Sheppardfrancis0147

Introduction Vaccination coverage among undernourished children often associated with higher risk of contracting infectious diseases due to lowered immunity is a critical public health concern. The vaccination coverage is low and the child mortality rate is high in Nigeria. This study investigates the association between selected vaccines uptake and undernutrition among Nigerian children.Methods The 2018 Nigeria Demographic and Health Survey dataset was used for this study. Children aged 0-36 months were included in the study. Stunting and wasting were the main outcome variables to define undernutrition outcomes. The effect of BCG, first dose of DPT/Pentavalent (DPT/Penta1), third dose of DPT/Pentavalent (DPT/Penta3) and measles vaccines on nutrition outcomes were individually examined using logistic regression at 5% significance level.Results Among 6,928 children aged 0 to 36 months old, 34.4% were stunted and 8.7% were wasted, while the vaccination rate was 70.0% (BCG), 65.0% (DPT/Penta1), 48.2% (DPT/Penta1), and 43.6% (measles). Vaccination uptake was consistently associated with less likelihood of stunting, while it was not associated with wasting. We also found that some vaccination uptake was negatively associated with stunting particularly among older children.Discussions/Conclusion The finding that vaccination is associated with less likelihood of stunting implies that the vaccination can be important to enhance the long-term nutrition outcomes. Targeting children with disadvantageous sociodemographic characteristics for vaccination can further enhance the overall nutrition outcomes among them.

To evaluate hypomethylating agent (HMA) persistence in patients with myelodysplastic syndromes (MDS), and examine its association with healthcare resource utilization (HRU) and progression to acute myeloid leukemia (AML).

A total of 2,400 adults diagnosed with MDS initiating HMAs were included from IBM MarketScan databases during 1/1/2011-3/31/2018. The index date was HMA initiation following MDS diagnosis. Patients were classified according to their persistence status by the end of a fixed 'landmark period' of 4 months post-index.

Median persistence to HMAs was 5.6 months (95% CI 5.2, 6.1); HMA non-persistence increased with time. Non-persistent patients had a significantly higher non-HMA-related HRU burden than persistent patients [adjusted incidence rate ratios, outpatient visits 1.12 (95% CI 1.10, 1.14); inpatient visits 1.48 (95% CI 1.30, 1.69); emergency department visits 1.30 (95% CI 1.12, 1.50); all

-values < 0.001]. All-cause and HMA-related outpatient visits were lower among non-persistent patients, likely because of fewer HMA administration-related visits. The incidence rate of AML was numerically, although not significantly, higher in non-persistent patients, when starting follow-up at the end of the landmark period. When follow-up began at the index date, non-persistent patients had a significantly higher rate of AML [adjusted hazard ratio, 1.88 (95% CI 1.53, 2.32);

-value < 0.001].

HMA non-persistence, which increased over time, was associated with significantly higher non-HMA-related HRU, and numerically higher AML progression in MDS patients initiating HMAs. Future studies should evaluate predictors of HMA non-persistence in this patient population.

HMA non-persistence, which increased over time, was associated with significantly higher non-HMA-related HRU, and numerically higher AML progression in MDS patients initiating HMAs. Future studies should evaluate predictors of HMA non-persistence in this patient population.

To provide a conceptual overview of how medical doctors and nurses experience patient suicide.

A systematic search identified ten qualitative papers for this interpretive meta-synthesis. Constructs were elicited and synthesized via reciprocal translational analysis.

Findings comprised four inter-related themes (1) Intrinsic but taboo patient suicide perceived as inevitable yet difficult to discuss. (2) Significant emotional impact clinicians deeply affected, with resilience important for mitigating impact. (3) Failure and accountability intense self-scrutiny, guilt and shame, with blame attributed differently across professions. (4) Legacy of patient suicide opportunities for growth but lack of postvention guidance.

Patient suicide affects clinicians profoundly. Further research should evaluate postvention procedures to inform effective guidance and support, acknowledging professional differences.HighlightsPatient suicide profoundly affects doctors and nurses as "suicide survivors."Despite common themes, professions differed in blame attributions.Organizations must develop postvention responses to meet clinicians' pastoral needs.

Patient suicide affects clinicians profoundly. Further research should evaluate postvention procedures to inform effective guidance and support, acknowledging professional differences.HighlightsPatient suicide profoundly affects doctors and nurses as "suicide survivors."Despite common themes, professions differed in blame attributions.Organizations must develop postvention responses to meet clinicians' pastoral needs.

Good nutrition is a key aspect of health. Cooking activities can improve dietary habits, cooking skills and food courage in terms of courage to cook and taste new foods, in individuals of all ages. However, targeting both grandchildren and grandparents at the same time through intergenerational cooking activities, is new.

This paper aims to present the impact of intergenerational cooking activities on dietary habits, food courage, cooking skills and two-way interaction between young and old participants in

.

In this observational pilot study, the Danish Heart Foundation's experimental cooking program for grandchildren and grandparents was developed and tested. The influence of the food workshop on the participants' dietary habits, food courage, cooking skills and two-way interaction was assessed by a before and after questionnaire. McNemar's and chi-squared tests were used to evaluate the effects.

