National Initiatives Research Articles

FP2.8 - Emergency CRC Resections: A single centre cohort Study

Abstract Aims According to NBOCA, 20% of cases of CRC’s are emergencies, associated with high rates of post-operative morbidity and death (11.3 % within 90 days, NBOCA annual report 2023). Emergency CRC commonly presents as obstruction and perforation, less commonly with other constitutional symptoms. Aim of study is to assess surgical outcomes in emergency malignant CRC resections. Methods Cohort study carried out from Jan'2008 to Jan'2023. Descriptive demography & post-operative surgical outcomes were analysed in all emergency CRC resections. All elective CRC resections were recruited as controls. Results Em CRC (n = 365) Elective CRC (n = 1349) Mann Whitney U test (p value) Age(yrs) 70.0 70.5 NS Sex(M:F) 193 : 172 764 : 585 NS ASA(median) 3 2 < 0.0001 BMI(kg/m2) 25.7 26.7 < 0.0005 Op time(mins) 134.1 186.1 < 0.0001 LOS(days) 11 7 < 0.0001 Complications (n) Leaks 7 59 NS Ileus 68 207 NS HAP 53 132 NS Anaemia (Tx) 8 47 NS Wound infections 41 115 NS Collections 29 67 NS Sepsis 31 55 NS Mortality (n) 30 day 32 26 NS 60 day 46 38 < 0.01 90 day 54 44 < 0.005 TNM stage (n) 0 10 16 1 20 351 2 107 456 3 158 446 4 45 52 Survival rates 1st year 71.1 92.3 5th year 48.3 77.1 10th year 41.1 68.5 Logrank p < 0.05 15th year 39.5 65.1 Conclusions Emergency CRC patients had a worse pre-operative functional limitation (ASA 3), prolonged hospitalization, greater 90-day mortality rate, thus poorer survival. Despite national bowel cancer screening initiatives, emergency CRC presentations remain a challenge. Our study supports prompt diagnosis and early surgical intervention.

Evaluating Parental Knowledge and Behaviors Regarding Developmental Toxicants in Jazan, Saudi Arabia Using the Prevention of Toxic Chemicals in the Environment for Children Tool (PRoTECT).

This study evaluated the level of knowledge among parents in Jazan, Saudi Arabia, regarding substances that can harm child development. The Prevention of Toxic Chemicals in the Environment for Children Tool (PRoTECT) was used for this assessment. A cross-sectional survey using a multi-stage cluster random sampling approach was undertaken among 424 parents who were enlisted from eight primary healthcare centers (PHCCs). The PRoTECT score's median value was 72 out of 90, suggesting a generally high level of awareness. The study found that individuals with higher education, particularly those with postgraduate degrees, had greater awareness of protecting their children's health. Interestingly, unemployed individuals and those residing in mountainous areas also demonstrated higher awareness, possibly due to having more time to focus on their children's health and well-being. Most participants (68.2%) acknowledged the correlation between exposure to toxic chemicals during pregnancy and early childhood, and the subsequent development of neurodevelopmental disorders. The study found a solid foundation of knowledge, with 85.1% of participants interested in learning more about reducing children's exposure, but it also stressed the need for specific actions to turn awareness into prevention. These findings would help policymakers develop effective strategies, such as targeted educational campaigns, collaboration with healthcare providers, utilization of media channels, and encouragement of community-led initiatives, to reduce children's exposure to developmental toxicants in line with national and global environmental health initiatives. Future research should focus on longitudinal consciousness and behavior evaluations and regional environmental contaminants.

Professional development is the key to securing a future rheumatology workforce. Long term evaluation of a summer school for medical students-a national scientific society's educational initiative.

