Arm Circumference Research Articles

Measurements and medication data are indispensable for population blood pressure monitoring

Abstract Background The National Study on Health of Older People in Germany “Gesundheit 65+” included blood pressure (BP) measurements at home by a study nurse and classification of all current medication. Methods Nationally representative examination survey of the population aged 65 years and older residing in Germany using two-stage population registry sampling from 128 sample points, with a standardized examination at home from June 2022 to April 2023. Three standardized blood pressure measurements at two-minute intervals were taken after 5 minutes rest with an oscillometric device (Mobil-O-Graph) using one of five cuffs according to upper arm circumference. The mean of the second and third measurement was used for analysis. Hypertension was defined as mean systolic BP (SBP) at or above 140 mmHg, or mean diastolic BP (DBP) at or above 90 mmHg, or the use of antihypertensives (antihypertensives, diuretics, beta-blockers, calcium-channel blockers, ACEI and ARB) in participants with self-reported hypertension diagnosis. Provisional weights account for unequal sampling and participation probabilities. Results The “Gesundheit 65+” examination part included 1,493 participants of whom 1,475 (98.8%) had successful BP measurements (763 men and 712 women, aged 66 to 101 years). Based on self-reported diagnoses alone, the prevalence of hypertension would be 58.3% [95% CI 53.2-63.3] in men and 59.5% [53.8-64.9] in women. However, overall hypertension prevalence was estimated at 70.4% [65.8-74.7] in men and 72.3% [66.9-77.1] in women based on the study definition which combines self-reported diagnoses, standardized BP measurements and medication. Conclusions The prevalence of hypertension is greatly underestimated in the absence of examination survey data with standardized measurements and recording of medication use. In addition, measurement and medication data are needed for monitoring the hypertension cascade, i.e. awareness, treatment and control of hypertension. Key messages • Hypertension prevalence is underestimated in the absence of health examination surveys with measurements and medication data. • The hypertension cascade, i.e. assessment of awareness, treatment and control of hypertension needs population surveys with measurements and medication assessment.

Mass azithromycin for prevention of child mortality among children with acute malnutrition: A subgroup analysis of a cluster randomized controlled trial.

Children with acute malnutrition are at high risk of morality. Mass azithromycin distribution reduces all-cause mortality among children aged 1-59 months, and effects may be greater in underweight infants. Here, we evaluate the efficacy of azithromycin for reducing all-cause mortality in children aged 6-59 months with acute malnutrition (mid-upper arm circumference, MUAC, < 12.5 cm). Communities in Nouna District, Burkina Faso were 1:1 randomized to biannual mass distribution of single dose azithromycin or placebo to all children aged 1-59 months. Mortality was assessed during each census and treatment round. MUAC measurements were collected for all children. We evaluated the effect of azithromycin on mortality in subgroups of children aged 6-59 months defined by acute malnutrition (MUAC < 12.5 cm versus MUAC ≥ 12.5 cm). In children with MUAC < 12.5 cm, mortality rates were 51% lower among those living in azithromycin communities compared to placebo (incidence rate ratio 0.49, 95% confidence interval, CI, 0.25 to 0.99; incidence rate difference -18.1 deaths per 1,000 person-years, 95% CI -37.0 to -0.01), which was greater than the reduction in mortality among children with MUAC ≥ 12.5 cm (P-value for interaction on the relative scale = 0.09; P-value for interaction of the additive scale = 0.03). Children with acute malnutrition may benefit from single dose azithromycin above and beyond those without acute malnutrition. Trial registration: ClinicalTrials.gov NCT03676764; https://clinicaltrials.gov/study/NCT03676764.

Examining the burden and relationship between stunting and wasting among Timor-Leste under five rural children.

