WHO Recommendations Research Articles

Inappropriate complementary feeding practice and associated factors among children aged 6–23 months in Shashemene, Southern Ethiopia: a community-based cross-sectional study

BackgroundInappropriate complementary feeding is widely practiced in low and middle income countries. These contribute to undernutrition, morbidity and mortality among young children. The incidence of malnutrition in the first two years of life has been directly linked with inappropriate complementary feeding practices along with high infectious disease levels.ObjectiveTo assess the level of inappropriate complementary feeding practice and associated factors among children aged 6 to 23 months in Shashemene, Southern Ethiopia.MethodA community-based cross-sectional study was conducted from July to August 2021 among 609 children aged 6 to 23 months paired with their caregivers. Systematic random sampling was used to identify study participants. Data were analyzed by using SPSS version 25 software. Binary logistic regression analysis was used to identify predictors of inappropriate complementary feeding practice. Statistical significance was determined using Adjusted Odds Ratio (AOR) with a 95% Confidence Interval (CI).ResultsThe prevalence of inappropriate complementary feeding practice among children aged 6–23 months was 55.3%. Being a mother under the age of 25 years [AOR = 2.07, 95% CI: 1.30, 3.31], aged 25–34 years [AOR = 1.82, 95% CI: 1.14, 2.91], having an occupation [AOR = 2.73, 95% CI: 1.84, 4.05], and households where husbands’ are the sole decision makers on their income [AOR = 2.41, 95% CI: 1.54, 3.77] increased the chance of inappropriate complementary feeding practice. On the other hand, mother’s whose infants were aged 9–11 months [AOR = 0.30, 95% CI: 0.19–0.45] were less likely to practice inappropriate complementary feeding.ConclusionsThe prevalence of inappropriate complementary feeding practice in the study area was high compared to the WHO recommendation. Child’s age, maternal age, maternal occupation, and decision-making role on income were found to be associated with inappropriate complementary feeding practice. Appropriate behavioral change communication to family and community decision-makers, and involvement of husbands in infant and young child feeding practice are recommendable.

Factors associated with full COVID-19 vaccination among persons living with diabetes mellitus in Uganda–A cross-sectional study

BackgroundDiabetes mellitus (DM) is associated with severe outcomes of coronavirus disease (COVID-19), including death. COVID-19 vaccination is crucial for preventing infection and severe disease in the general population, but most importantly, among high-risk populations such as persons with DM. However, while COVID-19 vaccination uptake in the general population is regularly tracked, information on vaccination behavior specific to persons with DM is scarce. This study aimed to identify factors associated with the uptake of full COVID-19 vaccination among persons living with DM at Kiruddu National Referral Hospital (KRH).MethodsWe employed a cross-sectional study design and administered a structured questionnaire on a systematically selected random sample of 340 people with DM attending Kiruddu National Referral Hospital from March 08 to May 25, 2023. We used a Modified Poisson Regression model to identify the factors associated with full COVID-19 vaccination and present adjusted prevalence ratios, along with their 95% confidence intervals. Full COVID-19 vaccination in this study was defined as having completed the last dose in the primary series of a COVID-19 vaccine.ResultsWe administered the questionnaire to 340 participants, with 75% (255 of 340) being female. The mean age of the participants was 52 years (± 12 years) and their median duration with diabetes mellitus was 5 years (± 7.3 years). Overall, 195 out of 340 participants (57.35%, 95% CI: 52-63%) completed the last dose in the primary series of a COVID-19 vaccine. The likelihood of receiving full vaccination was higher when a health provider advised one to receive a vaccine (aPR = 1.91, 95% CI: 1.20–3.02), when one reported having a comorbidity (aPR = 1.26, 95% CI: 1.06–1.53), and when one had a strong perceived benefit of vaccination (aPR = 1.76, 95% CI: 1.23–2.53). However, having a strong perceived barrier to vaccination was negatively associated with the likelihood of being fully vaccinated (aPR = 0.71, 95% CI: 0.60–0.84).ConclusionThe uptake of COVID-19 vaccines among persons with DM at KRH is low, with only 57% having a full COVID-19 vaccination status. This underscores the progress in meeting the WHO recommendation of having a 100% COVID-19 vaccination uptake among people with underlying health conditions, including diabetes mellitus. At the policy level, the Ugandan Ministry of Health (MoH) may implement a provider-initiated vaccination strategy where healthcare providers who attend to DM patients during their routine clinic visits initiate the idea of vaccinating, sensitize, and spearhead myth-bursting around COVID-19 vaccines.

Assessment of physicochemical properties and radioactivity in groundwater at households living in bac Lieu province, vietnam.

