood transfusion process for poor patients at lower cost and during any time of day and night. However, service providers and service recipients were heavily dependent on a network of unlicensed blood brokers for required blood for emergent PPH patients. Blood collected through unlicensed blood brokers is un-screened, unregulated and probably unsafe. Blood brokers feel that they are providing a needed service, acknowledged a financial incentive and unaware about safety of blood that they supply.Ensuring safe and timely blood transfusion is necessary to end preventable maternal mortality. In a context where facilities have no on-site blood, and both providers and patient attendants are heavily dependent on an unregulated cadre of unlicensed blood brokers, access to timely safe blood transfusion is seriously threatened. BIMA is a promising intervention to reduce inefficiencies in obtaining blood, but steps must be taken to ensure buy-in from current purveyors of blood, and to increase the acceptance of the intervention.

Background: The study aimed to explore the perception of mothers of adolescent girls and health service providers in urban slums toward HPV vaccination. Methodology: A cross-sectional mixed-method study in the slums of Rayer Bazaar, Kamlapur and Mohakhali was conducted. The quantitative part included a household survey of mothers (n=150) and service providers (n=30) through a semi-structured pre-tested questionnaire and qualitative interviews included in-depth interviews (IDI) with mothers (n=10) and key-informant interviews (KII) with service providers (n=10). Results: Around 96% of mothers had never heard of HPV, and 98% were unaware that the virus's transmission could be halted. Only 3.3% of mothers were aware that HPV can cause cervical cancer, although, during IDI, it was seen that the majority of mothers said that cervical cancer is a communicable disease. Nearly 98% of mothers wanted their daughters to get vaccinated. Service providers had a good understanding of HPV, HPV vaccine, and cervical cancer. All service providers during KII agreed that if they had received adequate training on HPV vaccination and cervical cancer, they could have treated their patients better. Conclusion: The findings of this study have important implications for the design and advocacy of HPV immunization programs in Bangladesh. [ABSTRACT FROM AUTHOR]

This study explores the differences in factors associated with hypertension between younger and older subjects in an urban slum community in Bangladesh. We analyzed the data of 1,008 men and 1,001 women obtained from a cross-sectional survey conducted between October 2015 and April 2016. Multivariable logistic regression models were stratified by age (18 to 44 and 45 to 64 years) in men and women separately. The multivariable model included age (continuous) and the following categorical variables simultaneously: education duration, marital status, tobacco smoking, smokeless tobacco use, total physical activity, body mass index (BMI), waist circumference, and the blood levels of glycated hemoglobin (HbA1c), triglycerides, high- and low-density lipoprotein (HDL and LDL) cholesterol. Hypertension was defined as the presence of either blood pressure ≥140/90 mmHg or the use of antihypertensive medication. The prevalence of hypertension was 13.0% (younger men), 14.6% (younger women), 35.6% (older men), and 38.7% (older women). In younger men, higher waist circumference and increased LDL cholesterol levels were significantly associated with hypertension. In older men, physical activity was the only significant factor that was inversely associated with hypertension. In younger women, higher BMI, increased HbA1c, triglycerides, and LDL cholesterol levels were associated with hypertension. In older women, a higher HbA1c was the only factor significantly associated with hypertension. These findings suggest that public health interventions to prevent hypertension may require different approaches according to sex and age groups within the poor urban population in Bangladesh. [ABSTRACT FROM AUTHOR]

High dietary salt intake increases the risk of noncommunicable diseases (NCDs). NCDs are increasing among the urban poor in Bangladesh, but the data of their dietary salt intake are yet scarce. This study aimed to explore the amount of dietary salt intake among adults in an urban slum area in Dhaka, Bangladesh. A cross-sectional community-based study was conducted. We randomly selected 100 residents (39 men and 61 women) aged 20–59 years without history of NCDs. A modified World Health Organization standard instrument was used for behavioral risk factor assessment and physical measurements. Dietary salt intake was estimated from the measurement of sodium (Na) excretion in spot urine samples.The estimated mean dietary salt intake was 7.8 ± 2.5 g/day, and the mean Na/potassium (K) ratio in urine was 4.9 ± 3.4. More than half (54%) of them always took additional salt in their meals, but only 6% of them consumed 5 or more servings of fruits and vegetables per day. A quarter of them perceived salt reduction not at all important. Increased mean salt intakes were marginally associated with lower waist circumference and lower waist-hip ratio. Dietary salt intake among urban slum residents was higher than the recommended level of 5 g/day; however, its association with NCD risk factors was not significant. Further studies are required to identify the urban poor specific factors. [ABSTRACT FROM AUTHOR]

