Limited Evidence Research Articles

Implementation of an enhanced recovery after surgery protocol for colorectal cancer in a regional hospital network supported by audit and feedback: a stepped wedge, cluster randomised trial

BackgroundEnhanced recovery after surgery (ERAS) protocols are known to potentially improve the management and outcomes of patients undergoing colorectal surgery, with limited evidence of their implementation in hospital networks and...

Young people, place-based stigma and resistance: A case study of Glasgow’s East End

This article analyses working-class young people’s perceptions of and resistance to place-based stigma, through a case study of a youth-led theatre project in the East End of Glasgow, UK. The impact of stigma on working-class communities is well-established; through the effects of poverty and inequality people and places are stigmatised. Although existing literature emphasises that we must recognise how working-class people construct alternative narratives, there is limited evidence on how people in neighbourhoods with high levels of poverty manage and resist stigma. There is a dearth of research on young people’s resistance to stigma. This qualitative study found promising signs of young people’s agency to resist place-based stigma by constructing alternative narratives. Through creative work, young people were able to convey powerful messages around poverty-related issues, making visible the effects of poverty on individuals and communities and encouraging empathy and understanding. However, it was also evident that individualistic understandings of poverty are so powerfully ingrained that these alternative narratives stopped short of an explicit recognition of structural causes of poverty. This article argues that viewing resistance as a process helps to identify possibilities for supporting young people to further develop critical consciousness, to confront stigmatising discourses in a way that exposes power relations, and to generate activism.

Transdiagnostic dimensions of symptoms and experiences associated with immune proteins in the continuity of psychosis.

There is limited evidence as to whether the immune protein profile is associated with a particular symptomatology pattern across the psychosis continuum. We estimated two bifactor models of general and specific dimensions of psychotic experiences in unaffected siblings of patients (n = 52) and community controls (n = 200), and of psychotic symptoms in first-episode psychosis (FEP) patients (n = 110). We evaluated associations between these transdiagnostic dimensions and trait (TNF-α, IFN-γ), state (IL-6, IL-1β), and regulatory (TGF-β, IL-10, IL-4) cytokines. We explored whether schizophrenia genetic liability (schizophrenia polygenic risk score; SZ-PRS) modified the associations. High levels of trait marker IFN-γ were associated with the severity of general psychosis dimension in the unaffected siblings and community controls, expanding to the depressive dimension in siblings and to the manic dimension in FEP. High TNF-α levels were associated with more positive psychotic experiences in unaffected siblings and manic symptoms in FEP. Low levels of state markers IL-6 and IL-1β were observed in unaffected siblings presenting more depressive experiences. Still, high levels of IL-6 and IL-1β were associated with the severity of the depressive and negative symptom dimensions at FEP. The severity of transdiagnostic dimension scores across the three groups was associated with lower regulatory cytokines. Exploratory analysis suggested that a high SZ-PRS contributed mostly to associations with psychotic dimensions. IFN-γ mapped onto the multidimensional expression of psychosis, reinforcing the trait concept. State markers IL-6 and IL-1β may fluctuate along the spectrum. Dysfunction in the regulatory arm may disinhibit the inflammatory system. Associations with psychotic dimensions may be more prone to SZ-PRS susceptibility.

Medical Home Care and Educational Services for Children and Youth on the Autism Spectrum: A Scoping Review.

This scoping review examined current evidence on medical home care and its association with educational services for children and youth on the autism spectrum. We searched five databases and grey literature resulting in 328 publications. Publications meeting inclusion criteria were mapped to medical home care component(s) addressed, type(s) of educational services and their strength and type of association. The Andersen Behavioral Model of Health Services Use was used to summarize predisposing, enabling, and need factors considered. Eighteen publications were reviewed, including eight practice/policy reports and ten original research publications. Medical home care components most addressed included family-centered care (n = 10), referrals (n = 16), and effective care coordination (n = 13). Seven publications also addressed multiple educational service types. Two of the five publications that established a significant association between medical home care components and educational services had mixed results, with one publication reporting a negative association and the other publication reporting a positive association. Challenges to medical home care and educational services were most categorized as enabling factors. Results suggest three areas for further investigation: (1) limited evidence on the strength and type of association between medical home care components and educational services; (2) limited use of population data sources; and (3) the need to consider a broader range of factors when examining their association.