This paper presents findings on groundwater physiochemical composition and radioactivity levels in households in Bac Lieu province, Vietnam. Through discriminant analysis, it was observed that groundwater quality exhibits spatial variations corresponding to saline intrusion zones. The paired-samples T-tests revealed significantly different ratios of Ra-224, Ra-226, and Ra-228 isotopes between Na-Cl and Ca-Na-HCO3 water types. All three water types had a ratio of Ra-226/Ra-228 of approximately one, indicating the presence of groundwater aquifers beneath the crust and fluvial marine sediment. Furthermore, strong associations between sulfate and calcium suggest that CO2 enrichment in groundwater aquifers indicates anoxic aquatic environments. Twenty-five of the thirty-three evaluated samples exceeded the national technical regulations for domestic water quality with parameters such as chloride, sulfate, sodium, gross alpha, or total dissolved solids. Fifteen samples exceeded gross alpha's allowable contamination threshold of 0.1Bq/L. The combination of Ra-226 and Ra-228 did not surpass the U.S. Environmental Protection Agency's recommended limit of 0.185Bq/L. However, nineteen samples exhibited annual committed effective doses of radium isotopes for infants that exceeded the WHO recommendation of 0.1mSv/year.

The safety of a dolutegravir (DTG)-based antiretroviral treatment (ART) regimen for pregnancy and birth outcomes in Ethiopia: evidence from multicenter cohort study

BackgroundA dolutegravir (DTG)-based antiretroviral regimen has been rolled out for pregnant women in low- and middle-income countries since 2020. However, available safety data are limited to a few clinical trials and observational studies. Hence, we present real-world pregnancy and birth outcome safety data from a large sample multicenter cohort study in Ethiopia.MethodsA retrospective cohort study was conducted in fourteen hospitals across Ethiopia from 2017 to 2022. HIV-infected pregnant women were followed from the date of prevention of mother-to-child transmission (PMTCT) care enrolment until the infant was 6–8 weeks old. The primary safety outcome was a composite of adverse pregnancy events comprising spontaneous abortion, intrauterine fetal death (IUFD) before onset of labor, preterm birth, and maternal death. Additionally, a composite adverse birth outcome was assessed, comprising intrapartum fetal demise, low birth weight, and neonatal death. Finally, a composite of adverse pregnancy or birth outcome was also investigated. The exposure of interest was the antiretroviral treatment (ART) regimen used during pregnancy for PMTCT of HIV.ResultsDuring the study period, 2643 women were enrolled in routine PMTCT care. However, 2490 (92.2%) participants were eligible for the study. A total of 136/1724 (7.9%, 95% CI: 6.7–9.3%) women experienced adverse pregnancy outcomes. Fewer women in the DTG-based group (5.4%, 95% CI: 3.7–7.5%) had adverse pregnancy outcomes than in the Efavirenz (EFV)-based group (8.3%, 95% CI: 6.6–10.3%), P = 0.004. After controlling for baseline differences, the DTG group had a 43% lower risk of adverse pregnancy outcomes (adjusted odd ratio (AOR), 0.57; 95% CI, 0.32–0.96%) and a 53% lower risk of preterm birth (AOR, 0.47; 95% CI, 0.22–0.98%) compared to the EFV group. A total of 103/1616 (6.4%, 95% CI: 5.2–7.7%) women had adverse birth outcomes. Although the difference was not statistically significant, fewer women in the DTG group (30/548; 5.5%, 95% CI: 3.7–7.7%) than in the EFV group (57/830; 6.9%, 95% CI: 5.2–8.8%) had adverse birth outcomes.ConclusionsIn this study, we observed that DTG-based regimens were associated with better pregnancy and birth outcome safety profiles, reaffirming the WHO recommendation. However, a prospective study is recommended to assess uncaptured maternal and perinatal adverse outcomes, such as congenital abnormalities, and infant growth and neurocognitive development.

