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Background: Depression is a major morbidity and the most common mental disorder among the medical students in medical schools globally. Undergraduate students suffer stress more due to their academic curriculum than the students of other faculties. In low-resource settings like Bangladesh, there is a dearth in research on the mental health of undergraduate medical students. This pilot study was conducted to add to the existing limited evidence by reporting the prevalence of depression and describing sleeping pattern and suicidal tendencies among medical students. Relevantly, we have investigated the overall mental health status among the medical students in Bangladesh. Methods: This cross-sectional study was conducted in two medical colleges of Dhaka between July 2013 and December 2013, among 221 Bangladeshi medical students from first to fifth year. By the convenience sampling technique, data were collected by a pretested, structured, self-administered questionnaire and analysis was done by SPSS version 18.0. Depression was assessed by the validated Patient Health Questionnaire-9 (PHQ-9) tool among the respondents. Goldberg's General Health Questionnaire (GHQ-28) was used for assessing overall mental health status. Results: Depression was found in 38.9% of participants, with 3.6%, 14.5%, and 20.8% being severe, moderate, and mild depression, respectively. 17.6% of medical students had suicidal tendency or attempted suicide at least once after attending medical school. The sleeping hours were inadequate and altered after starting this stressful academic course. 33.5% of medical students had poor mental health status. There was a statistically significant association between poor mental health status in the age group less than 22 years old and initial academic study year (1st to 3rd of MBBS). Conclusion: The findings are suggestive of a higher prevalence of depression among early-year medical students and marginal predominance in males. Suicidal tendency is also higher. This calls for further investigation with situation analysis, qualitative explorations, and surveys to explore the burden of such disorders in Bangladesh. [ABSTRACT FROM AUTHOR]

Background/Aim To audit the doses of opioids and sedatives administered to patients in the last 24 h of life in an Australian tertiary hospital and compare results with doses published in New Zealand ( NZ) benchmarking studies and to examine the effect of caring for dying patients using a modified version of the Liverpool Care Pathway ( mLCP) in respect to doses of opioids and sedatives. Methods A retrospective chart audit of 102 patients who died in a tertiary hospital was carried out over a 3-month period in 2011. Diagnosis, demographic patient characteristics, use of the mLCP, use of subcutaneous infusions and key symptoms were identified. Chi-squared and the non-parametric Mann-Whitney tests were applied to compare the group differences for categorical and continuous variables as appropriate. Parenteral morphine-equivalent daily dose ( pMEDD) was calculated. A t-test assessed the variable mean doses of medication and patient characteristics. Results Of the audited patients, 76.5% died of non-malignant disease. The overall mean dose of midazolam was significantly lower compared with that of the NZ study pMEDD (6.0 vs 20.7 mg). The overall mean dose of morphine benchmarked closely with the NZ study (56.5 mg Australian study vs 47.8 mg NZ study). A total of 83% of patients with a malignant diagnosis was supported with the mLCP compared with 51% of patients with a non-malignant diagnosis. Conclusion The significance of the lower midazolam doses was postulated, including the possibility of inadequate symptom control for patients with a non-malignant diagnosis. The use of the mLCP did not lead to the provision of higher doses of medications. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to investigate the impacts of water exercise training on functional and hemodynamic responses in HF patients. Methods: A systematic review and meta-analysis were conducted until February 15, 2024, using multiple databases. Mean difference (MD) with corresponding 95% confidence intervals (CIs) were calculated. Results: Sixteen studies, comprising 349 participants with HF, were included. Water exercise led to enhancements in peak VO2 (MD, 2.85 mL/kg/min; 95% CI, 1.89 to 3.80; p <.00001) and resting heart rate (MD, −4.16 bm; 95% CI, −6.85 to −1.46; p =.002) compared to no exercising controls. Water plus land exercise reduced resting heart rate (MD, −1.41 bm; 95% CI, −2.13 to −0.69; p =.0001) compared to land exercise alone. Furthermore, acute water exercises decreased resting heart rate (MD, −3.85 bm; 95% CI, −6.49 to −1.21; p =.004) and increased stroke volume (MD, 14.68 mL/beat; 95% CI, 8.57 to 20.79; p <.00001) and cardiac output (MD, 0.5 L/min; 95% CI, 0.27 to 0.73; p <.00001) compared to baseline. Conclusion: These findings suggest that water exercise holds promise as an effective intervention for enhancing functional capacity and hemodynamic parameters in individuals with HF, highlighting the importance of further research to optimize its implementation and elucidate long-term benefits. [ABSTRACT FROM AUTHOR]

Purpose: A growing body of research indicates a correlation between occupational exposure, particularly among individuals in driving-related occupations, and the incidence of low back pain (LBP). Methods: Databases were systematically searched, including PubMed, Embase, Web of Science, Cochrane Library, and SinoMed, from their inception through December 2023 for relevant studies of the prevalence and risk factors of LBP among professional drivers. Subsequent meta-analyses were performed utilizing Stata 17.0 and RevMan 5.4 software, while risk factor indicators were assessed using the Grading of Recommendations, Assessment, Development and Evaluation evidence quality grading system. Results: A systematic review and meta-analysis comprising 19 studies involving 7,723 patients indicated that the incidence of LBP among drivers was 39% (95% confidence interval [CI] 0.20–0.57) in the past 7 days and 53% (95% CI 0.43–0.63) in the past 12 months. A subgroup analysis revealed a prevalence of 48% (95% CI 0.33–0.64) in 2005–2015 and 56% (95% CI 0.42–0.70) in 2016–2023. Among the identified factors, robust evidence highlighted age ≥ 41 years (odds ratio [OR] = 2.10; 95% CI 1.36–3.24; P = 0.0008), alcohol consumption (OR = 1.75; 95% CI 1.31–2.34; P = 0.0001), sleeping < 6 h/night (OR = 1.60; 95% CI 1.13–2.24; P = 0.007), uncomfortable seating (OR = 1.71; 95% CI 1.23–2.36; P = 0.001), improper driving posture (OR = 2.37; 95% CI 1.91–2.94; P < 0.00001), and manual handling (OR = 2.23; 95% CI 1.72–2.88; P < 0.00001) as significant risk factors for LBP. There was moderate evidence of a lack of exercise (OR = 1.78; 95% CI 1.37–2.31; P < 0.0001), working > 10 h/day (OR = 2.49; 95% CI 1.89–3.28; P < 0.00001), > 5 years' driving experience (OR = 2.12; 95% CI 1.66–2.69; P < 0.00001), a lack of back support (OR = 1.81; 95% CI 1.25–2.62; P = 0.002), high work-related pressure (OR = 2.04; 95% CI 1.59–2.61; P < 0.00001), and job dissatisfaction (OR = 1.57; 95% CI 1.23–2.01; P = 0.0003) as moderate risk factors. There was no evidence of body mass index or smoking as risk factors for LBP among professional drivers. Conclusion: The current evidence indicates an increasing annual trend in the prevalence of LBP among professional drivers. Factors including age ≥ 41 years, alcohol consumption, and sleeping < 6 h/night were among the 12 influential factors contributing to LBP in professional drivers. Enhancing awareness of these factors and formulating targeted preventive strategies may be beneficial. [ABSTRACT FROM AUTHOR]

Methicillin‐resistant Staphylococcus aureus (MRSA) is an important zoonotic pathogen associated with a wide range of infections in humans and animals. Thus, the emergence of MRSA clones poses an important threat to human and animal health. This study is aimed at elucidating the genomics insights of a strong biofilm‐producing and multidrug‐resistant (MDR) S. aureus MTR_BAU_H1 strain through whole‐genome sequencing (WGS). The S. aureus MTR_BAU_H1 strain was isolated from food handlers' hand swabs in Bangladesh and phenotypically assessed for antimicrobial susceptibility and biofilm production assays. The isolate was further undergone to high throughput WGS and analysed using different bioinformatics tools to elucidate the genetic diversity, molecular epidemiology, sequence type (ST), antimicrobial resistance, and virulence gene distribution. Phenotypic analyses revealed that the S. aureus MTR_BAU_H1 strain is a strong biofilm‐former and carries both antimicrobial resistance (e.g., methicillin resistance; mecA, beta‐lactam resistance; blaZ and tetracycline resistance; tetC) and virulence (e.g., sea, tsst, and PVL) genes. The genome of the S. aureus MTR_BAU_H1 belonged to ST1930 that possessed three plasmid replicons (e.g., rep16, rep7c, and rep19), seven prophages, and two clustered regularly interspaced short palindromic repeat (CRISPR) arrays of varying sizes. Phylogenetic analysis showed a close evolutionary relationship between the MTR_BAU_H1 genome and other MRSA clones of diverse hosts and demographics. The MTR_BAU_H1 genome harbours 42 antimicrobial resistance genes (ARGs), 128 virulence genes, and 273 SEED subsystems coding for the metabolism of amino acids, carbohydrates, proteins, cofactors, vitamins, minerals, and lipids. This is the first‐ever WGS‐based study of a strong biofilm‐producing and MDR S. aureus strain isolated from human hand swabs in Bangladesh that unveils new information on the resistomes (ARGs and correlated mechanisms) and virulence potentials that might be linked to staphylococcal pathogenesis in both humans and animals. [ABSTRACT FROM AUTHOR]