Globally and in Timor-Leste, wasting and stunting remain major public health problems among 'under five years children, but the interrelationship between the two has been poorly investigated. A better understanding of this interrelationship is a prerequisite to improving wasting and stunting programming. In our study, we assessed the influence of age on the prevalence of wasting and stunting, the overlap between the two conditions, and the effect of wasting parameters on linear growth catch-up using the data of 401 children recruited at 0 to 54 months of age [median (IQR) of 17 (7-32) months] with repeated anthropometric assessments [median (IQR) follow-up time was 25 (16-39) months]. At recruitment, prevalences of stunting, wasting and concurrence of the two conditions were 54.6%, 9.5% and 4.6%, respectively. These prevalences were already high and above the thresholds for public health importance among children below months of age and remained high throughouttheir childhood. Over the follow-up period, the change (95%CI) in Height-for-Age Z-score (HAZ) was -0.01 (-0.13; 0.11) (p = 0.850), and that of the Height-for-Age Difference (HAD) was -3.74 (-4.28; -3.21) cm (p<0.001). Stunting reversal was observed in 25.6% of those stunted at recruitment, while a positive change in HAD was observed in only 19.6% of assessed children. Path analysis by structural equation modelling showed no significant direct effect of WHZ at recruitment on the likelihood of positive change in HAD, with its influence being fully mediated by its change over the follow-up period. This change had an inverse relationship with the occurrence of a positive change in HAD. On the contrary, Mid-Upper Arm Circumference at recruitment had a significant positive direct effect on the likelihood of a positive HAD change. These results show that interventions to combat wasting and stunting need to be integrated.

Effect of clustered nursing on liver function indexes, nutrition, and emotional status of patients with severe liver failure.

Liver failure is a metabolic disorder caused by a variety of mixed factors. For such diseases, adopting cluster care can effectively improve the relevant symptoms of patients. To explore the nursing effect of nutritional nursing combined with clustered nursing for patients with severe liver failure. A total of 129 patients with severe liver failure were selected as retrospective study subjects. Nine cases were due to an end event, such as death. The other patients were divided into control group and observation group according to different nursing methods. Among them, the control group adopted nutrition nursing, and the observation group implemented cluster nursing on this basis. The differences of liver function, anxiety and depression score, gastrointestinal recovery, nutritional status, and sleep quality were compared between the 2 groups before and after nursing. After nursing, the total bilirubin, albumin, and aspartate aminotransferase of the observation group were significantly higher than those of the control group (P < .05). The nursing staff used Self-Rating Anxiety Scale and Self-Rating Depression Scale of the observation group, which were slightly lower than those of the control group. The difference was statistically significant after testing (P < .05). After nursing, the observation group's upper arm circumference, brachial tri-scalp fold thickness, and hemoglobin were better than those of the control group. Statistics showed that the difference was statistically significant (P < .05). The depth of sleep, time to fall asleep, number of awakenings, time to fall asleep after awakening, overall sleep quality, and intensive care unit environmental noise intensity in the Richards-Campbell Sleep Questionnaire sleep scale after nursing in the 2 groups were significantly higher than those before nursing, and the scores of the observation group were significantly lower than those in the observation group. In the control group, this difference was statistically significant (P < .05). Nutritional nursing combined with clustered nursing can effectively promote the recovery of gastrointestinal function in patients with severe liver failure.

Effectiveness of an Exercise and Educational-Based Prehabilitation Program in Patients with Breast Cancer Receiving Neoadjuvant Chemotherapy (PREOptimize) on Functional Outcomes: A Randomized Controlled Trial.