P35: Older adult’s dementia. Implementation of a multidisciplinary day care program in Argentina

Background: Day care programs for older adults with dementia is an effective strategy that allows prolonging the functionality of the elderly, their support and that of their family reducing home care costs and delaying the institutionalization of patients with cognitive impairment.Objectives: The aim of the present work is to describe the main goals and the implementation of a multidisciplinary day care program for patients with dementia and their family caregivers in Argentina.Methods: Design: Prospective cohort study. Subjects: 22 patients and their family caregivers, who attend a day care program in Argentina. Instruments: socio-demographic and psychosocial questionnaire of both patient and caregiver (built ad hoc) Patient: MMSE, GDS, HAD-A, PANAS- VRARG, EQ-5D and instrumental and basic abilities of daily living. Family caregiver: Zarit Burden Interview. Procedure: The intervention for patients consists of two different lines of work, one for the patient, and another for the family member. The activities are coordinated by a multidisciplinary group of professionals. Regarding the caregiver, individual orientation interviews and therapeutic group spaces and psycho-educational material are offered.Results: Preliminary data of 22 patients and caregivers, who have taken part in the program so far, indicate that: Patient: median age was years 75,27 old (ds = 9,28), % 63,6 of which are woman. The values obtain in the instrument are: MMSE 22,45 (ds = 4,78) GDS 4,47 (ds = 3,73), HAD-A 3,66 (ds = 3,39), (PANAS -E-VRARG) Negative items 7,70 (ds = 3,11) (PANAS -E-VRARG) Positive ítems 18,7 (ds = 3,13), EQ-5D 77,35 (ds = 16,21) and BHDL 93,63 (ds = 13,10), IHDL 9,1 (ds = 3,31). And for family caregivers the mean age was 65,27 old (ds = 11,37), % 66,71 of which are woman. Caregivers Zarit Burden Interview mean score was 40, 18 (ds = 11,35).Discussion: Our findings concur with those presented in scientific literature and support the WHO recommendations regarding the need to implement multidisciplinary programs for patients with dementia and family caregivers, in order to moderate the impact that providing care for an elderly relative with a neurological disease has on them.

The 2022 WHO classification of tumors of the pituitary gland: An update on aggressive and metastatic pituitary neuroendocrine tumors.

The vast majority of pituitary neuroendocrine tumors (PitNETs) are benign and slow growing with a low relapse rate over many years after surgical resection. However, about 40% are locally invasive and may not be surgically cured, and about one percentage demonstrate an aggressive clinical behavior. Exceptionally, these aggressive tumors may metastasize outside the sellar region to the central nervous system and/or systemically. The 2017 (4th Edition) WHO Classification of Pituitary Tumors abandoned the terminology "atypical adenoma" for tumors previously considered to have potential for a more aggressive behavior since its prognostic value was not established. The 2022 (5th Edition) WHO Classification of the Pituitary Tumors emphasizes the concept that morphological features distinguish indolent tumors from locally aggressive ones, however, the proposed histological subtypes are not consistent with the real life clinical characteristics of patients with aggressive tumors/carcinomas. So far, no single clinical, radiological or histological parameter can determine the risk of growth or malignant progression. Novel promising molecular prognostic markers, such as mutations in ATRX, TP53, SF3B1, and epigenetic DNA modifications, will need to be verified in larger tumor cohorts. In this review, we provide a critical analysis of the WHO guidelines for prognostic stratification and diagnosis of aggressive and metastatic PitNETs. In addition, we discuss the new WHO recommendations for changing ICD-O and ICD-11 codes for PitNET tumor behavior from a neoplasm either "benign" or "unspecified, borderline, or uncertain behavior" to "malignant" neoplasm regardless of the clinical presentation, histopathological subtype, and tumor location. We encourage multidisciplinary initiatives for integrated clinical, histological and molecular classification, which would enable early recognition of these challenging tumors and initiation of more appropriate and aggressive treatments, ultimately improving the outcome.

183 Association between mental health and different patterns of physical activity in adolescents in Luxembourg – HBSC 2022

Abstract Purpose Regular physical activity (PA) is a key protective factor for health in youths. The WHO recommends that adolescents do at least an average of 60 minutes per day of moderate-to-vigorous physical activity (MVPA) and incorporate vigorous-intensity aerobic activities (VPA) at least 3 days a week. Nonetheless, lower amounts of PA already carry benefits. This study aims to explore and to examine association between well-being and PA levels in adolescents in Luxembourg. Methods A representative sample of 8117 adolescents (11-to-18-years-old) took part in the 2022 Health Behaviour in School-aged Children (HBSC) Luxembourg survey. Based on the WHO-5 Index adolescents were categorised as “depression symptomatology”, “low mood” and normal well-being. In addition, they were categorised as frequency per week (0 to 7 days) of MVPA and VPA practice. Multinomial logistic regressions were performed, controlling by sex and SES. Normal well-being and physical inactivity were the respective refence groups. Results The results showed an association between mental well-being and both MVPA and VPA (p<.001). Compared to their inactive peers and independently of sex and SES, adolescents in Luxembourg who practiced MVPA 4 days per week or VPA 2 times per week had decreased odds to present low mood (ORMVPA=0.63, 95%CI[0.45-0.87] and ORVPA=0.75, 95%CI[0.60-0.92]) and PA even in a small frequency (1 day per week) already decreased the odds to have depressive symptoms (ORMVPA=0.67, 95%CI[0.51-0.89] and ORVPA=0.61, 95%CI[0.49-0.75]). Conclusions These findings highlight the significance of physical activity in fostering well-being, revealing an inverse relationship between the frequency of physical activity and the occurrence of depressive symptomatology and low well-being. In this regard, the advantages of engaging in physical activity are linked not only to physiological benefits but also to social interactions within these practices. In this context, the benefits of regular physical activity extend beyond its direct impact on mental health, encompassing both physiological and social dimensions.