A cumulative imbalance between rheumatologic need and an inadequate number of young colleagues entering the field leads to a dearth of rheumatologists in the near future. The Austrian Society for Rheumatology and Rehabilitation (ÖGR) has been organizing an annual Rheumatology Summer School (RSS) for medical students since 2017. The aim of this study was to analyze the annual RSS evaluations, the RSS' overall effects on attracting new talent into the field and the lasting promotion of rheumatology. A questionnaire was distributed immediately after each RSS meeting. Additionally, we conducted an electronic survey among RSS participants (2017-2022) to assess their career development trajectories. From 2017-2023, a total of 220 students attended the RSS. They all completed the annual evaluation. Accordingly, students' expectations were met in 80% (2017) to 97% (2023) of cases. The electronic survey was completed by 64/133 (48%) students; 49 (77%) indicated that the RSS had markedly increased their desire to specialize in rheumatology. Among the 36 graduates, 10 (28%) had already been working in the field of rheumatology and 6 (17%) were considering this specialty but had not decided yet. RSS attendees in their 6th study year were influenced to a greater extent by the RSS to choose rheumatology as their primary specialty than 4th or 5th year students. The participants indicated that they benefited most from the RSS in terms of knowledge gain, personal awareness of rheumatology, networking among fellow students as well as gaining access to RSS faculty. The RSS enhanced students' intention to choose rheumatology, particularly in those close to graduation, and led to increased awareness and deeper knowledge about rheumatology.

Review of Menstrual Hygiene Management Practices Among Adolescent Girls: Challenges, Health Implications, and Future Directions

Although a woman's menstruation is a normal biological process that is essential to her reproductive life, managing menstrual hygiene is still a major worldwide issue, especially for teenage girls in low- and middle-income nations. Maintaining dignity and one's physical and mental health depend on practicing proper menstrual hygiene. However, barriers to good menstrual hygiene habits persist due to cultural taboos, a lack of resources, and inadequate knowledge. Examining national and international policies targeted at resolving these concerns, this analysis examines the relationship between menstrual hygiene, adolescent health, and the right to health. The conversation emphasizes how important it is to manage menstrual hygiene in an appropriate way to prevent a girl's period from interfering with her everyday activities or undermining her self-esteem. A variety of menstruation items are assessed, with a focus on choosing the right goods to preserve hygiene, including sanitary pads, tampons, menstrual cups, and period underwear. The review also touches on the effects of menstruation problems on women's lives. The support that national and international initiatives like the Swachh Bharat Abhiyan, Beti Bachao Beti Padhao (BBBP), Rashtriya Kishor Swasthya Karyakram (RKSK), and the Scheme for Promotion of Menstrual Hygiene provide for the management of menstrual hygiene and adolescent health are examined. In order to guarantee that teenage girls may have healthy, productive lives with dignity and respect, the article emphasizes the need for ongoing efforts to enhance menstrual hygiene management via education, access to sanitary products, and the breakdown of societal taboos.

The Dutch Dystrophinopathy Database: A National Registry with Standardized Patient and Clinician Reported Real-World Data.

Duchenne and Becker muscular dystrophy lack curative treatments. Registers can facilitate therapy development, serving as a platform to study epidemiology, assess clinical trial feasibility, identify eligible candidates, collect real-world data, perform post-market surveillance, and collaborate in (inter)national data-driven initiatives. In addressing these facets, it's crucial to gather high-quality, interchangeable, and reusable data from a representative population. We introduce the Dutch Dystrophinopathy Database (DDD), a national registry for patients with DMD or BMD, and females with pathogenic DMD variants, outlining its design, governance, and use. The design of DDD is based on a system-independent information model that ensures interoperable and reusable data adhering to international standards. To maximize enrollment, patients can provide consent online and participation is allowed on different levels with contact details and clinical diagnosis as minimal requirement. Participants can opt-in for yearly online questionnaires on disease milestones and medication and to have clinical data stored from visits to one of the national reference centers. Governance involves a general board, advisory board and database management. On November 1, 2023, 742 participants were enrolled. Self-reported data were provided by 291 Duchenne, 122 Becker and 38 female participants. 96% of the participants visiting reference centers consented to store clinical data. Eligible patients were informed about clinical studies through DDD, and multiple data requests have been approved to use coded clinical data for quality control, epidemiology and natural history studies. The Dutch Dystrophinopathy Database captures long-term patient and high-quality standardized clinician reported healthcare data, supporting trial readiness, post-marketing surveillance, and effective data use using a multicenter design that is scalable to other neuromuscular disorders.

