Adolescent Undernutrition Christian, Parul; Smith, Emily R.
Annals of nutrition & metabolism,
01/2018, Letnik:
72, Številka:
4
Journal Article
Recenzirano
Odprti dostop
Background: Adolescents, comprised of 10–19 year olds, form the largest generation of young people in our history. There are an estimated 1.8 billion adolescents in the world, with 90% residing in ...low- and middle-income countries. The burden of disease among adolescents has its origins in infectious and injury-related causes, but nutritional deficiencies, suboptimal linear growth, and undernutrition are major public health problems, even as overweight may be on the rise in many contexts. Summary and Key Messages: Girls are most vulnerable to the influences of cultural and gender norms, which often discriminate against them. Dietary patterns and physical activity, in addition to schooling and countervailing social norms for early marriage, influence health and nutritional well-being of adolescents. Nutrient requirements – including those for energy, protein, iron, calcium, and others – increase in adolescence to support adequate growth and development. In settings where dietary intakes are suboptimal, anemia and micronutrient deficiencies are high. Endocrine factors are essential for promoting normal adolescent growth and are sensitive to undernutrition. Growth velocity increases during puberty when peak height velocity occurs and catch-up is possible; in girls, about 15–25% of adult height is attained. A premature pregnancy can halt linear growth and increase the risk of adverse birth outcomes. Research is needed to fill the huge data gaps related to nutrition and growth during adolescence, in addition to testing interventions during this second window of opportunity to enhance growth and development, improve human capital, and to end the intergenerational cycle of growth failure.
To assess the existing evidence regarding breastfeeding initiation time and infant morbidity and mortality.
We conducted a systematic review and meta-analysis. We searched Pubmed, Embase, Web of ...Science, CINAHL, Popline, LILACS, AIM, and Index Medicus to identify existing evidence. We included observational studies and randomized control trials that examined the association between breastfeeding initiation time and mortality, morbidity, or nutrition outcomes from birth through 12 months of age in a population of infants who all initiated breastfeeding. Two reviewers independently extracted data from eligible studies using a standardized form. We pooled effect estimates using fixed-effects meta-analysis.
We pooled five studies, including 136,047 infants, which examined the association between very early breastfeeding initiation and neonatal mortality. Compared to infants who initiated breastfeeding ≤1 hour after birth, infants who initiated breastfeeding 2-23 hours after birth had a 33% greater risk of neonatal mortality (95% CI: 13-56%, I2 = 0%), and infants who initiated breastfeeding ≥24 hours after birth had a 2.19-fold greater risk of neonatal mortality (95% CI: 1.73-2.77, I2 = 33%). Among the subgroup of infants exclusively breastfed in the neonatal period, those who initiated breastfeeding ≥24 hours after birth had an 85% greater risk of neonatal mortality compared to infants who initiated <24 hours after birth (95% CI: 29-167%, I2 = 33%).
Policy frameworks and models to estimate newborn and infant survival, as well as health facility policies, should consider the potential independent effect of early breastfeeding initiation.
Ion channels form the basis for cellular electrical signaling. Despite the scores of genetically identified ion channels selective for other monatomic ions, only one type of proton-selective ion ...channel has been found in eukaryotic cells. By comparative transcriptome analysis of mouse taste receptor cells, we identified Otopetrin1 (OTOP1), a protein required for development of gravity-sensing otoconia in the vestibular system, as forming a proton-selective ion channel. We found that murine OTOP1 is enriched in acid-detecting taste receptor cells and is required for their zinc-sensitive proton conductance. Two related murine genes,
and
, and a
ortholog also encode proton channels. Evolutionary conservation of the gene family and its widespread tissue distribution suggest a broad role for proton channels in physiology and pathophysiology.
A combination of experimental and computational studies have identified a C=O⋅⋅⋅isothiouronium interaction as key to efficient enantiodiscrimination in the kinetic resolution of tertiary heterocyclic ...alcohols bearing up to three potential recognition motifs at the stereogenic tertiary carbinol center. This discrimination was exploited in the isothiourea‐catalyzed acylative kinetic resolution of tertiary heterocyclic alcohols (38 examples, s factors up to >200). The reaction proceeds at low catalyst loadings (generally 1 mol %) with either isobutyric or acetic anhydride as the acylating agent under mild conditions.