Indigenous sexual and reproductive health practices by girls in Makhado Municipality: A qualitative study.

Cultural practices are passed from one generation to the other. There has been limited evidence of willingness to use indigenous practices to enhance sexual and reproductive health among the youth in resource-constrained settings. This study aimed to explore the possibilities of reintroducing indigenous practices to enhance sexual and reproductive health education among girls. The study adopted a qualitative approach through participatory action research. Non-probability, purposive sampling was used to recruit girls aged 9-18. Data were generated through focus group discussions and key informant interviews. The study findings revealed that indigenous practices were beneficial in delaying sexual debut and nurturing self and peer respect. Additionally, girls appreciated indigenous knowledge and preferred introducing innovative approaches to promoting it. Youth involvement in indigenous knowledge and practices on sexual and reproductive health practices is paramount. The need to introduce critical dialogue to introduce innovative approaches to promoting indigenous practices to enhance sexual and reproductive health is imperative.

Lifestyle modification interventions for adults with intellectual disabilities: systematic review and meta-analysis at intervention and component levels.

Adults with intellectual disabilities (IDs) are susceptible to multiple health risk behaviours such as alcohol consumption, smoking, low physical activity, sedentary behaviour and poor diet. Lifestyle modification interventions can prevent or reduce negative health consequences caused by these behaviours. We aim to determine the effectiveness of lifestyle modification interventions and their components in targeting health risk behaviours in adults with IDs. A systematic review and meta-analysis were conducted. Electronic databases, clinical trial registries, grey literature and citations of systematic reviews and included studies were searched in January 2021 (updated February 2022). Randomised controlled trials and non-randomised controlled trials targeting alcohol consumption, smoking, low physical activity, sedentary behaviours and poor diet in adults (aged≥18years) with ID were included. Meta-analysis was conducted at the intervention level (pairwise and network meta-analysis) and the component-level (component network meta-analysis). Studies were coded using Michie's 19-item theory coding scheme and 94-item behaviour change taxonomies. Risk of bias was assessed using the Cochrane Risk of Bias (ROB) Version 2 and Risk of Bias in Non-randomised Studies of Interventions (ROBINS-I). The study involved a patient and public involvement (PPI) group, including people with lived experience, who contributed extensively by shaping the methodology, providing valuable insights in interpreting results and organising of dissemination events. Our literature search identified 12180 articles, of which 80 studies with 4805 participants were included in the review. The complexity of lifestyle modification intervention was dismantled by identifying six core components that influenced outcomes. Interventions targeting single or multiple health risk behaviours could have a single or combination of multiple core-components. Interventions (2 RCTS; 4 non-RCTs; 228 participants) targeting alcohol consumption and smoking behaviour were effective but based on limited evidence. Similarly, interventions targeting low physical activity only (16 RCTs; 17 non-RCTs; 1413 participants) or multiple behaviours (low physical activity only, sedentary behaviours and poor diet) (17 RCTs; 24 non-RCTs; 3164 participants) yielded mixed effectiveness in outcomes. Most interventions targeting low physical activity only or multiple behaviours generated positive effects on various outcomeswhile some interventions led to no change or worsened outcomes, which could be attributed to the presence of a single core-component or a combination of similar core components in interventions. The intervention-level meta-analysis for weight management outcomes showed that none of the interventions were associated with a statistically significant change in outcomes when compared with treatment-as-usual and each other. Interventions with core-components combination of energy deficit diet, aerobic exercise and behaviour change techniques showed the highest weight loss [mean difference (MD)=-3.61, 95% credible interval (CrI) -9.68 to 1.95] and those with core-components combination dietary advice and aerobic exercise showed a weight gain (MD 0.94, 95% CrI -3.93 to 4.91). Similar findings were found with the component network meta-analysis for which additional components were identified. Most studies had a high and moderate risk of bias. Various theories and behaviour change techniques were used in intervention development and adaptation. Our systematic review is the first to comprehensively explore lifestyle modification interventions targeting a range of single and multiple health risk behaviours in adults with ID, co-produced with people with lived experience. It has practical implications for future research as it highlights the importance of mixed-methods research in understanding lifestyle modification interventions and the need for population-specific improvements in the field (e.g., tailored interventions, development of evaluation instruments or tools, use of rigorous research methodologies and comprehensive reporting frameworks). Wide dissemination of related knowledge and the involvement of PPI groups, including people with lived experience, will help future researchers design interventions that consider the unique needs, desires and abilities of people with ID.

