Risk Of Diarrhea Research Articles

Contextual factors associated with diarrhea among under-five children in the Gambia: a multi-level analysis of population-based data

BackgroundDiarrhea poses a significant threat to the lives of children in The Gambia, accounting for approximately 9% of all deaths among children under the age of five. Addressing and reducing child mortality from diarrhea diseases is crucial for achieving the Sustainable Development Goal (SDG) 3, specifically target 3.2, which aims to eliminate preventable deaths in newborns and children under the age of five by 2030. Thus, this research aims to assess the prevalence and contextual factors associated with diarrhea among under-five children in The Gambia.MethodsThis research employed secondary data from the 2019/20 Gambia Demographic Health Survey (GDHS). The study initially involved 8,362 women aged between 15 and 49 years. Of these, 6,929 women with children under five were included in this analysis. Data were analyzed using STATA with cross-tabulation and model fitting. Multilevel logistic regression was applied to accommodate the hierarchical structure of the demographic health survey data. The model comparison parameters were BIC, AIC, deviance, and LLR. Variables with a p-value less than 0.05 were selected for multivariable analysis. The statistical significance of the factors was determined using an adjusted odds ratio with a 95% confidence interval (CI) and a p-value of less than 0.05.ResultsThe prevalence of diarrhea in under-five children was 53.2% in males and 46.8% in females. In the final model, Kerewan (aOR = 0.58; 95% CI = 0.33–0.98) and Basse (aOR = 0.59; 95% CI = 0.35–0.98) have significantly lower odds of childhood diarrhea compared to Banjul, female children show slightly lower, yet significant, odds of diarrhea compared to males (aOR = 0.96; 95% CI = 0.86–0.98), deliveries at government health centers are associated with higher odds of childhood diarrhea compared to home births (aOR = 1.24; 95% CI = 1.01–1.52). Mothers with post-secondary education had significantly lower odds of having children with diarrhea than those without any education (aOR = 0.50; 95% CI = 0.26–0.99) after controlling for confounders.ConclusionThe study findings indicate that several factors significantly impact the risk of childhood diarrhea in The Gambia. These factors include region of residence, sex of the child, place of delivery, and education level of the mother. The study suggests that existing interventions aimed at improving child health outcomes in the country should take into consideration these influential factors. Addressing these modifiable factors can enhance the effectiveness of interventions and promote better health outcomes for children in Gambia.

PSIII-2 Evaluation of medium-chain fatty acids on just-weaned piglet performance and diarrhea scores: A nursery trial

Abstract Weaning is one of the most stressful events for commercial pigs. The transition from mother’s milk (animal proteins) to a solid diet based on plant proteins, the reduction in lactose intake and the decline in HCl secretion by the digestive system of the piglet result in a sudden and significant increase in stomach pH as well as an increased risk of post-weaning diarrhea. The aim of this trial was to evaluate whether the use of a blend of medium-chain fatty acids (MCFAs) on top-off conventional nursery diets would improve zootechnical performance and intestinal problems in just-weaned piglets. Piglets [n = 624, 21-d of age, 6.5 kg body weight (BW), (♂ Fast Duroc x ♀ Fast 275)] were housed in 26 pens of an experimental nursery. Each pen (24 pigs/pen, with a starting density of 3.0 ft2/pig) was equipped with a height-adjustable water sucker, a water bowl and fitted with a single feeder-bin. Females and males were allocated to each pen, according to 3 BW categories (heavy, medium, and light). During a 46-d period of trial, the piglets (13 replicated pens per treatment) were allotted to a conventional 5 phases feeding program with 2 kg/MT of chlortetracycline (22%) and 400 g/MT of tiamuline (1.78%; CON). These basal diets contained 2,500 ppm Zn in Phases #1, 2, and only 2,000 ppm Zn in phase #3. Phases #1 to 3 were also supplemented with Ca-butyrate (1 kg/MT) and a blend of protected acidifiers (1 kg/MT). The treated group consisted to the basal diet (CON) supplemented with a blend of medium-chain fatty acids (MCFAs) at 1.0 or 0.75 kg/MT for Phases #1, 2,3 and Phases #4, 5, respectively and supplying of a proprietary blend of caprylic, capric, and lauric acids. Daily feed consumption, weekly pig pen BW, dead and removed pigs and daily diarrhea evaluation index were completed. Data are analyzed by an ANOVA model including treatment and pen as fixed and random effects, respectively. Pairwise comparisons were completed with a Chi-square test. The overall results are presented in Table 1. At the end of wk 2 and 3, animals receiving MCFAs had a better average daily gain (ADG; P < 0.05) than CON. Therefore, at wk 2, 3 and 4, MCFAs animals BW were heavier than CON ones (P < 0.05). Average daily feed intake (ADFI) was not significantly different for the overall duration of the trial (P > 0.05). However, at weeks 2 and 3, MCFAs piglets had a greater ADFI than CON ones (P < 0.05). The daily diarrhea index of the MCFAs group was less than CON at wk 3 (P < 0.05). In this trial, the significant improvement of diarrhea index on just-weaned MCFAs treated piglets could explain the significant better growth during the first 3 wk of nursery.