Early life stress (ELS) precedes alterations to neuro-immune activation, which may mediate an increased risk for stress-related psychiatric disorders, potentially through alterations of central kynurenine pathway (KP) metabolites, the latter being relatively unexplored. We hypothesized that ELS in a non-human primate model would lead to a reduction of neuroprotective and increases of neurotoxic KP metabolites. Twelve adult female bonnet macaques reared under conditions of maternal variable foraging demand (VFD) were compared to 27 age- and weight-matched non-VFD-exposed female controls. Baseline behavioral observations of social affiliation were taken over a 12-week period followed by the first cerebrospinal fluid (CSF) sample. Subjects were then either exposed to a 12-week repeated separation paradigm (RSP) or assigned to a "no-RSP" condition followed by a second CSF. We used high-performance liquid chromatography for kynurenine (KYN), tryptophan, 5-hydroxyindoleacetic acid, kynurenic acid (KYNA), and anthranilic acid (ANTH) as a proxy for quinolinic acid determination. At baseline, social affiliation scores were reduced in VFD-reared versus control subjects. CSF log KYNA and log KYNA/KYN ratio were lower in VFD-reared versus control subjects. CSF log KYNA/KYN was positively correlated with CSF log ANTH in VFD only (r = 0.82). Controlling for log KYNA/KYN, log ANTH was elevated in VFD-reared subjects versus controls. CSF log KYNA/KYN obtained post-RSP was positively correlated with mean social affiliation scores during RSP, specifically in VFD. ELS is associated with a reduced neuroprotective and increased neurotoxic pathway products. That the two contrasting processes are paradoxically correlated following ELS suggests a cross-talk between two opposing KP enzymatic systems. [ABSTRACT FROM AUTHOR]

As in most low‐income countries, there is a lack of scientific information on the incidence and pattern of child maltreatment (CM) in Bangladesh. However, the role of the media to disclose CM and to develop public awareness in society is noteworthy. The present study assessed newspaper reports about CM by type and socio‐demographics of victims and perpetrators in Bangladesh. In total, 790 news articles were collected retrospectively from four Bengali‐ and two English‐language newspapers from October to December 2014. Among all reported incidents, almost half of the CM cases concerned alleged physical abuse (26%) and sexual abuse (22%). Neglect and emotional or psychological abuse received less coverage. Female children were to a high degree (90%) victims of sexual abuse. The main perpetrators were males, and they were often known to the victims. Approximately 32 per cent of the reported abuse cases resulted in death and were related to rape, family violence, administrative negligence, abduction and ransom demand. Some of these deaths were suicides. News stories concerning CM were often reported in an unethical way by identifying the victim and not respecting child rights. Further, the stories seldom discussed the individual or social consequences of CM, or how maltreatment could be prevented. 'The present study assessed newspaper reports about CM by type and socio‐demographics of victims and perpetrators in Bangladesh' Key Practitioner Messages: The main types of reported cases of CM in Bangladeshi print media are physical abuse and sexual abuse, and there is a high proportion of fatal consequences.The perpetrators are often known to the victims.The identity of the victim is frequently reported, potentially putting the child at risk and violating child rights.Bangladeshi print media seldom discusses individual or societal consequences of CM, or how it could be prevented. [ABSTRACT FROM AUTHOR]