Test your resolve: Experimental and computational studies have identified a C=O⋅⋅⋅isothiouronium interaction as key to efficient enantiodiscrimination in the kinetic resolution of tertiary heterocyclic alcohols with up to three potential recognition motifs at the stereogenic tertiary carbinol center. The kinetic resolution of a range of such alcohols was achieved with an isothiourea catalyst and either isobutyric or acetic anhydride.
National health care policy recommends that patients and families be actively involved in discharge planning. Although children with medical complexity (CMC) account for more than half of pediatric ...readmissions, scalable, family-centered methods to effectively engage families of CMC in discharge planning are lacking. We aimed to systematically examine the scope of preferences, priorities, and goals of parents of CMC regarding planning for hospital-to-home transitions and to ascertain health care providers' perceptions of families' transitional care goals and needs.
We conducted semistructured interviews with parents and health care providers at a tertiary care hospital. Interviews were continued until thematic saturation was reached. Interviews were audio recorded, transcribed verbatim, and analyzed to identify emergent themes via a general inductive approach.
Thirty-nine in-depth interviews were conducted, including 23 with family caregivers of CMC and 16 with health care providers. Families' priorities, preferences, and goals for hospital-to-home transitions aligned with 7 domains: effective engagement with health care providers, respect for families' discharge readiness, care coordination, timely and efficient discharge processes, pain and symptom control, self-efficacy to support recovery and ongoing child development, and normalization and routine. These domains also emerged in interviews with health care providers, although there were minor differences in themes discussed.
Although CMC have diverse transitional care needs, their families' priorities, preferences, and goals aligned with 7 domains that bridged their hospital admission with reestablishment of a home routine. This research provides essential foundational data to engage families in discharge planning, guiding the operationalization of national health policy recommendations.
According to recent estimates, at least 11% of the total global burden of disease is attributable to surgically-treatable diseases. In children, the burden is even more striking with up to 85% of ...children in low-income and middle-income countries (LMIC) having a surgically-treatable condition by age 15. Using population data from four countries, we estimated pediatric surgical needs amongst children residing in LMICs.
A cluster randomized cross-sectional countrywide household survey (Surgeons OverSeas Assessment of Surgical Need) was done in four countries (Rwanda, Sierra Leone, Nepal and Uganda) and included demographics, a verbal head to toe examination, and questions on access to care. Global estimates regarding surgical need among children were derived from combined data, accounting for country-level clustering.
A total of 13,806 participants were surveyed and 6,361 (46.1%) were children (0-18 years of age) with median age of 8 (Interquartile range IQR: 4-13) years. Overall, 19% (1,181/6,361) of children had a surgical need and 62% (738/1,181) of these children had at least one unmet need. Based on these estimates, the number of children living with a surgical need in these four LMICs is estimated at 3.7 million (95% CI: 3.4, 4.0 million). The highest percentage of unmet surgical conditions included head, face, and neck conditions, followed by conditions in the extremities. Over a third of the untreated conditions were masses while the overwhelming majority of treated conditions in all countries were wounds or burns.
Surgery has been elevated as an "indivisible, indispensable part of health care" in LMICs and the newly formed 2015 Sustainable Development Goals are noted as unachievable without the provision of surgical care. Given the large burden of pediatric surgical conditions in LMICs, scale-up of services for children is an essential component to improve pediatric health in LMICs.
Kangaroo Mother Care (KMC) is an evidence-based intervention that reduces neonatal morbidity and mortality. However, adoption among health systems has varied. Understanding the interaction between ...health system functions—leadership, financing, healthcare workers (HCWs), technologies, information and research, and service delivery—and KMC is essential to understanding KMC adoption. We present a systematic review of the barriers and enablers of KMC implementation from the perspective of health systems, with a focus on HCWs and health facilities. Using the search terms ‘kangaroo mother care’, ‘skin to skin (STS) care’ and ‘kangaroo care’, we searched Embase, Scopus, Web of Science, Pubmed, and World Health Organization Regional Databases. Reports and hand searched references from publications were also included. Screening and data abstraction were conducted by two independent reviewers using standardized forms. A conceptual model to assess KMC adoption themes was developed using NVivo software. Our search strategy yielded 2875 studies. We included 86 studies with qualitative data on KMC implementation from the perspective of HCWs and/or facilities. Six themes emerged on barriers and enablers to KMC adoption: buy-in and bonding; social support; time; medical concerns; training; and cultural norms. Analysis of interactions between HCWs and facilities yielded further barriers and enablers in the areas of training, communication, and support. HCWs and health facilities serve as two important adopters of Kangaroo Mother Care within a health system. The complex components of KMC lead to multifaceted barriers and enablers to integration, which inform facility, regional, and country-level recommendations for increasing adoption. Further research of methods to promote context-specific adoption of KMC at the health systems level is needed.