Abstract PO1-18-01: Patient Preferences for HR+/HER2- Metastatic Breast Cancer Treatments in Italy: A Qualitative Assessment

Abstract Objectives: Factors that influence treatment preferences of patients with hormone receptor-positive/HER2-negative (HR+/HER2-) metastatic breast cancer (mBC) are being investigated using discrete choice experiment (DCE) methodology. Appropriate attributes for the ongoing quantitative online survey phase were identified by this initial qualitative pilot study. Methods: To generate hypotheses and inform variables of the quantitative survey, the pilot phase consisted in online telephone interviews with patients with a diagnosis of Stage IV HR+/HER2- breast cancer at various stages of treatment. Interviews focused on exploring patients' perspectives on their interaction with physicians, preferences, and treatment experiences. Transcripts were coded using NVivo software to identify key themes. The ongoing DCE online survey aims to recruit patients meeting the same selection criteria as in the qualitative phase, also at various stages of treatment. Results: Fifteen mBC patients (median age, 43 years [range, 29-64]), including nine chemotherapy-treated and six without chemotherapy exposure, were enrolled in the pilot qualitative study. Eight and four patients reported receiving little information about their treatment plan and their risk status beyond the risk of relapse, respectively. Most participants did not know what to expect from their therapy but expressed trust in their physician’s decision in terms of treatment goals. Few patients (n=3) looked for a second opinion before starting treatment. Four out of fifteen patients declared that they were actively involved in their treatment plan decision, although all relied on their physician’s knowledge and decision. Reduced symptoms and improved quality of life (QoL) were patients’ main treatment goals, and side-effects and efficacy of treatment were their main concerns. When asked about the degree of acceptability of certain side effects, some participants considered hair loss and vomiting as unacceptable side effects, regardless of severity, while others considered them to be the most acceptable. This discrepancy is to be interpreted in the light of participants’ own treatment journey. Severity and duration of side-effects were mentioned by three patients as acceptability factors. In a choice task, patients were asked to express preferences between two hypothetical treatments. Efficacy (n=9) and administration mode (n=6) were spontaneously deemed important for treatment selection. While assessing the difference in risk between the two hypothetical treatments, ten patients explained that the main choice feature was extended progression-free survival (PFS) rate. Risk of infection and neutropenia (n=12) were concerns expressed by most patients in the post-COVID-19 period. Considering their substantial impact on QoL, alopecia (n=9) and vomiting (n=9) were presented by patients as particularly important, regardless of their degree of severity; whereas almost all patients reported that only severe fatigue (n=12), diarrhea (n=13) or nausea (n=13) would be an issue. These results allowed selection of the following attributes for further quantification of their preference weights in a DCE: PFS, risk of neutropenia, risk of alopecia, risk of vomiting, risk of diarrhea, risk of grade 3/4 side effects and mode of administration. Conclusions: This qualitative pilot study allowed for identification of what matters most to patients when selecting a treatment for mBC, which will be further assessed in the DCE. It also highlighted the need of patients with HR+/HER2- mBC for information about their treatment, potential side-effects, and health management. This research suggests that there is a need for patients to be more involved in treatment plans, and that taking patient preferences into account may help improve the treatment selection experiences. Citation Format: Grazia Arpino, Carmine De Angelis, Lorenzo Gerratana, Matteo Lambertini, Sarah Igidbashian, Martina Bellini, Serena Giuntoli, Xavier Guillaume, Julie Behillil, Claire Graziani-Taugeron. Patient Preferences for HR+/HER2- Metastatic Breast Cancer Treatments in Italy: A Qualitative Assessment [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-18-01.

Abstract SS02-02: Hormone Replacement and Alternatives for Relief of Vasomotor Symptoms in Women at Increased Risk for Breast Cancer