The strong relationality model of relationship flourishing emphasizes the role of ethical responsiveness (how well a person intrinsically responds to the manifest or identifiable needs of others) as a direct predictor of relationship quality and as an indirect pathway for explaining the influence of vulnerabilities. This study is among the first explicit tests of the theorized role of ethical responsiveness. The sample consisted of 1432 adults in a romantic relationship, from the United States and Canada. Modeled as latent variables, ethical responsiveness served as a path between the variables of depression, anxiety, and friend and family support, and the dependent variable of relationship-focused relationship quality. Depression and friend support predicted ethical responsiveness. Ethical responsiveness, both supports, and depression predicted relationship quality. Friend support and depression had an indirect effect through ethical responsiveness. Our findings support the role of ethical responsiveness and suggest continued research into how and why it influences relationships. [ABSTRACT FROM AUTHOR]

Negative marital relationships are associated, concurrently, with less warm parenting (i.e., spillover) and this may be exacerbated for mothers with postpartum depression, who typically experience more marital conflict than other mothers. When examining time-lagged effects, however, previous work has found that mothers may compensate following negative marital interactions by investing more positively in parenting. Based on an emotion regulation perspective that emphasizes the temporal nature of affective experiences and the concept of positive emotions "undoing" the effect of negative emotions, we hypothesized that mothers with higher levels of depression may show greater increases in positive affect with their children in an effort to regulate negative affect elicited by marital conflict. To examine this temporal process, we coded mothers' (N = 46) positive and negative affect during marital conflict discussions and subsequent play interactions with their seven-month-old infants and examined sequential change in affect between the interactions. Mothers' self-reported depressive symptoms (BDI-II scores) were examined in relation to sequential change. Although all mothers were more positive with infants than with partners, higher levels of depressive symptoms were related to greater increases in positive affect with infants following more negative interactions with partners. Findings suggest mothers with depression may try to regulate negative affect elicited within marital relationships by engaging in positive interactions with their infants. Maternal depression may contribute to greater investment in parent-child relationships relative to marital relationships. Highlights: Negative marital relationships have been consistently associated with less warm parenting. Previous work examining temporal associations, however, suggests that mothers may "compensate" following more negative marital interactions by investing more positively in parenting. To explore this temporal process, we coded mothers' positive and negative affect during marital interactions and subsequent play interactions with their infants and examined sequential change in affect between the interactions. Although all mothers were more positive with infants than with partners, higher levels of depressive symptoms were related to greater increases in positive affect with infants following more negative interactions with partners. Findings suggest mothers with depressive symptoms may compensate for elevated negative emotions by heightening positive emotions in their mother-infant relationship. [ABSTRACT FROM AUTHOR]

Background: Medications are commonly used for symptom control in cancer patients at the end of life. This study aimed to evaluate medication utilization among home care palliative patients with cancer at the end of life and assess the appropriateness of these medications. Method: This retrospective observational study included adult cancer patients who received home care in 2020. Medications taken during the last month of the patient's life were reviewed and classified into three major categories: potentially avoidable, defined as medications that usually have no place at the end of life because the time to benefit is shorter than life expectancy; medications of uncertain appropriateness, defined as medications that need case-by-case evaluation because they could have a role at the end of life; and potentially appropriate, defined as medications that provide symptomatic relief. Results: In our study, we enrolled 353 patients, and 2707 medications were analyzed for appropriateness. Among those, 1712 (63.2%) were classified as potentially appropriate, 755 (27.9%) as potentially avoidable, and 240 (8.9%) as medications with uncertain appropriateness. The most common potentially avoidable medications were medications for peptic ulcers and gastroesophageal reflux disease (30.5%), vitamins (14.6%), beta-blockers (9.8%), anticoagulants (7.9%), oral antidiabetics (5.4%) and insulin products (5.3%). Among the potentially appropriate medications, opioid analgesics were the most frequently utilized medications (19.5%), followed by laxatives (19%), nonopioid analgesics (14.4%), gamma-aminobutyric acid analog analgesics (7.7%) and systemic corticosteroids (6%). Conclusion: In home care cancer patients, approximately one-third of prescribed medications were considered potentially avoidable. Future measures to optimize medication use in this patient population are essential. [ABSTRACT FROM AUTHOR]

BACKGROUND: Hypertension is a major cause of death worldwide. Although arsenic exposure has been associated with the risk of hypertension, this association appears nonuniform due to inconsistent results from studies conducted in different populations. Moreover, hypertension is a complex condition with multiple underlying mechanisms and factors. One factor is impaired production and bioavailability of vascular nitric oxide (NO). However, the implications of the effects of arsenic exposure on circulating NO and its association with hypertension in humans are largely unknown. OBJECTIVE: We investigated the dose–response relationship between arsenic exposure and hypertension with vascular NO levels as a potential mediator of arsenic-related hypertension in individuals exposed to a broad range of arsenic. METHODS: A total of 828 participants were recruited from low- and high-arsenic exposure areas in Bangladesh. Participants’ drinking water, hair, and nail arsenic concentrations were measured by inductively coupled plasma mass spectroscopy. Hypertension was defined as a systolic blood pressure (SBP) value of = 140 and a diastolic (DBP) value of = 90 mmHg. Serum NO levels reflected by total serum nitrite concentrations were measured by immunoassay. A formal causal mediation analysis was used to assess NO as a mediator of the association between arsenic level and hypertension. RESULTS: Increasing concentrations of arsenic measured in drinking water, hair, and nails were associated with the increasing levels of SBP and DBP. The odds of hypertension were dose-dependently increased by arsenic even in participants exposed to relatively low to moderate levels (10–50 µg/L) of water arsenic [odds ratios (ORs) and 95% confidence intervals (CIs): 2.87 (95% CI: 1.28, 6.44), 2.67 (95% CI: 1.27, 5.60), and 5.04 (95% CI: 2.71, 9.35) for the 10–50 µg/L, 50.01–150 µg/L, and >150 µg/L groups, respectively]. Causal mediation analysis showed a significant mediating effect of NO on arsenic-related SBP, DBP, and hypertension. CONCLUSION: Increasing exposure to arsenic was associated with increasing odds of hypertension. The association was mediated through the reduction of vascular NO bioavailability, suggesting that impaired NO bioavailability was a plausible underlying mechanism of arsenic-induced hypertension in this Bangladeshi population. [ABSTRACT FROM AUTHOR]

Background. Coronavirus disease (COVID-19) is an infectious illness that spreads widely over a short period of time and finally causes a pandemic. Unfortunately, the lack of radiologists, improper COVID-19 diagnosing procedures, and insufficient medical supplies have all played roles in these devastating losses of life. Deep learning (DL) could be used to detect and classify COVID-19 for potential image-based diagnosis. Materials and Methods. This paper proposes an improved deep convolutional neural network (IDConv-Net) to detect and classify COVID-19 using X-ray and computed tomography (CT) images. Before the training phase, preprocessing methods such as filtering, data normalization, classification variable encoding, and data augmentation were used in conjunction with the proposed IDConv-Net to increase the effectiveness of the detection and classification processes. To extract essential features, deep CNN is then employed. As a result, the suggested model can identify patterns and relationships crucial to the image classification task, resulting in more precise and useful diagnoses. Python and Keras (with TensorFlow as a backend) were used to carry out the experiment. Results. The proposed IDConv-Net was tested using chest X-rays and CT images collected from hospitals in Sao Paulo, Brazil, and online databases. After evaluating the model, the proposed IDConv-Net achieved an accuracy of 99.53% and 98.41% in training and testing for CT images and 97.49% and 96.99% in training and testing for X-ray images, respectively. Further, the area under the curve (AUC) value is 0.954 and 0.996 for X-ray and CT images, respectively, indicating the excellent performance of the proposed model. Conclusion. The findings of our proposed IDConv-Net model confirm that the model outperformed compared to existing COVID-19 detection and classification models. The IDConv-Net outperforms current state-of-the-art models by 2.25% for X-rays and 2.81% for CT images. Additionally, the IDConv-Net training approach is significantly quicker than the current transfer learning models. [ABSTRACT FROM AUTHOR]

Background: Previously, management of gestational diabetes (GDM) has focused largely on glycaemic control, with a view to reduce the occurrence of large‐for‐gestational‐age (LGA) infants. However, tight glycaemic control in GDM is associated with a higher incidence of small‐for‐gestational‐age (SGA) infants, which has been linked to higher rates of adverse outcomes. Aim: The aim was to characterise risk factors associated with having an SGA infant in women being treated for GDM. Methods: This was a retrospective observational cohort study of 308 women with GDM. Women were split into groups based on their infant's size at delivery (SGA, appropriate‐for‐gestational‐age (AGA) or LGA). Literature review and expert opinion helped to determine several predictors of women with GDM delivering an SGA infant, and statistical analysis was used to produce odds ratios (OR) for these predictors. Results: The sample included primiparous women with a mean pre‐pregnancy body mass index (BMI) of 25.72 (standard deviation: 5.75). Metabolic risk factors associated with delivering an SGA infant included a lower pre‐pregnancy BMI (adjusted OR 1.13, P = 0.04, 95% confidence interval (CI): 1.01–1.26), a lower fasting blood glucose level (BGL) (adjusted OR: 3.21, P = 0.01, 95% CI: 1.30–7.93) and growth that was high risk for SGA at baseline ultrasound scan (USS) (adjusted OR: 7.43, P < 0.001, 95% CI: 2.93–18.79). Conclusions: The combined clinical picture of lower pre‐pregnancy BMI, fasting BGL and baseline USS growth measurements may indicate a need for less aggressive glucose management in women with GDM to prevent SGA infants. [ABSTRACT FROM AUTHOR]