The study objective was to determine the effectiveness of a prehabilitation program to decrease postoperative musculoskeletal impairments in patients who have breast cancer and are receiving neoadjuvant therapy (NAT). Patients who had breast cancer and were receiving NAT before surgery were invited to participate in this randomized controlled trial. Patients randomized to the intervention group participated in a group-based prehabilitation program consisting of Nordic walking, resistance training, and therapeutic education from month 4 of NAT until before surgery. Patients in the control group received usual care (no prehabilitation). The main outcome was arm function measured with the short version of the Disabilities of the Arm, Shoulder and Hand questionnaire 1month after surgery. Other measures included pain, range of motion, functional capacity, cancer-related fatigue, handgrip strength, physical activity, and arm circumferences. A total of 64 patients were randomized during the study period, and 61 completed all assessments. A significant difference in the main outcome (short version of the Disabilities of the Arm, Shoulder and Hand questionnaire) was found before surgery as patients in the control group experienced worsening in arm function (mean difference = -9.84, 95% CI = -17.7 to -2). In addition, they also showed increased symptom frequency/severity according to the combined scale of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ-C30) (mean difference = +6.7 points, 95% CI = 13.4 to 0.1) compared to the intervention group. Prehabilitation also improved functional capacity (mean difference = 67.6m, 95% CI = 37.4 to 97.7) and physical activity levels and decreased cancer-related fatigue (mean difference = -1.3, 95% CI = -0.29 to -2.4) compared to the control group but had no effect on other secondary outcomes. After surgery, patients receiving prehabilitation also exhibited greater functional capacity at both 1 and 3months. No other difference was observed. A prehabilitation program was able to maintain arm function and increase functional capacity while decreasing fatigue in patients with breast cancer receiving NAT. Prehabilitation programs should be offered to patients with breast cancer to maintain functionality and enhance physical performance before surgery. An exercise program combined with therapeutic education in patients with breast cancer who receive neoadjuvant therapy before surgery can improve functional capacity and prevent declines of arm mobility and function.

Physical fitness of schoolchildren in the Metropolitan Region of Santiago: comparative analysis between types of educational establishments

Introduction: State and private subsidized schools usually have limited resources that may restrict the frequency and quality of physical activities offered in educational establishments. Objective: to compare the physical condition of schoolchildren between 6-14 years of age attending state, private subsidized and private schools in the boroughs of the Metropolitan Region of Santiago. Methods: we worked with a random sample by sex and age of 1656 schoolchildren aged 6-14 years. Anthropometry was measured (weight, height, arm circumference, waist circumference and skin folds). In addition, horizontal jump without impulse, grip strength and the distance covered in the six-minute walk test were measured. Results: there was a significantly higher proportion of obesity and waist circumference above the 90th percentile observed in students from state schools, compared to their peers from private and subsidized private schools. At the same time, girls in state schools had significantly lower physical performance, particularly in tests of grip strength and horizontal jump (p &lt; 0.01). Conclusion: State and subsidized schools tend to face resource limitations that may restrict the frequency and quality of physical activities offered. This may lead to lower results in physical fitness tests and, therefore, to a higher prevalence of risk indicators for cardiovascular and metabolic diseases in these students. Therefore, it is urgent to increase the quantity and quality of daily exercise time and to stimulate participation in sports to prevent and promote cardiovascular health.

Perceptions of stakeholders on the use of a simplified, combined protocol for treatment of acute malnutrition in Central African Republic.

Treatment of acute malnutrition requires novel approaches to improve coverage, reduce costs and improve the efficiency of standard protocols that separate the management of moderate acute malnutrition (MAM) and severe acute malnutrition (SAM). The use of simplified, combined protocols to treat both MAM and SAM has drawn research and policy interest among global, regional and national stakeholders. However, the perspectives of local communities and health care workers regarding the use of protocols to treat acute malnutrition in a routine health care system are generally lacking. This was a cross-sectional mixed-methods study aimed at assessing the perceptions of different stakeholders on the use of a simplified, combined protocol in two districts in the Central African Republic. Most of the respondents preferred the simplified, combined protocol over the standard protocol. They generally agreed that the protocol was easy to understand, allowed more children to receive treatment and was effective in treating acute malnutrition. The protocol modifications were well received, including the expanded admission criteria, use of mid-upper arm circumference (MUAC) only for admission and discharge criteria and reduced and simplified ready-to-use therapeutic food quantity to treat MAM and SAM. Some caregivers expressed concern with the use of MUAC only to declare recovery, flagging that underlying illnesses could still be present. The caregivers recommended the provision of other food basket interventions to improve the treatment. The support by caregivers and health care workers on the idea of training community health volunteers to treat acute malnutrition points to the potential of scaling up decentralized treatment to increase coverage in remote areas.