Kangaroo Mother Care (KMC) est une intervention axée sur des bases factuelles qui réduit la morbidité et la mortalité néonatales. Cependant, son adoption varie au sein des systèmes de santé. Il est essentiel de comprendre l’interaction entre les fonctions du système de santé - leadership, financement, agents de santé (AS), technologies, information et recherche, et prestation de services - et la méthode KMC pour comprendre l’adoption de ladite méthode. Nous présentons un examen systématique des obstacles et des facilitateurs de la mise en oeuvre de la méthode KMC du point de vue des systèmes de santé, en mettant l’accent sur les agents de santé et les formations sanitaires. En utilisant les termes de recherche «kangaroo mother care», «skin to skin (STS) care» et «kangaroo care», nous avons effectué des recherches dans Embase, Scopus, Web of Science, Pubmed et dans les bases de données régionales de l’Organisation mondiale de la santé. On a également inclus des rapports et des recherches manuelles de publications. Le filtrage et l’abstraction des données ont été effectués par deux examinateurs indépendants utilisant des formulaires normalisés. On a élaboré un modèle conceptuel permettant d’évaluer les thèmes d’adoption de la méthode KMC grâce au logiciel NVivo. Notre stratégie de recherche a produit 2875 études. Nous avons inclus 86 études contenant des données qualitatives sur la mise en oeuvre de la méthode KMC du point de vue des agents de santé et/ou des formations sanitaires. Six thèmes ont émergé sur les obstacles et les facilitateurs relatifs à l’adoption de la méthode KMC: acceptation et liens affectifs; soutien social; temps; préoccupations médicales; formation et normes culturelles. L’analyse des interactions entre les agents de santé et les formations sanitaires a révélé d’autres obstacles et facilitateurs dans les domaines de la formation, de la communication et du soutien. Les agents de santé et les formations sanitaires sont deux facteurs importants dans l’adoption de la méthode Kangaroo Mother Care dans un système de santé. Les composantes complexes de la KMC sont à l’origine d’obstacles et de facilitateurs multiformes à l’intégration, qui font connaître les recommandations des formations sanitaires, des régions et des pays pour une intensification de l’adoption. Il est nécessaire de poursuivre les recherches sur les méthodes permettant de promouvoir l’adoption d’une KMC spécifique au contexte des systèmes de santé.