Farmers' decisions regarding land usage have evolved over time. Small farmers have a tendency to make a variety of land usage choices. This study examined the relative profitability and determining factors of shifting cultivation. A total of 110 farmers were selected using a multistage random sampling technique. The objectives of the study were attained using descriptive statistics and Probit regression. The results indicated that the decision to shift land towards smallscale aquaculture is financially profitable. The econometric model indicated that occupation, education, farm size, and perception of rice price had a significant impact on the decision to shift land. Farmers who perceive a lower rice price are 6.1% more likely to shift than those who perceive a higher price. Capital shortage and a high cost of feed in shifting cultivation were among the various obstacles respondents faced. If a rice farm undergoes conversion into a fish farm, it is imperative for the government to enact policies that can facilitate farmers in making informed decisions. [ABSTRACT FROM AUTHOR]

Background. The passage of meconium during labor increased the chance of undesirable birth outcomes. The adverse effects of meconium are worsening in resource-limited countries. In Ethiopia, there is an argument concerning meconium's negative effects and management on pregnant women and their babies. Therefore, this study was intended to assess the adverse maternal and perinatal outcomes of meconium in term labor in the South Gondar Zone, Ethiopia. Methods. A prospective cohort study was conducted using 580 laboring mothers (145 exposed and 435 nonexposed groups). A two-stage sampling method was implemented to get study subjects. The data were collected using an interviewer-administered structured questionnaire and a medical chart review. SPSS version 25 was used for data analysis. Chi-squared and Fisher's exact tests were used to compare the two groups' differences. The strength of the association was measured using relative risk with a 95% CI. Result. There was more operative delivery (28.3% versus 5.3%), puerperal sepsis (79.54% versus 2.06%), nonreassuring fetal heart rate pattern (29.7% versus 2.1%), meconium aspiration syndrome (7.58% versus 0.68%), neonatal sepsis (9% versus 4.1%), perinatal asphyxia (13.8% versus 7.6%), admission to the neonatal intensive care unit (23.4% versus 3.2%), and early neonatal deaths (4.8% versus 1.4%) among meconium stained groups as compared to the clear amniotic fluid groups. Conclusion. Meconium-stained amniotic fluid significantly increased adverse maternal and perinatal outcomes in Ethiopia. The risk of perinatal asphyxia, nonreassuring fetal heart rate pattern, neonatal sepsis, meconium aspiration syndrome, admission to the NICU, early neonatal death, operative delivery, and puerperal sepsis were significantly higher in meconium-exposed groups. Special attention should be given to meconium-exposed mothers during the intrapartum period and in postnatal follow-up. [ABSTRACT FROM AUTHOR]

The literature indicates a robust negative relationship between depression and couple relationship satisfaction. However, less is known about the differential effects of romantic relationships on depression over time and whether one or both partners experience depression. Using data from 1215 couples across 4 years, we sought to examine couple classes of depressive symptom trajectories and investigate the degree to which relationship satisfaction predicted class membership. Using joint-probability growth mixture modeling, we found three couple classes of depressive symptom trajectories: women's moderate, men's low class, men's moderate, women's low class, and men's and women's low class. Logistic regression results revealed both men's and women's higher relationship satisfaction was associated with women's moderate, men's low class membership while both partners' higher relationship satisfaction was not associated with men's moderate, women's low class membership, in comparison to the men's and women's low stable class. These findings contribute to the literature by identifying the heterogeneity of patterns of depressive symptom trajectories among couples and the association of relationship satisfaction with couple classes. [ABSTRACT FROM AUTHOR]

Objective: The present study aimed to evaluate the impact of endometrial polyps (EPs) on the endometrium of patients with unexplained infertility using stanniocalcin‐1 and ‐2 proteins (STC), whose effects on endometrial receptivity have been reported recently. Materials and Methods: A case–control study was performed, consisting of 26 patients who underwent endometrial sampling for diagnosis and/or treatment and diagnosed with EP on biopsy and/or excision material, and 23 patients with normal endometrial findings in the pathology, for a total of 49 patients with unexplained infertility. An immunohistochemistry examination was performed on paraffin‐embedded tissue samples from both groups to understand whether there was a relationship between EP and STC. Staining results of the polyp and control groups for STC‐1 and STC‐2 were compared, and it was investigated whether STCs were predictive for EP. Results: In the comparison performed between the H‐score evaluation results of the control and polyp groups after the immunohistochemical staining method, the staining in the polyp group was significantly higher for both STC‐1 (p < 0.001) and STC‐2 (p < 0.001). There was more staining with STC‐1 than STC‐2 in all groups (STC‐1: 15.08; STC‐2: 8.27; p < 0.05). In the logistic regression analysis established with STC‐1, STC‐2, and age, the predictive effect of STC‐1 for EP was statistically significant (p = 0.040; odds ratio: 1.66; 95% confidence interval: 1.02–2.68). In EP, according to receiver operating characteristic curve analysis, area under the curve was 0.980 (likelihood ratio: 20.35; p < 0.05), and the cut‐off value was 18 for STC‐1. Conclusion: In infertile patients, since STC‐1, which affects endometrial receptivity, is found to be significantly higher in polyps and has a predictive effect on polyps, in patients with unexplained infertility, routine uterine cavity evaluation and routine excision of polypoid lesions detected during this period may have a positive effect on endometrial receptivity. [ABSTRACT FROM AUTHOR]

Background: One of the leading causes of mortality and morbidity in under-5 children is Diarrhea. Malnutrition, in association with the diarrheal disease, affect children negatively. On 2018, Bangladesh saw massive influx Rohingya people with almost 29% under-5 children. Objective: The purpose of the present study was to determine the prevalence of malnutrition among children admitted with acute diarrheal diseases at the Primary health Centers at Cox's Bazar. Methodology: This cross-sectional study was conducted among the diarrhea affected under-5 Rohingya children who reported to primary health centers at cox's bazar. The study was conducted from January to December 2018. Primary caregiver of 276 respondents were interviewed, their hospital records were reviewed. Data were collected by face-toface interview using a semi-structured questionnaire. Results: The majority (60.1%) of the participants were male. Only 2.9% of the participants reported passing of macroscopic blood in stool. Oral Rehydration Solution (ORS) was not taken by most of the participants (50.7%), prior to visit to the hospital. The mean (±SD) age was 18.54 (±12.44) months. Among the participants, 14.1% had severe underweight (<-3 WAZ score) and 27.2% had moderate underweight (-3 to <-2 WAZ score). No death was reported, and 97.1% were discharged with advice from the hospital. Statistically significant relationship was found between age of the participants and underweight (p<0.05) with a Moderate effect size (Φ=.21). Conclusion: The study findings would be helpful to identify the need for raising awareness among Rohingya caregiver and help healthcare providers to become more cautious in treating diarrheal patients. [ABSTRACT FROM AUTHOR]

Antimicrobial resistance (AMR) is a significant public health issue in Bangladesh like many other developing countries where data on resistance trends are scarce. Moreover, the existence of multidrug-resistant (MDR) Escherichia coli exerts an ominous effect on the poultry sector. Therefore, the current systematic review, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, was conducted to find out the AMR scenarios in E. coli isolates sourced from poultry and poultry environments in Bangladesh between 2010 and 2021. Following the PRISMA guidelines, a total of 17 published scientific articles were selected for this systematic review. This review revealed that 18 out of 64 districts in Bangladesh reported E. coli in poultry, having a higher prevalence (combined prevalence: 69.3%, 95% confidence interval, CI: 67.3-71%). Moreover, the prevalence ranged from 24.3% to 100%. This review found that E. coli isolates showed resistance to 14 antimicrobial classes and 45 different antimicrobial agents, including the last-line (reserve group) antibiotics and banned antimicrobial categories for the treatment of infections in agricultural animals. Phenotypic resistance of E. coli against penicillins and beta-lactamase inhibitors (20.2%-100%), cephalosporins (1.9%-100%), fluoroquinolones (5.98%-100%), aminoglycosides (6%-100%), tetracyclines (17.7%-100%), carbapenems (13.6%-72.7%), macrolides (11.8%-100%), polymyxins (7.9%-100%), phenicols (20%-97.2%), sulfa drugs (44.7%-100%), cephamycins (21.4%-48.8%), nitrofurans (21.4%-63.2%), monobactams (1.2%), and glycylcyclines (2.3%) was recorded in the last decades in Bangladesh. Also, 14 articles reported MDR E. coli in poultry, including a 100% MDR in nine articles and a 92.7% (95% CI: 91.2-94%) combined percentage of MDR E. coli isolates. Twenty-four different AMR genes encoding resistance to beta-lactams (blaTEM, blaCTX-M-1, blaCTX-M-2, blaCTX-M-9, blaOXA-1, blaOXA-47, blaSHV, and CITM), colistin (mcr1 and mcr3), fluoroquinolones (qnrB and qnrS), tetracyclines (tetA, tetB, and tetC), sulfonamides (sulI and sulII), trimethoprim (dfrA1), aminoglycosides (rmtB), streptomycin (aadA1), gentamicin (aac-3-IV), erythromycin (ereA), and chloramphenicol (catA1 and cmlA) were detected in E. coli isolates. The presence of MDR E. coli and their corresponding resistance genes in poultry and poultry environments is an alarming issue for all health communities in Bangladesh. We suggest a regular antimicrobial surveillance program with a strong One Health approach to lessen the hazardous effects of AMR E. coli in poultry industries in Bangladesh. [ABSTRACT FROM AUTHOR]

