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OBJECTIVETo examine the relationship between intake of vegetables/potatoes and incident type 2 diabetes (T2D) and explore whether the relationship between vegetable intake and incident T2D is mediated by baseline BMI.RESEARCH DESIGN AND METHODSCross-sectional associations between exposure (baseline intake of total vegetables, vegetable subgroups, and potatoes) and baseline BMI were assessed by multivariable-adjusted linear regression models. Associations between exposure and incident T2D were examined by multivariable-adjusted Cox proportional hazards models. Mediation by BMI was quantified through exploration of natural direct and indirect effects.RESULTSAmong 54,793 participants in the Danish Diet, Cancer and Health cohort, 7,695 cases of T2D were recorded during a median follow-up of 16.3 years. Participants in the highest total vegetable intake quintile (median 319 g/day) had a 0.35 kg/m2 (95% CI −0.46, −0.24) lower BMI and a 21% (95% CI 16, 26%) lower risk of incident T2D after multivariable adjustment compared with those in the lowest quintile (median 67 g/day). Baseline BMI mediated ∼21% of the association between vegetable intake and incident T2D. Participants in the highest compared with the lowest (median 256 vs. 52 g/day) potato intake quintile had a 9% (95% CI 2, 16%) higher risk of T2D after multivariable adjustment, with no association found after accounting for underlying dietary pattern. Of the vegetable subclasses, higher intake of green leafy and cruciferous vegetables was associated with a statistically significantly lower risk of T2D.CONCLUSIONSThe findings provide evidence that a higher vegetable, but not potato, intake might help mitigate T2D risk, partly by reducing BMI. OBJECTIVE: To examine the relationship between intake of vegetables/potatoes and incident type 2 diabetes (T2D) and explore whether the relationship between vegetable intake and incident T2D is mediated by baseline BMI.RESEARCH DESIGN AND METHODS: Cross-sectional associations between exposure (baseline intake of total vegetables, vegetable subgroups, and potatoes) and baseline BMI were assessed by multivariable-adjusted linear regression models. Associations between exposure and incident T2D were examined by multivariable-adjusted Cox proportional hazards models. Mediation by BMI was quantified through exploration of natural direct and indirect effects.RESULTS: Among 54,793 participants in the Danish Diet, Cancer and Health cohort, 7,695 cases of T2D were recorded during a median follow-up of 16.3 years. Participants in the highest total vegetable intake quintile (median 319 g/day) had a 0.35 kg/m2 (95% CI -0.46, -0.24) lower BMI and a 21% (95% CI 16, 26%) lower risk of incident T2D after multivariable adjustment compared with those in the lowest quintile (median 67 g/day). Baseline BMI mediated ∼21% of the association between vegetable intake and incident T2D. Participants in the highest compared with the lowest (median 256 vs. 52 g/day) potato intake quintile had a 9% (95% CI 2, 16%) higher risk of T2D after multivariable adjustment, with no association found after accounting for underlying dietary pattern. Of the vegetable subclasses, higher intake of green leafy and cruciferous vegetables was associated with a statistically significantly lower risk of T2D.CONCLUSIONS: The findings provide evidence that a higher vegetable, but not potato, intake might help mitigate T2D risk, partly by reducing BMI.

OBJECTIVE To examine the relationship between intakes of a) vegetables/potatoes and incident type 2 diabetes (T2D), and b) explore whether the relationship between vegetable intake and incident T2D is mediated by baseline BMI. RESEARCH DESIGN AND METHODS Cross-sectional associations between exposures (baseline intakes of total vegetables, vegetable subgroups, and potatoes), and baseline BMI were assessed by multivariable-adjusted linear regression models. Associations between exposures and incident T2D were examined by multivariable-adjusted Cox proportional hazards models. Mediation by BMI was quantified through exploring natural direct and indirect effects. RESULTS Among 54,793 participants of the Danish Diet, Cancer and Health cohort, 7,695 T2D cases were recorded during a median follow-up of 16.3 years. Participants in the highest total vegetable intake quintile (median: 319 g/d) had a 0.35 kg/m2 (95%CI:-0.46, -0.24) lower BMI and a 21% (95%CI: 16, 26%) lower risk of incident T2D after multivariable adjustments, compared to those in the lowest quintile (median: 67 g/d). Baseline BMI mediated ~21% of the association between vegetable intakes and incident T2D. Participants in the highest compared to the lowest (median: 256 vs 52 g/d) potato intake quintile had a 9% (95%CI: 2, 16%) higher risk of T2D after multivariable adjustments with no association found after accounting for underlying dietary patterns. Of the vegetable subclasses, higher intakes of green leafy and cruciferous vegetables were associated with a statistically significantly lower risk of T2D. CONCLUSIONS The findings provide evidence that a higher vegetable, but not potato, intake might help to mitigate T2D risk, partly by reducing BMI.

