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Background: Access to essential diagnostics is crucial for primary healthcare (PHC) in low-and-middle income countries (LMICs). Many LMICs have invested in equipping PHC with point-of-care (PoC) diagnostics for infectious diseases, however there has been no similar investment to improve PHC capacities for clinical chemistry. The biochemistry gap is among the deterrents to universal health coverage. Methods: A social sciences project was conducted with the aim to understand the key PHC stakeholders' insights on the pertinence of PoC biochemistry for PHC in LMICs. Data generation was conducted between July-November 2023 in Mongolia, Nigeria and Peru. Decision-makers in healthcare delivery, healthcare professionals, and patient and community advocates were engaged using a combination of sampling techniques. Unstructured individual and group conversations, and non-participant observation were conducted. Analysis involved an inductive line-by-line coding on printed transcripts, followed by a deductive coding and theme-by-theme analysis on digitized transcripts. Results: Fifteen, 51 and 20 informants from Mongolia, Nigeria and Peru, respectively, participated. Fifty-five of the 94 informants were female. Most informants considered that PoC biochemistry in PHC would be pertinent, from a clinical and a resources-saving perspective. Those households that currently bear the burden of referrals (i.e., the poor, the bedridden, the older adults) would benefit the most from the deployment of PoC biochemistry for essential biochemistry parameters. Improved access to PoC glycated hemoglobin (HbA1c), lipid, liver and kidney profile was perceived as helpful to inform clinicians' decision-taking. The value of PoC biochemistry for the management of noncommunicable diseases (diabetes, hypertension) and infectious conditions (dengue, malaria, tuberculosis), to improve child health outcomes (severe dehydration in children with diarrhea and/or malnutrition) and to reduce preventable causes of death (dengue-related renal failure) was highlighted. Conclusions: PoC biochemistry holds potential to revert the impact that the biochemistry gap has for patient care in some LMICs' PHC settings. PoC equipment for parameters such as HbA1c, urea, creatinine or electrolytes could enhance community-level management of preventable causes of mortality, improve service delivery for patients affected by locally-prevalent infectious conditions, and improve the psychosocial and economic wellbeing of patients facing the burden of referrals to remote biochemistry-equipped centers. Trial Registration: Not applicable. [ABSTRACT FROM AUTHOR]

Objectives. This study is to analyze the epidemiological characteristics of other infectious diarrhea diseases (OIDDs) reported in Guangzhou in the past 15 years and the meteorological data of the city in the same period, to explore the correlation between meteorological factors and the incidence. Methodology. This study starts with using quartiles to test the normal distribution of case data. This study has selected five meteorological factors with the highest correlation coefficients and case data from 2006 to 2018 were used to establish a multiple linear regression equation, and the regression equation was tested with case data from 2019 to 2020. Results. Regression modeling based on the statistics for OIDDs during 2006 to 2018 obtained a correlation coefficient R (multiple R) value of about 0.50. The R square value, also known as the coefficient of determination or goodness of fit, was about 0.25. The adjusted R square value was about 0.25. The overall significance test value (significance F) in the regression equation was much lower than the F statistic, thereby indicating that the dependent variable and independent variable were significant. Conclusion. The results indicated that factors other than meteorological or social factors should be considered to understand the outbreak of OIDDs in Guangzhou. [ABSTRACT FROM AUTHOR]

Globally, billions of people do not have access to safely managed drinking water and sanitation services. Interventions to improve drinking water, sanitation and hygiene could reduce the incidence of diarrhoea in low- and middle-income countries. This study aimed to investigate the association between these services and the incidence of diarrhoea. Worldwide, ecological observational study, utilising cross-sectional data. Data from the Global Burden of Disease Study 2019 and World Bank were used in this study. Diarrhoeal disease episodes were defined as three or more loose bowel movements within 24 h. Estimated Annual Percentage Change was used to quantify trends in disease incidence over a specific time interval. Quasi-Poisson Generalised Linear Model was introduced to analyse the influence of basic drinking water and sanitation services on the incidence of diarrhoea. Subgroup analyses were carried out to determine potential variations in the incidence of diarrhoeal diseases according to sex, age and sociodemographic index (SDI) region. Between 2000 and 2019, the incidence rate of global diarrhoea remained consistent, with regional variations linked to SDIs. A 1% increase in access to basic drinking water was associated with a 0.41% (95% confidence interval [CI], 0.33%–0.50%) increase in the age-standardised incidence rate of diarrhoea; meanwhile, a 1% increase in sanitation service usage was associated with a 0.47% (95% CI, 0.40%–0.54%) reduction in the age-standardised incidence rate of diarrhoea. The correlation differed across SDI regions. The use of safely managed drinking water was associated with a reduction in diarrhoeal disease rates, but the effect was non-significant in High SDI regions. Higher diarrhoeal disease incidence was seen in younger and older populations. Individuals in the age groups 55–59 years and 10–14 years showed the greatest association of water service usage with diarrhoea, while an increase in sanitation service usage was related to decreased diarrhoea rates in most age groups, excluding children aged 5–14 years. Emphasising initiatives to enhance water quality, elevate the standards of drinking water safety management, and strengthening related infrastructure development in global health policies and development plans could have a positive impact on overall global health. Such comprehensive interventions have the potential to not only prevent waterborne diseases but also elevate the general health status of societies worldwide. [ABSTRACT FROM AUTHOR]

Background: Diarrhea during enteral nutrition may induce various complications and increase the nursing workload. Local Problem: The diarrhea rate in our intensive care units (ICUs) was 37.14% from May to July 2021. Nurses reported a moderate to heavy burden regarding care for those with diarrhea. Methods: A pre-post implementation design was used to evaluate the impact of evidence-based interventions for diarrhea screening and prevention. Interventions: A diarrhea risk screening tool and countermeasures were developed through an extensive literature review. Tools were integrated into the electronic health record system. Results: The rate of diarrhea decreased from 37.14% to 17.33% (P = .000). Nurse's compliance with practice standards increased for diarrhea assessment, risk factor screening, agent choice, and countermeasures provision (P < .05). Conclusions: The evidence-based tools developed for this project helped decrease the diarrhea rate in our ICUs. [ABSTRACT FROM AUTHOR]

Context Increasing numbers of patients and caregivers are requesting transition to blenderized tube feeding. There is a lack of systematic reviews addressing the outcomes of blenderized tube feeding. Objective The aim was to evaluate the association of blenderized tube feeding on feeding tolerance in enterally fed pediatric patients. Data Sources A literature search for articles from 2012–2022 using PubMed, Medline, Embase, and CINAHL yielded 78 articles. Data Extraction A description and evaluation of the study's sample, purpose, and results were summarized for 9 studies using the Academy of Nutrition and Dietetics Evidence Analysis Library Worksheet. Data Analysis Nine studies were evaluated using the Evidence Analysis Library Quality Criteria checklist. Conclusions Studies demonstrated an improvement in vomiting (n = 7), gagging/retching and heartburn (n = 6), abdominal pain/upset and distension (n = 3), and diarrhea (n = 6) with blenderized tube feeding. The outcomes of blenderized tube feeding on gas (n = 5) and constipation (n = 9) are variable and remain unclear. Systematic Review Registration PROSPERO registration no. CRD42022369247. [ABSTRACT FROM AUTHOR]

Diarrhea continues to be a global health problem as acute diarrhea carries the risk of dehydration, while both acute and chronic diarrhea can significantly affect patients' quality of life and reduce productivity. The innovative medical device Actitan, which consists of a complex of natural molecules, could be an effective option for the treatment of diarrhea from various causes. The aim of this post-market cross-sectional study was to evaluate the perceived efficacy, safety and usage pattern of the two formulations for adults (Actitan-P) and children (Actitan-F) among patients/child caregivers, physicians and pharmacists. Participants completed online questionnaires with closed multiple-choice questions that were rated on a verbal 5-point Likert scale. These surveys were conducted via the online platform Real World Data, which provides digital questionnaires for patients, doctors and pharmacists. Two separate surveys were conducted for the two formulations, with a total of 2630 participants (1488 participants for Actitan-P and 1142 participants for Actitan-F). Overall, the results indicate a high level of efficacy and safety of the product. In the case of Actitan-F, more than 96% of caregivers rated safety as good or excellent, and over 92% rated efficacy as good or excellent. Actitan-P also received positive feedback: nearly 86% of patients reported good/excellent efficacy, and more than 93% rated safety as good or excellent. These positive evaluations were confirmed by physicians and pharmacists, who also did not report adverse effects. In summary, this study confirms the role of Actitan as a safe and effective option for the treatment of diarrhea of different causes and in different patient groups, including young children. [ABSTRACT FROM AUTHOR]