Healthcare workers have been affected both physically and mentally during the COVID-19 pandemic. This study aimed to investigate the impacts of COVID-19 on the mental health and sexual behaviour of male physicians working during the pandemic. A survey was carried out on male physicians working in Turkey during the pandemic. Participants' sexual behaviours, anxiety symptoms, and depressive symptoms were assessed. The frequency of anxiety and depressive symptoms was 55.9% and 44.1%, respectively. Among the 102 participants, 35.3% reported decreased sexual desire, and 41.2% reported decreased sexual intercourse. Working more, caring for COVID-19 patients, having higher scores for anxiety and depressive symptoms were related to changes in sexual behaviour. High prevalences of anxiety and depressive symptoms and sexual behaviour changes were found among male physicians during the COVID-19 pandemic. This study points out the importance of psychosocial support in health professionals during the pandemic period. [ABSTRACT FROM AUTHOR]

Background Three-quarters of births in Indonesia occur in a health facility, yet the neonatal mortality rate remains high at 15 per 1000 live births. The Pathway to Survival (P-to-S) framework of steps needed to return sick neonates and young children to health focuses on caregiver recognition of and care-seeking for severe illness. In view of increased institutional delivery in Indonesia and other low- and middle-income countries, a modified P-to-S is needed to assess the role of maternal complications in neonatal survival. Methods We conducted a retrospective cross-sectional verbal and social autopsy study of all neonatal deaths from June through December 2018, identified by a proven listing method in two districts of Java, Indonesia. We examined care-seeking for maternal complications, delivery place, and place and timing of neonatal illness onset and death. Results The fatal illnesses of 189/259 (73%) neonates began in their delivery facility (DF), 114/189 (60%) of whom died before discharge. Mothers whose neonate's illness started at their delivery hospital and lower-level DF were more than six times (odds ratio (OR)=6.5; 95% confidence interval (CI)=3.4-12.5) and twice (OR=2.0; 95% CI=1.01-4.02) as likely to experience a maternal complication as those whose neonates fell fatally ill in the community, and illness started earlier (mean=0.3 vs 3.6 days; P<0.001) and death came sooner (3.5 vs 5.3 days; P=0.06) to neonates whose illness started at any DF. Despite going to the same number of providers/facilities, women with a labour and delivery (L/D) complication who sought care from at least one other provider or facility on route to their DF took longer than those without a complication to reach their DF (median= 3.3 vs 1.3 hours; P=0.01). Conclusions Neonates' fatal illness onset in their DF was strongly associated with maternal complications. Mothers with a L/D complication experienced delays in reaching their DF, and nearly half the neonatal deaths occurred in association with a complication, suggesting that mothers with complications first seeking care at a hospital providing emergency maternal and neonatal care might have prevented some deaths. A modified P-to-S highlights the importance of rapid access to quality institutional delivery care in settings where many births occur in facilities and/or there is good care-seeking for L/D complications. [ABSTRACT FROM AUTHOR]

Adolescent mothers face numerous challenges. This study aimed to address the operationalisation of the new South African national policy for young mothers by testing the associations of potential protective provisions with three policy goals: School return, grade promotion, and pregnancy/HIV prevention. Adolescent mothers aged 12–24 from rural and urban communities of South Africa's Eastern Cape completed study questionnaires between 2017–2019. Using multivariate multi-level analysis, we simultaneously estimated associations between hypothesized provisions and protective variables and all policy-aligned goals. School return was associated with using formal childcare services, higher confidence and self-efficacy scores, and remaining in school throughout pregnancy. Grade promotion was associated with greater exposure to friendly and respectful health staff, using formal childcare services, higher confidence and self-efficacy scores, and remaining in school throughout pregnancy. Pregnancy/HIV prevention (condom use) was moderately associated with greater exposure to friendly and respectful health staff. There was evidence of synergies of provisions whereby a combination of protective characteristics showed larger positive effects than receipt of any single factor alone. This study provides essential evidence for operationalising South Africa's new policy on the Prevention and Management of Learner Pregnancy in Schools, and points to implementation strategies that provide low-cost opportunities to promote educational and health outcomes for adolescent mothers. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to determine the effect of a lifestyle training package that consisted of a 60‐ to 90‐min session of group training, educational booklet and text messages on physical activity and nutritional status in obese and overweight pregnant women. Methods: In this randomized controlled trial, 140 obese or overweight women (gestational age: 16–20 weeks) covered by health centres in Tehran, Iran, were equally randomized into two parallel groups using block randomization and stratified by the body mass index. Participants completed the Food Frequency Questionnaire and International Physical Activity Questionnaire at baseline and fourth and eighth weeks after intervention. Participants were 38 obese and 102 overweight women who were later followed‐up. Results: After the intervention, the mean weekly intake of the vegetable and fruit subgroups was significantly higher; and intake of fats and oils and the confections subgroups were significantly lower in the intervention compared with the control group (p < 0.05). Although physical activity was higher in the intervention group, 8 weeks after the intervention, this difference was not statistically significant (p > 0.05). Conclusions: The training package appears to offer a suitable strategy for adjusting the intake of the recommended food subgroups in obese and overweight pregnant women. Summary statement: What is already known about this topic? Many studies have demonstrated the positive correlation between women's obesity and overweight and the increased risk of adverse maternal and neonatal outcomes.Obese and overweight pregnant women require specific planning to regulate their gestational weight gain and improve their nutritional quality. What this paper adds? The lifestyle training package consisted of a 60‐ to 90‐min session of group training, educational booklet and text messages. The package significantly improved the intake of the vegetable and fruit subgroups and significantly decreased the intake of the fats and oils and confections subgroups in obese and overweight pregnant women. The implications of this paper: Appropriate and simple training packages about proper nutrition and physical activity should be provided to obese and overweight pregnant women to decease pregnancy complications and enhance their quality of life. [ABSTRACT FROM AUTHOR]

The media, which is a potent social system, has a significant impact on how people see reality. The idea that, in a broader cultural sense, the media mostly supported those values and standards that had already attained a broad consensus base, proved to be significant. People in Bangladesh's southwest use a variety of media to gather information. The objective of the study is to find out the pattern of media user in the southwestern part of Bangladesh. Uses and Gratification theory is used here, and a quantitative survey research design were used for this research. The study area includes the four districts of Bangladesh-Khulna, Jashore, Satkhira, and Bagerhat. Purposive and snowball sampling is used for this study. A standardized questionnaire was used to collect the data. Then the collected data are entered into the descriptive statistics module of SPSS using tools like tables, frequency counts, and simple. People in Bangladesh's southern region continue to consider that traditional media, such as television and newspapers, are more trustworthy information sources than social media or online portal. Due to their ample free time, the majority of adults consume media in the evening. Although it appears on the surface that the majority of people in Bangladesh's southern region utilize media for enjoyment, the reality is quite different. Major respondents concur that they are impacted by media. They think that biased information has been provided by the media. Also, according to the data, majority believes that local media coverage is insufficient. [ABSTRACT FROM AUTHOR]