The utility of elective flexible bronchoscopy to improve quality of life and clinical outcomes for children: A systematic review.

Elective flexible bronchoscopy (FB) is now widely available and standard practice for a variety of indications in children with respiratory conditions. However, there is limited evidence regarding the utility of elective FB in children. This systematic review (SRs) aimed to determine the utility of FB on its impact in clinical decision making and quality of life (QoL). We searched Pubmed, Cochrane central register of controlled trials, Embase, World Health Organization Clinical Trials Registry Platform and Cochrane database of SRs from inception to April 20, 2023. We included SRs and randomized controlled trials (RCTs) that used parallel group design (comparing use of elective FB vs. no FB, or a wait-list approach [early FB vs. usual wait FB]) in children aged ≤ 18 years. Our protocol was prospectively registered and used Cochrane methodology for systemic reviews of interventions. Our search identified 859 articles; 102 duplicates were removed, and 753 articles were excluded by title and abstract. Four full text articles were reviewed and subsequently excluded, as none met the inclusion criteria outlined in our patient, intervention, comparator, outcome measures framework. There is a paucity of high-quality RCT evidence to support the routine use of elective FB in children with respiratory conditions. However, available retrospective and a single prospective study demonstrate the high utility of FB in the elective pediatric setting. PROSPERO CRD42021291305.

Molecular physiology of Antarctic diatom natural assemblages and bloom event reveal insights into strategies contributing to their ecological success.

In the Southern Ocean, phytoplankton must cope with harsh environmental conditions such as low light and growth-limiting concentrations of the micronutrient iron. Using metratranscriptomics, we assessed the influence of oceanographic variables on the diversity of the phytoplankton community composition and on the metabolic strategies of diatoms along the Western Antarctic Peninsula, a region undergoing rapid climate change. We found that cross-shelf differences in oceanographic parameters such as temperature and variable nutrient concentrations account for most of the differences in phytoplankton community composition and metabolism. We opportunistically characterized the metabolic underpinnings of a large bloom of the centric diatom Actinocyclus in coastal waters of the WAP. Our results indicate that physicochemical differences from onshore to offshore are stronger than between southern and northern regions of the WAP; however, these trends could change in the future, resulting in poleward shifts in functional differences in diatom communities and phytoplankton blooms.

UNPACKING TOURISM FATIGUE: travel frequency, duration and its effects on satisfaction and revisit intention

ABSTRACT While prior research has recognised the significance of tourism fatigue, there exists limited empirical evidence regarding its causes and consequences. Drawing upon the stressor-strain-outcome framework, this study investigates the main antecedents and outcomes by constructing a research model of tourism fatigue. This study utilises two waves of cross-sectional data sets from two distinct destinations (i.e. nature-based and culture-based destinations). Findings suggest that travel frequency significantly influences tourism fatigue, with a predominant impact on psychological fatigue, while duration primarily affects physical fatigue in both destination types. It is also observed that physical fatigue exacerbates psychological fatigue. Tourist satisfaction is notably affected by psychological fatigue, but the effects of tourism fatigue on revisit intentions vary according to the specific travel context. Theoretical and managerial implications are also discussed.

Demographics, clinical characteristics, and treatment patterns among keloid patients: United States Electronic Health Records (EHR) Database Study.

There is limited epidemiologic evidence on keloids using real-world data, especially in the United States (US) across race and ethnicity. We conducted a retrospective cohort study using Cerner Real-World Data, between 2015 and 2021, to describe the demographic and clinical characteristics of US adults with keloids. Keloids were identified using a combination of ICD-10 and (Systemized Nomenclature of Medicine-Clinical Terms [SNOMED] codes). Demographics (including race and ethnicity), clinical characteristics, treatment patterns, and healthcare utilization were compared across keloid and non-keloid populations. Among 5,457 keloid patients identified in the study, the majority were female (61.8%) with a mean age of 34.2 years and of non-Hispanic Black, Hispanic, and Asian descent (P < 0.001). Relative to non-keloid cohorts, patients with keloids had significantly higher rates of integumentary, cardiorespiratory, general, auditory, and ocular surgeries and burns (all P < 0.05). Patients with keloids were also more likely to have comorbidities like obesity, hypertension, hyperlipidemia, and diabetes (P < 0.05) when compared to those with no keloids. A large proportion of keloids were untreated; among those treated, the most common keloid treatments were medication therapy (51.5%) and surgical excision (10.6%). Non-Hispanic Black and Hispanic keloid patients were significantly more likely to receive medication therapy and surgical excision (P < 0.001) compared to keloid patients of other races or ethnicities. This study provided real-world insights into the keloid population in the US. Our findings emphasize the high burden of keloids and its substantial impact on ethnic minorities. Given high keloid recurrence rates and limited standardized treatments for keloids, further research into keloids is crucial to the development of keloid-specific therapeutic options.