Background Healthcare seeking behavior (HSB) and community perception on cholera can influence its management. We conducted a cross-sectional survey to generate evidence on cholera associated HSB and disease perception in populations living in cholera hotspots in Ethiopia. Methods A total of 870 randomly selected households (HHs) in Shashemene Town (ST) and Shashemene Woreda (SW) participated in our survey in January 2022. Results Predominant HHs (91.0%; 792/870) responded "primary health center" as the nearest healthcare facility (HCF). Around 57.4% (247/430) of ST HHs traveled <30 minutes to the nearest HCF. In SW, 60.2% (265/440) of HHs travelled over 30 minutes and 25.9% (114/440) over 4 km. Two-thirds of all HHs paid

Background The Ethiopian government has developed the multisectoral cholera elimination plan (NCP) with an aim of reducing cholera incidence and case fatality rate (CFR). To better understand and monitor the progress of this plan, a comprehensive review of national cholera epidemiology is needed. Methods Reported data on cholera/acute watery diarrhea (AWD) cases in the past 20 years were extracted from the Ethiopian Public Health Institute and World Health Organization databases. Descriptive statistics, Pearson χ2, and logistic regression analyses were conducted. Results From January 2001 to November 2023, a total of 215 205 cholera/AWD cases, 2355 deaths with a cumulative CFR of 1.10% (95% confidence interval [CI], 1.092–1.095), and a mean annual incidence rate of 8.9/100 000 (95% CI, 6.5–11.3) were reported. Two major upsurges of cholera epidemics were found in the last two decades with mean attack rate (AR) of 20.57/100 000 in 2006–2010 and 14.83/100 000 in 2016–2020. Another resurgence of outbreaks occured in 2021–2023 (mean AR, 8.63/100 000). In 2015–2023, 54.0% (53 990/99 945) of cases were aged 15–44 years. National cholera CFR (3.13% [95% CI: 2.1–4.5]) was the highest in 2022. The 2015–2023 cumulative cholera CFR was different across regions: Benishangul Gumuz (6.07%), Gambela (1.89%), Sidama (1.42%), Southern Nation, Nationalities, and Peoples' (1.34%), Oromia (1.10%), and Amhara (1.09%). Cholera/AWD patients in older adults (≥45 years), severe dehydration, peak rainy season (June–August), and outpatients were associated with higher risk of death. Conclusions Cholera has been a public health problem in Ethiopia with case fatalities still above the global target. Case management needs to be improved particularly in outpatients and older populations. Outbreak preparedness should be rolled out well in advance of the typical rainy seasons. Significant investments are essential to advance the cholera surveillance system at healthcare setting and community level. Underlying factors of cholera deaths per areas should be further investigated to guide appropriate interventions to meet the NCP target by 2028. [ABSTRACT FROM AUTHOR]

Background. Diarrhea is the common gastrointestinal disorder accounting for 2.5 billion episodes and 1.5 million deaths annually. Limitations and inaccessibility of currently available medications are the main problem associated with treatment of diarrhea. Hence, medicinal plants are usually preferred to manage diarrhea because they may contain constituents with high activity and fewer side effects. Even though the dose, safety, and efficacy of Colocasia esculenta (L.) Schott are not substantiated scientifically, several societies use it for the treatment of diarrhea. Objective. This study was targeted at exploring the in vivo antidiarrheal activities of 80% methanol extract and solvent fractions of peels of Colocasia esculenta (L.) Schott in Swiss albino mice. Methods. The plant was collected and extracted with 80% methanol, followed by fractionation with distilled water, chloroform, and diethyl ether. Castor oil‐induced diarrhea, enteropooling, and motility tests were used to evaluate antidiarrheal activity. The test groups received graded doses of 100 mg/kg, 200 mg/kg, and 400 mg/kg. Negative controls received 10 ml/kg of 2% Tween 80 while positive controls received loperamide (3 mg/kg) or atropine (5 mg/kg). Results. The crude and solvent fractions of the plant extract have induced significant effects in reduction of the number and weight of wet stools at all tested doses. However, delay in onset of diarrhea was observed only at 400 mg/kg (P < 0.001) for both crude extract and solvent fractions. In antienteropooling test, 80% methanol extract and solvent fractions have significantly reduced the weight and volume of intestinal contents, especially at 200 mg/kg and 400 mg/kg. Regarding the antimotility test, the crude extract reduced motility at all tested doses, whereas the solvent fractions reduced intestinal motility mainly at 400 mg/kg (P < 0.001). Conclusion. The study has revealed that the 80% methanol extract and solvent fractions of the plant possess antidiarrheal activities supporting the traditional antidiarrheal claims of the plant. [ABSTRACT FROM AUTHOR]

All types of ginger have common fundamental components, although they possess distinct strengths and inclinations when it comes to effectiveness and medicinal applications. Fresh ginger possesses the ability to effectively stimulate movement within the body, alleviate the act of vomiting, induce sweating, and provide relief for external syndromes. Dried ginger possesses both defensive and stimulant characteristics, which effectively raise the internal temperature and enhance the Yang energy. Fresh ginger is more hydrating than dried ginger, highly skilled at heating the Middle-jiao, alleviating pain, halting bleeding, and managing diarrhea. Dried ginger possesses the ability to alleviate coldness when consumed in a heated form, as well as to alleviate diarrhea when consumed in a heated form. It thrives in warm conditions and has a tendency to revert back to its warm nature. The moisture content of baked ginger is inferior to that of dried ginger, but it is highly effective in alleviating pain, bleeding, and diarrhea by warming the Middle-jiao. Ginger charcoal and stir-fried charcoal, produced through carbonization, have excellent heat retention properties and are effective in warming meridians and stopping bleeding. The potency and ability to spread of roasted ginger is less intense compared to fresh ginger, and its moisture content is not as low as that of dried ginger. The medicinal characteristics of this substance are gentle, making it beneficial for alleviating vomiting in patients who are physically frail. Its primary mode of action is on the Middle-jiao. Nevertheless, the main chemical compositions of various traditional Chinese medicines are nearly identical due to their shared base element. Ginger, in particular, possesses a range of pharmacological activities including antioxidant, anti-inflammatory, anti-tumor, anti-bacterial, and anticoagulant properties. However, modern pharmacological research has not fully acknowledged the clinical medicinal value of ginger and consequently, fails to provide accurate guidance for clinical medication. This situation has a negative impact on the contemporary advancement of traditional Chinese medicine (TCM). The research on modernizing ginger is conducted by analyzing and considering the prospects. It is based on Traditional Chinese Medicine (TCM) theory and incorporates the comprehensive perspective of TCM philosophy. In order to modernize ginger, it is essential to have a proper knowledge of the concepts of "recognizing nature by efficacy, homology, and mutual expression of nature and efficacy" and "rationally utilizing modern drug research technology". By applying these principles, we can construct a bridge towards the advancement of ginger. [ABSTRACT FROM AUTHOR]

The prevention of wasting should be a public health priority as the global burden of acute malnutrition is still high. Gaps still exist in our understanding of context‐specific risk factors and interventions that can be implemented to prevent acute malnutrition. We used data from the four rounds of the Ethiopia Demographic and Health Survey (2000–2016) to identify risk factors that have contributed to the change in weight‐for‐height z‐score (WHZ) among children under 5 years of age. We performed a pooled linear regression analysis followed by a decomposition analysis to identify relevant risk factors and their relative contribution to the change in WHZ. Modest improvements in WHZ were seen between 2000 and 2016. The sharpest decrease in mean WHZ occurred from birth to 6 months of age. Perceived low weight at birth and recent diarrhoea predicted a decline in WHZ among children aged 0–5, 6–23 and 23–59 months. Less than 50% of the change in WHZ was accounted for by the change in risk factors included in our regression decomposition analysis. This finding highlights data gaps to identify context‐specific wasting risk factors. The decline in the prevalence of recent diarrhoea (15% of the improvement), decline in low birth size (7%–9%), and an increase in wealth (15%–30%) were the main risk factors that accounted for the explained change in WHZ. Our findings emphasize the importance of interventions to reduce low birthweight, diarrhoea and interventions that address income inequities to prevent acute malnutrition. Key messages: The sharpest decrease in weight‐for‐height z‐score (WHZ) was seen from birth to 6 months of age.Of the factors included in this analysis, perceived low size at birth and recent diarrhoea were the main drivers of change in WHZ.More than 50% of the improvement in WHZ was unexplained highlighting data gaps to understand context‐specific risk factors. [ABSTRACT FROM AUTHOR]