Road traffic crash data in Southwestern Nigeria: a qualitative analysis of sources, contents and management methods

Objective This study qualitatively examined road traffic crash (RTC) data collection and management in southwest Nigeria, with the goal of addressing the tenets of the UN Decade of Action Plan on Road Safety’s call for an effective data system. Methods Data on RTCs data collection in the study area was obtained through key informant interviews with five hospital accident emergency unit directors, three Federal Road Safety Commission (FRSC) Sector commanders, and three Nigeria Police Force (NPF) commissioners. Datasets were transcribed, categorized, and interpreted using content analysis, descriptive statistics, and WHO recommended minimal crash data element requirements. Results The study found disparate systems, a lack of synergy, and discrepancy in the various data sources in the country when compared with WHO recommendations on road traffic data collection systems, with 55% of agencies using non-standardized paper forms. The study also reveals that the minimum crash data elements recommended by WHO are not consistently captured in the NPF, FRSC, and hospital traffic crash data sources. Conclusions The study suggested the use of an upgraded National Road Traffic Crash Data Management System (NRTCDMS) Data Template to unify data gathering and linkage issues, but recommends a digital version of the template.

Economic Evaluation of Expanding HPV Vaccination Programs for Boys: A Systematic Review

Background: Human papillomavirus is responsible for almost all cases of cervical and non-cervical cancers. Various treatments have been carried out, but they have not been effective enough in reducing the burden. The U.S. Food and Drug Administration has approved three HPV vaccines for use. Since its recommendation in 2006, HPV infections have significantly decreased by 88% among teen girls and 81% among young adult women. Additionally, research has indicated that HPV vaccine is cost-effective in preventing both cervical and non-cervical cancers. The primary target group of HPV vaccination is girls aged 9-14, but some countries are starting to expand their programs according to the WHO recommendation for secondary targets: boys and adult women. This study gave updated information regarding the expansion of HPV vaccination programs for boys. Objective: To systematically review the health economic studies to evaluate the cost-effectiveness of expanding HPV vaccination program for including boys to prevent HPV-related cancer. Method: An electronic literature search was performed on two databases (Pubmed and ScienceDirect) to identify studies published from 2013 to 2023 in English and Indonesian. Three search strategies were used, including the terms «economic evaluation», «HPV», and «boys». The screening and selection of the literature was performed according to the PRISMA statement. Results: A total of 306 articles were identified. Only 26 of them were deemed relevant. This research compiled studies from countries with varying economic levels on the expansion of vaccination programs in boys to prevent or reduce cervical, anogenital, and HNC cancers. All the studies used a modeling approach to estimate the number of cases averted and the health care costs. Sixteen studies found that it was cost-effective to expand HPV vaccination programs to include boys. The ICER values were found to be sensitive to the vaccine price, duration of protection, and vaccination coverage. Conclusion: Expanding HPV vaccination to boys is considered a cost-effective solution for preventing HPV-related cancers, based on studies conducted in many countries. It is recommended to conduct an economic evaluation to estimate the cost-effectiveness of HPV vaccination as a prevention method for HPV-related cancers in low and middle-income countries like Indonesia. To begin the study, it is suggested to expand the HPV vaccination target to boys with a lower-priced vaccine and increased vaccination coverage.

Trends in the hand hygiene practices using alcohol-based hand rubs in Japanese hospitals before and after the novel coronavirus pandemic: an observational study using national surveillance data

Healthcare-associated infections (HAIs) are a global concern in healthcare facilities, and hand hygiene (HH) using alcohol-based hand rubs (ABHR) is fundamentally crucial for their prevention. While previous studies report improvements in HH compliance amid the COVID-19 pandemic, the real situation in Japanese medical settings remains unclear. This observational study sought data from the Japanese national surveillance, focusing on ABHR use in hospitals before and after the COVID-19 pandemic. Data were retrieved from facilities certified to receive the Additional Healthcare Reimbursements for Infection Prevention and Control I. The study spanned five years (2019-2023), segmented quarterly, and employed Joinpoint regression analysis to assess the annual percentage change (APC). Overall, ABHR use per patient per day significantly increased both in critical care units and general wards amid the pandemic. However, the APC in the critical care units demonstrated a downward trend from Q4 of 2021 to Q1 of 2023, and ABHR use in general wards remained below the amount of WHO recommendations. This trend analysis highlighted recent patterns of ABHR use in Japanese hospitals by comparing pre- and post-COVID-19 periods. Although increases in ABHR use were observed over time, sustained efforts to promote HH compliance are necessary, particularly in general wards.