Background: Although child physical abuse (CPA) is considered as a major global public health problem, it has not yet been recognized as such in Bangladesh. Very few studies have assessed the prevalence and victims’ characteristics of multiple forms of CPA. Objective: This population-based study assessed the prevalence of CPA committed by adults in a rural area of Bangladesh and examined its association with demographic and socio-contextual factors. Methods: Data were obtained using ISPCAN Child Abuse Screening Tool for Children (ICAST-C) in a random sample of 1416 children (49% girls, 51% boys) aged 11 to 17 years by face-to-face interviews during March-April 2017. The response rate was 91.5%. To estimate predictors of CPA, physical abuse was categorized into frequent and less frequent groups. Results: The prevalence of at least one form (≥ 1), two forms (≥2) and three or more forms (≥ 3) of CPA were estimated approximately to 99%, 95% and 83% in their lifetime and 93%, 79%, and 57% in the past year respectively. Hitting (except on buttocks), standing/kneeling and slapping were the most common physical abuse whereas given drugs or alcohol, pinched, burned or scalded, beaten-up and locked up were less reported. Female children were faced severe forms of CPA more than that of males. Male children, younger age groups, witnessing adults using weapons at home, bullied by siblings and low level of maternal education were found to be significant risk factors for both ≥ 1 form and ≥ 2 forms of frequent CPA whereas adding also adult shouting in a frightening way was found as a significant risk factor for ≥ 2 forms of frequent CPA. Conclusion: Self-reported prevalence of CPA is extremely common in the Bangladeshi rural society. The prevalence was associated with demographic and socio-contextual characteristics of the children such as being younger, witnessing domestic violence and maternal low education. The findings provide evidence to support parents and policy-makers to take effective measures to implement policy and programme on alternative up-bringing methods and creating awareness of negative effects of CM which in turn help Bangladesh to line up with UN Convention on the Rights of the Child, which the country signed in 1990. [ABSTRACT FROM AUTHOR]

Major depressive disorder (MDD) is a prevalent and debilitating disorder, often fatal. Treatment options are few and often do not provide immediate relief to the patients. The increasing involvement of inflammation in the pathology of MDD has provided new potential therapeutic avenues. Cytokine levels are elevated in the blood and cerebrospinal fluid of MDD patients whereas immune cells often exhibit an immunosuppressed phenotype in MDD patients. Blocking cytokine actions in patients exhibiting MDD show some antidepressant efficacy. However, the role of cytokines, and the immune response in MDD patients remain to be determined. We reviewed here the roles of the innate and adaptive immune systems in MDD, as well as potential mechanisms whereby the immune response might be regulated in MDD. [ABSTRACT FROM AUTHOR]

Objectives This study aims to describe the prevalence of non-communicable disease (NCD) risk factors among the urban poor in Bangladesh. Design We conducted a community-based crosssectional epidemiological study. Setting The study was conducted in a shantytown in the city of Dhaka. There were 8604 households with 34 170 residents in the community. Those households were categorised into two wealth strata based on the housing structure. Participants The study targeted residents aged 18-64 years. A total of 2986 eligible households with one eligible individual were selected by simple random sampling stratified by household wealth status. A total of 2551 residents completed the questionnaire survey, and 2009 participated in the subsequent physical and biochemical measurements. Outcome measures A modified WHO survey instrument was used for assessing behavioural risk factors and physical and biochemical measurements, including glycated haemoglobin (HbA1c). The prevalence of NCD risk factors, such as tobacco use, fruit and vegetable intake, overweight/obesity, hypertension, diabetes (HbA1c =6.5%) and dyslipidaemia, was described according to household wealth status and gender differences. Results The prevalence of current tobacco use was 60.4% in men and 23.5% in women. Most of them (90.8%) consumed more than 1 serving of fruits and vegetables per day; however, only 2.1% consumed more than 5 servings. Overweight/obesity was more common in women (39.2%) than in men (18.9%), while underweight was more common in men (21.0%) than in women (7.1%). The prevalence of hypertension was 18.6% in men and 20.7% in women. The prevalence of diabetes was 15.6% in men and 22.5% in women, which was much higher than the estimated national prevalence (7%). The prevalence of raised total cholesterol (≥190 mg/dL) was 25.7% in men and 34.0% in women. Conclusion The study identified that tobacco use, both overweight and underweight, diabetes, hypertension and dyslipidaemia were prevalent among the urban poor in Bangladesh. [ABSTRACT FROM AUTHOR]