Abstract 70% of women will experience vasomotor symptoms sufficient to impact their quality of life during menopause transition and the early menopause. These symptoms are thought result from neurotransmitter imbalances resulting from ovarian hormone reductions and hypersecretion of gonadotropins. Increases in gonadotropins result in neurotransmitter triggered stimulation of the neurokinin 3 (NK3) receptor and thermoregulatory imbalance. Estrogen deficiency also reduces serotonin which can also trigger increases in hot flashes, and sleep disturbances. Vasomotor symptoms last on the average for 7 years until acclimation to persistent low estrogen levels occurs. Estrogen +/- progestin replacement therapy is associated with the greatest likelihood of vasomotor symptom relief as it reduces gonadotropin and NK3 receptor signaling and increases serotonin. Progestins also increase the neuroinhibitory transmitter gamma-aminobutyric acid (GABA) which improves sleep quality. There continues to be confusion on the part of providers and patients regarding the excess risk of breast cancer and thromboembolic events as these risks are affected by type of agent, route of delivery, age, duration of treatment, and presence of obesity. The majority of placebo controlled randomized clinical trial data on hormone replacement with estrogen or estrogen + a progestin comes from the Women’s Health Initiative (WHI) for women 50-79 in which oral conjugated estrogen (CE) 0.625 mg was used as the estrogen for women without a uterus and medroxyprogesterone acetate (MPA) was added to CE for women with a uterus to protect against endometrial hyperplasia and cancer. The median age at entry to WHI that trial was 63 and a substantial proportion had previously taken hormones. Large longitudinal cohort studies have been helpful in assessing risks in women starting hormones at a more clinically relevant age (45-55) and with hormonal preparations other than oral CE and MPA. Five to seven years of estrogen alone results in minimal if any increased risk for breast cancer. However, combined estrogen+ progestin replacement for women over 50, necessary for women with a uterus, results in an ~ 30 % relative increased risk for breast cancer if taken for up to 5 years and a doubling of risk with 10 years of treatment. So called bioidentical hormones often compounded as oral troches of estradiol, progesterone, and testosterone, are also associated with increased breast cancer risk. Vaginal hormones have not been found to increase risk for breast cancer. Increased risk of thromboembolism is predominately observed in women over 50 using oral as opposed to transdermal preparations. Increased risk for stroke and dementia was observed in the WHI again with oral hormones in women over 65. In the WHI there was no increase in cancer related, cardiovascular or overall mortality with estrogen or estrogen and progestin. For high-risk peri and post-menopausal women with who would like to reduce/alleviate their vasomotor symptoms with no increase in risk for breast cancer there are several options: 1) the tissue selective estrogen complex bazedoxifene (BZA) combined with conjugated estrogen (CE) 2) the non-hormonal option of NK3 receptor antagonists such as fezolinetant ( 3) non-hormonal options of gabapentin, selective serotonin reuptake inhibitors (SSRI) and serotonin and norepinephrine uptake inhibitors (SNRI). BZA and CE and fezolinetant are reported to reduce hot flashes in 70% or more of individuals with paroxetine effectiveness reported as 50%. All three are FDA approved for reduction of vasomotor symptoms. The combination of BZA and CE is also being investigated for breast cancer risk reduction. These agents differ with respect to side effects with increased risk of blood clots for bazedoxifene and conjugated estrogen, increased risk of nausea, diarrhea, and liver dysfunction for fezolinetant and drowsiness and dry mouth for SSRIs. Drug costs may also dramatically affect insurance coverage and patient uptake of a particular strategy. A recent online perusal of a popular site for finding the lowest drug price suggested substantial differences in the cost of drugs for relief of vasomotor symptoms. The approximate cost for a 30- day supply of oral estradiol was $30, estradiol transdermal patches $35, oral progesterone $15, combined estradiol and levonorgestrel transdermal patches $240, oral CE $200, oral CE + medoxyprogesterone acetate $240, and for BZA+ CE $200. For non-hormonal therapies the cost of 30 days of gabapentin was $11, paroxetine $30 and fezolinetant $550. Crandall, Mehta, and Manson JAMA 2023 329:405-420 Collaborative Group on Hormonal Factors in Breast Cancer Lancet 2019 394: 1159-1168 Fabian et al Ca Prev Res 2019 10:711-720 Modi and Dhillo Neuroendocrinology 2019 109:242–248 Citation Format: C. Fabian. Hormone Replacement and Alternatives for Relief of Vasomotor Symptoms in Women at Increased Risk for Breast Cancer [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr SS02-02.

Abstract PO2-01-09: Patient preferences for CDK4/6 inhibitor treatments in HR+/HER2− early breast cancer: a discrete choice survey study

Abstract Background: Patients (pts) with stage II/III HR+/HER2− early breast cancer (EBC) are at risk of recurrence that persists over years. The addition of a CDK4/6 inhibitor (CDK4/6i) to adjuvant endocrine therapy (ET) was investigated in monarchE, evaluating abemaciclib (ABE) in lymph node (LN)+ high-risk pts, and NATALEE, using ribociclib (RIB) in stage II/III disease, including pts with N0 disease. ABE was FDA approved in this indication in 2021, while NATALEE recently reported statistically significant iDFS results. Both efficacy and tolerability are relevant for pts treated in a curative setting. This prospective study evaluated the extent pts with EBC value different treatment (tx) attributes and how these may translate into preferences between the two CDK4/6i in the US. Methods: A web-based discrete choice experiment survey was conducted among pts with EBC between Jan and May 2023 before NATALEE results were available. Eligible pts were adult women in a US clinical practice setting with self-reported stage II/III HR+/HER2− EBC +/- prior chemotherapy receiving only adjuvant ET at the time of survey, who completed curative surgery 1-3 years ago. Pts selected the scenario that best reflected their preferences from a series of choice cards, each displaying a pair of hypothetical tx profiles. A total of 8 attributes related to efficacy (5-year iDFS), adverse events (AEs), monitoring requirements, tx duration, and schedule were included (Table 1). Attributes were included based on an initial pilot qualitative assessment that selected efficacy and safety attributes most relevant to pts, clinical input, and differentiating features between CDK4/6i. A conditional logit regression model was used to estimate preference weights and relative importance (RI) of each attribute. Utility scores, summarizing overall preference for CDK4/6i tx profiles, were estimated from the model, and various scenarios were tested. Subgroup analyses by menopausal status and BC stage will be presented. Results: 409 pts participated in the survey (median age, 53 years; White/Black/other race, 59%/23%/18%; BC stage II/III, 48%/52%; employed, 38%). Pt preferences for attributes that significantly impacted tx decision, in order of high to low RI, were higher efficacy (iDFS), lower risk of diarrhea, lower risk of fatigue, shorter tx duration, and lower risk of venous thromboembolic events. Attributes based on monitoring or schedule, including number of blood tests, number of EKGs, and tx schedule, did not affect tx choice (Table 2). Overall utility scores were consistently higher for reconstructed tx profiles that resembled RIB features, including under conservative scenarios where efficacy of RIB was assumed to be equivalent or lower than that of ABE. Conclusions: This study showed that, driven by strong preference for lower risk of AEs, pts with HR+/HER2− EBC prefer tx profiles that more closely resemble the clinical experience of receiving RIB. These pt preferences are important for shared decision making when discussing the addition of a CDK4/6i to adjuvant tx for eligible pts with HR+/HER2− EBC. Discrete Choice Experiment Attributes and Levels Estimated Preference Weight and Relative Importance Citation Format: Erica Mayer, Mary Lou Smith, Annie Guerin, Dominick Latremouille-Viau, Nisha C. Hazra, Yan Meng, Wendi Qu, Remi Bellefleur, Vaidyanathan Ganapathy, Liz Santarsiero, Robert Morlock, Maryam Lustberg. Patient preferences for CDK4/6 inhibitor treatments in HR+/HER2− early breast cancer: a discrete choice survey study [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-01-09.

