Helicobacter pylori cagA status and gastric mucosa-associated lymphoid tissue lymphoma: a systematic review and meta-analysis

Background Recent studies have investigated the role of Helicobacter pylori infection in the development of gastric mucosa-associated lymphoid tissue (MALT) lymphoma. It is estimated that approximately 0.1% of people infected with H. pylori develop gastric MALT lymphoma. However, the role of the CagA antigen, the highest causative agent of H. pylori, in increasing the risk of gastric MALT lymphoma remains unclear and controversial. A systematic review and meta-analysis were conducted to evaluate the effect of cagA status on the development of gastric MALT lymphoma. Methods All articles evaluating the status of the cagA gene in the development of gastric MALT lymphoma were collected using systematic searches in online databases, including PubMed, Scopus, Embase, and Google Scholar, regardless of publication date. The association between cagA and gastric MALT lymphoma was assessed using the odds ratio (OR) summary. In addition, a random-effects model was used in cases with significant heterogeneity. Results A total of 10 studies met our inclusion criteria, among which 1860 patients participated. No association between cagA status and the development of MALT lymphoma (extranodal marginal zone B-cell lymphoma) was found in this study (OR 1.30; 0.906–1.866 with 95% CIs; I2: 45.83; Q-value: 12.92). Surprisingly, a meaningful association was observed between cagA status and diffuse large B-cell lymphoma (OR 6.43; 2.45–16.84 with 95% CIs). We also observed an inverse association between vacA and gastric MALT lymphoma risk (OR 0.92; 0.57–1.50 with 95% CIs). Conclusions It seems that the infection with cagA-positive H. pylori strains does not have a meaningful effect on the gastric MALT lymphoma formation, while translocated CagA antigen into the B cells plays a crucial role in the development of diffuse large B-cell lymphoma.

Socio-biomedical predictors of child nutrition in India: an ecological analysis from a nationally representative Demographic and Health Survey, 2015–2016

Background Despite significant economic growth and development, undernutrition among children remains a major public health challenge for low- and middle-income countries in the twenty-first century. In Millennium Development Goals, India committed halving the prevalence of underweight children by 2015. This study aimed to explain the geographical variation in child malnutrition level and understand the socio-biomedical predictors of child nutrition in India. Methods We used the data from India’s National Family Health Survey 2015–2016. The survey provided estimates of stunting, wasting, and underweight at the national, state, and district level to measure nutritional status of under-five children. Level of stunting, wasting and underweight at the district level are considered as outcome variables. We have used variance inflation factor to check the multicollinearity between potential predictors of nutrition. In this study, we performed spatial analysis using ArcGIS and multiple linear regression analysis using Stata version 15. Results Five states (Uttar Pradesh, Bihar, Madhya Pradesh, Jharkhand and Meghalaya) had very high prevalence of stunting (40% and above). High prevalence of wasting was documented in Jharkhand, Madhya Pradesh, Chhattisgarh, and Karnataka (23 to 29%). Jharkhand, Madhya Pradesh, Maharashtra, and Chhattisgarh had the highest proportion of underweight children in the country. We found that electricity and clean fuel use in the household, use of iodized salt, and level of exclusive breastfeeding had significantly negative influence on the stunting level in the districts. The use of iodized salt has similar effect on the wasting status of under-five children in the districts (b: − 0.27, p < 0.10). Further, underweight level had a negative association with clean fuel use for cooking (b: − 0.17, p < 0.01), use of iodized salt (b: − 0.36, p < 0.10), breastfeeding within one hour (b: − 0.18, p < 0.10), semisolid/solid food within 6–8 months (b: − 0.11, p < 0.05) and Gross Domestic Product of the districts (b: − 0.53, p < 0.10). Conclusion In the study, a variety of factors including electricity and clean fuel use in the household, use of iodized salt, level of exclusive breastfeeding, breastfeeding within one hour, semisolid/solid food within 6–8 months and Gross Domestic Product of the districts have a significant association with nutritional status of children.