Geospatial patterns, and individual and community levels factors of cesarean section deliveries in Ethiopia: A spatial and multilevel analysis.

Cesarean Section (CS) is the most popular surgery worldwide in obstetric care to save a mother's or the fetus's life. The prevalence of CS delivery in Ethiopia was 0.7% and 1.9% in 2000 and 2016 respectively and its spatial distribution and variation in Ethiopia are limited. This study provides evidence for healthcare providers and pregnant women on the national CS geospatial distribution and variation to promote evidence-based decision-making and improve maternal and neonatal outcomes. Therefore, this study aimed to determine geospatial patterns and individual and community-level factors of CS deliveries in Ethiopia. A secondary data analysis of 5,527 weighted samples of mothers using the 2019 Ethiopian mini demographic and health survey was conducted. The spatial hotspot analysis using Getis-Ord Gi* hot spot analysis of ArcGIS version 10.7.1 was used to show the spatial cluster of CS and multilevel mixed effect logistic regression analyses were employed. Statistical significance was declared at p-value <0.05 and adjusted odds ratio (AOR) with 95% confidence interval (CI) was reported. The prevalence of CS delivery in Ethiopia was 5.4% with 95%CI (4.6%, 6.4%). The spatial autocorrelation shows CS was clustered in Ethiopia (global Moran's index = 1.009, and p-value<0.001). Spatial hotspot indicates CS was prevalent in Addis Ababa, Diredewa, Oromo, and Somali regions. The odds of CS delivery were higher among mothers aged 24-35: AOR = 1.98, 95% CI (1.3, 3.1), and 35-49: AOR = 3.7, 95% CI(2.2, 6.1), live with female household heads: AOR = 1.9, 95% CI (1.2, 3.1), mothers with primary AOR = 1.6, 95% CI (1.07, 2.7), secondary: AOR = 2.4, 95% CI (1.3, 4.25) and higher education: AOR = 2.06, 95% CI (1.03, 4.2), multiple births: AOR = 8.1, 95% CI (3.4, 19.74), mothers in Addis Ababa: AOR = 3.4, 95% CI (1.1, 11.9) and Diredewa: AOR = 7, 95% CI (1.23, 40.7) as compared to their counterparts. In Ethiopia, CS deliveries remain below the World Health Organization estimate with distinct geospatial variation. Geographically, CS delivery is concentrated in urban areas like Addis Ababa and Diredewa, as well as in parts of the Somali and Oromia regions. Maternal age, female household head, Muslim religion, higher educational status, and multiple births at the individual level, and region at the community level were factors of CS delivery in Ethiopia. Therefore, efforts should be geared towards strategies and interventions to ensure fair access to CS delivery in line with WHO recommendations, especially in the regions where the CS delivery rate is below WHO estimates in Tigray, Amhara, Afar, and Benishangul Gumze regions.

Simultaneous removal of malachite green and lead from water by consortium dry-biomasses of Bacillus licheniformis AG3 and Bacillus cereus M116

Synthetic textile dye malachite green (MG) and heavy metals present in industrial wastewater are hazardous to the ecosystem. Bioremediation of dyes and heavy metals using dry-biomasses has advantages over chemical methods. This study screened an acclimatized, heavy metal-resistant, and dye-degrading Gram positive Bacillus licheniformis AG3 strain from the textile wastewater near Kolkata, West Bengal. The EDXRF analysis of this colored wastewater effluent showed 36.33 mg/L lead, significantly higher than the WHO recommendation. Previously, Bag et al. showed bioremediation of synthetic dyes using dry-biomass of Bacillus cereus M116 from an aqueous solution (Bag et al. Arch Microbiol 203(7):3811–3823, 2021). Here, a consortium of dry-biomasses of B.licheniformis AG3 and B. cereus M116 strains (1:1 w/w ratio) was prepared for the simultaneous removal of lead and MG from wastewater. Statistical optimization determines that the pH, initial concentration of contaminants, and dry-biomass concentrations are critical for bioremediation under batch procedures. Further, optimization using the response surface methodology showed that 0.01% consortium dry-biomasses eliminated a maximum of 99.35% MG and 96.01% lead (II) within 6 h. SEM–EDS and FTIR confirmed a strong surface biosorption. Furthermore, a fixed-bed biofilter column of the consortium dry-biomasses was prepared, which was able to remove 98.1% MG and 98.5% lead at the 0.5–1 mL/min flow rate. Together, this study developed a biofilter with a consortium dry biomasses of B. licheniformis AG3 and B. cereus M116 for the simultaneous removal of MG and lead from wastewater.