Nutritional Assessment Based on Mid-upper Arm Circumference Among Tribal Preschool Children of Three Distinct Ecological Zones of India

Undernutrition among infants and children retards the physical and cognitive growth and increases susceptibility to infections and diseases. Educational attainment and productivity of children get adversely affected by undernutrition, NFHS (2019–2020) and IIPS (2021) found the prevalence of undernutrition indicators to be high among the under-five children of the nation and tribal children to be in a more vulnerable condition. Mean mid-upper arm circumference (MUAC) is a quick, simple and precise screening tool to use in large-scale community-based nutritional programme. The present study aimed to assess the prevalence of undernutrition based on MUAC among three tribes of three distinct ecological zones of India, namely Bhil Tribe (Desert ecology), Dhodia tribe (Coastal ecology) and Kinnaura tribe (Himalayan ecology). The present cross-sectional study consists of 985 tribal children (509 boys and 476 girls) belonging to the age group 0–1 through 5+ years (below six years). Z-score was computed using WHO (2006) recommended age and sex-specific cutoff points for MUAC and the prevalence of undernutrition was assessed for children of below five years of age. MUAC has been found to have significant age difference among all communities ( p &lt; .001). Prevalence of undernutrition was found to be the highest among the Bhil tribe, the one residing in the desert ecology (41.03%) followed by Dhodia (18.06%) and Kinnaura tribe (12.16%). Among Bhil and Kinnaura children, prevalence of undernutrition was higher among the girls, while the Kinnaura boys manifested higher prevalence of undernutrition in comparison to their counterpart. Significant ( p &lt; .01) sex difference in undernutrition prevalence was found only in case of Bhil tribe (boys: 33.33%, girls: 48.02%). The prevalence of undernutrition significantly differs among the tribes of three distinct ecological zones ( p &lt; .001). The nutritional status of the tribal children, particularly that of the Bhil children, was unsatisfactory. To improve the nutritional wellbeing of the tribal population of the nation, studies at regular intervals focusing on the causes responsible for nutritional status are needed.

Improving case-detection of severe wasting among under-five-year-old children in Timor Leste: A secondary analysis of data from the 2020 national cross-sectional food and nutrition survey.

The World Health Organization recommends using weight-for-height Z-score (WHZ) <-3 or Mid-Upper Arm Circumference (MUAC) <115 mm as independent criteria for diagnosing severe wasting. However, there are several challenges in using the WHZ criterion. As a result, the MUAC (and edema)-only approach for identifying children needing treatment for severe wasting has been developed and is being rapidly scaled-up globally, including in Timor-Leste. But previous studies reported that MUAC<115 mm has poor diagnostic accuracy for detecting children with WHZ<-3. The two options being explored globally for improving the identification of these children in MUAC (and edema)-only programming contexts include expanding MUAC cut-off and the combination of the indicators MUAC and Weight-for-Age Z-score (WAZ). This study explored the accuracy for diagnosing severe wasting (WHZ<-3) of these two options in Timor-Leste. We conducted a secondary analysis of data from the 2020 national Timor-Leste Food and Nutrition Survey. We tested the accuracy of various MUAC cut-offs, and predefined case definitions in five age groups (0-5 months, 6-23 months, 24-59 months, 6-59 months, and 0-59 months). We calculated the standard diagnostic test parameters (sensitivity, specificity, Youden Index, and others) and used the Youden Index as the principal criterion for rating the overall level of accuracy. The sample analyzed comprised 11,056 children with complete information on our key variables (anthropometric data, age, and sex), of whom 52.2% were boys. The age groups 0 to 5 months, 6 to 23 months, and 24 to 59 months represented 9.0%, 33.7%, and 57.3% of the sample, respectively. We found that the optimal diagnostic MUAC cut-off varied across the age groups between 117 mm and 142 mm, with the Youden Index remaining < 55% in all the age groups considered. The use of case definitions combing MUAC and WAZ optimized the identification of children with WHZ<-3. The case definition MUAC<130 mm or WAZ<-3 Z-score had the best diagnostic accuracy in all the age groups except for the 0 to 5 months age group for which the case definition MUAC<110 mm or WAZ<-2 Z-score had the highest Youden Index. Our findings show that it is challenging to significantly improve diagnostic accuracy for identifying children with WHZ<-3 by only expanding the MUAC cut-off in under five Timorese children. However, In settings facing challenges in using WHZ, the combination of MUAC and WAZ indicators offers a promising approach. Further research is needed to confirm the effectiveness of the proposed combination of MUAC and WAZ indicators case definitions in a programmatic context in Timor-Leste, and other similar contexts.

