Objective The Lidcombe therapeutic program is one of the treatments for stuttering in preschool children whose effectiveness on improvement in stuttering has been confirmed. Some families have no ...access to care centers due to different reasons and as such, they are deprived of treatment. Distant treatment would be a proper solution for this issue, in which all people can reach their needed treatment without being concerned over their geographical locations. Because some research has been conducted on telepractice for speech and language disorders in different ways in different countries, regarding the cultural differences that influence the duration of the Lidcombe program as well as its distant implementation, we investigated the extent of the stuttering effect in telepractice program on preschool children in Iran. Materials & Methods In this single-subject study, the Lidcombe program was implemented through live video communication between the therapist in a clinic and the subjects at home for 15 weekly sessions on five 4-6-year-old children, including three boys and two girls. To investigate the progress of the effect, the percentage of stuttered syllables, which were recorded by the therapist as well as the 9-score stuttering severity scale, which was recorded by the parents at home, were employed. During the first base line, which had been considered as three weeks, 21 times the severity rating were recorded, while 3 times the percentage of stuttered syllables were recorded. In the treatment phase, which lasted 15 weekly sessions, 105 and 15 times the score of severity and the percentage of stuttered syllables were recorded respectively. In the second base line, which had been considered as three weeks, 21 and 3 times the score of severity and the percentage of stuttered syllables were recorded respectively. Results To analyze the data of this study, Z-index and diagram plotting were used. The investigation of the stuttering severity scores and the percentage of stuttered syllables before and after the treatment suggest diminished severity and percentage of the stuttered syllables in children. After 15 sessions, two subjects approached the final criteria of the first phase of the Lidcombe program (scores with intensities one and two); however, they did not achieve the criteria. Other subjects did not achieve the final criteria in the first phase either, in spite of the diminished severity and percentage of stuttering. Conclusion The results obtained from this research suggest the effects of the Lidcombe telepractice program on the reduction of stuttering in the subjects. The results of this study showed that after 15 treatment sessions, the other subjects did not manage to achieve the final criteria of the first phase of this program. The outcome of this research indicates a positive effect of the Lidcombe telepractice program on the reduction of stuttering severity in the subjects. Nevertheless, they did not manage to approach the final criteria in the first phase of this program after joining 15 sessions. Based on these results, it can be concluded that the presentation of the Lidcombe telepractice program can be effective in reducing the severity of stuttering. However, more sessions may be required in this type of treatment, compared to the in-person one.
Background Improving the minimum acceptable diet (MAD) is essential for ensuring optimal growth and development of children, as well as preventing malnutrition and its consequences. Previous studies ...in Ethiopia have focused on the magnitude and determinants of a minimum acceptable diet. However, much emphasis was not given to minimum acceptable diet and its associated factors among 6-23 months old children enrolled in Outpatient therapeutic programs (OTP), particularly, in the study area. This study determines the minimum acceptable diet and associated factors among 6-23-month-old children enrolled in OTP. Methods A community-based cross-sectional study was conducted among 346 randomly selected mothers with children aged 6-23 months who were admitted to the OTP. The data were collected using interviewer-administered structured questionnaires. The data were entered, cleaned, coded into Epidata version 4.6, and exported to SPSS version 26 for further analysis. Multivariate logistic regression was used to assess the determinants of MAD. Results The overall prevalence of minimum Acceptable diet among children aged 6-23 months enrolled to OTP was 14.5% (95% CI: 12.02-19%). The odds of MAD were 1.9 times higher among children aged 18-23 months compared to children aged 6-11 months (AOR = 1.9, 95% CI ((1.2 3.9). The odds of MAD were 2.9times higher in children whose mothers had a good knowledge on recommended feeding (AOR = 2.9, 95% CI (1.2, 6.35). Mothers who had no formal education were 81% less likely to provide minimum acceptable diets for their children compared to their counterpart.(AOR = 1.94, 95% CI = 1.24, 4.19). Conclusion The practice of a minimum acceptable diet is inadequate. Nutrition education should be emphasized to improve the mothers' nutrition knowledge regarding infant and young child feeding recommendations, to support mothers in overcoming barriers to feeding their children with adequate diets, and to foster complementary feeding practices for malnourished children. Keywords: Knowledge, Complementary feeding, Minimum acceptable diet, Outpatient therapeutic program, 6-23 months old children, Ethiopia