Simple Summary: Fertility-sparing treatment for young women with endometrial atypical hyperplasia or endometrioid endometrial cancer has become an important priority. The aim of our retrospective study was to evaluate the effects of different weight statuses and related metabolic disorders on the oncological and reproductive outcomes of fertility-sparing treatment. We found that there was a parabola-shaped relationship between the cumulative complete response rate of treatment and BMI. The apex of the curve was observed at a BMI of 21–22 kg/m2. Furthermore, we demonstrated that hyperuricemia was an independent risk factor for the failure of conservative treatment, correlating with a lower cumulative 32-week CR rate and longer treatment duration. Our results indicate that a target BMI interval for weight management should be appropriately established for patients with EAH/EEC. Early active interventions for related metabolic disorders, preferably before 32 weeks of treatment, should be provided to improve treatment efficacy. Background: Although obesity was an independent risk factor for fertility-sparing treatment in endometrial atypical hyperplasia (EAH) and endometrioid endometrial cancer (EEC), the roles of other weight statuses and related metabolism were unclear. This study aimed to investigate the body mass index (BMI) interval that produced optimal treatment efficacy and the effects of related metabolic disorders in EAH/EEC patients. Methods: A total of 286 patients (including 209 EAH and 77 well-differentiated EEC) under progestin therapy were retrospectively analyzed. The cumulative complete response (CR) rate, relapse rate, and fertility outcomes were compared among different weight or metabolic statuses. Results: Underweight and overweight/obese status significantly decreased the cumulative 16-week and 32-week CR rate (p = 0.004, p = 0.022, respectively). The highest 16-week CR rate was observed at a BMI of 21–22 kg/m2 in the overall population (p = 0.033). Obesity (HR 0.37, 95%CI 0.15–0.90, p = 0.029) and PCOS (HR 0.55, 95%CI 0.31–0.99, p = 0.047) were associated with lower 16-week CR rate. Hyperuricemia (HR 0.66, 95%CI 0.45–0.99, p = 0.043) was associated with lower 32-week CR rate. The 16-week and 32-week CR rate (p = 0.036, p = 0.008, respectively) were significantly lower in patients exhibiting both obesity and hyperuricemia. Conclusions: The optimal fertility-sparing treatment efficacy was observed at a BMI of 21–22 kg/m2 in EAH/EEC. Hyperuricemia was an independent risk factor for long-term treatment outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Ultrasound estimated fetal weight (EFW) is a vital part of prenatal care. We aimed to determine the accuracy of sonographic EFW at a regional Australian hospital, explore factors associated with EFW accuracy and review accuracy calculation methods. Methods: Ultrasound EFW (Hadlock C) was calculated within one week of a live delivery, for 357 singleton pregnancies. EFW accuracy, the difference between EFW, and live birthweight (LBW), were quantified using percentage error (PE); absolute error (AE); 'signed' error and AE ≤10% of LBW. Results: Estimations of accuracy varied by calculation method, with PE smaller (mean 2.3% [CI 1.5, 3.1], median PE 2.4% [IQR −3.4, 6.7]) than AE (mean 6.4% [CI 5.9, 6.9], median AE 5.1% [IQR 2.7, 9.0]). Signed error indicated the majority of EFWs were overestimates and 80.1% of EFW calculations had an AE within 10% of LBW. EFW inaccuracy (AE ≥10% of LBW) varied between sonographers (p =.023) and scan to delivery interval (p =.003). Conclusions: EFW accuracy rates at the regional hospital were similar to published error rates. EFW accuracy varied with sonographer and with time from scan to delivery. Absolute error provides more useful and comparable information than percentage error of EFW. [ABSTRACT FROM AUTHOR]

Mobility among sex workers has been linked not only to improved economic and social opportunities, but also to concerns regarding displacement, criminalization, and violence. In 2014, new "end-demand" legislation criminalized new aspects of sex work in Canada (e.g., third-party advertising, purchasing) while leaving the sale of sex legal. Utilizing data from a longitudinal community-based cohort of women sex workers in Metro Vancouver (An Evaluation of Sex Workers Health Access [AESHA], 2010-2016), we used kernel density mapping to understand and identify geographic patterns of workplace neighborhood mobility (i.e., changing the primary neighborhood in which one worked in the last 6 months); multivariable logistic regression using generalized estimating equations was also used to model contextual (policing, violence, and safety) and individual correlates of workplace mobility among sex workers over the 6-year period, including potential changes in mobility patterns pre- and post-end-demand criminalization. A total of 543 sex workers were included in analyses, contributing 2,199 observations. A total of 402 (74.0%) experienced workplace neighborhood mobility during the study period. Neighborhood mobility was negatively correlated with age (adjusted odds ratio [AOR] = 0.98/year older, 95% confidence interval [CI] = [0.97, 0.99]) and positively correlated with homelessness (AOR = 1.43, 95% CI = [1.12, 1.82]), identifying as a gender/sexual minority (AOR = 1.31, 95% CI = [1.04, 1.70]), and servicing clients primarily outdoors (vs. informal indoor or in-call venues; AOR = 1.48, 95% CI = [1.21, 1.81]); police harassment (AOR = 1.19, 95% CI = [0.96, 1.48], p =.11) and changing one's neighborhood of work due to safety concerns (AOR = 1.37, 95% CI = [0.94, 2.00], p =.09) were both marginally correlated. Steps to promote safer working conditions for marginalized women in urban environments remain urgently needed, including shifts away from criminalized enforcement toward community-led initiatives and promoting access to safer indoor workspaces. [ABSTRACT FROM AUTHOR]

Purpose: To determine cultural competence of health care workers on maternal health care service utilization among mothers of Mt. Elgon Constituency in Bungoma County. Methodology: A descriptive-analytical cross-sectional study design was adopted using mixed methods for data collection. Cultural competence tool was used to assess health care workers cultural competence. Qualitative data was collected using key informant interviews (KII) and focus group discussion (FGD). Data entry and analysis was done using SPSS Version 25 software. Descriptive and inferential statistical analyses were used. Bivariate and multivariate logistic regressions were applied and odds ratio used to determine the strength of association. A p-value of = 0.05 was considered as statistical significance threshold. Findings: Unemployment (OR: 0.6; 95% CI: 0.4 - 0.9; p = 0.02); lack of mobile clinic (OR: 0.7; 95% CI: 0.4 - 1.0; p = 0.06); use of interpreter (OR: 0.2; 95% CI: 0.01 - 0.81; p = 0.02); service provided in public facilities (OR: 0.5; 95% CI: 0.3 - 0.8; p = 0.004); being too busy (OR: 0.5; 95% CI: 0.3 - 0.9; p = 0.02); consulting health care workers (OR: 0.5; 95% CI: 0.2 - 0.9; p = 0.03); not consulting elders (OR: 0.7; 95% CI: 0.4 - 1.0; p = 0.08) and culturally incompetent (100%) were significantly associated with utilization of maternal and child health services. The determinants of maternal health care service utilization in Mt. Elgon Sub-County are women who are employed (OR: 2.8; 95% CI: 1.1 - 7.3; p=0.03) and cultural incompetence of health care workers (100%). A unique contribution to theory, practice, and policy: The study findings have identified cultural competence gaps among health care workers which need to be addressed by policy makers to increase utilization in the study area and other similar environment. [ABSTRACT FROM AUTHOR]

Violence against women has been treated as a global epidemic and not uncommon in Bangladesh like in many other low-income countries. The occurrence of domestic violence against women (DVAW) in the urban slums of Bangladesh is not well documented. There is also scarce evidence regarding the factors contributing to DVAW. Hence, the aim of this study was to investigate DVAW in the urban slums and its associated factors in Chittagong, Bangladesh. A cross-sectional survey was conducted among 87 women of reproductive age having at least one child below 5 years of age and staying with their husband for at least last 1 year in selected slums under Chittagong City Corporation area. Structured questionnaire was used to interview the study participants. The data underwent descriptive and regression analysis. Of 87 respondents, 50 (57.5%) reported to suffer from domestic violence by their husband during the last 1 year. Physical violence was found to be significantly associated with age at marriage (p =.043), number of family members (p =.027), and wealth index (p =.000). DVAW is highly prevalent in Bangladesh. More extensive research should be performed to identify the factors contributing to the high prevalence of domestic violence in urban slums of Bangladesh. Household-based intervention incorporating effective community participation, education, and counseling is needed to limit this burning problem. [ABSTRACT FROM AUTHOR]

BACKGROUND Teen pregnancy continues to burden families, communities, and society. Programs continue to educate and impower youth and young adults to make positive behavioral decisions. METHODS: We evaluated a program aimed at high‐risk youth in after‐school programs. The goal of the program was to instill a sense of community and empathy, as well as sexual health decision‐making. The evaluation was a multiyear evaluation from external evaluators. RESULTS: There were statistically significant changes in empathy toward others in the community and a feeling of safety at school. Other positive changes noted were that students felt empowered to use condoms, other barriers, or birth control in the future when having sexual relations. The program noted a positive direction in students feeling they develop plans or goals and stick to them. CONCLUSIONS: These programs serve to instill a sense of empowerment, community, and responsibility in students. Evaluation data can serve as a metric of the merit of these programs and the impact on school health programs and communities. [ABSTRACT FROM AUTHOR]

Background: Studies analyzing the association between parity and normal-weight metabolic syndrome (MetS) in postmenopausal women of normal weight remain limited, this study aimed to explore the association between parity and MetS among Chinese normal-weight postmenopausal women. Methods: In total, 776 normal-weight undiagnosed type 2 diabetes postmenopausal women who visited the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University for a routine health check-up between 1 January 2017 and 31 December 2019 were included in the cross-sectional study. All individuals had fully completed information records encompassing standardized electronic medical records, physical examinations, and biochemical measurements. Metabolic health was defined as fewer than 2 parameters of the MetS were present, in combination with normal weight. Continuous variables which were normally distributed were expressed as means and standard deviation. Comparisons among normally distributed continuous variables were made using one-way ANOVA while that among non-normal distribution parameters were made using Kruskal-Wallis. The association between parity and MetS was analyzed using multivariate logistic regression. All of the analyses were performed with SPSS statistical software (Version 23.0, SPSS, Inc., Chicago, IL, USA) and the statistical software package EmpowerStats (http://www.empowerstats.com, X&Y Solutions, Inc., Boston, MA). Results: After adjusting for potential confounding factors including hip circumference, parity was failed to show a significantly relationship with MetS in normal-weight women(P=0.054). Women with a higher parity (≥3) had an increased OR of abdominal obesity, while the OR (95% CI) of the parity 3 group was 2.06 (1.13, 3.77) and that of the parity ≥4 group was 3.08(1.42, 6.66) the P for trend was 0.002 after adjusting for potential confounding factors. No significant differences were detected for other metabolic disorders including high levels of triglycerides (TG), blood pressure, fasting plasma glucose (FPG), and decreased high-density lipoprotein cholesterol (HDL-C) in different parity groups. Conclusions: Higher parity was not associated with a higher risk of MetS in normal weight Chinese postmenopausal women. As for the components of MetS, only waist circumference was associated with multiparity even after controlling for hip circumference. [ABSTRACT FROM AUTHOR]