Intestinal parasites in children from native communities of Salta, Argentina.

Intestinal parasites particularly affect vulnerable populations, making their management crucial in endemic areas. To evaluate the relationship between intestinal parasites, socioeconomic characteristics, and anthropometric nutritional status. This is an observational, cross-sectional study conducted on children aged 1 to 15 years in Tartagal, Argentina, for a year. Intestinal parasitic infections were determined through fecal analysis using sedimentation techniques (Teleman), Kato-Katz, and the Baerman method. Demographic and socioeconomic data were collected using a standardized survey. Height, weight, and mid-upper arm and head circumference were measured in the participants. Of the 588 participants who provided fecal samples, 55.4% had intestinal parasites, with G. lamblia and H. nana being the most prevalent species. Additionally, 31.9% of participants were found to have malnutrition due to excess weight. Risk factors for intestinal parasite presence included age, overcrowding, and walking barefoot, while owning a refrigerator, having an animal corral, adequate water storage, and belonging to the Guaraní ethnic group were protective factors. High vulnerability areas were observed regarding housing conditions and access to public services. An association between socioeconomic conditions and the risk of intestinal parasite presence was observed. However, no association was found between anthropometric nutritional status and the presence of intestinal parasites.

Relationship between maternal anemia during pregnancy and the risk of preeclampsia: A multicenter case-control study.

Introduction: Anemia, defined as a low hemoglobin level, is a common condition in pregnancy that can have adverse effects on maternal and fetal outcomes. Anemia can result from various causes, such as iron deficiency, vitamin B12 deficiency, folate deficiency, hemolysis, or bleeding. The association between anemia and preeclampsia is not fully understood, but some studies have suggested that anemia may increase the risk of developing preeclampsia, especially in women with iron deficiency or chronic inflammation. Objective: To assess the association of anemia during pregnancy and the risk of developing preeclampsia. Study Design and Setting: A multicenter unmatched case-control study was conducted. The study was conducted from 2 December 2020 to 1 January 2021 in West and North Gojjam zone governmental hospitals, North West Ethiopia. A total of 337 pregnant women (113 cases and 224 controls) who consented verbally and attended antenatal or delivery services were enrolled in the study. Population: The participants of this study were mothers attending attended antenatal care and delivery services. Data Management: The analysis involved manual checking, data entry using EpiData Manager, and subsequent analysis using SPSS version 23, with logistic regression and p-values <0.05 determining statistical significance. Results: Being nonanemic, high consumption of fat related, mid-upper arm circumference ≥25.6 cm, frequent consumption of milk products, and fruits and vegetables rich in vitamin A were found to be factors associated with the risk for developing preeclampsia. Conclusion and recommendations: Being nonanemic, diets that are characterized by a high intake of vitamin A-rich fruits and vegetables and milk products were significantly associated with a low risk of preeclampsia. On the other hand, high intake of fatty foods and obesity were associated with the development of preeclampsia. Therefore, preventing anemia encouraging and promoting healthy eating habits during pregnancy by including vitamin A-rich fruits and vegetables and milk products can effectively prevent the development of preeclampsia.