Alzheimer's disease (AD) is a multifactorial, progressive, neurodegenerative disease typically characterized by memory loss, personality changes, and a decline in overall cognitive function. Usually ...manifesting in individuals over the age of 60, this is the most prevalent type of dementia and remains the fifth leading cause of death among Americans aged 65 and older. While the development of effective treatment and prevention for AD is a major healthcare goal, unfortunately, therapeutic approaches to date have yet to find a treatment plan that produces long-term cognitive improvement. Drugs that may be able to slow down the progression rate of AD are being introduced to the market; however, there has been no previous solution for preventing or reversing the disease-associated cognitive decline. Recent studies have identified several factors that contribute to the progression and severity of the disease: diet, lifestyle, stress, sleep, nutrient deficiencies, mental health, socialization, and toxins. Thus, increasing evidence supports dietary and other lifestyle changes as potentially effective ways to prevent, slow, or reverse AD progression. Studies also have demonstrated that a personalized, multi-therapeutic approach is needed to improve metabolic abnormalities and AD-associated cognitive decline. These studies suggest the effects of abnormalities, such as insulin resistance, chronic inflammation, hypovitaminosis D, hormonal deficiencies, and hyperhomocysteinemia, in the AD process. Therefore a personalized, multi-therapeutic program based on an individual's genetics and biochemistry may be preferable over a single-drug/mono-therapeutic approach. This article reviews these multi-therapeutic strategies that identify and attenuate all the risk factors specific to each affected individual. This article systematically reviews studies that have incorporated multiple strategies that target numerous factors simultaneously to reverse or treat cognitive decline. We included high-quality clinical trials and observational studies that focused on the cognitive effects of programs comprising lifestyle, physical, and mental activity, as well as nutritional aspects. Articles from PubMed Central, Scopus, and Google Scholar databases were collected, and abstracts were reviewed for relevance to the subject matter. Epidemiological, pathological, toxicological, genetic, and biochemical studies have all concluded that AD represents a complex network insufficiency. The research studies explored in this manuscript confirm the need for a multifactorial approach to target the various risk factors of AD. A single-drug approach may delay the progression of memory loss but, to date, has not prevented or reversed it. Diet, physical activity, sleep, stress, and environment all contribute to the progression of the disease, and, therefore, a multi-factorial optimization of network support and function offers a rational therapeutic strategy. Thus, a multi-therapeutic program that simultaneously targets multiple factors underlying the AD network may be more effective than a mono-therapeutic approach.
The importance of human‐animal bonds has been documented throughout history, across cultures, and in recent research. However, attachments with companion animals have been undervalued and even ...pathologized in the field of mental health. This article briefly surveys the evolution of human‐animal bonds, reviews research on their health and mental health benefits, and examines their profound relational significance across the life course. Finally, the emerging field of animal‐assisted interventions is described, noting applications in hospital and eldercare settings, and in innovative school, prison, farm, and community programs. The aim of this overview paper is to stimulate more attention to these vital bonds in systems‐oriented theory, practice, and research. A companion paper in this issue focuses on the role of pets and relational dynamics in family systems and family therapy (Walsh, 2009a).
RESUMEN
Vínculos entre animales y humanos I: La importancia de los animales de compañía en las relaciones
La importancia de los vínculos entre animales y humanos se ha documentado a lo largo de la historia, en distintas culturas, y en investigaciones recientes. Sin embargo, en el campo de la salud mental, el apego a los animales de compañía se ha subestimado e incluso patologizado. En este artículo se estudia brevemente la evolución de los vínculos entre humanos y animales, se analizan las investigaciones acerca de sus beneficios para la salud física y mental, y se examina su profunda importancia para las relaciones en el transcurso de la vida. Finalmente, se describe el campo emergente de las intervenciones asistidas por animales, observando aplicaciones en hospitales y en centros de asistencia para personas mayores así como en programas de escuelas innovadoras, en programas de cárceles, de granjas y comunitarios. El objetivo de este artículo general es estimular más atención a estos vínculos fundamentales en la teoría, la práctica y la investigación orientadas a los sistemas. Hay un artículo complementario en este número que se centra en el rol de las mascotas y la dinámica relacional en los sistemas familiares y la terapia familiar (Walsh, 2009a).