Inadequate safe water supply and poor sanitation and hygiene continue to be important risk factors for diarrhoea and stunting globally. We used data from the four rounds of the Ethiopian Demographic and Health Survey and applied the new World Health Organization (WHO)/UNICEF Joint Monitoring Program (JMP) service standards to assess progress in water, sanitation and hygiene (WASH) coverage between 2000 and 2016. We also performed an age‐disaggregated pooled linear probability regression analysis followed by a decomposition analysis to determine whether changes in WASH practices have contributed to the changing prevalence of diarrhoea and stunting in children under 5 years of age. We observed a significant increase in the coverage of safe drinking water and adequate sanitation facilities over the period. At the national level, the use of a basic water source increased from 18% in 2000 to 50% in 2016. Open defecation declined from 82% to 32% over the same period. However, in 2016, only 6% of households had access to a basic sanitation facility, and 40% of households had no handwashing facilities. The reduction in surface water use between 2000 and 2016 explained 6% of the decline in diarrhoea observed among children aged 0–5 months. In children aged 6–59 months, between 7% and 9% of the reduction in stunting were attributable to the reduction in open defecation over this period. Despite progress, improvements are still needed to increase basic WASH coverage in Ethiopia. Our findings showed that improvements in water and sanitation only modestly explained reductions in diarrhoea and stunting. [ABSTRACT FROM AUTHOR]

Background: Diarrhea-dominant irritable bowel syndrome (IBS-D) is a deliberating and chronic condition that can impair social activities. Determining proper medication with satisfactory outcomes has been a challenge. The 5-hydroxytryptamine 3 receptor antagonist (5-HT3 RA) drugs have demonstrated favorable outcomes on IBS-D in the last 3 decades. Ondansetron, also a 5-HT3 RA is known as an antiemetic. Our aim was to evaluate the efficacy of ondansetron in IBS-D. Methods: In this single-center, double-blind, randomized controlled trial, patients with IBS-D were recruited. Patients were randomized on a 1:1 ratio and assigned into two groups: imipramine 25 mg/daily plus ondansetron 4 mg/3 times per day and imipramine 25 mg/daily plus placebo. The primary endpoint was the frequency of diarrhea per day after 8 weeks of treatment. The secondary endpoints consisted of changes in the frequency of defecation urgency per day, the number of days with gastrointestinal pain and bloating, and the patients' overall satisfaction regarding bowel habits after 8 weeks of the treatment. Results: Data from 98 patients were analyzed. Ondansetron, compared to placebo, improved the primary outcome, and the stool consistency was increased significantly (3.29 ± 1.19 vs 4.55 ± 1.17, P < 0.001). Moreover, the response rate for the diarrhea frequency was significantly higher in the ondansetron group compared to the placebo (77.5% vs 34.7%, P < 0.001). In the ondansetron group, fewer urgencies were experienced, and pain severity and feeling of bloating declined as well (P < 0.01). Conclusion: Ondansetron can mitigate almost all IBS-D-related symptoms, which may indicate it as a drug of choice; however, further evidence is required to ascertain its safety. [ABSTRACT FROM AUTHOR]

This article provides an overview of the approach to preparing patients for travel, including travel counseling and risk mitigation through vaccination and chemoprophylaxis. Although some patients require referral for consultation with a travel medicine specialist, others can be managed by their primary care provider. In this article, traveler's diarrhea, updated travel-related immunizations, and malaria prophylaxis are discussed. [ABSTRACT FROM AUTHOR]

Background: Morphine withdrawal syndrome is often treated with chemical drugs; however, these drugs can have concerning side effects. Some natural substances might offer safer alternatives for managing withdrawal symptoms. The neuroprotective activity of the adenosine A1 receptor (A1R) in the central nervous system (CNS) has been mentioned before. As a novel natural agent, Japanese sake yeast is enriched with adenosine analogs. Objectives: As the first report, the present study was designed to evaluate the effects of the Japanese sake yeast supplement against the excitatory signs of morphine withdrawal syndrome in mice. Methods: Mice were treated orally (gavage) with sake yeast at doses of 100, 200, and 300 mg kg-1 once daily for a week. Furthermore, during the last 3 days of receiving sake yeast, the animals were made physically dependent on morphine by being given twice-daily subcutaneous injections of increasing doses of morphine (30 - 90 mg/kg) for 3 consecutive days. The withdrawal syndrome was induced in animals through the intraperitoneal (i.p.) administration of naloxone (3 mg kg-1) or was elicited spontaneously. After the examination of withdrawal signs, the animals were decapitated, and their brains were prepared for histopathology. Results: Sake yeast alleviated the intensity of ptosis, piloerection, diarrhea, irritability, and tremor during the two withdrawal syndrome protocols (P < 0.05) and diminished the number of jumping in naloxone-induced withdrawal syndrome (P < 0.01). The withdrawal symptom-lowering effect of sake yeast was reversed by the i.p. injection of an A1R-selective antagonist, 8-cyclopentyltheophylline (10 mg kg-1), and maintained following the i.p. injection of ZM241385 (15 mg kg-1), a selective adenosine A2AR antagonist. Furthermore, histopathological findings demonstrated that sake yeast at doses of 200 and 300 mg kg-1 inhibited the CA1 hippocampal neuronal damage induced by withdrawal syndrome (P < 0.05). Conclusions: Sake yeast suppresses the morphine withdrawal syndrome via the activation of A1R. [ABSTRACT FROM AUTHOR]

There are wide‐ranging probiotic choices in Australasia. We reviewed the efficacy of probiotics for the management of gastrointestinal (GI) conditions in adults and assessed relevance to clinical practice. The benefits of probiotics were inconsistent, with a strong consensus reached for only a few of the indications. As different species/strains and combinations differ in efficacy, results cannot be extrapolated from one to another. This review endorses specific probiotics for limited indications. Efficacy of most marketed probiotic formulations remains unstudied and unproven, warranting further research. [ABSTRACT FROM AUTHOR]

Background: Epilepsy secondary to acquired immunodeficiency syndrome (AIDS) can be challenging to manage. The potential interactions between antiretroviral drugs and antiepileptic drugs may result in the failure of both treatments. Therefore, it is crucial to develop more effective strategies to enhance the clinical outcomes of patients. Case presentation: We report a case of epilepsy secondary to AIDS. After administration of Bacteroides Fragilis 839 (BF839), the secondary generalized tonic-clonic seizures disappeared, the frequency of complex partial seizures decreased by 70%, and the duration of each episode was shortened. Additionally, long-term diarrhea associated with antiretroviral therapy for AIDS resolved, and the syphilis serofast reaction turned negative. No serious adverse reactions were observed during the three-year follow up. Conclusions: This case report suggests that the specific gut microbiota preparation could possibly improve refractory epilepsy in HIV patients while also potentially alleviating adverse reactions to antiretroviral drugs and concurrent syphilis infection. Our case may provide a new perspective for the treatment of HIV infection/AIDS. [ABSTRACT FROM AUTHOR]

BACKGROUND: Diarrheal disease is a leading cause of childhood morbidity and mortality globally. Household water, sanitation, and handwashing (WASH) interventions can reduce exposure to diarrhea-causing pathogens, but meteorological factors may impact their effectiveness. Information about effect heterogeneity under different weather conditions is critical to refining these targeted interventions. OBJECTIVES: We aimed to determine whether temperature and precipitation modified the effect of low-cost, point-of-use WASH interventions on child diarrhea. METHODS: We analyzed data from a trial in rural Bangladesh that compared child diarrhea prevalence between clusters (푁 = 720) that were randomized to different WASH interventions between 2012 and 2016 (NCT01590095). We matched temperature and precipitation measurements to diarrhea outcomes (푁 = 12,440 measurements, 6,921 children) by geographic coordinates and date. We estimated prevalence ratios (PRs) using generative additive models and targeted maximum likelihood estimation to assess the effectiveness of each WASH intervention under different weather conditions. RESULTS: Generally, WASH interventions most effectively prevented diarrhea during monsoon season, particularly following weeks with heavy rain or high temperatures. The PR for diarrhea in the WASH interventions group compared with the control group was 0.49 (95% CI: 0.35, 0.68) after 1 d of heavy rainfall, with a less-protective effect [PR = 0:87 (95% CI: 0.60, 1.25)] when there were no days with heavy rainfall. Similarly, the PR for diarrhea in the WASH intervention group compared with the control group was 0.60 (95% CI: 0.48, 0.75) following above-median temperatures vs. 0.91 (95% CI: 0.61, 1.35) following below-median temperatures. The influence of precipitation and temperature varied by intervention type; for precipitation, the largest differences in effectiveness were for the sanitation and combined WASH interventions. DISCUSSION: WASH intervention effectiveness was strongly influenced by precipitation and temperature, and nearly all protective effects were observed during the rainy season. Future implementation of these interventions should consider local environmental conditions to maximize effectiveness, including targeted efforts to maintain latrines and promote community adoption ahead of monsoon seasons. [ABSTRACT FROM AUTHOR]