Blood Pressure Cuff Sizes for Pregnant Women in the United States: Findings from the National Health and Nutrition Examination Survey.

The use of correctly-sized blood pressure (BP) cuffs is important to ensure accurate measurement and effective management of hypertension. The goals of this study were to determine the proportions of pregnant women that would require small, adult, large, and extra-large (XL) cuff sizes, and to examine the demographic characteristics associated with need for a large or XL cuff. This cross-sectional study analyzed 1,176 pregnant women (≥18 years) included in the National Health and Nutrition Examination Survey (NHANES) 1999-2006 cycles. Recommended BP cuff sizes, based on American Heart Association recommendations, were categorized by mid-arm circumference: small adult (≤26cm), adult (>26 to ≤34cm), large (>34 to ≤44cm), and extra-large (XL) (>44cm). Among US pregnant women, recommended cuff sizes were: 17.9% small adult, 57.0% adult, and 25.1% for large or XL. About 38.5% of non-Hispanic Black, 21.6% of Mexican American and 21.0% of non-Hispanic White pregnant women required a large or XL cuff. About 81.8% of women in the highest quartile for BMI required large or XL cuffs, which was significantly higher than women in other quartiles. Roughly one out of every four pregnant women required large or XL BP cuffs. The requirement for large or XL cuffs was highest among non-Hispanic Black women and women with the highest BMI. For pregnant women, measuring the arm circumference and selecting an appropriately-sized cuff is important to facilitate accurate blood pressure monitoring and hypertension management.

Validation of the TMB-2296-BT blood pressure monitor in adults according to the ISO 81060-2:2018 + Amd.1:2020.

This study aimed to validate the accuracy of the test device (TMB-2296-BT) blood pressure (BP) monitor in adults according to International Standard Organization (ISO) 81060-2:2018 + Amd.1:2020 universal standard protocol, which is a digital monitor. Three trained observers used the same arm sequential method to compare the SBPs and DBPs measured by the test device with those measured by the reference device (mercury sphygmomanometer). For the test device with cuff ranging from 22 to 32 cm, there are 88 adults, with a male-to-female ratio of 35 : 53. The mean difference and SD between reference BPs and test device BPs readings were (0.21 ± 2.59)/(0.66 ± 2.12) mmHg for SBP/DBP for criterion 1, and (0.21 ± 2.07)/(0.66 ± 1.76) mmHg for SBP/DBP for criterion 2. For the test device with cuffs ranging from 22 to 42 cm, there are 87 adults, with a male-to-female ratio of 49 : 38. The mean difference and SD between reference BPs and test device BPs readings were (-1.62 ± 2.80)/(0.12 ± 3.01) mmHg for SBP/DBP for criterion 1, and (-1.62 ± 2.35)/(0.12 ± 2.60) mmHg for SBP/ DBP for criterion 2. And for the test device with cuff arm circumference sizes of 22-32 cm and 22-42 cm fulfilled both validation criterion 1 and 2 of the ISO 81060-2:2018 + Amd.1:2020 standard and can be recommended for both clinical and self/home BP measurement in adults.

Long Versus Mixed Muscle Length Training On Changes In Arm Circumference

Long Versus Mixed Muscle Length Training On Changes In Arm Circumference

Utility of mid-upper arm circumference in pediatric malnutrition: An Australasian Society of Parenteral and Enteral Nutrition consensus statement using the Delphi method.