Non-governmental organizations, green space equity, and policy change: A national study in the US

Worldwide, low-income and racial/ethnic minority communities tend to have a lower provision of green space than less disadvantaged groups. To address these inequities, some non-governmental organizations (NGOs) have worked on projects, such as new parks in underserved communities, and policy change, such as green space funding prioritizing underserved areas. To date, limited research has examined the landscape of NGOs working to advance green space equity via policy change. In this paper, we studied what kind of NGOs engage in green space equity policy advocacy in the US. We used topic modeling, keywords-in-context, and inferential statistics to analyze grant applications for a national initiative to fund green space equity advocacy, the first and only of its kind. We found that NGOs also advocate for several interrelated topics related to green space equity (e.g., environmental issues, social services), engage numerous policy actors in campaigns (e.g., politicians, youth), and use other strategies such as coalitions, power building, and research. NGOs working to address green space inequities also need to contend with other systemic issues affecting underserved communities (e.g., poverty, health disparities). Our findings can inform the work of public and philanthropic funders, local governments seeking partnerships with NGOs, and NGOs themselves.

Education Research: The Current Landscape of Clinician Educator Tracks in Adult Neurology Residency Programs: A National Survey of Program Directors.

As the concept of a clinician-educator (CE) evolves and the multiple competencies of the role become better defined, there seems to be a growing need for targeted training for clinicians pursuing a career in medical education. This study aims to describe the current state of CE tracks in adult neurology residency programs and to identify the barriers to implementation, potential solutions, and program goals and outcomes. We characterized CE tracks using 2 methods. First, we reviewed the websites of all US adult neurology residency programs to determine the availability of a CE track and its characteristics. Second, we administered a 20-item survey to program directors (PDs) of all US neurology residency programs, with questions focused on track availability, characteristics, perceived benefits of CE tracks on resident career development, barriers to implementation, and ideas for national initiatives that may facilitate track development or improvement. Fifty-eight of 177 (33%) PDs responded to the survey. Combining the results of the website reviews and surveys, we found that 34 of 179 (19%) programs have CE tracks. Seventy percent of PDs felt that CE tracks are very impactful or impactful for participating residents' careers, a perception more common among PDs of programs with tracks. The greatest perceived benefit was in preparing residents for educational leadership roles. The greatest barriers to implementation were a lack of teaching faculty, a lack of resources, and limited resident time. The highest ranked idea for a national initiative that can facilitate track development was live and recorded lectures on medical education topics. Although most PDs surveyed agreed that CE tracks are impactful for preparing residents as teachers and education leaders, such tracks are available in only 19% of adult neurology residency programs. PDs report that the benefits of CE tracks extend beyond the participants, with implications for the health of the residency program and the neurology department. While some programs have significant barriers to implementation, national initiatives may help reduce the resource burden on individual programs. Future areas of study include assessing the development and outcomes of national initiatives and analyzing the outcomes associated with CE tracks.

Cybercrime and Digital Fraud Among University Students in Lagos, Nigeria: Socio-Economic Drivers and Prevention Approaches

Cybercrime among university students in Lagos, Nigeria, is an escalating issue influenced by various socio-economic, psychological, and social factors. This paper examines the key types and patterns of cybercrime affecting students, including phishing, identity theft, and financial fraud, while highlighting the significant role of economic challenges, digital access disparities, and social perceptions in driving involvement. The study also explores the psychological traits of offenders, such as risk-taking and opportunity-seeking behaviors, and the impact of peer groups and online communities. A review of existing university policies and national anti-cybercrime initiatives reveals several gaps, including limited reach, inadequate funding, and a lack of targeted strategies. To address these challenges, the paper recommends a more integrated approach, incorporating increased funding, targeted interventions, and robust monitoring frameworks. Enhancing cybercrime prevention efforts is essential to protect students and foster a safer digital environment in Lagos.