Introduction Early life stress (ELS) has been shown to play a role in establishing persistent maladaptive HPA axis modifications that may contribute to the pathogenesis of mood and anxiety disorders. Central glucocorticoid receptor (GR) messenger RNA (mRNA) expression may facilitate (mal)adaptive responsivity to ELS. The role of adult monocytic GR mRNA expression, a putative CNS proxy, during acute stress exposure was explored as well as the ELS marker, juvenile cerebrospinal fluid (CSF) corticotropin-releasing factor. Methods Six adult macaques (three of which were exposed to variable foraging demand, a form of ELS) underwent acute restraint. Baseline GR expression and plasma cortisol concentrations were separately measured followed by subsequent measurements following stress completion ( t = 0 min, 4 h, 5 days and 7 days). Juvenile CSF CRF concentrations were available in five subjects to determine their developmental association with GR expression in response to stress. Results As expected acute restraint stress produced a significant increase in plasma cortisol concentrations most robustly observed at 4 h post-stress time point. There was a significant juvenile CSF CRF concentration x time interaction in predicting adult GR mRNA expression in response to stress (partial η 2 = 0.80). During acute stress juvenile CRF concentrations negatively predicted GR expression and during recovery, “flipped” to positively predict expression. Juvenile CSF CRF concentrations positively correlated with the volatility of adult GR mRNA expression. Conclusions During acute stress, relatively high CSF CRF concentrations are associated with relatively rapid reductions in GR expression. Return to an ambient post-stress state was characterized by a direct relationship, consistent with increased HPA axis restraint in high CRF subjects. An ELS-associated allostatic adaptation suggests relative elevations of juvenile CSF CRF concentration set the stage for a relative hyper-volatility of adult GR mRNA expression in response to acute stress with potential long-term implications for HPA axis regulation. [ABSTRACT FROM AUTHOR]

Objectives: A population survey was conducted in an urban shantytown in Bangladesh, as a baseline study of future epidemiological studies. This paper aims to describe the findings of the study, including the population profile and residential environment of the urban poor. Methods: We conducted a complete count household survey in an urban poor community in Dhaka. Using a brief structured questionnaire in Bengali language, trained interviewers visited each household and asked questions such as: duration of residence; ownership of house, toilet and kitchen; water supply; number of family members; age, sex, education, occupation, tobacco use, and history of diseases of each family member. Results: We found that there were 8604 households and 34,170 people in the community. Average number of household members was 4.0. Most people had access to safe water, but only 16% lived in the house with a toilet. Based on the proxy indicators of household wealth levels, we identified that about 39% were relatively well-off, while the rest were very poor. Tobacco use was prevalent in men regardless of age and in women aged over 35 years. Prevalence of self-reported hypertension and diabetes was slightly higher in women than in men, although over 70% of the respondents didn't know if they had such diseases. Incidences of diarrhea in the last one month were relatively low. Conclusions: The study showed population profile and sanitation environment in an urban poor community by a complete count survey. We expect the study to serve as a baseline for future epidemiological studies. [ABSTRACT FROM AUTHOR]