Community managed Village Common Forest (VCF) in Chittagong Hill Tracts (CHTs) in Bangladesh is an example of sustainable forest management under non-governmental customary rules and regulations. This study explored the diversity of medicinal plants and their therapeutic uses by ethnic communities at two VCFs in Rangamati hill district. A total of 30 square plots of 10 m × 10 m size was selected by stratified random sampling from the two VCFs. All medicinal plants of different habits were recorded to calculate phytosociological attributes and diversity indices. A semi-structured questionnaire was used to survey the community and local herbalists to list the ethno-medicinal uses of available plant species. A total 204 species belonging to 160 genera and 76 families used by the communities in CHTs for treating about 197 diseases/ailments were recorded. Leaves were the most used part (145 species) followed by roots (119 species) and stem (53 species). In terms of habit form, herbs were the highest percentage (44%) followed by trees (26%) and shrubs (16%). The diversity indices indicated the presence of diverse medicinal plants. [ABSTRACT FROM AUTHOR]

Introduction: Anemia in pregnancy is one of the most common widespread public health problems in the world and it remains as emerging problem in the developing countries and is an important indicator for maternal mortality and morbidity in the Middle East. Objective: This study aimed to determine the level of compliance with iron supplementation and its determinants among pregnant women. Methods: The study adopted a descriptive cross-sectional research design. Noronha compliance questionnaire was used to determine the level of compliance to iron supplementation and its determinants. One hundred and sixty five Omani pregnant women of 20 weeks of gestation and above visiting antenatal outpatient department were the participants of the study. Descriptive and inferential statistics were used to analyze the data. Results: The results showed that 72.7% of the women were compliant and 27.3% of them were non-compliant to iron supplementation. A chi-square test showed that there was a significant relationship between side effect and non-compliance to iron supplementation X2 (1, N=165)=6.53, P < 0.05. Results of Logistic regression analysis showed that side effects of iron supplementation significantly predicted the non-compliance to iron supplementation b=-1.76, Wald X2 (165)= 8.36, P < 0.05. Conclusion: Increasing awareness among the pregnant women on the importance of iron supplementation during pregnancy is essential to expect desirable outcomes in both the mother and the newborn. [ABSTRACT FROM AUTHOR]

Purpose: To assess the efficacy and safety of F-100, diluted F-100 (F100D), and infant formula (IF) for dietary management in the rehabilitation phase of severe acute malnutrition (SAM) of infants aged under 6 months (u6m). Methods: Double-blind randomized clinical trial was conducted to assess the efficacy and safety of F-100, F-100D, and IF at the Nutrition Rehabilitation Unit, icddr,b. Infants (n = 153) u6m with SAM were enrolled and randomly assigned to any of the three diets after stabilization. Two ml blood was collected on study days 1, 3, and 7 for measuring serum electrolytes, creatinine and osmolality, urine samples for specific gravity and osmolality creatinine ratio. Renal Solute Load (RSL) and Potential Renal Solute Load (PRSL) were calculated. Infants were discharged when gained 15% of the admission bodyweight or had edema-free weight-for-length Z-score ≥ − 2. Results: Infants fed F-100 and F-100D had higher weight gain than infants who received IF. Mean difference between F-100 and IF was 4.6 g/kg/d (95% CI 1.5–7.6, P = 0.004) and between F-100D and IF was 3.1 g/kg/d (95% CI 0.6–5.5, P = 0.015). Total energy intake from study diet and breast milk was significantly higher in infants fed F-100 compared with other two diets (P = 0.001 in each case). RSL was highest in infants fed F-100 but serum sodium showed no sign of elevation. Urinary specific gravity and serum sodium values were within normal range. Conclusions: F-100 can be safely used in the rehabilitation phase for infants u6m with SAM and there is no need to prepare alternative formulations. [ABSTRACT FROM AUTHOR]

Background: The in vivo anticancer effect of the Trema orientalis leaves crude methanol extract (TLME) was screened against Ehrlich ascites carcinoma (EAC) in Swiss albino mice. Materials and methods: The cytotoxic activity of TLME was determined in vitro by the 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2H-tetrazolium bromide (MTT) assay. The growth inhibitory activity and morphological alterations were determined by the hemocytometer counting of the EAC cells using trypan blue dye. The apoptotic cells were assessed by DAPI (4′,6-diamidino-2-phenylindole) staining. The hematological and biochemical parameters of experimental mice were also estimated. Results: After treatment with the TLME, the viable tumor cell count, morphological changes and nuclear damages of the EAC cells were observed along with the hematological parameters of the experimental mice. The LD50 of TLME was 3120.650 mg/kg body weight, and this extract was proven to be safe at a dose of as high as 800 mg/kg body weight. The oral administration of the TLME at 400 mg/kg body weight resulted in approximately 59% tumor cell growth inhibition compared with the control mice, with considerable apoptotic features, including membrane blebbing, chromatin condensation, nuclear fragmentation and aggregation of the apoptotic bodies in DAPI staining under a fluorescence microscope. The TLME also dose-dependently restored the altered hematological parameters to approximately normal levels. The TLME exhibited bolstering cytotoxic effect against the EAC cell with the IC50 value of 29.952 ± 1.816 μg/mL. Conclusion: The TLME has potential as a natural anti-cancer product with apoptosis induction property and cytotoxicity against carcinoma cells. [ABSTRACT FROM AUTHOR]

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The purpose of this study was to investigate the effects of body mass index(BMI) on insulin. fasting blood sugar(FBS), and hemoglobin A1c(HbA1c). This study analyzed the data of 2015, The Sixth KNHANES, and it was included to 4554 subject over 20 years old. Data were analyzed using descriptive statistics, t-test, ANOVA, Pearson correlation coefficient and stepwise multiple regression analysis(SPSS 25.0). The major findings, BMI was positively correlated with insulin(r=0.397, p<0.001), FBS(r=0.241, p<0.001), and HbA1c(r=0.237, p<0.001). Factors affecting insulin are overweight(β=.130, t=8.193, p<0.001), obesity(β=.390, t=24.390, p<0.001) and age. the explanatory power is 13.1% (F=53.584, p<0.001). Factors affecting FBS were overweight(β=.072, t=4.478, p<0.001), obesity(β=.186, t= 11.485, p<0.001), age, the explanatory power was 10.6% (F=42.351, p<0.001). Factors affecting HbA1c were overweight(β=.059, t=3.712, p<0.001), obesity(β=.190, t=11.895, p<0.001) age and sex, the explanatory power is 14.1% (F=58.134, p<0.001). Based on this study result, diabetes mellitus prevention and management programs should include interventions related to obesity. [ABSTRACT FROM AUTHOR]

There is no reliable and valid psychometric measure in Bangladesh to assist mental health and relevant professionals to assess the presence and severity of symptoms of schizophrenic patients as regularly used in developed countries. Hence two widely used measures, SAPS (34-items) and SANS (25-items) had been tested with a Bangladeshi sample to determine their psychometric properties. Factor analysis, reliability and validity had been tested for the measures on 170 patients (Mean age= 28.10 years; SD= 10.04). A two factors (positive and negative) model for the total nine global items using exploratory factor analysis were identified. Both measures showed high internal consistency and all items were significantly correlated with each other and total scores of the measures. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to map end-of-life care in acute hospital settings against Elements 1–5 of the Australian Commission on Safety and Quality in Health Care's (ACSQHC) Essential Elements for Safe and High-Quality End-of-Life Care. Methods: A retrospective medical record audit of deceased in-patients was conducted from 2016 at one public (n = 320) and one private (n = 132) hospital in Melbourne, Australia. Ten variables, key to end-of-life care according to the ACSQHC's Elements 1–5 were used to evaluate end-of-life care. Results: Most patients (87.2%) had a limitation of medical treatment. In 91.97% (P < 0.0001) of cases, a written entry indicating poor prognosis preceded a documented decision to provide end-of-life care, with a documented decision noted in 81.1% of cases (P < 0.0001). Evidence of pastoral care involvement was found in 41.6% of cases (P < 0.0001), with only 33.1% of non-palliative care patients referred to specialist palliative care personnel (P = 0.059). An end-of-life care pathway was used in 51.1% of cases (P < 0.0001). Conclusion: There is clear scope for improvement in end-of-life care provision. Health services need to mandate and operationalise Elements 1–5 of the ACSQHC's Essential Elements into care systems and processes, and ensure nationally consistent, high-quality end-of-life care. What is known about the topic?: Acute care settings provide the majority of end-of-life care. Despite the ACSQHC's Ten Essential Elements, little is known about whether current end-of-life care practices align with recommendations. What does this paper add?: There is room for improvement in providing patient-centred care, increasing family involvement and teamwork, describing and enacting goals of care and using triggers to prompt care. Differences between public and private hospitals may be the result of differences in standard practice or policy and differences in cultural diversity. What are the implications for practitioners?: The Essential Elements need to be mandated and operationalised into mainstream care systems and processes as a way of ensuring safe and high-quality end-of-life care. [ABSTRACT FROM AUTHOR]