Chemical speciation of methylmercury and mercury(II) cations in fish by new fluorogenic naphthalimide alkynyl gold complexes: The ultimate test for detecting fish contamination

The proof of concept of a new portable protocol for the detection and speciation of methylmercury and mercury(II) cations in fish samples is described. In this way, traces of methylmercury and/or mercury(II) cations in fish were quantitatively detected using an elaborated protocol and including a fluorescent sensor. In-the-field accurate results were obtained due to the selective behavior of the chemical sensor in the presence of both cations, working at very low concentrations of mercury species in fish under standard laboratory conditions, that are suitable for daily use in ordinary sampling by border companies importing fish or remote laboratories where large devices cannot be carried. The reported fish protocol is useful under real-life conditions for analyzing fish for the presence of methylmercury in contrast to total mercury analysis. The combination of the protocol and the fluorescent reporter constitutes the ultimate test for fish contamination by mercury(II) species in the workplace. The reported limits of detection of 0.72 nM for Hg2+ and 1.62 nM for CH3Hg+ and the closely related values of the two mercury(II) species in fish samples, obtained by ICP-MS analysis and fluorescent measurements, make the method suitable for daily control of methylmercury in fish under the EU legislation parameters and the WHO recommendations.

Reliability and validity of the German version of the Iowa infant feeding attitude scale (IIFAS-G) and relations to breastfeeding duration and feeding method

BackgroundPublic health initiatives (e.g., the Baby Friendly Hospital Initiative) have led to an increase in breastfeeding rates worldwide. However, as (exclusive) breastfeeding duration is still below WHO recommendations, it is crucial to understand the factors that influence decisions on breastfeeding practice. Modifiable psychological factors such as intention to breastfeed have therefore become targets of recent interventions. As the intention to breastfeed is among the strongest predictors of breastfeeding duration, reliable tools for measuring the intention to breastfeed are needed. The Iowa Infant Feeding Attitude Scale (IIFAS) measures attitudes towards infant feeding and is used in various languages and across different cultural contexts. However, there has been no German version of the IIFAS (IIFAS-G) so far. The aim of this study was to investigate reliability, validity, and associations of the IIFAS-G with feeding method and breastfeeding duration.MethodsBetween August and November 2022, a total of 353 mothers (Mage = 35 years, SDage = 4.2 years) of singleton infants (47.3% female (1 undetermined), Mage = 10.8 months, SDage = 4.7 months, age range: 3-547 days; 90.4% living in Switzerland) participated in an online survey. The IIFAS-G was administered as a part of a larger study on early child development and infant feeding method.ResultsThe translated IIFAS-G showed unsatisfactory model fit for the two factor 17-item solution. Four items showed low factor loadings. After item reduction, a 13-item two factor solution showed satisfactory model fit (CFI = 0.92, TLI = 0.90, RMSEA = 0.07) and high internal consistency (Cronbach’s α = 0.85). The IIFAS-G score was higher for mothers who exclusively breastfed their infants compared to mothers who additionally or exclusively fed infant formula. Moreover, mothers with higher IIFAS-G scores were less likely to stop breastfeeding their child over the course of 1.5years (HR = 0.87).ConclusionA shorter two-factor IIFAS-G is proposed to investigate attitudes towards breastfeeding and formula feeding in German-speaking mothers.

Patient-reported physical activity, pain, and fear of movement after cardiac surgery: a descriptive cross-sectional study