Recently, there has been an increasing interest in the association of gut microbiota with health conditions and the potentially beneficial role of several types of biotics in several population groups, including children and adolescents. Children and adolescents comprise a unique population group due their rapid growth rates, high nutritional requirements, the immaturity of their immune system in early life, and their susceptibility to infectious diseases. The aim of the present study is to investigate the role and limitations of the administration of biotics in specific conditions affecting children and adolescents. A narrative review of related articles published on PubMed up to October 2023 was conducted. The administration of biotics has been evaluated in several health conditions among children and adolescents, such as the treatment and prevention of infectious diarrhea, the prevention of diarrhea after the use of antibiotics, the prevention of necrotizing enterocolitis, the treatment of functional gastrointestinal diseases, such as infant colic, functional abdominal pain, and irritable bowel syndrome, the eradication of H. pylori, the treatment of ulcerative colitis and pouchitis, and the prevention of atopic dermatitis, and the findings indicate improved symptoms and various beneficial health outcomes. However, some limitations have been identified regarding probiotics' use. In conclusion, biotics may have a beneficial impact in several health conditions among children and adolescents. There is a need for additional randomized, controlled clinical studies on the effects of the administration of biotics in children and particularly in adolescents and young adults. [ABSTRACT FROM AUTHOR]

Nigeria ranks second in the global prevalence of diarrhoea with most cases concentrated in the Northern-region of the country. This research explored the antidiarrhoeal efficacy of the hydroethanolic extract of Piliostigma thonningii leaves (HEPTL), locally used to manage diarrhoeal conditions in Kebbi State, Nigeria. P. thonningii leaves were screened for their secondary metabolites and mineral constituents. Using 3 standard-diarrhoea models, female Wistar rats completely-randomised into six-groups of six animals each were utilised for probing the antidiarrhoeal activity of HEPTL. Animals in groups I and II served as the negative and positive controls, whereas the rats in groups III, IV and V respectively received 50, 100, and 200 mg/kg body weight-(bw) of HEPTL. Six secondary metabolites and eight minerals were found in the extract, with flavonoids and calcium being the most abundant while steroids and zinc were the least prevalent, respectively. High performance liquid chromatographic analysis revealed the presence of 19 bioactive substances. Furthermore, there was a significant (p<0.05) and dose-related reduction in diarrhoea onset, water content, and wet faeces count. Similarly, the amount of intestinal fluid and average distance traversed by the charcoal-meal were decreased dose-dependently by the HEPTL with a commensurate rise in the suppression of intestinal fluid accrual and peristalsis. Acetylcholinesterase, Na+/K+-ATPase, reduced glutathione, intestinal-alkaline phosphatase and protein levels increased significantly (p<0.05) whereas superoxide-dismutase, catalase, intestinal-nitric oxide and malondialdehyde levels all fell significantly (p<0.05). However, the level of intestinal glucose was not significantly altered. Overall, the HEPTL exhibited a profound effect in the alleviation of the severity of diarrhoea, notably at 200 mg/kg bw. [ABSTRACT FROM AUTHOR]

The purpose of this activity is to increase students' knowledge about PHBS and diarrhea prevention using herbal ingredients as well as the application of clean water treatment simulations using slow sand filter and biomass filter methods. This method of implementing service uses a participatory and collaborative approach through active and interactive discussions. This activity was carried out by involving 54 students of Bahrul Magfiroh Islamic Boarding School Malang. Service participants directly practice and understand the function of applying water treatment devices and the use of herbal ingredients for the prevention of diarrhea. The results of activities on clean water treatment are almost 90% understood by students, both the use of biomass filters and slow sand filters, while 42.6% of students still have a low understanding of how to process herbal ingredients for the prevention of diarrhea. The importance of continuous training on increasing knowledge of clean and healthy living behavior must continue to be improved as an effort to prevent the risk of disease transmission and health problems, including maintaining personal health and the Islamic boarding school environment.

Background: A new commercially available sodium bicarbonate (SB) supplement claims to limit gastrointestinal (GI) discomfort and increase extracellular buffering capacity. To date, no available data exists to substantiate such claims. Therefore, the aim of this study was to measure blood acid–base balance and GI discomfort responses following the ingestion of SB using the novel "Bicarb System" (M-SB). Twelve well-trained male cyclists completed this randomised crossover designed study. Maximal oxygen consumption was determined in visit one, whilst during visits two and three participants ingested 0.3 g∙kg−1 BM SB using M-SB (Maurten, Sweden) or vegetarian capsules (C-SB) in a randomised order. Finger prick capillary blood samples were measured every 30 min for pH, bicarbonate (HCO3−), and electrolytes (potassium, chloride, calcium, and sodium), for 300 min. Visual analogue scales (VAS) were used to assess GI symptoms using the same time intervals. Results: Peak HCO3− was 0.95 mmol∙L−1 greater following M-SB (p = 0.023, g = 0.61), with time to peak HCO3− achieved 38.2 min earlier (117 ± 37 vs. 156 ± 36 min; p = 0.026, r = 0.67) and remained elevated for longer (p = 0.043, g = 0.51). No differences were observed for any electrolytes between the conditions. Aggregated GI discomfort was reduced by 79 AU following M-SB (p < 0.001, g = 1.11), with M-SB reducing stomach cramps, bowel urgency, diarrhoea, belching, and stomach-ache compared to C-SB. Conclusions: This is the first study to report that M-SB can increase buffering capacity and reduce GI discomfort. This presents a major potential benefit for athletes considering SB as an ergogenic supplement as GI discomfort is almost eliminated. Future research should determine if M-SB is performance enhancing. Key Points: The novel 'Bicarb System' (M-SB) reduced, and almost eliminated the gastrointestinal (GI) discomfort compared to vegetarian capsules (C-SB). The changes in acid-base balance following ingestion of M-SB were significantly greater compared to C-SB. It is unkown if this would translate to increased performance benefits, however, and the next step therefore is to determine the performance responses from M-SB. The increase in HCO3− was sustained >5 mmol L−1 HCO3− for longer with M-SB ingestion versus C-SB. This might suggest there is an "ergogenic window", and ingestion timing could therefore be flexible prior to exercise. [ABSTRACT FROM AUTHOR]

Background: Nutrition among children under 5 plays an important role in the overall development of children physically and psychologically. Nutritional deficiencies and malnutrition generally affect children. In this study, we estimate the prevalence of 3 malnutrition indicators underweight, stunting and wasting and to assess factors associated with them. Objective: The main objective of the study was to assess the factors contributing to malnutrition among children under 5 years old. Design: The study employed a descriptive cross-sectional study design to assess the factors contributing to malnutrition among children under 5 years of age. Methods: This is quantitative cross-sectional facility-based study of 245 children aged 11 to 49 months. A structured questionnaire was used, and anthropometric measurements were taken to collect data. The Pearson chi-square test was used to assess the bivariate association between the outcomes and the characteristics. The binary logistic regression model was employed to estimate the crude and adjusted odds of malnutrition indicators among the characteristics observed in the study. Results: The prevalence of underweight, stunting, and wasting were 35.9, 13.9, and 33.9%, respectively. Underweight was significantly higher among females compared to males (42.0% vs. 24.1%) and highest among children aged 11 to 23 months (53.6%). Female children had 3 times more odds of being underweight (AOR: 3.09, 95% CI: 1.56-6.12). Compared to children aged 11 to 23 months, the odds of being underweight were less among children aged 24 to 35 months (AOR: 0.26, 95% CI: 0.13-0.51, P <.001), and 36 to 47 months (AOR: 0.9, 95% CI: 0.03-0.29, P <.001). Wasting was less prevalent among children aged 11 to 23 months (4.8%). Also, wasting was high among children aged 24 to 35 months (AOR: 27.41, 95% CI: 9.12-82.37, P <.001), 36 to 47 months (AOR: 28.23, 95% CI: 7.59-104.94, P <.001), and 48 to 59 months (AOR: 18.10, 95% CI: 3.04-107.76, P <.001). None of the observed factors were associated with stunting in the study. Conclusion: This study concludes that child malnutrition was high among under-five children. Promoting the use of healthy complementary feeding, preventing diarrheal diseases, and vaccinating children integrated with access to nutrition education programs are vital interventions to improve the nutritional status of children. [ABSTRACT FROM AUTHOR]