Purpose: Balancing medications that are needed and beneficial and avoiding medications that may be harmful is important to prevent drug-related problems, and improve quality of life. The aim of this study is to describe medication use, the prevalence of deprescribing of medications suitable for deprescribing, and the prevalence of new initiation of potentially inappropriate medications (PIMs) in nursing home (NH) residents with life-limiting disease in Flanders. Methods: NH residents aged ≥ 65, suffering from end stage organ failure, advanced cancer, and/or dementia (n = 296), were included in this cross-sectional study with retrospective analyses of medication use at the time of data collection (t2) and 3 to 6 months before (t1). The appraisal of appropriateness of medications was done using a list of medications documented as suitable for deprescribing, and STOPPFrail criteria. Results: Residents' (mean age 86 years, 74% female) mean number of chronic medications increased from 7.4 (t1) to 7.9 (t2). In 31% of those using medications suitable for deprescribing, at least one medication was actually deprescribed. In 30% at least one PIM from the group of selected PIMs was newly initiated. In the subgroup (n = 76) for whom deprescribing was observed, deprescribing was associated with less new initiations of PIMs (r = − 0.234, p = 0.042). Conclusion: Medication use remained high at the end of life for NH residents with life-limiting disease, and deprescribing was limited. However, in the subgroup of 76 residents for whom deprescribing was observed, less new PIMs were initiated. [ABSTRACT FROM AUTHOR]

Background: The cultivated banana and plantain (Musa spp.) are valuable for nutritional and socio-economic security for millions of people worldwide. In Benin, banana and plantain are among the most produced, consumed, and traded commodities. Its production is mainly for local consumption and remains insufficient to the demand. However, the varietal diversity of banana and plantain cultivated in Benin is not documented. This study aims at characterizing the banana and plantain cropping systems, genetic diversity, and production constraints as a baseline to the full utilization of this resource in crop improvement and to identify the potential production and agronomic qualities. Methods: A baseline investigation of ethnobotanical attributes of banana cultivars was done in 51 randomly chosen villages in southern Benin. Interviews with randomly selected representative farmers were carried out. Key informant interviews and focus group discussions were used for global confirmatory investigation of survey data. Socio-demographic data and indigenous knowledge on the farmer uses of banana and plantain diversity, such as cultural practices, origin, and availability of banana and plantain planting materials, and the constraints and criteria of varietal preference cited by farmers were ranked. Results: Eighty-seven locally recognized cultivars were found: 73 of banana and 14 of plantain groups. The most popular cultivars were Sotoumon (banana) (52.94%), Aloga (plantain) (41.17%), Planta (banana) (33.33%), and Adjangan (plantain) (27.45%). Of the eleven production constraints identified, the main biotic challenges were banana weevil Cosmopolites sordidus Germar and banana bunchy top virus (BBTV), while abiotic problems were drought and the wind. Some local varieties like Amandan, Assonwonnou, Coleti, and Ninkouin are extremely rare owing to agronomic and economic preference perceptions. Conclusion and implications: This study provides a baseline for banana diversity in Benin and the West African region and entry points for biological characterization and production improvement. This would enable the exploitation of this resource for plant breeding towards biotic and abiotic challenges facing banana production. [ABSTRACT FROM AUTHOR]

Abstract: We aimed to determine the prevalence and importance of fear of cancer progression (FoP) in melanoma patients with stage IA tumours to assess psychosocial and demographic factors associated with severity of FoP and to determine the relationship of FoP and quality of life (QoL). One hundred and thirty‐six patients with stage IA melanoma completed the short version of the Fear of Progression Questionnaire (FoP‐Q‐SF), the Hospital Anxiety and Depression Scale (HADS) and the EORTC‐QLQ‐C30. We found a mean FoP‐Q‐SF sum score of 30.2 points (±8.4 points SD). In this study, 33% of patients reported high FoP at or above the cutoff‐value of 34 points. Higher FoP was found in women (p < 0.01), young (p = 0.03) and employed (p = 0.02) patients. Being confronted with a cancer diagnosis in closely related persons predicted higher FoP (p < 0.01). FoP correlated positively with the HADS anxiety (r = 0.50, p < 0.01) and depression scales (r = 0.26, p < 0.01) and negatively with the EORTC‐QLQ‐C30 global health state (r = −0.32, p < 0.01). FoP is considerably prevalent in low‐risk melanoma patients and associated with reduced QoL, cancer in related persons, women sex and participation in working life. Considerably high levels of FoP, even in patients with low‐risk malignancies, underline the need for psychosocial support and psychotherapeutic interventions for melanoma patients. [ABSTRACT FROM AUTHOR]

We explored the relationship between unmet care needs, health status, health utility and costs in people treated for melanoma via a cross‐sectional follow‐up survey (N = 455) 3 months to 5 years after complete resection of stage I–III cutaneous malignant melanoma. 51% (n = 232) had unmet care needs. This group had higher mean resource use, estimated conservatively (£28 vs. £10 per person) and worse overall health. Mean health‐related utility index (AQoL6D) was 0.763 (95% CI 0.74; 0.79) in those with self‐reported unmet need vs. 0.903 (0.89; 0.92) in those with no unmet need. Melanoma survivors with unmet need had worse outcomes in terms of anxiety (HADS 6.86 vs. 4.29), depression (HADS 4.29 vs. 2.01), overall quality of life (QoL: FACT‐M 84.2 vs. 96.5). Higher resource use was associated with younger age (rs = −.29, p < .001), older school‐leaving age (rs = .21, p < .001), reduced health utility (rs = −.14, p = .005), higher anxiety (rs = .22, p < .001), higher depression (rs = .16, p = .001) and lower QoL (overall rs = −.24, p < .001; melanoma QoL rs = −.20, p < .001; surgery QoL rs = −.19, p < .001). Lower health outcomes indicate increased service use, suggesting that interventions to address unmet need and improve health outcomes may reduce health costs. Integrated clinical and economic evaluations of interventions that target unmet need in melanoma survivors are required. [ABSTRACT FROM AUTHOR]

Background Population-based studies have found that early language delays are associated with poorer long-term outcomes in adolescence and adulthood. Few studies have explored the influence of change in language ability over time on adult outcomes. Aim To examine the educational, vocational and mental health outcomes for adults accounting for different vocabulary developmental profiles over a 16-year period. Methods & Procedures A total of 1914 participants of the Mater-University of Queensland Study of Pregnancy (MUSP) were categorized into four groups based on their vocabulary skills at 5 and 21 years: (1) persistently good ( n = 1679), (2) persistently poor ( n = 33), (3) improved ( n = 160), and (4) deteriorated ( n = 42). The associations between vocabulary group and educational, vocational, and mental health outcomes at 21 years were investigated. Outcomes & Results Adults with deteriorated and persistently poor vocabulary skills were less likely to have completed secondary school; with the improved, deteriorated and persistently poor groups being less likely to be engaged in education, employment or training at the 21-year follow-up, compared with the persistently good group. Adults with deteriorated performance were at an increased risk of affective disorders, as well as substance and alcohol abuse/misuse. Conclusions & Implications These findings provide evidence that impaired vocabulary skills in adulthood, regardless of whether the deficit was acquired early or later, are associated with adverse outcomes. Clinicians and educators need to be aware of these adversities and ensure they are supporting children and adolescents in whom language difficulties exist or emerge so as to prevent poor long-term outcomes from occurring. [ABSTRACT FROM AUTHOR]

A study was conducted in the greater Houston area in the United States with 1840 Asian American participants where 413 (22.5%) were 55 years and older and 12.6 percent had depressive symptoms. Logistic regression analysis found that the likelihood of being depressed was significantly increased among individuals with anxiety symptoms (odds ratio (OR) = 769.36), at least a high school education (OR = 21.756), a greater number of generations living in the household (OR = 3.789), and chronic pain (OR = 2.604). Conversely, being married reduced the likelihood of being depressed by 89.5 percent (OR = .105). Implications focus on help-seeking behaviors of older Asian Americans in relation to their mental health needs. [ABSTRACT FROM AUTHOR]

The first two years of life are critical for growth and development. Little is known about infant and young child feeding (IYCF) practices in the Ecuadorian highlands and how they contribute to stunting. With the objective of understanding nutritional status and the influencing factors to design an intervention, we assessed the nutritional status of 293 infants and children between 0 and 24 months of age, living in 14 communities in the provinces of Tungurahua and Chimborazo using a cross-sectional study design. We used the WHO IYCF indicators to assess feeding practices; estimated dietary intake with 24-h recalls; and identified nutritious local foods by food frequency questionnaires. Multiple regression modelling was performed to identify correlates of nutritional status. Stunting was found in 56.2% of children. Mean protein, vitamin A and vitamin C intakes were above recommendations for all ages. Only infants 6.0 to 8.9 months of age and non-breastfed children 12-23.9 months of age consumed energy intakes below recommendations. Younger age groups had below recommended intakes for iron and calcium. While mean complementary food densities met recommendations for protein, vitamin A, vitamin C and energy, those for zinc, iron and calcium were lower than recommended. Older age, respiratory infections and being male were predictors of lower HAZ, whereas early initiation of breastfeeding, higher socioeconomic status, consumption of iron-rich foods and higher dietary protein density were protective. Interventions that promote and support optimal breastfeeding practices and enable increased consumption of nutritious local foods have potential to contribute to reducing stunting in this vulnerable population. © 2016 John Wiley & Sons Ltd [ABSTRACT FROM AUTHOR]