Exploring the Health Literacy Behavior Patterns of Male Patients Using an Interpretable Method.

Improving overall and individual health literacy is a major focus of national initiatives in China and similar initiatives globally. However, few studies have examined the identification and improvement of individual health literacy levels, especially among patients. To develop an interpretable method with decision rules to assess the health literacy levels of male patients and identify key factors influencing health literacy levels. Using a convenience sampling method, we conducted on-site surveys with 212 male patients of a hospital in China from July 2020 to September 2020. The questionnaire was developed by the Ministry of Health of the People's Republic of China. A total of 206 of the completed surveys were ultimately included for analyses in this study. The rough set theory was used to identify conditional attributes (ie, key factors) and decision attributes (ie, levels of health literacy) and to establish decision rules between them. These rules specifically describe how different combinations of conditional attributes can affect health literacy levels among men. Basic knowledge, concepts, and health skills are important in identifying whether male patients have health literacy. Health skills, scientific health concepts, healthy lifestyles and behaviors, infectious disease prevention and control literacy, basic medical literacy, and health information literacy can be identified as cognitive behaviors with varying degrees of health literacy among patients. This model can effectively identify the key factors and decision rules for male patients' health literacy. Simultaneously, it can be applied to clinical nursing practice, making it easier for hospitals to guide male patients to improve their health literacy.

Abstract P403: Implementation of Knowledge Exchange Sessions to Catalyze Advancement of Sustainable Community-Clinical Relationships that Prioritize Hypertension Control.

Introduction/Background: The American Heart Association’s National Hypertension Control Initiative (NHCI) collaborated with public health champions by participating in Learning Collaboratives (LC) in five regions across the United States to address hypertension through LC groups that facilitated the exchange of best practices and lessons learned. LCs convene stakeholders for expert-led sessions to promote collaboration in the health care ecosystem. Research Questions/Hypothesis: LCs can be an effective way for national initiatives to convene in expert-led sessions on best practices in hypertension control, including the advancement of Community-Clinical Linkages (CCL) by fostering collaboration among diverse health care stakeholders. Methods/Approach: NHCI planned to convene stakeholders in 5 regions to learn how they operationalized the Centers for Disease Control and Prevention CCL approach. Areas were chosen based on criteria such as highly engaged NHCI Community Health Centers, NHCI funded community-based organizations with strong administrative capacity, a robust community health worker network, and active Primary Care Associations. Local assessments conducted during the planning phase led NHCI to pivot and collaborate with existing LCs instead of initiating new ones. During these LCs, NHCI conducted listening sessions to enhance collaboration and community-health center integration through knowledge exchange discussions and co-learning experiences. Results/Data: NHCI staff worked with local field staff to understand community needs. They leveraged trusted relationships with public health champions to identify LCs for conducting listening sessions. The local field staffs’ strong relationships with public health advocates presented NHCI with opportunities to plan meetings to obtain the buy-in for the listening sessions. NHCI conducted 6 listening sessions in 5 regions. Engagement in local LCs provided insight on operationalizing CCLs to address hypertension. Stakeholders exchanged best practices, lessons learned, strategies, and social determinants of health to advance CCLs for hypertension control. Conclusion(s): Leveraging trusted relationships and participating in existing LCs is key to conducting successful listening sessions around best practices in hypertension control, including the advancement of Community-Clinical Linkages.