The gram-negative bacterium Shigella is a leading cause of diarrheal morbidity and mortality in children in low- and middleincome countries. Several promising vaccine candidates are in late stages of clinical development against this increasingly antibiotic-resistant pathogen. However, considering the increasingly crowded and costly paediatric immunization schedule, and likely advent of other important new vaccines, it is unclear whether introduction of a Shigella vaccine would represent a high priority for international agencies or health ministries in low- and middle-income countries. To determine whether there is a compelling public health value proposition for a Shigella vaccine, we used the World Health Organization's Full Value of Vaccine Assessment analytic framework and formulated five broad scientific, policy, economic and commercial-related propositions regarding the development of a Shigella vaccine. We also explored the current regulatory, clinical, policy and commercial challenges to a Shigella-containing combination vaccine development and adoption. Through a series of literature reviews, expert consultations, social science field studies and model-based analyses, we addressed each of these propositions. As described in a series of separate publications that are synthesized here, we concluded that the economic and public health value of a Shigella vaccine may be greater than previously recognized, particularly if it is found to also be effective against less severe forms of diarrheal disease and childhood stunting. The decision by pharmaceutical companies to develop a standalone vaccine or a multipathogen combination will be a key factor in determining its relative prioritization by various stakeholders in low- and middle-income countries. [ABSTRACT FROM AUTHOR]

Background: Although diarrhoea is a real source of morbidity for critically ill patients, this issue has been little studied, making it difficult to understand its mechanisms and management. Aims: We conducted a quality improvement study in an adult surgical intensive care unit before/after the implementation of a specific protocol to firstly improve diarrhoea management for patient benefit and secondly to understand the impact on caregivers. Study design: The first part of this before/after study consisted in assessing the proportion of patients receiving an anti‐diarrheal treatment before (phase I)/after (phase II) the implementation of the protocol. The second part of the study was to survey the caregivers on this topic. Results: Sixty four adults were included (33 in phase I; 31 in phase II) with 280 diarrheal episodes (129 in phase I; 151 in phase II). The proportion of patients who received at least one anti‐diarrheal treatment was similar between the two phases (79% (26/33) vs. 68% (21/31), p =.40). Diarrhoea incidence was also similar (9% (33 patients/368 admissions) vs. 11% (31 patients/275 admissions), p =.35). The delay to initiate at least one treatment was significantly shorter in phase II (2 days [1–7] vs. 0 day [0–2]; p <.001). The patients' rehabilitation was no longer impacted by the occurrence of a diarrheal episode in phase II (39% (13/33) vs. 0% (0/31), p <.001). Eighty team members completed the surveys in phase I and 70 in phase II. Caregivers perceived diarrhoea like a burden and its economic impact remained high. Conclusions: The implementation of a protocol for the management of ICU diarrhoea did not increase the proportion of patients treated, but it did significantly improve the delay to initiate a treatment. The patients' rehabilitation was no longer affected by diarrhoea. Relevance to clinical practice: The use of specific anti‐diarrhoea guidelines may help to reduce the burden of diarrhoea in an ICU. [ABSTRACT FROM AUTHOR]

Background and Aims Guar fiber is a soluble fiber that has been used for symptom management of irritable bowel syndrome (IBS), functional constipation (FC), and functional diarrhea (FD). However, the effect of guar fiber supplementation on symptom management is currently unclear. The aim of this review is to determine the effect of guar fiber supplementation compared with any other nutrition intervention on gastrointestinal (GI) symptoms with individuals diagnosed with IBS, FC, and FD. A secondary aim is to determine the dosage of guar fiber supplementation required to elicit an improvement in associated symptoms. Methods A systematic review (CRD42022374730) was performed with literature from inception. PubMed, EMBASE, CINAHL, and Web of Science were searched on October 28, 2022, to identify eligible studies which reported guar fiber supplementation in patients diagnosed with IBS, FC, and/or FD using the Rome criterion. Findings were synthesized narratively. Study quality was assessed using the Johanna Briggs Institute quality assessment tools. Results Nine articles reported on stool consistency, defecation frequency, laxative use, bloating, abdominal pain, flatulence, and quality of life (QOL). All pre-post studies (n = 5) reported statistically significant improvements for GI symptoms and QOL. Two of 4 randomized controlled trial studies reported improvements in GI symptoms when supplemented daily with 5 to 6 g of guar fiber for 4 to 12 weeks. Conclusions Our study shows that guar fiber supplementation appears effective in improving symptom management of IBS and FC with a 5-g/d dosage most used. Future studies are required to more clearly understand the benefits of guar fiber supplementation and elucidate dosing strategies. This review provides the grounds for further well-designed studies to investigate the impact of guar fiber supplementation in populations with IBS, FC, and FD. [ABSTRACT FROM AUTHOR]

Introduction Immune-related adverse events (irAEs) constitute a challenge in the clinical management of solid tumors. This study aims to collect real-world data on the occurrence of immune-mediated diarrhea and colitis (IMDC) in advanced non-small cell lung cancer (aNSCLC) treated with immune checkpoint inhibitors (ICIs) and to assess the clinical impact of a multidisciplinary approach (MDA) on IMDC management. Methods We retrospectively collected data on patients with aNSCLC consecutively treated with ICIs, either as single agent or in combination with chemotherapy, between September 2013 and July 2022. Among patients developing IMDC, we conducted blinded revision of colonic biopsies and evaluated the clinical impact of the introduction of MDA through predefined indicators. Results Among the 607 patients included, 84 (13.8%) experienced IMDC. Pathological review highlighted a high prevalence of microscopic colitis (28%), with a collagenous pattern linked to longer symptoms duration (P  = .01). IMDC occurred more frequently in females (P  = .05) and PD-L1 expressors (P  = .014) and was correlated with longer progression-free survival (17.0 vs 5.8, P  < .001) and overall survival (28.3 vs 9.5, P  < .001). The introduction of MDA was associated with increased employment of diagnostical tools such as fecal calprotectin test (P  < .001), colonoscopy (P  < .001), and gastroenterological evaluation (P  = .017) and a significant decrease in both grade 3 conversion rate (P  = .046) and recurrence after rechallenge (P  = .016). Hospitalization rate dropped from 17.2% to 3.8% (P : ns). Conclusion These findings highlight the clinical relevance of IMDC and support the incorporation of a MDA to optimize the clinical management of this irAE to improve patient care. Prospective validation has been planned. [ABSTRACT FROM AUTHOR]

Diarrhoea is common in enterally fed patients and can impact their nutritional and overall outcomes. This meta-analysis evaluates the potential benefits of fibre-supplemented (FS) feeds on incidence of diarrhoea and stool frequency in non-critically ill tube-fed adults. Databases including PubMed, Embase and CINAHL with full text were searched for randomised controlled trials (RCT) with adults on exclusive tube feeding, published until August 2022. The Cochrane Collaboration's tool was used for quality assessment. Studies with published results on incidence of diarrhoea and stool frequency were analysed using RevMan 5. Thirteen RCT with 847 non-critically ill patients between 20 and 90 years old without diarrhoea at the onset of enteral feeding were included. Study duration ranged from 3 to 35 d. Nine papers investigated the incidence of diarrhoea where intervention group was given FS and control was given non-fibre-supplemented (NFS) enteral feeds. Those receiving FS feeds were significantly less likely to experience diarrhoea as compared with those using NFS feeds (OR 0·44; 95 % CI 0·20, 0·95; P = 0·04; I2 = 71 %). Combined analysis showed no differences in stool frequency in those receiving NFS feeds (SMD 0·32; 95 % CI −0·53, 1·16; P = 0·47; I2 = 90 %). Results should be interpreted with caution due to considerable heterogeneity between study population, assessment tool for diarrhoea, potential conflict of interest and short duration of studies. This meta-analysis shows that FS feeds can reduce the incidence of diarrhoea in non-critically ill adults; however, the effects of stool frequency remain debatable. [ABSTRACT FROM AUTHOR]