Core clock genes adjust growth cessation time to day-night switches in poplar

Poplar trees use photoperiod as a precise seasonal indicator, synchronizing plant phenology with the environment. Daylength cue determines FLOWERING LOCUS T 2 (FT2) daily expression, crucial for shoot apex development and establishment of the annual growing period. However, limited evidence exists for the molecular factors controlling FT2 transcription and the conservation with the photoperiodic control of Arabidopsis flowering. We demonstrate that FT2 expression mediates growth cessation response quantitatively, and we provide a minimal data-driven model linking core clock genes to FT2 daily levels. GIGANTEA (GI) emerges as a critical inducer of the FT2 activation window, time-bound by TIMING OF CAB EXPRESSION (TOC1) and LATE ELONGATED HYPOCOTYL (LHY2) repressions. CRISPR/Cas9 loss-of-function lines validate these roles, identifying TOC1 as a long-sought FT2 repressor. Additionally, model simulations predict that FT2 downregulation upon daylength shortening results from a progressive narrowing of this activation window, driven by the phase shift observed in the preceding clock genes. This circadian-mediated mechanism enables poplar to exploit FT2 levels as an accurate daylength-meter.

The firm-level costs of utilizing free trade agreements

The number of free trade agreements (FTAs) has surged in recent years. In order to benefit from lower import duties, firms must apply for preferential customs treatment and comply with rules of origin requirements. This is costly and explains why preference utilization rates are typically far below 100 percent. Analyzing Switzerland’s wide FTA network based on a novel data set on all import transactions, our findings shed light on how sourcing requirements affect FTA utilization. Using a revealed preference criterion, we identify a fixed cost component of the utilization which firms avoid especially for urgent shipments. We also find limited evidence of learning effects and provide well-identified estimates of the restrictive effects of rules of origin.

Role of Governance in Implementing Climate Change Adaptation Strategies in the Congo Basin Case of Cameroon and the Democratic Republic of Congo

The low adaptability capacity of the Central African sub-region to climate change has made it one of Africans’ most vulnerable sub-regions in the continent as this sub-region depends heavily on resources sensitive to climate change. Cameroon and the Democratic Republic Congo are host to the world's second largest rainforest after the Amazon. This implies that climate change will undermine development in this sub-region and the rest of the continent as the effects of climate change are faced more by the most vulnerable. There is however rising interest in SSA to mitigate and adapt climate change solutions. While such efforts exist, knowledge on the governance arrangements exist in very fragmented forms. Specifically, knowledge on how global climate changes processes is reflected in national policies remain relatively less studied. So too are their limited evidence on how national policies play out at local level. Such knowledge deficits stall scientific evidence building and policy orientation to strengthen climate adaptation practices in countries of SSA, with Cameroon and DRC being classical examples. Yet theory building on climate change governance requires such context specific evidence. In addition, for a comprehensive policy to be adopted and made effective, climate change actions require such scientific evidence. This therefore validates the need to analyze how such global processes are framed into national policy and policy instruments for climate mitigation and adaptation, and to establish the connections and disconnections between what is framed at national level and what applies at local level in terms of climate change policy instrument and what explains such variations. Though effective climate action requires political commitment, well-aligned multi-level governance and institutional frameworks, laws, policies and strategies, as outlined by the Intergovernmental Panel on Climate Change (IPCC), there is still need for clear goals, adequate finance and financing tools, coordination across multiple policy domains, and inclusive governance processes in Cameroon and the Democratic Republic of Congo to harness these goals. This study investigated the role of governance in implementing climate change adaptation in Cameroon and the DRC. This research therefore aimed at examining the role of governance in implementing climate change adaptation strategies in Cameroon and the DRC. The study made use of primary and secondary data which was analyzed using content analysis to triangulate the relationship that exist between governance and the implementation of climate change adaptation strategies in Cameroon and the DRC. Results highlight the dominant role of governance in shaping adaptation efforts, challenges in implementation, spatial disparities, and the influence of national policies and stakeholder engagement. Policy recommendations emphasize the need for improving governance structures, enhancing stakeholder participation, mainstreaming gender considerations, and addressing financial constraints to build resilience and effectively respond to climate change impacts in both countries. The findings underscore the importance of context-specific strategies that prioritize inclusivity, transparency, and collaboration to address the complex challenges posed by climate change.