Association Between Household Deprivation and Living in Informal Settlements and Incidence of Diarrhea in Children Under 5 in Eleven Latin American Cities

Diarrhea is a leading cause of death in children globally, mostly due to inadequate sanitary conditions and overcrowding. Poor housing quality and lack of tenure security that characterize informal settlements are key underlying contributors to these risk factors for childhood diarrhea deaths. The objective of this study is to better understand the physical attributes of informal settlement households in Latin American cities that are associated with childhood diarrhea. We used data from a household survey (Encuesta CAF) conducted by the Corporación Andina de Fomento (CAF), using responses from sampled individuals in eleven cities. We created a household deprivation score based on household water and sewage infrastructure, overcrowding, flooring and wall material, and security of tenure. We fitted a multivariable logistic regression model to estimate odds ratios (OR) and 95% confidence intervals (95% CI) to test the association between the deprivation score and its individual components and childhood diarrhea during the prior 2 weeks. We included a total of 4732 households with children, out of which 12.2% had diarrhea in the 2-week period prior to completing the survey. After adjusting for respondent age, gender, and city, we found a higher risk of diarrhea associated with higher household deprivation scores. Specifically, we found that the odds of diarrhea for children living in a mild and severe deprived household were 1.04 (95% CI 0.84–1.28) and 3.19 times (95% CI 1.80–5.63) higher, respectively, in comparison to households with no deprivation. These results highlight the connections between childhood health and deprived living conditions common in informal settlements.

Benefit-Risk Balance of Ketamine versus Midazolam + Fentanyl for Sedation-Analgesia in Mechanically Ventilated Patients: Randomised Controlled Trial

Objective: Ketamine has interesting pharmacological properties for sedation-analgesia in intensive care. However, there are few studies on its benefit-risk balance. The aim of this study was to evaluate the efficacy and safety of ketamine compared with midazolam + fentanyl in mechanically ventilated patients. Methods: Randomised, non-inferiority, open-label, multicentre controlled trial. Patients aged 18 years or older requiring invasive mechanical ventilation for at least 24 hours were randomised to receive, after rapid sequence intubation, ketamine at a starting dose of 0.5 mg/kg/h (n = 191) or midazolam 0.2mg/kg/h + fentanyl 1μg/kg/h (n =191). Infusion rates were subsequently adjusted to achieve a RASS score between -2 and +1. The primary endpoint was the percentage of time spent in the RASS range -2 to +1 without the use of an alternative sedative; secondary endpoints included level of analgesia, adverse events (AEs), length of stay and mechanical ventilation, and cost of sedation. Results: In total, 73.5% of patients in the ketamine group vs. 71.3% in the midazolam group were within the target RASS range, a difference of 2.2% [95% CI: -3.2% to 7.5%]; p = 0.18. The most frequently observed AEs in the ketamine group were hypersalivation (21.2% vs. 2.3%; p<0.001), psychodysleptic phenomena (19.8% vs. 2.6%;p<0.001) and hallucinations (9.42% vs. 1.04%; p<0.001). Delirium was the only AE more frequent in the Midazolam group than in the Ketamine group (23.5% vs 43.4%; p < 0.0001). However, the risk of arterial hypertension (7.3% vs 4.2%; p = 0.188), diarrhoea (0% vs 5%; p = 0.05) and self-extubation (3.1% vs 4.2%; p = 0.452) did not differ between the 2 groups. The length of stay in intensive care between the 2 groups was 6.3 ± 1.6 days vs 7.3 ± 1.7 days (p < 0.001) and that of mechanical ventilation 4.1 ± 0.94 days vs 4.84 ± 0.85 days (p < 0.001). The daily cost of sedative treatment was lower with ketamine than with midazolam ($32.4 ± 0.8 vs $43 ± 6.3; p<0.001). Conclusion: In this study, the efficacy of ketamine was not inferior to that of the midazolam + fentanyl combination, but its safety was poorer. Its low cost is a real advantage in our context.