Abstract Background Water, sanitation, and hygiene (WASH) interventions, which are specifically targeted towards young children—known as “BabyWASH”—reduce exposure to environmental contamination and prevent microbial burden in their play and feeding environments. The purpose of this endline study was to evaluate the effectiveness and potential sustainability of a multimedia educational intervention in influencing key BabyWASH and diarrhea prevention practices in four hard-to-reach woredas (i.e. administrative districts) of the Afar and Somali regions of Ethiopia. Methods A mixed-method, comparative cross-sectional study was conducted, which included 457 household surveys, 16 key informant interviews, and 8 focus group discussions. The multimedia educational intervention comprised: broadcasting radio talk shows and radio spot messages, capacity-building training for community health workers and community leaders, community mobilization campaigns, and the distribution of promotional print media materials. Propensity score matching analysis was used to estimate the effect of the multimedia educational intervention on key BabyWASH and diarrhea prevention attitudes and practices, which was then triangulated with qualitative findings. Results The multimedia intervention had a significant positive impact on good BabyWASH and diarrhea prevention practices, including appropriate practices of child feces disposal (t-test = 5.17; p

BACKGROUND: The burden of diarrheal diseases remains high among children in low-income countries. Enteropathogens are challenging to control because they are transmitted via multiple pathways. Chickens are an important animal protein source, but live chickens and their products are often highly contaminated with enteropathogens. OBJECTIVES: We conducted this study to a) understand the contribution of multiple transmission pathways to the force of infection of Campylobacter spp. and nontyphoidal Salmonella spp., b) quantify the potential impact of reducing each pathway on human infection, and c) quantify hypothesized pathway reduction from the context of Maputo, Mozambique. METHODS: We developed transmission models for Campylobacter and Salmonella that captured person-to-person, water-to-person, food-to-person, soil-to-person, animal-to-person, and all-other-sources-to-person in an urban, low-income setting in Mozambique. We calibrated these models using prevalence data from Maputo, Mozambique and estimates of attributable fraction of transmission pathways for the region. We simulated the prevalence of human infection after reducing transmission through each pathway. RESULTS: Simulation results indicated that if foodborne transmission were reduced by 90%, the prevalence of Campylobacter and Salmonella infection would decline by [52.2%; 95% credible interval (CrI): 39.7, 63.8] and (46.9%; 95% CrI: 39, 55.4), respectively. Interruption of any other pathway did not have a substantial impact. Combined with survey and microbiology data, if contamination of broiler chicken meat at informal markets in Maputo could be reduced by 90%, the total infection of Campylobacter and Salmonella could be reduced by 21% (16–26%) and 12% (10–13%), respectively. DISCUSSION: Our transmission models showed that the foodborne transmission has to be reduced to control enteropathogen infections in our study site, and likely in other similar contexts, but mitigation of this transmission pathway has not received sufficient attention. Our model can serve as a tool to identify effective mitigation opportunities to control zoonotic enteropathogens. https://doi.org/10.1289/EHP12314 [ABSTRACT FROM AUTHOR]

Chemotherapy-induced diarrhea (CID) is a common adverse event in cancer patients, which, unless treated, may lead to drug discontinuation and treatment failure. Some probiotics such as Lactobacillus, Bifidobacterium, and Saccharomyces species have been gaining clinical attention in alleviating chemotherapy-induced adverse events including diarrhea. This comprehensive review provides an overview and discusses preventive approaches of probiotics with respect to CID in several types of cancers. The potential mechanisms of probiotics may comprise regulation of intestinal microbiota, modulation of immune functions, or reduction of proinflammatory cytokines. The efficacy and safety precautions of probiotics in immunocompromised cancer patients are discussed. The non-pharmacological strategy using probiotics could reduce the use of anti-diarrheal or antibiotic agents. Some individuals experienced shorter length of hospital stay, better gastrointestinal function, and reduced incidence of chemotherapy dose reduction after probiotic administration. Nonetheless, some studies failed to report the benefits of probiotics in certain patients. This review also highlights preventive protocols and therapeutic implications by considering the potential influencing factors, particularly types of probiotic strains, dosages of probiotics, duration of their administration, patients’ tolerability, and variations in probiotic effects over the cancer stages. [ABSTRACT FROM AUTHOR]

Traveler's diarrhea (TD) is one of the most common illnesses afflicting the modern traveler. TD refers to a watery diarrhea that varies in severity from tolerable to incapacitating and that develops in individuals during or within 10 days of returning from travel to developing or low-/middle-income countries. Most cases of TD are self-limiting, but in consideration of the ease of international travel, it is important for providers to diagnose and manage TD with the best available evidence. [ABSTRACT FROM AUTHOR]

Childhood undernutrition and diarrhea remain a global health burden in the 21st century. We assessed the effect of access to basic drinking water and sanitation at home on reducing children's likelihood of being undernourished and experiencing diarrhea in Laos. We pooled two rounds of nationally representative cross-sectional household surveys: the Lao Social Indicator Surveys 2011/2012 and 2017, encompassing 23 070 children aged <5 years. We employed multivariate multilevel logistic regression for the analysis. The results showed that access to basic drinking water was associated with a reduced likelihood of undernutrition and was effective in improving child undernutrition. Moreover, access to basic sanitation reduced diarrhea in addition to undernutrition. Notably, sanitation facilities only mitigated childhood stunting and diarrhea when basic drinking water facilities were present in the household. We also confirmed that socio-economic disparities existed among children accessing basic drinking water and sanitation. Consequently, further efforts are needed toward equitable access to these facilities in Laos. [ABSTRACT FROM AUTHOR]

Background: Water, sanitation, and hygiene (WASH) interventions, which are specifically targeted towards young children—known as "BabyWASH"—reduce exposure to environmental contamination and prevent microbial burden in their play and feeding environments. The purpose of this endline study was to evaluate the effectiveness and potential sustainability of a multimedia educational intervention in influencing key BabyWASH and diarrhea prevention practices in four hard-to-reach woredas (i.e. administrative districts) of the Afar and Somali regions of Ethiopia. Methods: A mixed-method, comparative cross-sectional study was conducted, which included 457 household surveys, 16 key informant interviews, and 8 focus group discussions. The multimedia educational intervention comprised: broadcasting radio talk shows and radio spot messages, capacity-building training for community health workers and community leaders, community mobilization campaigns, and the distribution of promotional print media materials. Propensity score matching analysis was used to estimate the effect of the multimedia educational intervention on key BabyWASH and diarrhea prevention attitudes and practices, which was then triangulated with qualitative findings. Results: The multimedia intervention had a significant positive impact on good BabyWASH and diarrhea prevention practices, including appropriate practices of child feces disposal (t-test = 5.17; p < 0.001), handwashing with soap or ash (t-test = 8.85; p < 0.001), maintaining separate playgrounds for young children (t-test = 2.83; p < 0.001), washing of child's body, hands, and faces (t-test = 15.78; p < 0.001), and food hygiene practices (t-test = 2.74; p < 0.05). The findings of the qualitative assessment also revealed that the multimedia intervention packages and the approaches used were successful in influencing key BabyWASH and diarrhea prevention behaviors in the intervention implementation woredas. In addition, providing capacity building training to local actors and community leaders and recording radio talk shows and sharing them with community members were recognized as effective intervention implementation strategies. Conclusion: The endline evaluation found that the multimedia educational intervention improved awareness, perception, and practice of BabyWASH and diarrhea prevention behaviors in intervention woredas compared to control woredas. Sanitation and hygiene promotion interventions in pastoralist settings can be effective when using locally and contextually appropriate intervention strategies. However, considerations for integrating both behavioral and structural components in WASH interventions is essential. [ABSTRACT FROM AUTHOR]

Pregnant travellers are often unaware of the various infections that can be acquired during travel and that pregnant people may be at increased risk of severe disease compared to their non‐pregnant counterparts. Pregnant people often seek pre‐travel counselling from their obstetrician or primary care physicians, who may not be well versed in travel medicine. This paper aims to provide information for maternity care providers regarding important travel‐related food, water and mosquito‐borne illnesses, including their prevention and treatment methods, equipping maternity care providers to confidently counsel prospective travellers during pregnancy. [ABSTRACT FROM AUTHOR]