Determinants of undernutrition among khat chewing and non-khat chewing male adults in Addis Ababa, Ethiopia: a comparative cross-sectional study

Khat chewing is a deep-rooted socio-cultural tradition that affects appetite, gastric emptying, and food intake, ultimately influencing nutritional status. Moreover, there is significant variation in lifestyles and ways of living among khat chewing and non-chewing people. However, there is limited evidence on the disaggregated determinants of undernutrition among khat chewers and non-chewers in Ethiopia. A community-based comparative cross-sectional study was conducted with 253 Khat-chewing and 249 non-chewing male adults in Addis Ababa, Ethiopia. Weight and height were measured under standard procedure and used to calculate the body mass index (BMI < 18.5 kg/m2 indicates undernutrition). Variables with p-values below 0.25 in the bi-variable analysis were entered into a multivariable logistic regression model to identify factors associated with undernutrition and to control confounding respectively. An adjusted odds ratio with 95% confidence interval was used to declare the presence and the strength of association between the independent and outcome variable. Statistical significance was declared at a p value of 0.05. In this study, a total of 138 (27.5%: 23.6–31.6%) adult males were undernourished; among them, 78 (32.0%) were khat chewers and 60 (23.9%) were non chewers. Christian religion (AOR = 1.49; 1.02–2.30), vegetable consumption (AOR = 1.69; 95% CI 1.12–2.55) and khat chewing (AOR = 1.60; 1.04–2.45) were independent risk factors for undernutrition. However, none of the above factors showed a statistically significant association among non-khat chewer male adults. In conclusion, undernutrition was a public health concern in male adults in the study area. Frequent consumption of fruits, vegetables and family size of the households were the independent predictors of undernutrition. The practical implication of identifying risk factors of undernutrition among chewers and non-chewers could be helpful in depicting the relevant risk factors by exposure category and helping to further refine intervention packages. In addition, focusing on interventions which can increase the availability and accessibility of fruits and vegetables are important to improve the nutritional status of adult male populations.

Intra-pericardial thrombin injection in iatrogenic cardiac tamponade: a case report

BackgroundNowadays, percutaneous procedures are expanding in use, and this comes with complications associated with the procedure itself. Cardiac tamponade is rare but may be life threatening since it can involve hemodynamic instability. It is known that after pleural effusion during a percutaneous procedure, pericardiocentesis should be used as drainage of the cavity. However, that does not achieve hemostasis in some cases, and in those patients who are hemodynamically unstable, a sealing agent to promote hemostasis might be useful, like thrombin.Case presentationWe present a case report of 89-year-old patient with history of melanoma undergoing treatment with pembrolizumab, who attended the emergency department referring chest pain (intensity 5/10) and palpitations that have lasted hours. He had TnTUs 554/566 ng/L and an echocardiogram that showed dilated right chambers, hypertrophy and global hypokinesia of the left ventricle, increased filling pressures of the left ventricle and pulmonary hypertension. Myocarditis associated with pembrolizumab was suspected, so high dose steroids were initiated and endomyocardial biopsy was conducted, resulting in iatrogenic cardiac tamponade. To determine the etiology of the suspected myocarditis, an endomyocardial biopsy was performed. Unfortunately, an intraprocedural complication arose: pleural effusion resulting in iatrogenic cardiac tamponade, leading to hemodynamic instability. It required immediate pericardial drainage via subxiphoid puncture, obtaining a 550 mL hematic debit. Clinical manifestations raised suspicion of tamponade, prompting a bedside echocardiogram for a definitive diagnosis. Despite these efforts, the patient remained hemodynamically unstable, and due to the elevated surgical risk, intrapericardial thrombin was employed to achieve successful hemostasis.ConclusionsCardiac tamponade is a life-threatening condition that can sometimes be induced iatrogenically, resulting from percutaneous interventions. Despite limited evidence regarding this therapeutic strategy, in patients experiencing iatrogenic cardiac tamponade with hemodynamic instability and high surgical risk, the administration of intra-pericardial thrombin could be contemplated.