A total of 180 grandchildren (10 to 12 years) and 183 grandparents participated in

. A total of 82 (46%) grandchildren (71% of which were girls) and 125 (68%) grandparents (83% of which were women) responded to the baseline and follow-up questionnaires. The impact on dietary habits and food courage was limited, while there was an impact on cooking skills in the grandchildren. The already good two-way interaction was unaltered.

The findings indicate an impact on cooking skills among grandchildren participating in

, while the impact on dietary habits, food courage and two-way interaction between age groups was limited. Further research, including more detailed dietary data, should explore the significance of an intergenerational approach.

The findings indicate an impact on cooking skills among grandchildren participating in The Grandchildren's Food Workshop, while the impact on dietary habits, food courage and two-way interaction between age groups was limited. Further research, including more detailed dietary data, should explore the significance of an intergenerational approach.

Health-related quality of life (HRQL) is a key factor in making anticoagulant treatment decisions. The objective of this study was to assess the HRQL of patients with nonvalvular atrial fibrillation by treatment type direct oral anticoagulants (DOACs) or vitamin K antagonists (VKAs).

We carried out a cross-sectional observational study with clinical practice data, gathering demographic and clinical variables. HRQL was measured using the 5-level 5-dimension EuroQol questionnaire (EQ-5D-5L). Differences between the study groups in HRQL as measured by the EQ-5D-5L were analyzed using two-part multivariate regression models. First, using logistic regression, the adjusted probability, p(x), of having perfect health was estimated in each subgroup. Secondly, generalized linear models were used to estimate mean disutility values, w(x), in a population that does not have perfect health, i.e. utility less than 1 or 1-w(x).

We recruited 333 patients, of whom 126 were on DOACs and 207 on VKAs. A significant difference was observed in the EQ-5D-5L anxiety/depression dimension, with a higher percentage of patients classified in the 'no problems' category in the DOAC group. The same type of analysis did not identify significant differences in any of the other dimensions (mobility, self-care, usual activities or pain/discomfort).

In the multivariate model, utility was significantly higher in the DOAC group than in the VKA group, although the difference was small (0.0121). This difference is attributable to patients on DOACs having less anxiety/depression.

Patients treated with DOACs report a slightly better quality of life than those treated with VKAs.

Patients treated with DOACs report a slightly better quality of life than those treated with VKAs.In Norway, the incidence of invasive meningococcal disease (IMD) is higher among 16-19-year-olds than in the general population. Most IMD cases among teenagers are caused by serogroup Y. Since 2011, one dose of meningococcal ACWY conjugate vaccine (MCV4) has been recommended for teenagers with out-of-pocket payment. The teenagers are usually vaccinated through the school health service at age 18. This study aimed to estimate costs and health gains of introducing MCV4 to Norwegian teenagers through the national immunization program (NIP). A Markov model was used to analyze the cost-effectiveness of universal MCV4 vaccination of either 15-year-olds or 18-years-olds. Occurrences of IMD were simulated from 15 until 23 years of age. Costs were estimated from a healthcare perspective. Sensitivity analyses evaluated the impact of vaccine price, vaccination uptake, IMD incidence and discount rate. Compared to today's practice of vaccinating 18-year-olds with out-of-pocket payment, introducing MCV4 to 15-year-olds in a NIP-setting, with 90% vaccine uptake and 50% rebate on vaccine price, prevented 3.2 hospitalizations, 0.20 sequelae and 0.47 deaths among 15-23-year-olds, annually. Total costs were reduced by €30,000 and 9.7 quality-adjusted life-years (QALYs) were gained per birth cohort. The probability of cost-effectiveness was 99.0%, assuming a willingness-to-pay threshold of €86,000/QALY for severe diseases in Norway. Cost-effectiveness was highly dependent on vaccine price. Vaccination of 18-year-olds in a NIP-setting was also cost-effective, but less than NIP-vaccination of 15-year-olds. Introduction of MCV4 to the 15-year-olds in the Norwegian NIP is likely to be cost-effective given a rebate on the vaccine price.Rationale Diagnosis of chronic obstructive pulmonary disease (COPD) relies on abnormal spirometry. However, spirometry may underestimate the effects of smoking, missing smokers with respiratory disease who have minimal or no airflow obstruction. Objectives To develop a multidimensional definition of a lung-related "resilient smoker" that is useful in research studies and then identify a resilient smoker subgroup in the SPIROMICS (SubPopulations and InteRmediate Outcome Measures In COPD Study) cohort using this definition. Methods We performed a three-round modified Delphi survey among a panel of COPD experts to identify and reach a consensus on clinical and radiographic domains to be included in a lung-related resilient smoker definition. DC661 datasheet Consensus on domains of resilience was defined as ⩾80% of experts voting "agree" or "strongly agree" on a 5-point Likert scale. The Delphi-derived definition of resilience was applied to SPIROMICS to identify resilient smokers, whom we then characterized using known biomarkers of COPD.