Mid-upper arm circumference (MUAC) is a simple anthropometric tool used to screen for childhood undernutrition in humanitarian settings or low-income and middle-income countries. However, there is conflicting evidence and a lack of consensus with regard to its diagnostic use in clinical settings or population groups beyond this context. In 2023, a project officer was appointed by the Australasian Society of Parenteral and Enteral Nutrition (AuSPEN) to lead the development of a consensus review into the use of MUAC in the pediatric clinical setting. An AuSPEN appointed multidisciplinary group of informed clinicians used the Delphi method to critically appraise the evidence and develop a series of consensus statements. Delphi surveys were anonymous and distributed electronically. Members were asked to rate their level of agreement with each consensus statement using a 5-point Likert scale. A priori definition of consensus was established as ≥80% responses "agree" or "strongly agree." Three Delphi rounds were required to reach consensus. A total of 18 consensus statements, including rationale, were developed across the topics 'assessment and diagnosis', 'screening and monitoring' and 'clinical settings'. An evidence-based, region-specific consensus approach to the use of MUAC in pediatric malnutrition is a valuable tool for clinicians. MUAC is a straightforward, non-invasive and cost-effective tool, and may provide an advantage over traditional anthropometric tools in some clinical settings. There are limitations to the utility of MUAC and this consensus paper provides an empirical summary of advantages and limitations as they apply to the screening, assessment, diagnosis, and monitoring of pediatric malnutrition.

Reliability of calf circumference and mid-upper arm circumference as estimates of muscle mass

Reliability of calf circumference and mid-upper arm circumference as estimates of muscle mass

Interactive Support in The Tambak Wedi Village Area of Surabaya City to Avoid Stunting

ABSTRACT Stunting remains a serious challenge for Indonesian society. The 2018 basic health research reported that the prevalence of stunting among toddlers reached 30.8%. The impact of stunting is not only on physical growth but also on cognitive development and the risk of diseases in adulthood. Community service plays a crucial role in supporting government efforts to address stunting through nutrition education, infant and child feeding practices, sanitation, hygiene, and family economic empowerment. Based on this, the involvement of higher education institutions is necessary to improve public health through an approach of interprofessional collaboration and interprofessional education designed in community service activities that focus on empowering communities through integrative assistance. This community service is carried out in 2024, located in Tambak Wedi Village, Surabaya. The activities conducted include training and assistance in the production of processed foods based on moringa leaves and fish, health education on healthy living behaviors, guidance on parenting and breastfeeding/MPASI, training for early detection of high-risk pregnancies for families, and checking hemoglobin and protein levels for pregnant women in a state of chronic energy deficiency who receive supplementary feeding based on moringa leaves and fish. At the beginning of the community service activities, the results of health and laboratory examinations were as follows: several mothers were found to have a mid-upper arm circumference (MUAC) below 23.5 cm, which may indicate a risk of chronic energy deficiency (CED). Pregnant women were still found with hemoglobin levels below 11 g/dL, indicating anemia during pregnancy. Additionally, protein levels in pregnant women were found to be 6.2 g/dL, and there was one stunted child and seven children in a pre-stunting condition. Following up on the results of the initial health examination, interventions were carried out for pregnant women with chronic energy deficiency and toddlers at risk of stunting by providing snacks made from moringa and fish for two weeks. The Surabaya Hebat cadres also received a refresher on early detection screening for high-risk pregnant women INDEX TERMS Stunting, Moringa leaves and fish, Tambak Wedi

Integration of Immunization and Health Care Services on the Nutritional Status of Children 6-59 Months of Age in Flood-Affected Areas of South Punjab