Homeostasis of gut microbiota is a critical contributor to growth and health in weaned piglets. Fish oil is widely reported to benefit health of mammals including preventing intestinal dysfunction, yet its protective effect during suckling-to-weaning transition in piglets remains undetermined. Low (30 g/d) and high (60 g/d) doses of n-3-rich fish oil were supplemented in sows from late gestation to lactation. Serum indicators and gut microbiota were determined to evaluate the effects of maternal fish oil on growth performance, immunity and diarrhea of piglets. DHA and EPA in the colostrum as well as serum of suckling and 1-week post-wean piglets were significantly and linearly increased by maternal supplementation of fish oil (P < 0.05). IGF1 and T3 in nursing and weaned piglets were significantly elevated by maternal fish oil (P < 0.05), and the increase of IGF1 was concerning the dosage of fish oil. Colostrum IgG, plasma IgG, IgM in suckling piglets, IgG, IgM and IgA in weaned piglets were significantly increase as maternal replenishment of fish oil increased (P < 0.05). Additionally, cortisol was significantly reduced in weaned pigs (P < 0.05), regardless of dosage. 16S rRNA sequencing revealed that α-diversity of fecal microbiota in nursery piglets, and fecal Lactobacillus genus, positively correlated with post-weaning IgA, was significantly increased by high dosage. Collectively, maternal fish oil during late pregnancy and lactation significantly promoted growth, enhanced immunity, and reduced post-weaning diarrhea in piglets, therefore facilitated suckling-to-weaning transition in piglets, which may be partially due to the altered gut microbial community. [ABSTRACT FROM AUTHOR]

Objectives: Limited data is available regarding nutrition practices for patients with acute respiratory distress syndrome (ARDS) who are also receiving veno-venous-extracorporeal membrane oxygenation (VV-ECMO). The aim of the study was to describe the nutritional status of patients receiving VV-ECMO and compared with those who did not. Methods: Patients (> 18 years-old) diagnosed with ARDS who received VV-ECMO (= 72 hours) were included in this retrospective study. The daily achievement of an energy target (%) and average protein intake during 2 weeks after initiation of VV-ECMO were calculated. Adequate feeding was defined as achieving 80-110% of the calculated target. The duration before initiating parenteral (PN) and enteral nutrition (EN), feeding route, length of intensive care, and hospital stay were evaluated. Data was compared between groups. Results: In this study, 24 patients were included, of whom 12 received VV-ECMO. EN was started in a median 1.5 and 1 day in the VV-ECMO and non-ECMO groups, respectively. In the VV-ECMO group, 75% of the patients could achieve nutritional adequacy (> 80% energy goal) and 83.3% in the non-ECMO group (p = 0.615). PN being required in 4 (33.3%) patients who received VV-ECMO and 3 (25%) patients who did not (p = 0254). Ten of all patients experienced inadequate EN because of hemodynamic instability (n = 3), prone position (n = 4), gastric distension (n = 2) and diarrhea (n = 1). Conclusions: VV-ECMO was not an obstacle for adequate nutrition, but prone position and hemodynamic instability were common causes of enteral feeding interruptions and inadequate energy delivery. [ABSTRACT FROM AUTHOR]

Introduction: Diarrhoea disease is one of the commonest under-five children's diseases with increasing prevalence rate in our communities. Complication of the disease may lead to death however; the diseases as well as its complications are preventable when proper measures are put in place by the mothers of under-five children. Objective: The study was designed to assess maternal strategies in the prevention of under-five's diarrhoea in two selected communities in Ibadan. Methods: Community based descriptive design was adopted. Study population included 246 mothers of under-five in the two communities. Data on patient's demographic characteristics, mother's knowledge about diarrhoea and maternal strategies in diarrhoea prevention were recorded using structured questionnaire. The data was analysed using descriptive analysis and Chi-square was used to test the set hypotheses. Results: Mean age of the 243 mothers, who participated in the study is 30 years (± SD 6.4). Overall, 89.3% of mothers had adequate knowledge of diarrhoea; however, there were deficiencies in some areas, 71.6% of mothers acknowledged teething as causes of diarrhoea, 39.9% and 33.3% did not know that rotavirus vaccine and exclusive breast feeding may reduce diarrhoea incidence respectively. In addition, 55.6% of participants' children had incidence of diarrhoea. Also, 94.2% of mothers had appropriate maternal strategies in the prevention of diarrhoea. Mothers always practice exclusive breastfeeding for the first six months of life (62.6%) and always wash hands with soap and water (68.3%). Only 11.5% mothers received rotavirus vaccine. Conclusion: The study findings indicated low uptake of rotavirus vaccine and high incidence of diarrhoea among the respondent's children. Therefore, effort should be made to provide information about rotavirus vaccine and prevention of diarrhoea disease. [ABSTRACT FROM AUTHOR]

Ostomy surgery is a life-changing intervention, with many significant and challenging lifestyle changes expected from the individual. The community nurse, with their wide-ranging scope of practice and intimate access to patients' lives, are well-placed to support individuals to manage their condition, especially in the case of a high-output stoma, a relatively common complication with potentially deadly consequences. The author outlines the practical interventions the community nurse can offer to the patient to optimise stomal output, including fluid restriction, dietary changes and support in self-care and management. [ABSTRACT FROM AUTHOR]

Diarrhoeal disease remains a leading cause of death in children in sub-Saharan Africa, attributed to environmental health factors such as inadequate water, sanitation and hygiene (WASH) and food hygiene. This formative study in low-income areas of Blantyre focussed on the practices in Early Childhood Development Centre (ECDCs) environments where children spend a significant amount of time. A mixed-methods approach was applied to identify key hygiene behaviours in ECDCs through; checklist and structured observations (n = 849 children; n = 33 caregivers), focus group discussions (n = 25) and microbiological sampling (n = 261) of drinking water, food handler's hands, and eating utensils. ECDCs had inadequate WASH infrastructure; coupled with poor hygiene practices and unhygienic environments increased the risk of faecal-oral disease transmission. Presence of E. coli in drinking water confirmed observed poor water handling habits by staff and children. Addressing undesired hygiene practices in ECDCs has the potential to improve the health outcomes of children in low-income settings. [ABSTRACT FROM AUTHOR]

Background: Adults and children who are enterally tube‐fed can experience adverse gastrointestinal symptoms (GIS). Observational data suggests that blended diets (BD) could mitigate such symptoms, with potential to improve quality of life and clinical outcomes. We present a novel systematic review examining the impact of BD, compared to commercial feeds, on GIS of adults and children who are tube‐fed. Methods: The protocol was registered with PROSPERO (CRD42021261147). Four electronic databases were searched from inception to August 2021. Search terms included 'tube‐fed', 'blended diet' and 'formula'. Inclusion criteria were intervention studies comparing blended and commercial feeds using quantitative measures of GIS. Heterogeneity of outcome measures precluded meta‐analysis; therefore, a narrative synthesis was conducted. Results: Six papers (n = 219), including two randomised control trials (RCT) and four single arm pre–post studies, were identified. Equal numbers studied in‐ and out‐patients, adults and children. Risk of bias was notable for all studies. Equivocal and insufficient evidence prevented consensus on outcomes of vomiting, gagging, oral intake, bloating and constipation. However, one RCT and two single arm pre–post studies suggest that diarrhoea symptoms may be improved on BD. Conclusions: Diarrhoea is prevalent in tube‐fed populations and associated with adverse outcomes. Improvements in diarrhoea symptoms attributed to BD may be clinically important. Our findings are congruous with the wider observational evidence base, and support recommendations of the British Dietetic Association. BD may pose a viable alternative to commercial formula, and may mitigate symptoms of diarrhoea for adults and children who are tube‐fed. Key points: People who are enterally fed may experience adverse gastrointestinal symptoms (GIS) such as vomiting, diarrhoea, bloating, constipation and reflux.This systematic review finds evidence to suggest blended diets (BD) may mitigate symptoms of diarrhoea for adults and children who are enterally fed.There was insufficient evidence to determine the effect of BD on other GIS.These findings are congruous with the wider observational evidence base and support recommendations of the British Dietetic Association. [ABSTRACT FROM AUTHOR]