Background & aims: Circulating levels of acylcarnitines (ACs) have been associated with the risk of various diseases such as cancer and type 2 diabetes. Diet and lifestyle factors have been shown to influence AC concentrations but a better understanding of their biological, lifestyle and metabolic determinants is needed. Methods: Circulating ACs were measured in blood by targeted (15 ACs) and untargeted metabolomics (50 ACs) in 7770 and 395 healthy participants of the European Prospective Investigation into Cancer and Nutrition (EPIC), respectively. Associations with biological and lifestyle characteristics, dietary patterns, self-reported intake of individual foods, estimated intake of carnitine and fatty acids, and fatty acids in plasma phospholipid fraction and amino acids in blood were assessed. Results: Age, sex and fasting status were associated with the largest proportion of AC variability (partial-r up to 0.19, 0.18 and 0.16, respectively). Some AC species of medium or long-chain fatty acid moiety were associated with the corresponding fatty acids in plasma (partial-r ¼ 0.24) or with intake of specific foods such as dairy foods containing the same fatty acid. ACs of short-chain fatty acid moiety (propionylcarnitine and valerylcarnitine) were moderately associated with concentrations of branched-chain amino acids (partial-r ¼ 0.5). Intake of most other foods and of carnitine showed little association with AC levels. Conclusions: Our results show that determinants of ACs in blood vary according to their fatty acid moiety, and that their concentrations are related to age, sex, diet, and fasting status. Knowledge on their potential determinants may help interpret associations of ACs with disease risk and inform on potential dietary and lifestyle factors that might be modified for disease prevention.

A signal control method considering platoon-based actuation is presented with a focus on its application to two arterial corridors in the Houston Metropolitan Area, where the signal coordination is required for adjacent intersections. For the purpose of immediate implementation, the system was developed based on existing conventional loop detectors and control technologies used by Texas Department of Transportation. Simply based on volume and occupancy - the only traffic information reported by a conventional loop detector, it is impossible to precisely detect a platoon of vehicle approaching an intersection. As a compromise way, two specific logics were proposed to switch the system between the original coordinated control and the new platoon-based actuated control systems. At one testbed suffering from large left-turn traffic, the results revealed by the detector data before and after the implementation show that the model works well to relieve the delay for both left-turn traffic and through traffic on the major road. On another testbed where the platoon-based control is activated only when the through traffic is not high, some improvements were also observed. This method opens the door of wide application of the platoon-based signal control system (simply based on conventional loop detectors) to arterial corridors.

We present the first systematic, global stocktake of the academic literature on human adaptation. We screen 48,316 documents and identify 1,682 articles that present empirical research documenting human efforts to reduce risk from climate change and associated hazards. Coding and synthesizing this literature highlights that the overall extent of adaptation across global regions and sectors is low. Adaptations are largely local and incremental rather than transformative. Behavioural adjustments by individuals and households are more prevalent than any other type of response, largely motivated by drought and precipitation variability. Local governments and civil society are engaging in risk reduction across all sectors and regions, particularly in response to flooding. Urban technological and infrastructural adaptations to flood risk are prevalent in Europe, while shifts in farming practices dominate reporting from Africa and Asia. Despite increasing evidence of adaptation responses, evidence that these responses are reducing risks (observed and projected) remains limited.