S16 National initiatives and cross-country collaboration for HEPA promotion: showcasing experiences of the EU Physical Activity Country Focal Points Network

S16 National initiatives and cross-country collaboration for HEPA promotion: showcasing experiences of the EU Physical Activity Country Focal Points Network

Abstract P404: Using Target: BP™ Initiative Resources and Awards To Improve Evidence-Based Practice Adoption And Blood Pressure Control

Target: BP™ is a national initiative created by the American Heart Association and the American Medical Association in 2017 in response to the high prevalence of uncontrolled blood pressure (BP). Committed to advancing health equity, Target: BP supports health care organizations to improve blood pressure control by leveraging AHA guidelines and scientific statements and the AMA MAP ™ framework; assists health care organizations in their journeys to improve and sustain BP control with professional education and resources; and recognizes health care organizations annually with achievement awards. Target: BP recognizes organizations that commit to improvement, adopt evidence-based BP activities, and achieve BP control rates ≥70 percent, currently defined as SBP<140 and DBP<90 mmHg in CMS Controlling High Blood Pressure #236. Evidence-based BP activities include 1) calibrating BP measurement devices, 2) checking to see if devices are validated, 3) training and, 4) testing care team members in BP measurement every 6-12 months, 5) using a protocol to measure and confirm BP measurements, and 6) posting a positioning graphic (job aid) next to every place where BP is measured. Since adding evidence-based activity award criteria, self-attested achievement levels have improved from 2021 to 2023 for device calibration from 47.9% to 65.3%, for team training from 67.6% to 85.5%, for team testing from 67.0% to 86.2%, for measurement protocol use from 83.3% to 94.4%, and for job-aid posting from 54.8% to 69.6%. For each activity, Target: BP provides no-cost education and resources to help achieve the criteria. Overall participation has grown from 330 to 1806 organizations since 2017, now caring for 8.6 million patients with hypertension. In 2023, 866 organizations reported BP control rates ≥70 percent and 1489 reported the adoption of ≥4 of 6 evidence-based BP activities. Future expansion of the evidenced-based activity criteria will address treatment intensification, lifestyle risk factors, self-measured blood pressure monitoring, and equitable health outcomes. In a 2023 survey of participating organizations, 85.2% of 230 respondents reported “improving patient outcomes” as their primary reason for participating in Target: BP. Among respondents, 95.7% agree or strongly agree that expanded criteria will help to focus QI priorities. Award incentives appear to play a positive role in encouraging organizations to adopt evidence-based practices and improve blood pressure control.

Overcoming Obstacles: a Systematic Review of Challenges Faced by Women in Healthcare Management and Innovative Interventions

Abstract Background: Despite the underrepresentation of women in healthcare leadership, there is limited evidence on impactful organisational strategies, practices, and policies to advance women's careers. This study aimed to explore such strategies across various sectors, providing insights into measurably advancing women in leadership roles in healthcare. Methods: A systematic review was conducted using Medline via OVID; Medline in-process and other non-indexed citations via OVID; PsycINFO, and SCOPUS from January 2000 to March 2021. The methods were outlined in a published protocol registered a priori on PROSPERO (CRD42020162115). Eligible studies reported on organizational interventions for advancing women in leadership with at least one measurable outcome. Two reviewers independently assessed the studies. Identified interventions were categorized, and a meta-synthesis was completed following the 'ENhancing Transparency in REporting the synthesis of Qualitative research' (ENTREQ) statement. Findings: The search identified 952 potentially relevant records, supplemented by an additional 76 records from other sources. After eliminating duplicates and conducting an initial review of titles and abstracts, 834 records were excluded, leaving 142 records for a thorough screening of full texts. Among these, 75 articles were further excluded for various reasons: 12 were not on the main topic, 10 involved medical students, 46 were personal commentaries or opinion papers, and 7 were not empirical. This process resulted in the selection of 48 articles that met eligibility criteria and underwent detailed analysis. Interpretation: This review establishes an evidence base on organizational interventions for advancing women in leadership across diverse settings, offering valuable lessons for healthcare. It transcends individual focus to target organizational change, capturing measurable outcomes across intervention categories. The findings directly inform a national initiative with international links, aiming to enable women to achieve their career goals in healthcare, and shifts the focus from barriers to solutions.