Palabras clave: vínculos entre animales y humanos; beneficios para la salud física y mental; vínculos con animales de compañía, mascotas; intervenciones asistidas por animales; aplicaciones en programas terapéuticos
Background In Ethiopia, about 57% of child mortality is associated with acute malnutrition in which the burden is dominant at the rural community. In that regard, the Ethiopian government has been ...implementing the Outpatient Therapeutic Program (OTP) for managing the uncomplicated sever acute malnutrition among children aged 6 to 59 months at community level by health extension workers. But nothing is known about the implementation status of OTP. Thus, this evaluation aims to evaluate the implementation status of OTP in Dehana district, northern Ethiopia. Methods A facility-based cross-sectional evaluation with concurrent mixed-method was employed from 1st February to 30th April 2020. A total of 39 indicators were used to evaluate the availability, compliance and acceptability dimensions of the program implementation. A total of 422 mothers/caregivers for exit interview, 384 children's (diagnosed with acute malnutrition) record reviews, nine key informants' interview, and 63 observations were done in this evaluation. A multi-variable logistic regression analysis was used to identify the predictor variables associated with acceptability. Adjusted Odds Ratio (AOR) with 95% confidence interval (CI), and p-value < 0.05 were used to declare statistically significant variables. The qualitative data were tape recorded, transcribed in Amharic and translated into English and finally thematic analysis was done. Results The overall implementation of OTP was 78% measured by availability (87.5%), compliance (75.3%), and acceptability (71.0%) dimensions. Trained healthcare providers, Ready to Use Therapeutic Food (RUTF), Mebendazole, and Oral Rehydration Salt (ORS) were available in all health posts, whereas vitamin A and folic acid were stocked out in some health posts. The health care providers complained that interruption of supplies, work overload and improper usage of RUTF by caregivers were the common challenges of program delivery. Rural residence (AOR = 0.18, 95% CI: 0.09-0.39), knowledge on childhood malnutrition and program services (AOR = 2.27, 95% CI: 1.04-4.97), and had malnourished children previously (AOR = 1.82, 95% CI: 1.01-3.30) were significantly associated with the acceptability of OTP program. Conclusion The overall implementation status of OTP was judged fair. Low achievement was observed on the compliance of health care providers to the standards, and acceptability of program services. Therefore, the program needs great improvement to enhance the outcome of childhood malnutrition management. Keywords: Evaluation, Outpatient therapeutic program, Implementation, Dehana, Ethiopia
Background Managing severe acute malnutrition (SAM) involves an outpatient therapeutic program (OTP), targeting more than 80% of SAM children where the quality of primary healthcare remains poor. ...Treatment success and recovery from SAM remain poor and could be affected by many factors, where such evidence is limited in East Hararghe. This study assessed the predictors of time to recovery from SAM in eastern Ethiopia. Methods A retrospective cohort study was conducted on 402 records of SAM children under 5 years of age enrolled on OTP at 12 health posts retrieved from 2020 to 2021. We used the Kaplan–Meir estimate along with the p -value of the log-rank test and the survival curve to compare the time to recovery across categories. A multivariable Cox proportional hazard model was fitted to identify predictors of time to recovery from SAM. A p -value below 0.05 was used to declare statistical significance. Results A total of 402 records were reviewed, and the cure rate from SAM was 89.6% 95% confidence interval (CI), 87–93. Moreover, a death rate of 0.7%, a default rate of 9.5%, and a non-responder rate of 0.2% were obtained with a median length of stay of 7 weeks. The median time to recovery was significantly shorter for children from shorter distances from OTP sites with edema, amoxicillin, ( p < 0.05). Edema at admission adjusted hazard ratio (AHR) = 1.74; 95% CI: 1.33–2.29, without diarrhea (AHR = 1.51; 95% CI: 1.18–1.94), taking amoxicillin (AHR = 1.55; 95% CI: 1.19–2.02), shorter travel time to the OTP site (AHR = 1.44; 95% CI: 1.13–1.85), breastfeeding (AHR = 1.60; 95% CI: 1.27–2.02), adequacy of ready-to-use therapeutic food (RUTF) (AHR = 1.22; 95% CI: 0.90–1.65), and new admission (AHR = 1.62; 95% CI: 0.84–3.10) were important predictors of recovery from SAM. Conclusion Recovery from SAM was found to be acceptable in comparison with the Sphere Standards and is predicted by edema, diarrhea, distance from the OTP site, amoxicillin, and RUTF adequacy. These allow for focused interventions that address the identified factors for better recovery from SAM.