The Incidence and Risk Factors for Enterotoxigenic E. coli Diarrheal Disease in Children under Three Years Old in Lusaka, Zambia.

This study aimed to estimate the incidence and risk factors for Enterotoxigenic Escherichia coli (ETEC) diarrhea. This was a prospective cohort study of children recruited in a household census. Children were enrolled if they were 36 months or below. A total of 6828 children were followed up passively for 12 months to detect episodes of ETEC diarrhea. Diarrheal stool samples were tested for ETEC using colony polymerase chain reaction (cPCR). Among the 6828 eligible children enrolled, a total of 1110 presented with at least one episode of diarrhea. The overall incidence of ETEC diarrhea was estimated as 2.47 (95% confidence interval (CI): 2.10-2.92) episodes per 100 child years. Children who were HIV-positive (adjusted Hazard ratio (aHR) = 2.14, 95% CI: 1.14 to 3.99; p = 0.017) and those whose source of drinking water was public tap/borehole/well (aHR = 2.45, 95% CI: 1.48 to 4.06; p < 0.002) were at increased risk of ETEC diarrhea. This study found that children whose mothers have at least senior secondary school education (aHR = 0.49, 95% CI: 0.29 to 0.83; p = 0.008) were at decreased risk of ETEC diarrhea. Our study emphasizes the need for integrated public health strategies focusing on water supply improvement, healthcare for persons living with HIV, and maternal education.

Clinical efficacy and safety of erlotinib combined with chemotherapy in the treatment of advanced pancreatic cancer: A meta-analysis.

Advanced pancreatic cancer is resistant to chemotherapeutic drugs, resulting in limited treatment efficacy and poor prognosis. Combined administration of the chemotherapeutic gemcitabine and erlotinib is considered a potential first-line treatment for advanced pancreatic cancer. However, their comparative benefits and potential risks remain unclear. To assess the clinical efficacy and safety of erlotinib combined with other chemotherapy regimens for the treatment of advanced pancreatic cancer. Literature on the clinical efficacy and safety of erlotinib combined with chemotherapy for advanced pancreatic cancer was retrieved through an online search. The retrieved literature was subjected to a methodological qualitative assessment and was analyzed using the RevMan 5.3 software. Ten randomized controlled trials involving 2444 patients with advanced pancreatic cancer were included in the meta-analysis. Compared with chemotherapeutic treatment, erlotinib combined with chemotherapy significantly prolonged the progression-free survival time of pancreatic cancer patients [hazard ratio (HR) = 0.78, 95%CI: 0.66-0.92, P = 0.003]. Meanwhile, the overall survival (HR= 0.99, 95%CI: 0.72-1.37, and P = 0.95) and disease control rate (OR = 0.93, 95%CI: 0.45-0.91, P = 0.84) were not significantly favorable. In terms of safety, the erlotinib and chemotherapy combination was associated with a significantly higher risk of diarrhea (OR = 3.59, 95%CI: 1.63-7.90, P < 0.05) and rash (OR = 3.63, 95%CI: 1.64-8.01, P < 0.05) compared with single-agent chemotherapy. Moreover, the risk of vomiting (OR = 1.27, 95%CI: 0.62-2.59, P = 0.51), regurgitation/anorexia (OR = 1.61, 95%CI: 0.25-10.31, P = 0.62), and infection (OR = 0.72, 95%CI: 0.28-1.87, P = 0.50) were not significant in either group. Compared with a single chemotherapeutic modality, erlotinib combined with gemcitabine can prolong progression-free survival in pancreatic cancer, but does not improve survival benefit or disease control rate, and can increase the risk of diarrhea and rash.

Analysis of Social Demography, Behavioral Hygiene, Breast Milk, And Nutritional Status in Children with Diarrhea in Surabaya City

Purpose: The purpose of this research is to investigate the impact of social demographics, personal hygiene, breastfeeding, and nutritional status on the incidence of diarrhea among children. Understanding these factors is crucial for assessing and improving the quality of health services, particularly in reducing child mortality rates associated with diarrhea. Methods: The research employed an explanatory survey research design, aimed at exploring new insights, identifying relationships between phenomena, and understanding the reasons behind certain events. Approval for data collection was obtained from the Candel Surabaya's ethics committee. Data were gathered from the Wonokromo sub-district in Surabaya in June 2023, with a sample size ranging from 300 to 400, selected through purposive sampling. Questionnaires were distributed to mothers attending Posyandu in Wonokromo village, and data were analyzed univariately using logistic regression. Results and Discussion: Statistical analysis revealed several significant findings. Ethnicity and the number of children were found to have no significant effect on the incidence of diarrhea (p-value = 0.322 and p-value = 0.930, respectively). However, factors such as mother's age (p-value = 0.021), education (p-value = 0.000), employment (p-value = 0.000), income (p-value = 0.000), child's age (p-value = 0.000), gender (p-value = 0.019), personal hygiene (p-value = 0.000), breastfeeding (p-value = 0.000), and nutritional status (p-value = 0.000) were significantly associated with the incidence of diarrhea. These results suggest that social demographics and personal hygiene, breastfeeding, and nutritional status play significant roles in influencing diarrhea occurrence among children. Implications of the Research: The findings of this study carry important implications for public health interventions. It underscores the necessity of promoting healthy lifestyle practices among parents, particularly mothers, to mitigate the incidence of diarrhea in children. Improving education, employment opportunities, income levels, and access to healthcare services can contribute to better health outcomes for children. Additionally, emphasizing the importance of personal hygiene, breastfeeding, and maintaining adequate nutritional status can significantly reduce the risk of diarrhea. Originality/Value: This research contributes to the existing body of knowledge by highlighting the specific factors that influence the incidence of diarrhea among children in a particular setting. By elucidating the significance of social demographics and various health-related practices, this study provides valuable insights for healthcare professionals, policymakers, and community stakeholders to develop targeted interventions aimed at reducing child morbidity and mortality associated with diarrhea.