Incidence of Hypertriglyceridemia in Patients on Propofol, Clevidipine, or Both.

Propofol and clevidipine (PC) are commonly used in the treatment of critically ill patients. While both medications are lipid emulsions, there is limited evidence concerning the incidence of hypertriglyceridemia (HTG) when these agents are used individually or concurrently. The objective of this study is to determine the effects of propofol, clevidipine, or concurrent PC on triglycerides (TGs) and related outcomes in critically ill adults. This was a retrospective cohort study conducted at an academic medical center. Patients were included if they received ≥24 hours of continuous propofol and/or clevidipine. Excluded were those without TG levels after ≥24 hours of infusion, baseline HTG, acute pancreatitis at admission, or receiving total parenteral nutrition with lipids. The primary outcome was incidence of HTG (defined as a TG level >400 mg/dL). Secondary outcomes included median and peak TG levels, hospital length of stay, intensive care unit length of stay, total lipid infused, time to peak TG level, peak lipase level, and development of pancreatitis. In total, 190 patients were studied: 109 in the propofol group, 50 in the clevidipine group, and 31 in the PC group. Incidence of HTG was similar (19 [17.4%] vs 6 [12%] vs 4 [12.9%] patients, P = 0.6246). Peak and median TG levels were similar for propofol, clevidipine, and PC groups (216 mg/dL vs 189.5 mg/dL vs 205 mg/dL, P = 0.7069; 177 mg/dL vs 185.5 mg/dL vs 177 mg/dL, P = 0.6791). There was a similar incidence of HTG in all groups. The results of this study suggest that the concurrent use of PC should not modify the frequency of TG level monitoring.

Therapeutics effects of bovine colostrum applications on gastrointestinal diseases: a systematic review

BackgroundEvidence on the effects of bovine colostrum (BC) supplementation on gastrointestinal (GI) diseases is conflicting.ObjectivesThis systematic review summarized the findings of clinical trials (CTs) on the effects of BC supplementation on GI diseases.MethodsA systematic search was conducted in online databases, including PubMed, ISI Web of Science, and Scopus, until March 2021 and updated until December 2023. CTs investigated BC’s effect on any measurable symptomatic change in terms of GI health as the primary outcome variable or as one of the outcomes in any population eligible for this systematic review.ResultsOut of 6881 records, 22 CTs (uncontrolled = 4, cross-over = 1, and parallel = 17) with 1427 patients were enrolled in the systematic review. Diarrhea, the most frequently evaluated symptom (20 interventional arms), was decreased in frequency with BC supplementation in 15 of these arms. However, most studies reported no change in its duration. BC supplementation consistently reduced stool frequency across all seven studies. Abdominal pain relief was noted in four interventional arms but showed no improvement in five others. Assessment of other GI symptoms was limited, yielding inconclusive results.ConclusionsThere is limited evidence on the effects of BC on GI diseases, with mixed findings. More well-designed controlled clinical trials are required to explore its effects.

Predictors of vaccination card retention in Tamale Metropolis, Ghana.

The home-based vaccination card is an important health record for determining vaccination status of children during surveys, particularly in low- and middle-income countries. However, there are limited evidence on the factors that influence its retention in Ghana. We assessed the predictors of vaccination card retention in Tamale Metropolis, Ghana. We conducted a cross-sectional study from 21st December 2022 to 10th January 2023 among children aged 0-59 months in the Tamale Metropolis. Multi-stage sampling was used to select caregivers of children aged 0-59 months for enrolment in the study. Data were collected using validated questionnaire through face-to-face interviews of caregivers. A vaccination card was retained if it was presented for physical inspection by research assistants. The factors that influence vaccination card retention were determined in a multivariate logistic regression analysis at p<0.05. A total of 1,532 eligible children were enrolled in this study. Vaccination card retention was 91.5%. Negative predictors of card retention included: being resident in the Nyohini (AOR = 0.28; 95% CI = 0.15-0.50) and Tamale Central (AOR = 0.51; 95% CI = 0.29-0.90) sub-Metro areas and being caregivers of children aged 24-59 months (AOR = 0.39; 95% CI = 0.22-0.68). On the other hand, paying for the vaccination card (AOR = 5.14; 95% CI = 2.95-8.95) was a positive predictor of vaccination card retention. In this study, vaccination card retention among children aged 0-59 months was higher than national estimates. Vaccination card retention was mainly influenced by sub-Metro area, age of child and mode of acquisition of the card such as out-of-pocket payment. There is need to design and deliver tailored messages including the importance of vaccination card retention to caregivers of children based on geographic context. Additionally, the policy on sale of vaccination cards should be revised to allow for cost sharing to enhance its retention.