Child malnutrition remains a serious public health problem in many parts of the developing world, particularly in South and Southeast Asia and sub-Saharan Africa. The situation is exacerbated by natural disasters, particularly floods, which increase the risk of infectious diseases and worsen the nutrition crisis in vulnerable areas. In Pakistan, the 2018 National Nutrition Survey showed high levels of stunting, underweight and wasting among children under the age of five. This study aimed to determine whether integration of immunization and health services can improve the nutritional status of children aged 6-59 months in flood-affected areas of South Punjab, Pakistan. This study used a mixed methods approach, combining a cross-sectional observational study with structured interviews. A sample of 384 children aged 6-59 months was selected through convenience sampling in flood-affected areas. Data were collected through surveys and interviews with families, focusing on maternal feeding practices and factors affecting child nutritional status. Statistical analysis was conducted using IBM SPSS version 25, including frequency distributions for categorical variables and Pearson correlations to determine the association between upper arm circumference (MUAC) and nutritional status, weight, and height. Results showed significant correlations between MUAC and child nutritional status (p=0.035), MUAC and child weight (p=&lt;0.001), and MUAC and child height (p=&lt;0.001). Of the total 384 participants, 60.68% had MUAC more than 12.5 cm, while 39.32% had MUAC less than 12.5 cm. This study confirms the importance of integrating health and immunization services in addressing child malnutrition in disaster-prone areas. Findings show that factors such as parents' socioeconomic status, occupation, education and living environment are significantly related to children's nutritional status.

Are previously validated blood pressure self-measurement devices accepted under the Universal Standard? A systematic review.

This study aimed to analyze whether oscillometric blood pressure devices validated for the general population may be considered approved under Universal Standard criteria. A systematic review was conducted, with searches in nine databases, up to September 2023, including 32 validation studies of noninvasive arm cuff devices for self-measurement. The British Hypertension Society protocol was most common (68%), followed by the Association for the Advancement of Medical Instrumentation (40%). Most devices met Universal Standard criterion 1, but only 17 (53%) met criterion 2. Few studies contained details about the choice of cuffs, the number of participants by arm circumference, or the differences between methods by cuff subgroup. Due to the considerable differences between validation protocols, 53% of the devices analyzed were approved under the Universal Standard. The study contributes to expanding the validated pool of self-measurement devices under the Universal Standard.

Determinants of breakfast skipping among pregnant women from South Ethiopia Gamo Zone: a case-control study.

Skipping breakfast during pregnancy presents several challenges and potential health risks for both the mother and her baby. Breakfast plays a crucial role in providing essential nutrients and energy after an overnight fast. Skipping breakfast during pregnancy creates an unhealthy environment for the fetus. Thus, this study aimed to identify the determinants of breakfast skipping among pregnant women. An unmatched, community-based case-control study was conducted among 116 randomly selected cases (breakfast skippers) and 232 neighboring controls (regular breakfast consumers). Data was collected using pre-tested interviewer-administered structured questionnaire. Binary logistic regression analysis was employed to determine predictors of breakfast skipping using STATA version 16. The odds of non-formal education (AOR = 3.92; 95% CI: 1.75, 8.78), low socioeconomic status (AOR = 2.93; 95% CI: 1.12, 7.68), poor dietary knowledge (AOR = 2.89; 95% CI: 1.29, 6.47), and experiencing morning sickness (AOR = 2.57; 95% CI: 1.13, 5.84) were higher among cases than controls. The odds of breakfast skipping were higher for every increase in family size (AOR = 1.65; 95% CI: 1.25, 2.18), but decrease with every unit increase in mid-upper arm circumference (AOR = 0.58; 95% CI: 0.46, 0.72) and weekly frequency of drinking coffee leaf tea beverage (AOR = 0.84; 95% CI: 0.78, 0.89). Findings of this study showed that poor economic status, lack of formal education, poor dietary knowledge, having morning sickness, having large family size, maternal nutritional status, and frequent consumption of coffee leaf tea beverage were significantly associated with breakfast skipping among pregnant women. Thus, efforts should focus on improving dietary awareness during pregnancy, strengthening dietary counseling during antenatal care, enhancing access to contraceptive services, and ensuring timely management of morning sickness.