Background: Medicinal plants are becoming more popular in the treatment of various diseases because of the adverse effects of the current therapy, especially antioxidant plant components such as phenols and flavonoids have a protective role against oxidative stress-induced degenerative diseases like diabetes. Thus, the purpose of this study was to investigate β-cell protection and antidiabetic activities of Crassocephalum crepidioides (Asteraceae) Benth. S. Moore. Method: The in-vitro study was conducted by the pancreatic β-cell culture and α-amylase inhibition technique which includes two methods, namely starch-iodine method and 3,5-dinitrosalicylic acid (DNSA) method. On the other hand, the in-vivo study was performed by oral glucose tolerance test (OGTT) method and alloxan-induced diabetes method by using Wistar albino rat. At the end pancreatic specimens were removed and processed for histopathological study. Result: The plant extract showed significant (*p < 0.05, **p < 0.01) effect on hyperglycemia as compared to standard (Gliclazide) in OGTT. The plant extract showed efficient protection activity of pancreatic β-cell from cell death in INS-1 cell line by significantly reduced (*p < 0.05, **p < 0.01) the levels alloxan-induced apoptosis and intracellular reactive oxygen species (ROS) accumulation. In addition, the plant extract showed a significant (*p < 0.05, **p < 0.01) effect on hyperglycemia by increases in percent of β-cells present in each islet (45% - 60%) compared to the diabetic group. Conclusion: The result showed that C. crepidioides had β-cell protection and antidiabetic activities in pancreatic β-cell culture and Wistar albino rat. [ABSTRACT FROM AUTHOR]

Aims and objectives To describe prevalence of reproductive coercion, sexual risk behaviours and mental health symptoms among women reporting lifetime sexual experiences with men and women compared to peers reporting sex exclusively with men. Background Reproductive coercion, a global public health problem, is understudied among sexual minority women. Violence against women remains high among women who have sex with women and men. Rates of sexual and physical violence among this population are higher than women reporting exclusive sexual partnerships with either men or women. Nurses and other healthcare providers often do not conduct comprehensive sexual histories; assumptions related to a sex partner's gender may provide indications of broader health implications. Design Cross-sectional survey of low-income Black women ages 18-25 recruited from six community-based sites for a parent study focused on intimate partner violence and health. Methods We analysed survey data from participants who reported lifetime sexual experiences with men and women ( N = 42) and compared their outcomes to those of women reporting sexual experiences with men only ( N = 107). Results A greater proportion of women who have sex with women and men reported experiencing reproductive coercion. Women who have sex with women and men also reported a greater number of lifetime intimate partner physical and sexual violence experiences, traded sex for resources, and had post-traumatic stress disorder symptoms. Conclusions Findings provide vital information that can inform nursing clinical practice, specifically related to history-taking, screening protocols and counselling strategies for intimate partner violence and mental health among women who have sex with women and men. Relevance to clinical practice Strategies for addressing reproductive coercion and intimate partner violence as well as the health consequences among women who have sex with women and men in clinical and community-based settings should include a longitudinal understanding of sexual behaviour and gender of sex partners. [ABSTRACT FROM AUTHOR]

Background: Callistemon citrinus (Curtis.) (Family- Myrtaceae) is a popular evergreen shrub in Bangladesh. In the present study, the leaves of this plant have been assessed comprehensively for free radical scavenging, thrombolytic and membrane stabilizing activities. Methods: The leaves were collected, powdered and extracted with methanol. The extract was then concentrated and successively fractionated into petroleum ether, carbon tetrachloride, chloroform and aqueous soluble fractions. The extractives were investigated for free radical scavenging, thrombolytic and membrane stabilizing activities. Results: In case of 1,1 diphenyl-2-picrylhydrazyl (DPPH) and hydrogen peroxide radical scavenging assays, the crude methanol extract of the leaves showed the highest free radical scavenging activity among the tested materials including standard ascorbic acid (p = 0.0000). Besides, this extract was also found significantly rich (p = 0.0000) in phenolics and flavonoids compared to other organic fractions. In thrombolytic study, the petroleum ether fraction exhibited significantly stronger thrombolysis (p = 0.024) than other leaf extractives but was weaker than the standard streptokinase. In membrane stabilizing assay, the activity of chloroform fraction was similar to that of standard acetylsalicylic acid (p= 1.000) in hypotonic solution induced hemolysis. However, membrane stabilization activity of this chloroform fraction was found significantly stronger than that of the standard (p = 0.0000) in heat induced hemolysis. Conclusion: This study has revealed the medicinal capabilities of different organic fractions of C. citrinus displaying free radical scavenging, thrombolysis and membrane stabilizing antiinflammatory potentials. Further bioactivity guided isolation is required to obtain pharmacologically secondary metabolites. [ABSTRACT FROM AUTHOR]

Background Infant complementary food can be home-made or bought as ready-to-eat commercial products. The nutrient composition of commercial products is regularised in a European Commission guideline, whereas the preparation of home-made complementary meals is the responsibility of caregivers. In the present study, the composition of commercial and home-made complementary meals as eaten by healthy German infants was compared. Methods Of 8226 complementary meals (74% commercial and 26% home-made) recorded in 1083, 3-day weighed dietary records from 396 participants (6-12 months old) of the German DONALD ( DOrtmund Nutritional and Anthropometric Longitudinally Designed) study were analysed. Results Median energy density (kcal 100 g-1) was highest in commercial and home-made cereal-milk meals (89 kcal 100 g-1). In home-made savoury and cereal-fruit meals, the energy density was significantly higher compared to their commercial counterparts. Median protein contents were highest in savoury and cereal-milk meals (>2.5 g 100 g-1) and dairy-fruit meals (2-4 g 100 g-1). Added sugars were found in less than a quarter of meals. Highest median sodium contents were found not only in commercial savoury meals (median 38 mg 100 g-1) and vegetable meals (32 mg 100 g-1), but also in home-made cereal-milk meals (36 mg 100 g-1). Both median fat and iron contents were higher in home-made meals compared to commercial savoury and cereal-fruit meals. Conclusions With the exception of the higher sodium content in commercial savoury meals for older infants, the lower fat content in commercial savoury and cereal-fruit meals, and the added sugar content in some commercial dairy-fruit meals, a comparison of commercial and home-made complementary meals did not reveal any serious inadequacy. [ABSTRACT FROM AUTHOR]

Zinc (Zn) deficiency in infancy and early childhood is of public health concern in developing countries. This study aimed to longitudinally assess Zn intake of urban South Indian term infants in the first 6 months of life using measures of breast milk (BM) volume and BM Zn concentrations and, additionally, to study the effect of BM Zn intake on infant length and weight gain. BM intake by the deuterium dilution technique, BM Zn concentration at months 1, 3 and 6, as well as serum Zn level at months 3 and 6 were assessed in 50 mother-infant pairs. BM intake significantly declined from 627 mL day−1 at month 1 to 608 mL day−1 at month 6 ( P < 0.01). BM Zn concentration and intake significantly declined from month 1 to month 6 ( P < 0.001 for both). Mean infant serum Zn level at months 3 and 6 were 93.0 ± 27.1 and 99.6 ± 30.1 µg dL−1, respectively. Infant BM Zn intake at months 1 and 3 was not associated with the weight and length gain between 1-3 and 3-6 months, respectively. Zn intake from BM, maternal BM Zn content and serum Zn levels were not significantly different between small-for-gestational age and appropriate-for-gestational age infants. Therefore, among urban south Indian term infants less than 6 months of age, BM Zn intakes were low, owing to low volumes of BM intake, despite BM Zn concentrations being in the normal range. Promotion of breastfeeding and thereby increasing the volumes of milk produced is a first important step towards improving Zn intake among infants. [ABSTRACT FROM AUTHOR]

Children born after an unplanned pregnancy have poorer developmental scores. This could arise from less favorable parenting but also could reflect confounding from the socioeconomic circumstances. In a large representative sample in the United Kingdom, the Millennium Cohort Study (2001-2005), cognitive delay at 3 years was explored with the Bracken Assessment. Its association with unplanned pregnancy was studied in logistic models controlling for demographic and socioeconomic characteristics of the family, the child's characteristics, and parenting behavior. Stratification by the mother's educational level (grouped into 3 categories) was explored. Of 12,182 children included in the analysis, 41% were born after a pregnancy reported by the mother to have been a "surprise." Such unplanned pregnancies were associated in univariate analysis with more cognitive delay. Among mothers with a low or middle level of education, this association vanished when socioeconomic circumstances were controlled. Among mothers with a high level of education, the risk of cognitive delay remained significantly and unexplainedly raised after unplanned pregnancies, despite controlling for socioeconomic characteristics and parental behavior. In conclusion, for socially disadvantaged children, having resulted from an unplanned pregnancy does not seem to increase their already disproportionate risk of cognitive delay. Births after unplanned conceptions are mainly a symptom rather than a source of disadvantage. [ABSTRACT FROM AUTHOR]