袋鼠妈妈护理法 （KMC） 是一项降低新生儿疾病和死亡率的 循证干预。但是, 不同卫生体系对该方法的采用有所差异。为 了了解KMC 的采用, 必须理解卫生体系功能（领导、筹资、 医疗工作者 （HCWs）、技术、信息与研究、服务提供）和 KMC 之间的相互作用。我们对从卫生体系角度探讨KMC实 施的阻碍和促进因素的文献进行了系统综述, 重点关注HCWs 和卫生机构。使用“袋鼠妈妈护理 （kangaroo mother care） ”, “肌肤接触护理 （skin to skin care） ” 和“袋鼠护理 （kangaroo care） ” 为检索词, 检索Embase 、Scopus 、 Web of Science、Pubmed 和世界卫生组织的区域数据库。 包含项目报告和文献的手动检索结果。由两名研究人员采用 标准化表格进行文献筛选和数据提取。使用NVivo 软件建立 评估KMC 采纳的概念模型。检索策略检索到 2875 项研究。 纳入的 86 项研究提供了 HCWs 和/或卫生机构角度的KMC 实施定性数据。分析显示了 KMC 阻碍和促进因素的 6 个相 关主题：认同和亲子关系；社会支持；时间；医疗因素；培 训；文化规范。关于 HCWs 与卫生机构相互作用的分析显示, 在培训、沟通和支持方面还存在更多阻碍和促进因素。 HCWs 和卫生机构是卫生体系中采用袋鼠妈妈护理的重要实 行者。KMC 的复杂构成导致了多方面的阻碍和促进因素, 在 机构、区域和国家层面推进 KMC 时都要考虑这些因素。需 要进一步研究如何促进在卫生体系层面根据具体环境采用 KMC 。
La Atención de la Madre Canguro (AMC) es una intervención basada en evidencia que reduce la morbilidad y la mortalidad neonatal. Sin embargo, la adopción entre los sistemas de salud ha variado. Comprender la interacción entre las funciones del sistema de salud -liderazgo, financiación, trabajadores de la atención de la salud (TASs), tecnologías, información e investigación y prestación de servicios- y la AMC es esencial para comprender la adopción de la AMC. Presentamos una revisión sistemática de las barreras y los facilitadores para la implementación de la AMC desde la perspectiva de los sistemas de salud, con un enfoque en los TASs y las instalaciones de salud. Usando los términos de búsqueda ‘atención de la madre canguro’, ‘cuidado de piel a piel (PAP)’ y ‘cuidado de canguro’, llevamos a cabo búsquedas en Embase, Scopus, Web of Science, Pubmed y en las Bases de Datos Regionales de la Organización Mundial de la Salud. También se incluyeron informes y referencias de búsqueda manual de las publicaciones. La revisión y la extracción de datos fueron realizadas por dos revisores independientes usando formularios estandarizados. Se desarrolló un modelo conceptual para evaluar los temas de adopción de la AMC usando el software NVivo. Nuestra estrategia de búsqueda arrojó 2875 estudios. Incluimos 86 estudios con datos cualitativos sobre la implementación de la AMC desde la perspectiva de los TASs y/o de las instalaciones. Seis temas surgieron sobre las barreras y los facilitadores para la adopción de la AMC: aceptación y vinculación; apoyo social; tiempo; preocupaciones médicas; entrenamiento; y normas culturales. El análisis de las interacciones entre los TASs y las instalaciones arrojó nuevas barreras y facilitadores en las áreas de entrenamiento, comunicación y apoyo. Los TASs y las instalaciones de salud sirven como dos importantes adoptadores de la Atención de la Madres Canguro dentro de un sistema de salud. Los complejos componentes de la AMC conducen a barreras y facilitadores multifacéticos de la integración, los cuales informan las recomendaciones para aumentar la adopción a nivel de instalación, regional y nacional. Se necesita más investigación de métodos para promover la adopción de la AMC en contextos específicos a nivel de sistemas de salud.
Understanding the economic value of health interventions is essential for policy makers to make informed resource allocation decisions. The objective of this systematic review was to summarize ...available information on the economic impact of children's surgical care in low- and middle-income countries (LMICs).
We searched MEDLINE (Pubmed), Embase, and Web of Science for relevant articles published between Jan. 1996 and Jan. 2015. We summarized reported cost information for individual interventions by country, including all costs, disability weights, health outcome measurements (most commonly disability-adjusted life years DALYs averted) and cost-effectiveness ratios (CERs). We calculated median CER as well as societal economic benefits (using a human capital approach) by procedure group across all studies. The methodological quality of each article was assessed using the Drummond checklist and the overall quality of evidence was summarized using a scale adapted from the Agency for Healthcare Research and Quality.
We identified 86 articles that met inclusion criteria, spanning 36 groups of surgical interventions. The procedure group with the lowest median CER was inguinal hernia repair ($15/DALY). The procedure group with the highest median societal economic benefit was neurosurgical procedures ($58,977). We found a wide range of study quality, with only 35% of studies having a Drummond score ≥ 7.
Our findings show that many areas of children's surgical care are extremely cost-effective in LMICs, provide substantial societal benefits, and are an appropriate target for enhanced investment. Several areas, including inguinal hernia repair, trichiasis surgery, cleft lip and palate repair, circumcision, congenital heart surgery and orthopedic procedures, should be considered "Essential Pediatric Surgical Procedures" as they offer considerable economic value. However, there are major gaps in existing research quality and methodology which limit our current understanding of the economic value of surgical care.