Background Children with severe acute malnutrition (SAM) without complication are treated in the outpatient therapeutic program (OTP) and the program has been reported to be effective. However, ...relapse post-discharge from the program is poorly defined, and scarcely evaluated across programs and research. The objective of this study is to assess the prevalence of SAM among children post-discharge from the OTP and to identify factors associated with SAM relapse in Gambella Region, Western Ethiopia. Methods We conducted a facility-based cross-sectional study among 208 children aged 6-59 months who have been discharged from the OTP as cured. Baseline data were collected from caregivers using structured questionnaire. Child anthropometry and oedema was measured. The association between SAM relapse and the risk factors were assessed using bivariate and multivariable logistic regression models. Results The prevalence of SAM relapse was 10.1% (95% CI: 5.8-14.0%). The odds of SAM relapse was significantly higher in children with mothers who had no exposure to education and promotion about infant and young child feeding (IYCF) practices (OR = 5.7; 95% CI: 1.3-12.6), children who were not fully immunized for their age (OR = 8.0; 95% CI: 3.8-23.4), and children with mid-upper arm circumference (MUAC) at discharge of < 12.5 cm (OR = 4.4; 95% CI: 2.1-12.8) than their counterparts. Conclusions To reduce SAM relapse, the OTP programs should avoid premature discharge and consider provision of supplementary food for children with low MUAC at discharge. Further, the OTP discharge criteria should consider both the anthropometric indicators - weight-for-height/length z-score (WHZ) and MUAC - and the absence of bilateral pitting oedema irrespective of the anthropometric indicator that is used during admission. Promotion of nutrition education and improving child immunization services and coverage would help reduce SAM relapse. Keywords: Severe acute malnutrition, Relapse, Discharge, Therapeutic program
Technological advances together with machine learning techniques give health science disciplines tools that can improve the accuracy of evaluation and diagnosis. The objectives of this study were: ...(1) to design a web application based on cloud technology (eEarlyCare-T) for creating personalized therapeutic intervention programs for children aged 0-6 years old; (2) to carry out a pilot study to test the usability of the eEarlyCare-T application in therapeutic intervention programs. We performed a pilot study with 23 children aged between 3 and 6 years old who presented a variety of developmental problems. In the data analysis, we used machine learning techniques of supervised learning (prediction) and unsupervised learning (clustering). Three clusters were found in terms of functional development in the 11 areas of development. Based on these groupings, various personalized therapeutic intervention plans were designed. The variable with most predictive value for functional development was the users' developmental age (predicted 75% of the development in the various areas). The use of web applications together with machine learning techniques facilitates the analysis of functional development in young children and the proposal of personalized intervention programs.
In Ethiopia uncomplicated severe acute malnutrition (SAM) is managed at health posts level through the outpatient therapeutic program (OTP). Yet, evidence on the treatment success rate of the program ...is scarce. This study determines the treatment outcomes and predictors of time-to-recovery among children 6-59 months of age with SAM managed at the health posts level in Shebedino district, Southern Ethiopia.
This was a prospective cohort study that enrolled 216 children with SAM identified through a campaign conducted in May 2015 and treated over eight weeks at 25 health posts of the district. The average time-to-recovery was estimated using Kaplan-Meier survival curve and the independent predictors of the recovery were determined using multivariable Cox-proportional hazard model. The outputs of the analyses are presented via adjusted hazard ratio with 95% confidence intervals (AHR, CI).
At the end of the eight weeks of treatment 79.6% (95% CI: 74.2-85.0%) of cases recovered from SAM with a weight gain rate of 5.4 g/kg/day. The median time-to-recover was 36 days. The analysis indicated, maternal illiteracy (0.54, 0.38-0.78), severe household food insecurity (0.47, 0.28-0.79), walking for more than 1 h to receive the treatment (0.69, 0.50-0.96), diarrhoea co-morbidity (0.63, 0.42-0.91) and practicing sharing of ready to use therapeutic food (RUTF) (0.53, 0.32-0.88) were associated with slower propensity of recovery from SAM. Children who were enrolled with marasmus diagnosis showed lower recovery than children with kwashiorkor (0.30, 0.18-0.51).
The median time-to-recover was 36 days. Discouraging sharing of RUTF, appropriate management of diarrhoea in SAM cases and improving access to OTP sites can help to improve the treatment outcome for SAM.
In Poland, breast cancer (BC) is the most frequently diagnosed cancer in women and the second most common cause of death after lung cancer. This disease has important economic implications for ...patients, public payers, and the whole Polish economy. This study aimed to estimate the total National Health Fund (NHF) expenditures on the diagnosis and treatment of patients with breast cancer. In addition, the costs of productivity losses were also calculated.
Cost estimation was prepared using a top-down approach. Direct cost calculations were based on data reported by NHF for patients with the diagnosis of breast cancer. Medical care costs included the following components: screening program, oncological package, surgical treatment, hospitalization, drug program, chemotherapy, radiotherapy, and outpatient care. Indirect costs in the form of absenteeism costs were calculated based on data from Statistics Poland (gross domestic product, number of employees) and the Social Insurance Institution database (the number of sick leave days).
Total expenditures for BC including direct costs and indirect costs amounted to EUR 305,371, EUR 332,998, and EUR 344,649, respectively in 2017, 2018, and 2019. Total healthcare costs in 2019 were EUR 4114 lower than in 2018, which resulted from the reduction in expenditure on the drug program (decrease of EUR 13,527), despite the observed increase in all remaining resources. From direct costs, the highest expense was spent on the drug program (nearly 50% of total direct costs), but this expense dropped significantly in 2019. For the remaining parameters, the costs increased year by year, of which the most expensive were surgical treatment (15%), radiotherapy (12%), and the screening program (10%). BC generated over EUR 120 thousand of social costs in 2019 and compared to 2017, there was an increase in productivity loss by 26%.
Our results from 2017-2019 demonstrated that total expenditure for BC in Poland increased from year to year. Breast cancer generated almost EUR 345 thousand expenses in 2019, which translates into a significant burden on the public payer's budget and the society in Poland.
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