Climate change adaptation responses are being developed and delivered in many parts of the world in the absence of detailed knowledge of their effects on public health. Here we present the results of a systematic review of peer-reviewed literature reporting the effects on health of climate change adaptation responses in low- and middle-income countries (LMICs). The review used the ‘Global Adaptation Mapping Initiative’ database (comprising 1682 publications related to climate change adaptation responses) that was constructed through systematic literature searches in Scopus, Web of Science and Google Scholar (2013–2020). For this study, further screening was performed to identify studies from LMICs reporting the effects on human health of climate change adaptation responses. Studies were categorised by study design and data were extracted on geographic region, population under investigation, type of adaptation response and reported health effects. The review identified 99 studies (1117 reported outcomes), reporting evidence from 66 LMICs. Only two studies were ex ante formal evaluations of climate change adaptation responses. Papers reported adaptation responses related to flooding, rainfall, drought and extreme heat, predominantly through behaviour change, and infrastructural and technological improvements. Reported (direct and intermediate) health outcomes included reduction in infectious disease incidence, improved access to water/sanitation and improved food security. All-cause mortality was rarely reported, and no papers were identified reporting on maternal and child health. Reported maladaptations were predominantly related to widening of inequalities and unforeseen co-harms. Reporting and publication-bias seems likely with only 3.5% of all 1117 health outcomes reported to be negative. Our review identified some evidence that climate change adaptation responses may have benefits for human health but the overall paucity of evidence is concerning and represents a major missed opportunity for learning. There is an urgent need for greater focus on the funding, design, evaluation and standardised reporting of the effects on health of climate change adaptation responses to enable evidence-based policy action.

Assessing global progress on human adaptation to climate change is an urgent priority. Although the literature on adaptation to climate change is rapidly expanding, little is known about the actual extent of implementation. We systematically screened >48,000 articles using machine learning methods and a global network of 126 researchers. Our synthesis of the resulting 1,682 articles presents a systematic and comprehensive global stocktake of implemented human adaptation to climate change. Documented adaptations were largely fragmented, local and incremental, with limited evidence of transformational adaptation and negligible evidence of risk reduction outcomes. We identify eight priorities for global adaptation research: assess the effectiveness of adaptation responses, enhance the understanding of limits to adaptation, enable individuals and civil society to adapt, include missing places, scholars and scholarship, understand private sector responses, improve methods for synthesizing different forms of evidence, assess the adaptation at different temperature thresholds, and improve the inclusion of timescale and the dynamics of responses. Determining progress in adaptation to climate change is challenging, yet critical as climate change impacts increase. A stocktake of the scientific literature on implemented adaptation now shows that adaptation is mostly fragmented and incremental, with evidence lacking for its impact on reducing risk.

IntroductionPremenstrual syndrome (PMS) has the potential to affect the quality of life adversely. Published guidelines recommend the use of exercise as part of the first-line management interventions for PMS. However, the published evidence related to the effectiveness of physical activity and PMS is inconclusive. This review will assess the effectiveness of exercise-based interventions in reducing PMS in women screened or diagnosed with PMS in low and middle-income countries, where the prevalence of PMS is high.Methods and analysisElectronic databases will be researched, including Embase, Cochrane Central Register of Controlled Trials, MEDLINE, PsycINFO, Web of Science, ClinicalTrials.gov and Google Scholar. All the studies published until March 2020 will be included. A standardised data extraction form will be used adapted from the Cochrane Handbook of Systematic Reviews of Interventions. Included articles will be assessed using the risk of bias tools based on study design. Data will be analysed using Review Manager V.5.3. The inverse-variance random-effects method will be used to report the standardised mean difference. A meta-analysis will be used only if studies are sufficiently homogenous. A narrative synthesis will be undertaken when studies are heterogeneous. Methodological heterogeneity between studies will be evaluated by considering the study types. Statistical heterogeneity will be tested using the I2test. Subgroup analyses may be performed only for the primary outcome in case of sufficient studies. Sensitivity analysis will be conducted to assess the impact of intervention excluding studies without randomisation and studies with a high risk of bias. Funnel plots will be used to assess the potential reporting bias and small-study effects only when there are more than 10 studies included in the meta-analysis.Ethics and disseminationThis study does not require ethical approval, as the review is entirely based on published studies. The results will be published and/or will be presented at a pertinent conference.PROSPERO registration numberCRD42020163377.