Unmet community care needs among older adults in China: an observational study on influencing factors

BackgroundWith the rapidly aging population in China, there is an urgent need to understand and address the community care needs of older adults. This study sought to examine these unmet community care needs of older adults in China and the factors influencing them, with the goal of providing essential groundwork for the development of community care health policies.MethodsThis study used data from the 2018 China Longitudinal Healthy Longevity Survey of 8,870 adults aged 65 years and older. Logistic regression analysis was performed to identify factors related to unmet community care needs.ResultsThe results showed that lower number of children, increased years of schooling, poorer self-perceived economic and health status, residing in an institution rather than living with household members, not having public old-age pensions, and not having activity due to daily living impairments were associated with a higher likelihood of unmet community care needs among older adults.ConclusionsThese findings indicate the necessity for crafting policies that consider the factors affecting unmet community care needs of older adults, including their health vulnerabilities and individual needs. Implementing national initiatives aimed at enhancing the quality of services delivered to older adults is crucial, along with establishing programmes to proactively address their vulnerabilities and individual needs. This study can contribute to the formulation of policy measures aimed at enhancing community care services of older adults in China.

Public health and system approach in eliminating disparities in hypertensive disorders and cardiovascular outcomes in non-Hispanic Black women across the pregnancy life course

Hypertension is one of the leading risk factors for cardiovascular disease. The ACC/AHA/Multisociety hypertension guideline covered all aspects of the recommendations for optimal blood pressure diagnosis and management to improve cardiovascular outcomes. Despite this, there remains a growing prevalence of hypertension within the United States, largely in non-Hispanic Black women at earlier stages of their life course. This highlights the evident racial disparities, but offers a targeted opportunity for improved outcomes. With hypertension increasingly seen in the antenatal and immediate postpartum period, and obstetrics societies weighing in on the need to alter pharmacotherapy initiation goals, national initiatives have purposefully targeted pregnant and postpartum women in an effort to improve outcomes. This same energy must also re-focus health care efforts across the entire health continuum. Public health and system strategies are in place to do so, with the strongest enforcing initiatives as early as childhood with a greater focus on primordial prevention.

Development, implementation, and evaluation of an advanced primary care pharmacist pilot training program as a strategy to enhance team-based primary care.

Canada's 50,000+ pharmacists play a crucial role in the comprehensive delivery of primary care. Recognizing this, a program in alignment with the Team Primary Care national initiative was developed to enhance their skills and knowledge in collaborative care, aiming to cultivate advanced primary care pharmacist leaders. The curriculum development involved aligning activities with pharmacist roles and competencies, emphasizing interprofessional teamwork. A mixed-methods evaluation revealed positive outcomes: 14/15 pharmacists completed the program, reporting improved readiness for team-based care. All non-pharmacist team members expressed a desire for continued pharmacist collaboration. Overall, satisfaction was high among participants and team members, indicating success in training. The program's comprehensive approach, covering primary care landscape, clinical skills, teaching, change management, and advocacy, empowered pharmacists to integrate team-based care and contribute to positive change in primary care settings. Training more pharmacists with this program is one of the many strategies to further establish and optimize team-based primary care.

Evaluating the Initial Experience and Clinical Impact of Prostate-Specific Membrane Antigen (PSMA) Positron Emission Tomography/Computed Tomography (PET/CT) Scans in Prostate Cancer Management: A Retrospective Study in Iraq.