Background and Objectives: In Bangladesh, postpartum hemorrhage (PPH) is the leading cause of maternal mortality accounting for 31% of all blood transfusions in the country. Although safe blood transfusion is one of the 8 signal functions of Comprehensive Emergency Obstetric Care (CEmOC) strategy, most of the designated public sector CEmOC facilities do not have on-site blood storage system. Emergent blood is mainly available from external blood banks. As a result, emergent patients are to rely on an unregulated network of brokers for blood which may raise question about blood safety. This study explored lived experiences of patients’ attendants, managers, providers, and blood brokers before and after the implementation of an on-line Blood Information and Management Application (BIMA) in regards to barriers and facilitators of blood transfusion for emergent patients. Methods: Data were collected at Dhaka Medical College Hospital (DMCH), a tertiary-level teaching hospital before (January 2014) and after (March 2015) the introduction of an online BIMA system. Data collection methods included 24 key informant interviews (KIIs) and 40 in-depth interviews (IDIs). KIIs were conducted with formal health service providers, health managers and unlicensed blood brokers. IDIs were conducted with the relatives and husbands of women who suffered PPH, and needed emergency blood. Results: Patients’ attendants were unaware of patients’ blood type and availability of blood in emergency situation. Newly introduced online BIMA system could facilitate blood transfusion process for poor patients at lower cost and during any time of day and night. However, service providers and service recipients were heavily dependent on a network of unlicensed blood brokers for required blood for emergent PPH patients. Blood collected through unlicensed blood brokers is un-screened, unregulated and probably unsafe. Blood brokers feel that they are providing a needed service, acknowledged a financial incentive and unaware about safety of blood that they supply. Conclusions: Ensuring safe and timely blood transfusion is necessary to end preventable maternal mortality. In a context where facilities have no on-site blood, and both providers and patient attendants are heavily dependent on an unregulated cadre of unlicensed blood brokers, access to timely safe blood transfusion is seriously threatened. BIMA is a promising intervention to reduce inefficiencies in obtaining blood, but steps must be taken to ensure buy-in from current purveyors of blood, and to increase the acceptance of the intervention. [ABSTRACT FROM AUTHOR]

Glucagon-like peptide-1 (GLP-1) regulates carbohydrate metabolism and promotes neurogenesis. We reported an inverse correlation between adult body mass and neurogenesis in nonhuman primates. Here we examine relationships between physiological levels of the neurotrophic incretin, plasma GLP-1 (pGLP-1), and body mass index (BMI) in adolescence to adult neurogenesis and associations with a diabesity diathesis and infant stress. Morphometry, fasting pGLP-1, insulin resistance, and lipid profiles were measured in early adolescence in 10 stressed and 4 unstressed male bonnet macaques. As adults, dentate gyrus neurogenesis was assessed by doublecortin staining. High pGLP-1, low body weight, and low central adiposity, yet peripheral insulin resistance and high plasma lipids, during adolescence were associated with relatively high adult neurogenesis rates. High pGLP-1 also predicted low body weight with, paradoxically, insulin resistance and high plasma lipids. No rearing effects for neurogenesis rates were observed. We replicated an inverse relationship between BMI and neurogenesis. Adolescent pGLP-1 directly predicted adult neurogenesis. Two divergent processes relevant to human diabesity emerge-high BMI, low pGLP-1, and low neurogenesis and low BMI, high pGLP-1, high neurogenesis, insulin resistance, and lipid elevations. Diabesity markers putatively reflect high nutrient levels necessary for neurogenesis at the expense of peripheral tissues. [ABSTRACT FROM AUTHOR]

Summary Inflammation has been involved in the pathophysiology and treatment response of major depressive disorder (MDD). Plasma cytokine profiles of 171 treatment-naive MDD patients (none of the MDD patients received an adequate trial of antidepressants or evidence-based psychotherapy) and 64 healthy controls (HCs) were obtained. MDD patients exhibited elevated concentrations of 18 anti- and proinflammatory markers and decreased concentrations of 6 cytokines. Increased inflammasome protein expression was observed in MDD patients, indicative of an activated inflammatory response. The plasma of MDD patients was immunosuppressive on healthy donor peripheral blood mononuclear cells, inducing reduced activation of monocytes/dendritic cells and B cells and reduced T cell memory. Comparison between 33 non-responders and 71 responders at baseline and 12 weeks revealed that after treatment, anti-inflammatory cytokine levels increase in both groups, whereas 5 proinflammatory cytokine levels were stabilized in responders, but continued to increase in non-responders. MDD patients exhibit remodeling of their inflammatory landscape. Highlights • Treatment-naive MDD patients have elevated levels of inflammatory markers • Overall, plasma of treatment-naive MDD patients is immunosuppressive • Defective anti-inflammatory response occurs in non-responders Treatment-naive MDD patients have increased levels of pro- and anti-inflammatory markers, but overall the balance shifts toward immunosuppression of immune cells. Consistent with these findings, absence of response to antidepressant treatments has been associated with defective anti-inflammatory response. [ABSTRACT FROM AUTHOR]