Diarrhea is one of the most frequent side effects of antibiotic treatment and occurs in 25 to 40% of patients in use. One potential strategy to prevent this side effect is the concurrent use of probiotics. This study evaluated the efficacy of the strain Bifidobacterium lactis CCT 7858 in the prevention of diarrhea and improvement of gastrointestinal symptoms in hospitalized patients using antibiotics. This was a randomized, blinded, placebo-controlled clinical trial. This study included 104 patients in antibiotic treatment. Patients were randomized into two groups: placebo (maltodextrin) and intervention (strain Bifidobacterium lactis CCT 7858 at 9 × 1010 CFU concentration; GABBIA® Biotecnology, Santa Catarina, Brazil). Patients were supplemented depending on the duration of antibiotic therapy, and both were evaluated with scales in two moments: before and after treatment. We included 104 hospitalized patients. In follow-up, 38 (74.5%) of the B. lactis group have no reported diarrhea. In secondary outcomes, in five day strong abdominal distension was reported in 4 (7,3) placebo group and not reported in B. lactis. Abdominal noises, nausea, and vomiting were not registered in any group. B. lactis strain has been considered safe and with several benefits, including reduction of soft stools and gastrointestinal symptoms how abdominal noise, pain and distension, as well reduction of diarrhea. [ABSTRACT FROM AUTHOR]

Diarrhea is an environment-based disease and occurs in almost all geographical areas in the world. Sustainable Development Goals (SDGs) are improvements to the Millennial Development Goals (MDGs). SDGs target number three, namely healthy and prosperous life, is to ensure a healthy life and improve the welfare of all people of all ages. The purpose of this study is to analyze the influence of snakes and ladders game media on children's knowledge in diarrhea prevention at SDN Kembang Tanjong District. This research is quantitative research with a quasi-experimental research design (pseudo-experiment) using a non-equivalent control group design. Gender. In this study, the results of frequency distribution based on the characteristics of respondents totaling 80 people were as many as 40 people (50%) were male and as many as 40 people (50%) were female. Based on the results of the distribution of efficiency based on class characteristics, as many as 16 people (20%) are in class IV (four), as many as 28 people (35%) are in class V (five) and as many as 36 people (45%) are in class VI (six). The results of the analysis using the Wilcoxon test with a confidence level of 95% using snake and ladder game media with a p-value of knowledge value of 0.000 ≤ 0.05 so that it can be concluded that there is an influence of health education with snakes and ladders game media on children's knowledge in preventing diarrhea in children at SDN Kembang Tanjong District. [ABSTRACT FROM AUTHOR]

Context Clinical trials have investigated the effect of probiotics on postsurgical complications in colorectal cancer (CRC). However, so far, there are no systematic reviews evaluating the effect of probiotics and synbiotics on the clinical or infectious postsurgical complications of colorectal cancer. Objective The objective of this review was to synthesize the best available evidence on the effects of the use of probiotics or synbiotics on pre-, peri-, and post-operative complications of CRC surgical resection. Data Sources A search of the PubMed, Embase, LILACS, Scopus, Cochrane, Web of Science, ProQuest, and Google Scholar databases was conducted for clinical trials published up until January 2022. Data Extraction The population characteristics, period and protocol of supplementation, and postoperative complications were extracted and reported. A random-effects model was used to estimate the effect of probiotic and synbiotic treatment on these variables. Data Synthesis In total, 2518 studies were identified, of which 16 were included in the qualitative synthesis and 13 in the meta-analysis. Overall, probiotic supplementation reduced the incidence of ileus (odds ratio [OR] = .13, 95% confidence interval [CI]:.02,.78), diarrhea (OR = .32, 95% CI:.15,.69), abdominal collection (OR:.35, 95% CI:.13,.92), sepsis (OR = .41, 95% CI:.22,.80), pneumonia (OR = .39, 95% CI:.19,.83), and surgical site infection (OR = .53, 95% CI:.36,.78). The results of the subgroup analysis indicated that lower dose (<109 colony-forming units), higher duration of supplementation (>14 days), and being administrated ≤5 days before and >10 days after surgery was more effective at reducing the incidence of surgical site infection. Conclusion Probiotics and synbiotics seem to be a promising strategy for the prevention of postoperative complications after CRC surgery. Larger, high-quality randomized controlled trials are needed to establish the optimal treatment protocol for the use of probiotics and synbiotics in preventing postoperative complications for CRC surgery. [ABSTRACT FROM AUTHOR]

Objectives: Diarrhoea is a leading cause of infant mortality with the main transmission pathways being unsafe water and contaminated food, surfaces and hands. The 'Safe Start' trial evaluated a food hygiene intervention implemented in a peri-urban settlement of Kisumu, Kenya, with the aim of reducing diarrhoeagenic enteric infections among infants. Four food hygiene behaviours were targeted: handwashing with soap before preparation and feeding, boiling infant food before feeding, storing infant food in sealed containers, and exclusive use of designated utensils during feeding. Methods: A process evaluation of the intervention was guided by a theory of change describing the hypothesised implementation and receipt of the intervention, mechanisms of change, and the context. These were assessed by qualitative and quantitative data that included debriefing sessions with the delivery teams and Community Health Volunteers (CHVs), and structured observations during food preparation. Results: The intervention achieved high coverage and fidelity with over 90% of 814 eligible caregivers participating in the intervention. Caregivers in the intervention arm demonstrated an understanding of the intervention messages, and had 1.38 (95% CI: 1.02–1.87) times the odds of washing hands before food preparation and 3.5 (95% CI: 1.91–6.56) times the odds of using a feeding utensil compared to caregivers in the control group. Contextual factors, especially the movement of caregivers within and outside the study area and time constraints faced by caregivers influenced uptake of some intervention behaviours. Conclusion: Future interventions should seek to explicitly target contextual factors such as secondary caregivers and promote food hygiene interventions as independent of each other. Significance: What is already known on this subject. Diarrhoea is known to be a significant cause of infant morbidity and mortality, mainly through unsafe water and food, and mainly from rural areas. What this study adds. This study describes the implementation of a novel food hygiene intervention to reduce diarrhoea causing enteric infections among children in low income peri urban settlements. The manuscript details the delivery of the intervention, describes the context, and explores associations influencing adoption of the intervention. Findings of the evaluation are meant to support the results of the trial. [ABSTRACT FROM AUTHOR]

Background: Statistical modeling suggests that decreasing diarrhea-associated mortality rates in recent decades are largely attributed to improved case management, rotavirus vaccine, and economic development. Methods: We examined data collected in 2 multisite population-based diarrhea case-control studies, both conducted in The Gambia, Kenya, and Mali: the Global Enteric Multicenter Study (GEMS; 2008–2011) and Vaccine Impact on Diarrhea in Africa (VIDA; 2015–2018). Population-level diarrhea mortality and risk factor prevalence, estimated using these study data, were used to calculate the attribution of risk factors and interventions for diarrhea mortality using a counterfactual framework. We performed a decomposition of the effects of the changes in exposure to each risk factor between GEMS and VIDA on diarrhea mortality for each site. Results: Diarrhea mortality among children under 5 in our African sites decreased by 65.3% (95% confidence interval [CI]: –80.0%, −45.0%) from GEMS to VIDA. Kenya and Mali had large relative declines in diarrhea mortality between the 2 periods with 85.9% (95% CI: −95.1%, −71.5%) and 78.0% (95% CI: −96.0%, 36.3%) reductions, respectively. Among the risk factors considered, the largest declines in diarrhea mortality between the 2 study periods were attributed to reduction in childhood wasting (27.2%; 95% CI: −39.3%, −16.8%) and an increased rotavirus vaccine coverage (23.1%; 95% CI: −28.4%, −19.4%), zinc for diarrhea treatment (12.1%; 95% CI: −16.0%, −8.9%), and oral rehydration salts (ORS) for diarrhea treatment (10.2%). Conclusions: The VIDA study sites demonstrated exceptional reduction in diarrhea mortality over the last decade. Site-specific differences highlight an opportunity for implementation science in collaboration with policymakers to improve the equitable coverage of these interventions globally. We demonstrated exceptional reduction in diarrhea mortality over a decade. Among the risk factors considered, the largest declines in diarrhea mortality were attributed to reduction in childhood wasting and an increased rotavirus vaccine coverage, zinc, and oral rehydration salts for diarrhea treatment. [ABSTRACT FROM AUTHOR]