Neonatal deaths now account for more than two-thirds of all deaths in the first year of life and for about half of all deaths in children under-five years. Sub-Saharan Africa accounts up to 41% of ...the total burden of neonatal deaths worldwide. Our study aims to describe causes of neonatal mortality and to evaluate predictors of timing of neonatal death at Tamale Teaching Hospital (TTH), Ghana. This retrospective study was conducted at TTH located in Northern Ghana. All neonates who died in the Neonatal Intensive Care Unit (NICU) from 2013 to 2017 were included and data was obtained from admission and discharge books and mortality records. Bivariate and multivariate logistic regression were used to assess predictors of timing of neonatal death. Out of the 8,377 neonates that were admitted at the NICU during the 5-year study period, 1,126 died, representing a mortality rate of 13.4%. Of those that died, 74.3% died within 6 days. There was an overall downward trend in neonatal mortality over the course of the 5-year study period (18.2% in 2013; 14.3% in 2017). Preterm birth complications (49.6%) and birth asphyxia (21.7%) were the top causes of mortality. Predictors of early death included being born within TTH, birth weight, and having a diagnosis of preterm birth complication or birth asphyxia. Our retrospective study found that almost 3/4 of neonatal deaths were within the first week and these deaths were more likely to be associated with preterm birth complications or birth asphyxia. Most of the deaths occurred in babies born within health facilities, presenting an opportunity to reduce our mortality by improving on quality of care provided during the perinatal period.
IMPORTANCE: Convalescent plasma is a proposed treatment for COVID-19. OBJECTIVE: To assess clinical outcomes with convalescent plasma treatment vs placebo or standard of care in peer-reviewed and ...preprint publications or press releases of randomized clinical trials (RCTs). DATA SOURCES: PubMed, the Cochrane COVID-19 trial registry, and the Living Overview of Evidence platform were searched until January 29, 2021. STUDY SELECTION: The RCTs selected compared any type of convalescent plasma vs placebo or standard of care for patients with confirmed or suspected COVID-19 in any treatment setting. DATA EXTRACTION AND SYNTHESIS: Two reviewers independently extracted data on relevant clinical outcomes, trial characteristics, and patient characteristics and used the Cochrane Risk of Bias Assessment Tool. The primary analysis included peer-reviewed publications of RCTs only, whereas the secondary analysis included all publicly available RCT data (peer-reviewed publications, preprints, and press releases). Inverse variance–weighted meta-analyses were conducted to summarize the treatment effects. The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation. MAIN OUTCOMES AND MEASURES: All-cause mortality, length of hospital stay, clinical improvement, clinical deterioration, mechanical ventilation use, and serious adverse events. RESULTS: A total of 1060 patients from 4 peer-reviewed RCTs and 10 722 patients from 6 other publicly available RCTs were included. The summary risk ratio (RR) for all-cause mortality with convalescent plasma in the 4 peer-reviewed RCTs was 0.93 (95% CI, 0.63 to 1.38), the absolute risk difference was −1.21% (95% CI, −5.29% to 2.88%), and there was low certainty of the evidence due to imprecision. Across all 10 RCTs, the summary RR was 1.02 (95% CI, 0.92 to 1.12) and there was moderate certainty of the evidence due to inclusion of unpublished data. Among the peer-reviewed RCTs, the summary hazard ratio was 1.17 (95% CI, 0.07 to 20.34) for length of hospital stay, the summary RR was 0.76 (95% CI, 0.20 to 2.87) for mechanical ventilation use (the absolute risk difference for mechanical ventilation use was −2.56% 95% CI, −13.16% to 8.05%), and there was low certainty of the evidence due to imprecision for both outcomes. Limited data on clinical improvement, clinical deterioration, and serious adverse events showed no significant differences. CONCLUSIONS AND RELEVANCE: Treatment with convalescent plasma compared with placebo or standard of care was not significantly associated with a decrease in all-cause mortality or with any benefit for other clinical outcomes. The certainty of the evidence was low to moderate for all-cause mortality and low for other outcomes.
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