Preconception Micronutrient Supplementation Affects Maternal BMI and Body Composition Postpartum: A Randomized Controlled Trial in Vietnam

BackgroundAlthough there is growing evidence on the role of preconception nutrition for birth outcomes, limited evidence exists for its effects on maternal health. ObjectivesThis study evaluates the impact of preconception micronutrient supplementation on maternal BMI (kg/m2) and body composition at 6 to 7 y postpartum (PP). MethodsWe followed females who participated in a randomized controlled trial of preconception supplementation in Vietnam and delivered live offspring (n = 1599). Females received weekly supplements containing either 2800 μg folic acid (FA) only, 60 mg iron and 2800 μg FA (IFA), or multiple micronutrients (MMs) (15 micronutrients including IFA) from baseline until conception followed by daily prenatal IFA supplements until delivery. Height, weight, mid-upper arm circumference, triceps skinfold, and waist-hip circumference were measured at recruitment and at 1, 2, and 6 to 7 y PP. Body fat was assessed using bioelectric impedance at 6 to 7 y PP (n = 867). Group comparisons were made using analysis of variance or chi-square tests and general linear models for adjusted models. ResultsAt 6 to 7 y PP, we found significant differences (P < 0.05) by treatment group for mean percent fat (MM: 29.2%; IFA: 27.6%; FA: 27.8%), absolute fat mass (MM: 15.1 kg; IFA: 14.0 kg; FA: 14.3 kg), and prevalence of underweight based on BMI < 18.5 (MM: 5.8%; IFA: 10.3%; FA: 14.3%). Mean BMI and triceps skinfold thickness were higher in the MM group, but these differences were not statistically significant; the differences in absolute fat mass were also attenuated after controlling for body weight. No differences were observed for fat-free mass, prevalence of overweight (BMI >23), or other anthropometric measurements. ConclusionsPreconception MM supplementation was associated with lower prevalence of underweight and higher percent fat when compared with IFA and/or FA only. Preconception micronutrient interventions may have long-term effects on maternal health and merit further examination.This trial was registered at clinicaltrials.gov as NCT01665378.

Venetoclax adverse event monitoring: a safety meta-analysis of randomized controlled trials and a retrospective evaluation of the FAERS.

Concerns persist about venetoclax's long-term safety in larger populations, with limited evidence of infrequent and delayed adverse events (AEs). The study integrated safety data on venetoclax in leukemia patients from randomized controlled trials (RCTs) and FDA adverse event monitoring system (FAERS). We systematically reviewed RCTs reporting safety outcomes of venetoclax in adult leukemia patients of any gender, either monotherapy or in combination, applying advanced search on databases like PubMed, EMBASE, and ClinicalTrial.gov. The quality assessment was done using the Cochrane Risk of Bias Tool. We utilized a random effect meta-analysis to calculate risk ratio (RR) with 95% confidence intervals (CI). The Open Vigil 2.1 MedDRAv24 was used to search the FAERS database, with data available until September 2023. The disproportionality was calculated using the proportional reporting ratio and the reporting odds ratio. The study protocol for meta-analysis was registered with PROSPERO; CRD42022378006. For the safety meta-analysis, seven RCTs with available AEs were examined. A total of 942 AEs were found associated with the venetoclax group; 79% of them were in grade three or above. Venetoclax significantly increased the risk of neutropenia grade three or above (RR = 1.34, 95% CI: 1.10-1.64, p: 0.0033) compared with the control group. In FAERS, 26,436 patients were reported with AEs associated with venetoclax. Significant signal scores were observed in hematological, cardiac, vascular, and gastrointestinal disorders. 11 out of 30 generated signals, failed to meet the signal criteria upon refinement. The current study updated and improved the safety profile of venetoclax in the post-marketing period, assisting in risk evaluation and mitigation for the best possible patient health care.