Background Prostate cancer is a significant health concern globally, especially in the Middle East, including Iraq. This study explores the adoption and impact of prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) scans in Erbil, Iraq, from 2020 to 2023, marking a pivotal advancement in prostate cancer diagnostics in a region where the disease's prevalence is rising. Materials and methods Through a retrospective analysis at Medya Diagnostic Center in Erbil, Iraq, involving 172 patients, we assessed the feasibility, applicability, and clinical utility of PSMA PET/CT in the local population. Results The study highlights the modality's enhanced sensitivity and specificity in detecting prostate cancer and its metastases, with bone being the most frequent metastasis site. Despite positive outcomes, challenges such as integration into clinical practice, adherence to guidelines, and financial implications were identified. The majority of referrals came from medical oncologists, primarily for staging and response evaluation, indicating PSMA PET/CT's critical role in managing prostate cancer. The findings suggest a need for national guidelines, interdisciplinary collaboration, and educational initiatives to optimize the use of PSMA PET/CT in Iraq's healthcare setting. Conclusions This study contributes valuable insights into the early experiences with PSMA PET/CT, paving the way for improved prostate cancer diagnostics and management in similar contexts.

Future of U.S. living donor liver transplant: Donor and recipient criteria, transplant indications, transplant oncology, liver paired exchange, and non-directed donor graft allocation.

In the United States, living donor liver transplant (LDLT), from both directed and nondirected living donors, has expanded over the past several years. LDLT is viewed as an important opportunity to expand the overall donor pool for liver transplantation (LT), shorten waiting times for a life-prolonging LT surgery, and reduce LT waitlist mortality. The LT community's focus on LDLT expansion in the United States is fostering discussions around future opportunities, which include the safe expansion of donor and recipient candidate eligibility criteria, broadening indications for LDLT including applications in transplant oncology, developing national initiatives around liver paired exchange, and maintaining vigilance to living donor and recipient candidate risk/benefit equipoise. Potential opportunities for expanding living liver donor and recipient candidate criteria include using donors with more than minimal hepatic steatosis, evaluating older donors, performing LDLT in older recipients to facilitate timely transplantation, and providing candidates who would benefit from an LT, but may otherwise have limited access (ie, lower MELD scores), an avenue to receive a life-prolonging organ. Expansion opportunities for LDLT are particularly robust in the transplant oncology realm, including leveraging LDLT for patients with advanced HCC beyond Milan, intrahepatic cholangiocarcinoma, and nonresectable colorectal cancer liver metastases. With ongoing investment in the deliberate growth of LDLT surgical expertise, experience, and technical advances in the United States, the LT community's future vision to increase transplant access to more patients with end-stage liver disease and selected oncology patients may be successfully realized.

Promoting Agroforestry Systems for Livelihoods and Ecosystem Management: The Role of Global, National and Sectorial Initiatives

Promoting Agroforestry Systems for Livelihoods and Ecosystem Management: The Role of Global, National and Sectorial Initiatives

Treatment of anaemia in pregnancy with oral iron, folic acid or iron, folic acid and vitamin B12 supplementation: A hospital-based open randomized study

: National iron plus initiative recommended that anaemic pregnant women should be treated with 200 mg of elemental iron and 1 mg folic acid. An increase in vitamin B12 deficiency has been reported in last two decades. An open randomised study was taken up in urban antenatal clinics to assess the impact of addition of vitamin B12 to the iron and folic acid supplementation.: Anaemic pregnant women willing to participate in the study were randomised into Group 1 (240 iron mg and 5 mg folic acid) or Group 2 (240 mg iron, 1.5 mg of folic acid and 15 µg vitamin B12); the impact of supplementation on Hb, ferritin, folic acid and vitamin B12 was assessed.: In both groups mean Hb improved by 1g/dL at 8 weeks and by 1.5g/dL by 38 weeks of pregnancy; at 38 weeks only 30% were anaemic. Mean ferritin and folic acid levels improved in both groups. There was a fall in the mean vitamin B12 levels in the group which received 5 mg of folic acid.: With assured supply and supportive supervision, the supplementation achieved substantial reduction in anaemia in both groups. Supplementation with folic acid 5 mg should not be done because it causes a fall in vitamin B12 levels. The reason why addition of vitamin B12 to iron folic acid supplementation did not result in improvement in mean Hb, or vitamin B12 levels has to be investigated.