Evaluating the impact of efpeglenatide on cardiometabolic and safety outcomes in individuals with diabetes: a systematic review and meta-analysis.

Efpeglenatide, a novel GLP-1 receptor agonist, has shown promise in improving glycemic control and inducing weight loss in individuals with type 2 diabetes (T2DM). This meta-analysis assessed its therapeutic potential and safety profile. A literature search was conducted on PubMed, SCOPUS, and Cochrane Central from inception until September 2023. We selected patients with T2DM and identified and compared those receiving efpeglenatide to placebo. Outcomes assessed included fasting plasma glucose (FPG), HbA1c, body weight, BMI, and cardiometabolic parameters. Data were analyzed using a random-effects model, with results presented as mean differences (MD) for continuous outcomes and risk ratios (RR) for safety analysis, along with their respective 95% confidence intervals. Quality assessment was conducted using the Cochrane risk of bias tool. We included 11 studies in our analysis. Efpeglenatide demonstrated significant reductions in FPG (MD = -1.53 mmol/L, 95% CI = [-2.86, -0.66], p < 0.01), HbA1c (MD = -0.84, 95% CI= [-1.08, -0.60], p < 0.01), body weight (MD = -2.24kg, 95% CI = [-4.20, -2.00], p < 0.01), and BMI (MD = -1.61kg/m2, 95% CI= [-2.12, -1.09], p < 0.01). However, efpeglenatide was associated with a moderate increase in the risk of gastrointestinal adverse events, nausea, diarrhea, and vomiting. There was a non-significant elevated risk of hypoglycemia. Efpeglenatide significantly improves glycemic outcomes and promotes weight loss in individuals with diabetes. However, it is associated with moderate adverse effects related to the gastrointestinal system. Thus, further trials are warranted to comprehensively assess its safety and efficacy to derive a robust conclusion. The online version contains supplementary material available at 10.1007/s40200-024-01409-3.

The Relationship between Clean and Healthy Living Behavior and Risk of Diarrhea in Toddler

Background: Diarrhea is a process of defecation in which the stool is more liquid which can be accompanied by blood or mucus with the intensity of defecation increasing more than 3 times a day. The occurrence of diarrhea in children is often attributed to inadequate environmental hygiene. This study aimed to examined the relationship between clean and healthy behavior (PHBS) and diarrhea among toddlers in the working area of ​​the Kalijaga Permai Cirebon Community Health Center. Subjects and Method: This was a cross-sectional study conducted at ​​the Kalijaga Permai Cirebon Community Health Center from May to June 2023. A total of 119 mothers with toddlers (aged 0-59 months) was selected for this study. The dependent variable was diarrhea. The independent variable was clean and healthy behavior (PHBS). The data were collected using a questionnaire and analyzed using chi square. Results: Mothers with poor PHBS increased the risk of diarrhea in children by 4.69 times compared to good PHBS (OR= 4.69; 95% CI = 3.04 to 7.24; p&lt;0.001). Conclusion: Implementation of household clean and healthy behavior lower the risk of diarrhea.

Ferric citrate for the treatment of hyperphosphatemia and iron deficiency anaemia in patients with NDD-CKD: a systematic review and meta-analysis.