Funder: Bamenda Regional Hospital, BACKGROUND: To date, several clinical laboratory parameters associated with Coronavirus disease 2019 (COVID-19) severity have been reported. However, these parameters have not been observed consistently across studies. The aim of this review was to assess clinical laboratory parameters which may serve as markers or predictors of severe or critical COVID-19. METHODS AND FINDINGS: We conducted a systematic search of MEDLINE, Embase, Web of Science, CINAHL and Google Scholar databases from 2019 through April 18, 2020, and reviewed bibliographies of eligible studies, relevant systematic reviews, and the medRxiv pre-print server. We included hospital-based observational studies reporting clinical laboratory parameters of confirmed cases of COVID-19 and excluded studies having large proportions (>10%) of children and pregnant women. Two authors independently carried out screening of articles, data extraction and quality assessment. Meta-analyses were done using random effects model. Meta-median difference (MMD) and 95% confidence interval (CI) was calculated for each laboratory parameter. Forty-five studies in 6 countries were included. Compared to non-severe COVID-19 cases, severe or critical COVID-19 was characterised by higher neutrophil count (MMD: 1.23 [95% CI: 0.58 to 1.88] ×109 cells/L), and lower lymphocyte, CD4 and CD8 T cell counts with MMD (95% CI) of -0.39 (-0.47, -0.31) ×109 cells/L, -204.9 (-302.6, -107.1) cells/μl and -123.6 (-170.6, -76.6) cells/μl, respectively. Other notable results were observed for C-reactive protein (MMD: 36.97 [95% CI: 27.58, 46.35] mg/L), interleukin-6 (MMD: 17.37 [95% CI: 4.74, 30.00] pg/ml), Troponin I (MMD: 0.01 [0.00, 0.02] ng/ml), and D-dimer (MMD: 0.65 [0.45, 0.85] mg/ml). CONCLUSIONS: Relative to non-severe COVID-19, severe or critical COVID-19 is characterised by increased markers of innate immune response, decreased markers of adaptive immune response, and increased markers of tissue damage and major organ failure. These markers could be used to recognise severe or critical disease and to monitor clinical course of COVID-19.

Background and Objectives: The aim of the paper was designed to know the relationship between complementary feeding, nutritional knowledge and behavior of mothers (IYCF practices) and nutritional status of children less than two years of age at Ambhanjyang Village Development Committee (VDC) of Makwanpur district.Material and Methods: The study was conducted in aforesaid VDC of Makwanpur districts with a total of 120 samples. The questionnaire used consisted of socio-demographic information, health profile, dietary behavior of the child such as amount of feeding, frequency of feeding, diversified food and attitude statements of mothers regarding nutritional knowledge. The nutritional status of the child was assessed on the basis of anthropometric measurements weight and height.Results: In this survey, 21.2 percent of the children were found to be moderately underweight while 5.8 percent of the children were severely underweight, 19.2 percent were moderately stunted while 15 percent were found severely stunted. Likewise, 10.8 percent of the children found moderately wasted and only 1 child was found to be severely wasted. No significant association was observed between various socio-economic factors, complementary feeding practices and nutritional status of a child.Conclusion: The prevalence of under nutrition, stunting and inadequate complementary feeding practices was observed in the study sample. Although no significant association was observed between various socio-demographic factors and nutritional status of a child, there is an immediate requirement of healthy knowledge and change in behavior of mothers of children about complementary feeding practices to prevent the deteriorating nutritional status of child. Janaki Medical College Journal of Medical Sciences (2017) Vol. 5(1): 22-32

Background and aims: HIV infection and insufficient nutritional intake form a malicious cycle which leads to immunodeficiency and malnutrition. Thus, this research was done to see the effect of nutritional counseling on knowledge, attitude and practice (KAP) of HIV patients of Udupi district. Also, the rational evidence of association of nutritional status with CD4 counts and opportunistic infections combined are limited which led to design of this study. Methods: This interventional study was done in ART Centre, Udupi, India with a sample size of 66 with 33 each in experimental and control group (EG and CG). At first, the biochemical parameters, KAP, 3 day dietary intake and food group intake over Food Frequency Questionnaire (FFQ) were recorded. PG-SGA (Scored Patient-Generated Subjective Global Assessment) scoring was used to categorize patients' nutritional status. Individual nutritional counseling was provided to EG and change in KAP of EG and CG were recorded after 1 month. Results: Pre-KAP mean of EG was 151.56 which increased to 169.13 after intervention. The mean KAP score of EG was statistically different from CG after counseling, P < 0.001. Of the total, 15 (22.7%) patients were found to be malnourished. The dietary intake of nutrients and food group was significantly lower than RDA. Tukey HSD post hoc analysis showed significant statistical difference for the CD4 count between moderate and severe malnourished category with P ¼ 0.017. Statistically significant nutrient intake differences were also observed between PGSGA groups while odds ratio showed no significant association. Conclusions: Improvement in KAP and poor nutritional status indicates that individual Nutrition and Health Education Counseling be made an integral part in the management of HIV in Udupi. Also, the difference in CD4 count across two PG-SGA stages depicts an association between nutritional status and immune status of HIV patients.