Objectives After cardiac surgery, there may be barriers to being physically active. Patients are encouraged to gradually increase physical activity, but limited knowledge exists regarding postoperative physical activity levels. This study aimed to assess patient-reported physical activity six months after cardiac surgery, determine adherence to WHO's physical activity recommendations, and explore potential relationships between pain, dyspnea, fear of movement, and activity levels. Methods The study design was a cross-sectional study at Örebro University Hospital, Sweden. Preoperative and surgical data were retrieved from medical records and questionnaires concerning physical activity (Frändin-Grimby Activity Scale, the Physical activity Likert-scale Haskell, Patient-Specific Functional Scale, and Exercise Self-efficacy Scale) were completed six months after surgery. Data were collected on pain, dyspnea, general health status and kinesiophobia i.e. fear of movement, using the Tampa Scale of Kinesiophobia Heart. Results In total, 71 patients (68 ± 11 years, males 82%) participated in this study. Most patients (76%) reported a light to moderate activity level (Frändin-Grimby levels 3-4) six months after cardiac surgery. In total, 42% of the patients adhered to the WHO’s physical activity recommendations (150 min/week). Pain and dyspnea were low. Patients with lower activity levels exhibited significantly higher levels of fear of movement (p =.025). Conclusions The majority of patients reported engaging in light to moderate activity levels six months after cardiac surgery. Despite this, less than half of the patients met the WHO's physical activity recommendations. Potential barriers to physical activity such as pain, dyspnea and fear of movement were reported to be low.

Navigating the Waves: A Comprehensive Analysis of India's COVID-19 Journey from 2019 to the Arrival of JN.1 Subvariant in 2023

COVID-19, caused by the SARS-CoV-2 virus, has emerged as a global threat. The journey of COVID-19, from its origins in Wuhan in 2019 to the emergence of various variants, including the recent JN.1 subvariant, is a complex narrative marked by global efforts to control the pandemic. The progression of the virus in India, as illustrated by data from 2020 to 2023, reflects both the challenges faced and the resilience exhibited by different states. The decline in cases in 2023, compared to the previous year, is attributed to factors such as extensive vaccination campaigns, the emergence of less severe variants, and changing immune responses. The inclusion of comprehensive WHO recommendations emphasizes the ongoing importance of preventive measures. The evolving scenario also highlights the need for continued vigilance, international collaboration, and public health initiatives to minimize the impact of the virus. The advent of JN.1 serves as a reminder of the virus's adaptability and the significance of remaining in advance of emerging variants as the globe struggles with COVID-19's unexpected nature.

Nutritional Status, Sugar Sweetened Beverage Consumption and Physical Activity Level in Male and Female College Students Living in Dormitory

Introduction: The global prevalence of obesity is on the rise, including in Indonesia. High energy intake from sugar is a growing concern worldwide due to its association with weight gain, tooth decay, and non-communicable diseases. A prior study revealed that 10.9% of Indonesian adults consumed energy from sweetened beverages in excess of the WHO recommendation. This study aimed to assess the consumption of sweetened beverages in male and female college students in Indonesia. Method: The study was conducted at Universitas Indonesia and involved 107 subjects aged 19-21 years who resided in student dormitories. Result: The result found the median BMI in female was higher than male. In female, 3 out of 10 students was overweight-obese, while 1 out of 10 in male. Interestingly, the median daily intake of sweetened beverages significantly higher in male than female; 387 (25–1580) vs 246 (0–762) ml/day (p=0.001). Added sugar content in beverages in males was higher than half of Indonesian recommendation (28.4 [1.9–134.4] vs 19.2 [0–61.1]) which contributed to energy as much as 170.9 (12.4–625.7) kcal/ day or about 8.9% of total energy intake than female (108.5 [0–394.4] kcal/day). Compared to Indonesian guideline, 12% of male subjects consumed added sugar higher than 50 g/day. Simultaneously, 7 out of 10 subjects consumed energy from sweetened beverages higher than 10% of their total energy intake (WHO recommendation). The BMI and prevalence of overweight-obese were higher in female, while the sweetened beverage was higher in male. It might be caused by the physical activity in male was higher than female. Although male had higher energy intake from SSB, their energy output through physical activity balanced with energy input. Conclusion: These finding alerted the university as educational institution should take an action to prevent this issue since the prevalence of overweight-obesity and sweetened beverage consumption has occurred in young age.

How Safe Are Nepal’s Roads? A Study of Road Safety Legislation and WHO Standards

Around the world, traffic accidents result in significant catastrophes. The consequences of traffic accidents go far beyond the immediate suffering of the individuals involved. This paper aims to examine the road safety legislation and WHO standards adopted in Nepal. The paper is based on secondary data and policy documents related to road safety and WHO standards in the context of Nepal. It presents Nepal’s road network, significant improvements in road safety indicators, and encouraging advancements in road safety. The study finds five major areas for improvement in road safety laws in Nepal: seat-belt regulations, helmet laws, speed laws, child restraint laws, and drinking and driving laws. The study also reveals that Nepal’s current regulatory framework needs to be improved by monitoring actual appropriate helmet fastening and standardization. There is a lack of precise BAC restrictions for drivers and insufficient speed limits under WHO recommendations. Nepal’s child restraint rules also need to be expanded to include seat belt usage in all cars and forbid children from sitting in the front seats. To close those regulatory gaps and protect Nepalese citizens’ safety on the roads, it ends by providing a strict set of recommendations, such as increased enforcement, public awareness campaigns, and changes to road design and concrete making plans. Policymakers, researchers, and stakeholders working to promote street safety measures in Nepal and abroad would find great assistance from this article, which offers a detailed examination and smart recommendations.