Background: The application of ferric citrate therapy has yielded unexpected benefits in recent years for Chronic kidney disease patients suffering from hyperphosphatemia and iron deficiency -anaemia. Despite this, earlier research on the impact of ferric citrate on NDD-CKD has been contentious. Objective: The goal of the meta-analysis is to evaluate the evidence regarding the advantages and dangers of ferric citrate for the treatment of hyperphosphatemia and iron deficiency anaemia in NDD-CKD patients. Methods: Between the start of the study and June 2022, we searched PubMed, Embase, Cochrane, EBSCO, Scopus, Web of Science, Wan Fang Data, CNKI, and VIP databases for randomised controlled trials of iron citrate for hyperphosphatemia and anaemia in patients with NDD-CKD. For binary categorical data, risk ratios (OR) were employed, and for continuous variables, weighted mean differences The effect sizes for both count and measurement data were expressed using 95% confidence intervals Results: The meta-analysis includes eight trials with a total of 1281 NDD-CKD patients. The phosphorus-lowering effect of ferric citrate was greater compared to the control group (WMD, -0.55, 95% CI, -0.81 to -0.28; I2 = 86%, p < 0.001). Calcium (WMD, 0.092; 95% CI, -0.051 to 0.234; p > 0.05; I2 = 61.9%), PTH (WMD, -0.10; 95% CI, -0.44 to 0.23; I2 = 75%, p > 0.05) and iFGF23 (WMD, -7.62; 95% CI, -21.18 to 5.94; I2 = 20%, p > 0.05) levels were not statistically different after ferric citrate treatment compared to control treatment. Furthermore, ferric citrate increased iron reserves and haemoglobin. The ferric citrate group had considerably greater levels than the controls. Ferric citrate, on the other hand, may raise the risk of constipation, diarrhoea, and nausea. Conclusion: This meta-analysis found that ferric citrate had a beneficial effect in the treatment of NDD-CKD, particularly in reducing blood phosphorus levels when compared to a control intervention. It also shown that ferric citrate has a favourable effect on iron intake and anaemia management. In terms of safety, ferric citrate may increase the likelihood of gastrointestinal side effects.

Infant Non-Secretor Histoblood Group Antigen Phenotype Reduces Susceptibility to Both Symptomatic and Asymptomatic Rotavirus Infection.

The infant non-secretor histoblood group antigen phenotype is associated with reduced risk of symptomatic rotavirus diarrhea, one of the leading global causes of severe pediatric diarrheal disease and mortality. However, little is known regarding the role of secretor status in asymptomatic rotavirus infections. Therefore, we performed a nested case-control study within a birth cohort study previously conducted in Dhaka, Bangladesh, to determine the association between infant secretor phenotype and the odds of asymptomatic rotavirus infection, in addition to the risk of rotavirus diarrhea, in unvaccinated infants. In the parent cohort, infants were enrolled in the first week of life and followed through the first two years of life with multiple clinic visits and active surveillance for diarrheal illness. Secretor phenotyping was performed on saliva. Eleven surveillance stools collected over the first year of life were tested for rotavirus by real-time RT-PCR, followed by conventional PCR and amplicon sequencing to identify the infecting P-type of positive specimens. Similar to findings for symptomatic diarrhea, infant non-secretors experienced significantly fewer primary episodes of asymptomatic rotavirus infection through the first year of life in a likely rotavirus P-genotype-dependent manner. These data suggest that non-secretors experienced reduced risk from rotavirus due to decreased susceptibility to infection rather than reduced infection severity.

Provision of education to increase knowledge in the prevention of diarrhea in children

Introduction: Prevention of diarrhea in children involves various steps that parents or educators can take to improve knowledge and healthy living habits. By providing this education, parents and educators can help increase children's knowledge about diarrhea prevention and form healthy living habits to prevent the disease. Objective: knowing the provision of education to increase knowledge in preventing diarrhea in children. Methods: Experimental queasy with one group pretest-posttest design. The research sample was 60 respondents with consecutive sampling techniques. The instruments in the study were questionnaires and counseling units regarding diarrhea-statistical data analysis using the Wilcoxon Sign Rank Test. Results: Statistical tests show p values of 0.000 &lt; ? 0.05, so it means that there is a significant influence between providing education about diarrhea and the level of knowledge of mothers in preventing diarrhea in children. Conclusion: There is a significant influence between the provision of education about diarrhea and mothers' knowledge level in preventing diarrhea in children. Increasing knowledge about diarrhea prevention in children involves various aspects of hygiene, nutrition, and healthy lifestyle. This holistic approach is expected to reduce the risk of diarrhea in children and improve their overall health. In addition, it is crucial to constantly monitor the child's health, respond quickly to diarrhea symptoms, and seek medical help if needed.

Risk factors of post-operative diarrhoea in patients with pancreatic cancer after neoadjuvant chemotherapy: A retrospective cohort study.

Post-operative diarrhoea is a common adverse event after pancreatic surgery. While the risk factors for this condition have been identified, the increasing trend of administering chemotherapy before surgery might change these factors. This study aimed to identify the risk factors of post-operative diarrhoea in patients with pancreatic ductal adenocarcinoma (PDAC) who underwent neoadjuvant chemotherapy. A retrospective cohort study. Patients who underwent neoadjuvant chemotherapy and pancreatectomy because of PDAC between 2021 and 2023 were included. The preoperative characteristics of, operative details of and post-operative outcomes in patients with and without post-operative diarrhoea were collected and compared. The independent risk factors of post-operative diarrhoea were identified using logistic regression analysis. STROBE checklist was used. Post-operative diarrhoea occurred in 65 out of 145 (44.8%) patients during hospitalization. Elevated white blood cell count, advanced tumour stage, and late abdominal drain removal were independent risk factors for post-operative diarrhoea (p < .001, p = .006 and p = .009, respectively). Some perioperative factors influence post-operative diarrhoea in patients who undergo neoadjuvant chemotherapy. More attention should be paid to patients at a higher risk of post-operative diarrhoea, with an emphasis on high-quality management for these patients.

The effects of ambient temperature and feeding regimens on cecum bacteria composition and circadian rhythm in growing rabbits.

Seasonal environmental shifts and improper eating habits are the important causes of diarrhea in children and growing animals. Whether adjusting feeding time at varying temperatures can modify cecal bacterial structure and improve diarrhea remains unknown. Three batches growing rabbits with two groups per batch were raised under different feeding regimens (fed at daytime vs. nighttime) in spring, summer and winter separately, and contents were collected at six time points in 1 day and used 16S rRNA sequencing to investigate the effects of feeding regimens and season on the composition and circadian rhythms of cecum bacteria. Randomized forest regression screened 12 genera that were significantly associated with seasonal ambient temperature changes. Nighttime feeding reduced the abundance of the conditionally pathogenic bacteria Desulfovibrio and Alistipes in summer and Campylobacter in winter. And also increases the circadian rhythmic Amplicon Sequence Variants in the cecum, enhancing the rhythm of bacterial metabolic activity. This rhythmic metabolic profile of cecum bacteria may be conducive to the digestion and absorption of nutrients in the host cecum. In addition, this study has identified 9 genera that were affected by the combination of seasons and feeding time. In general, we found that seasons and feeding time and their combinations affect cecum composition and circadian rhythms, and that daytime feeding during summer and winter disrupts the balance of cecum bacteria of growing rabbits, which may adversely affect cecum health and induce diarrhea risk.

Stress Ibu Selama Kehamilan Merupakan Risiko Persalinan Prematur

Under-five mortality in Southeast Sulawesi province is estimated to be more than 50% due to the risk of LBW, asphyxia, pneumonia, diarrhea and congenital abnormalities. The incidence of LBW with the most cases was found in South Konawe District with 266 infants out of a total of 5,796 births. The purpose of the study was to determine the causative factors of preterm labor at the South Konawe District Hospital, this research method is quantitative with an observational approach using a Case Control Study design, this research was conducted from February to March 2023 at the South Konawe District Hospital with a total sample of 116 respondents. The sampling technique for the condition group (Premature Labor) carried out in this study used a probability sample, namely Simple random sampling. The results of the study showed that stress has a risk of 11.22 times the incidence of preterm labor in South Konawe District Hospital. It is concluded that stress in pregnant women is a risk factor for preterm labor.

WASH interventions and child diarrhea at the interface of climate and socioeconomic position in Bangladesh

Many diarrhea-causing pathogens are climate-sensitive, and populations with the lowest socioeconomic position (SEP) are often most vulnerable to climate-related transmission. Household Water, Sanitation, and Handwashing (WASH) interventions constitute one potential effective strategy to reduce child diarrhea, especially among low-income households. Capitalizing on a cluster randomized trial population (360 clusters, 4941 children with 8440 measurements) in rural Bangladesh, one of the world’s most climate-sensitive regions, we show that improved WASH substantially reduces diarrhea risk with largest benefits among children with lowest SEP and during the monsoon season. We extrapolated trial results to rural Bangladesh regions using high-resolution geospatial layers to identify areas most likely to benefit. Scaling up a similar intervention could prevent an estimated 734 (95% CI 385, 1085) cases per 1000 children per month during the seasonal monsoon, with marked regional heterogeneities. Here, we show how to extend large-scale trials to inform WASH strategies among climate-sensitive and low-income populations.

Evaluation of the Use of Digital Booklets on Increased Knowledge and Motivation of Pregnant Women in Exclusive Breastfeeding

Background: The main focus of the Indonesian Ministry of Health is to reduce the stunting rate, the Maternal Mortality Rate (MMR) and the Infant Mortality Rate (IMR). Based on health profile data for 2019, there were 20,244 children aged 0-28 months who died, with the main cause of death being diarrhea. Exclusive breastfeeding has been shown to be effective in preventing stunting and reducing the risk of diarrhea. However, only 34% of babies at the Tirtamulya Health Center received breast milk, and far below the target of 48%. To increase awareness of the importance of breastfeeding, it is recommended to use a booklet containing information about the benefits of breastfeeding. The digital booklet is a version that can be accessed via mobile devices to make it easier to access information. Purpose of Writing: Describe the effect of digital booklets on the level of knowledge and motivation of third trimester pregnant women regarding exclusive breastfeeding at the Tirtamulya Health Center.Research Method : This study used a quasi-experimental design with pre-test and post-test with the control group. A total of 15 pregnant women in the third trimester were selected as samples for each group. Purposive sampling method was used for sampling. The independent variable in this study was the provision of digital booklets and videos, while the dependent variable was the level of knowledge and motivation about exclusive breastfeeding in third trimester pregnant women. Data collection is done through Google Form. Data analysis was performed using the Wilcoxon test and the Mann-Whitney test. Research results: Wilcoxon test of knowledge of the treatment group (p-value = 0.004), the control group (p-value = 0.008), the motivation of the treatment group (p-value = 0.002), the control group (p-value = 0.007). Mann Whitney test of knowledge (p-value = 0.017), motivation (p-value = 0.83). The treatment group had a mean value of knowledge and motivation that was greater than the control group. Conclusions and Suggestions: Digital booklets have a more significant effect on increasing the level of knowledge about exclusive breastfeeding among third trimester pregnant women compared to videos.