A bio-behavioral model of systemic inflammation at breast cancer diagnosis and fatigue of clinical importance 2 years later

We aimed to generate a model of cancer-related fatigue (CRF) of clinical importance 2 years after diagnosis of breast cancer building on clinical and behavioral factors and integrating pre-treatment markers of systemic inflammation. Women with stage I-III hormone receptor-positive/human epidermal growth factor receptor 2-negative breast cancer were included from the multimodal, prospective CANTO cohort (NCT01993498). The primary outcome was global CRF of clinical importance [European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ)-C30 ≥40/100] 2 years after diagnosis (year 2). Secondary outcomes included physical, emotional, and cognitive CRF (EORTC QLQ-FA12). All pre-treatment candidate variables were assessed at diagnosis, including inflammatory markers [interleukin (IL)-1α, IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, interferon γ, IL-1 receptor antagonist, tumor necrosis factor-α, and C-reactive protein], and were tested in multivariable logistic regression models implementing multiple imputation and validation by 100-fold bootstrap resampling. Among 1208 patients, 415 (34.4%) reported global CRF of clinical importance at year 2. High pre-treatment levels of IL-6 (quartile 4 versus 1) were associated with global CRF at year 2 [adjusted odds ratio (aOR): 2.06 (95% confidence interval [CI] 1.40-3.03); P= 0.0002; area under the receiver operating characteristic curve= 0.74]. Patients with high pre-treatment IL-6 had unhealthier behaviors, including being frequently either overweight or obese [62.4%; mean body mass index 28.0 (standard deviation 6.3 kg/m2)] and physically inactive (53.5% did not meet World Health Organization recommendations). Clinical and behavioral associations with CRF at year 2 included pre-treatment CRF [aOR versus no pre-treatment CRF: 3.99 (95% CI 2.81-5.66)], younger age [aOR per 1-year decrement: 1.02 (95% CI 1.01-1.03)], current tobacco smoking [aOR versus never: 1.81 (95% CI 1.26-2.58)], and worse insomnia or pain [aOR per 10-unit increment: 1.08 (95% CI 1.04-1.13), and 1.12 (95% CI 1.04-1.21), respectively]. Secondary analyses indicated additional associations of IL-2 [aOR per log-unit increment: 1.32 (95% CI 1.03-1.70)] and IL-10 [0.73 (95% CI 0.57-0.93)] with global CRF and of C-reactive protein [1.42 (95% CI 1.13-1.78)] with cognitive CRF at year 2. Emotional distress was consistently associated with physical, emotional, and cognitive CRF. This study proposes a bio-behavioral framework linking pre-treatment systemic inflammation with CRF of clinical importance 2 years later among a large prospective sample of survivors of breast cancer.

Evaluation of drinking water quality and associated health risks in Adama City, Ethiopia

Drinking water deterioration causes to risk of public health which is essential to supply safe water to the public. This study assessed groundwater quality and health risks in Adama City by analyzing groundwater and chlorine samples. Ion photometry techniques detected anions and cations, ensuring accuracy with quality control protocols. Water Quality Index (WQI) and chlorine decay modeling via WaterGEMs assessed water quality. Hazard index (HI) calculations evaluated exposure risks; Pearson correlation analyzed physicochemical relationships. Findings highlighted water quality and hazards. Aquachem software analyzed Adama's groundwater, revealing high total alkalinity and potassium exceeding WHO limits. Other parameters (nitrate, nitrite, chloride, fluoride, and sulfate) met WHO standards. Sodium, calcium, magnesium, iron, manganese, and boron also complied. Multivariate analysis showed significant parameter associations. Water types included Ca–Na–HCO3 (27.27 %), Na–Ca–HCO3 (36.36 %), Na–Ca–Mg–HCO3, Na–HCO3 (9.09 % each), and Na–Mg–HCO3 (18.18 %). Drinking Water Quality Index rated boreholes as "Good." Health risk assessments found no significant fluoride, iron, or manganese risks across ages. Chlorine residual analysis indicated 74 % had levels below WHO recommendations, prompting chlorine dosing adjustments. Findings inform groundwater management in Adama City.