The impact of a peer-based education on fruits and vegetables intake among housewives

Background Evidence indicates the lower intake of fruits and vegetables than the recommended daily amount. Study aimed at determining the effects of peer education intervention on the consumption of fruits and vegetable in housewives. Methods A quasi-experimental was conducted with 130 housewives referring to health care centers in Bandar Abbas, Iran. Sixty-five subjects were recruited in each of the intervention and the control groups. Intervention group were divided into three subgroups each receiving a seven-sessions educational programs (lecturing and group discussion) through peers about the importance of benefits of fruits and vegetables consumption. Participants were followed for two months. Data were collected using a questionnaire in two stages of pre- and post-intervention. Differences in the outcome before and after the intervention were tested using T-test and paired T-test. Results The daily servings of fruits and vegetables in the intervention group increased from 1.73 to 4.20 and in the control group from 1.96 to 2.16; a statistically significant difference was also observed between the groups (P < 0.001). After the intervention benefits and self-efficacy of fruits and vegetables consumption significantly increased and perceived barriers of fruits and vegetables consumption significantly decreased in the intervention group (P < 0.001). Conclusion Peer education improves benefits and self-efficacy, reduces barriers, and increases the daily servings of fruits and vegetables in housewives.

Perceived stress, eating behavior, and overweight and obesity among urban adolescents

Background WHO estimated 20% of adolescents (10–19 years) have mental health problems. We examined the prevalence and associated risk predictors of overweight/obesity and perceived stress using eating behaviors and physical activity among school-and-college-going urban adolescents in Bangladesh. Methods A cross-sectional study with a multistage sampling technique was employed to select 4609 adolescent students, aged 13–19 years, from all eight Bangladesh divisions during January–June 2019. Data were collected using a self-administered questionnaire containing Turconi Physical Activity Questionnaire (PAQ), Adolescent Stress Questionnaire (ASQ), Dutch Eating Behavior Questionnaire (DEBQ), and Anthropometric measurements. Logistic regression and different association measures assessed relationships among adolescent characteristics. Results The major 61.5% of adolescents were in moderate-to-extremely-severe levels of stress, 28.2% were overweight/obese, only 2.7% had a very active lifestyle, and 30.5% had a sedentary lifestyle. Perceived stress was positively and significantly correlated with eating behaviors and body mass index, whereas physical activity was significantly associated with the prevalence of overweight/obesity and high stress. The prevalence of overweight/obesity (53.8%) and high stress (52.5%) was higher in males. Adolescents’ obesity was 2.212 times more likely who had a sedentary lifestyle (95% CI 1.377–3.552), 1.13 times more likely for those who had experienced stress due to school/leisure conflict (95% CI 1.051–1.222), and 1.634 times more likely for those who were tempted by restrained eating behavior (95% CI 1.495–1.786). Conclusion Stress on secondary school-and-college-going students needs to be recognized, and strategies need to be developed to improve adolescents’ mental health.

Analysis of childhood overweight and obesity in Namibia using spatio-temporal quantile interval models

The global prevalence of overweight (including obesity) in children under 5 years of age was 7% in 2012, and it is expected to rise to 11% by the year 2025. The main objective of this study was to fit spatio-temporal quantile interval regression models for childhood overweight (including obesity) in Namibia from 2000 to 2013 using fully Bayesian inference implemented in R-INLA package in R version 3.5.1. All the available Demographic and Health Survey (DHS) datasets for Namibia since 2000 were used in this study. Significant determinants of childhood overweight (including obesity) ranged from socio-demographic factors to child and maternal factors. Child age and preceding birth interval had significant nonlinear effects on childhood overweight (including obesity). Furthermore, we observed significant spatial and temporal effects on childhood overweight (including obesity) in Namibia between 2000 and 2013. To achieve the World Health Organisation (WHO) global nutrition target 2025 in Namibia, the existing scaling-up nutrition programme and childhood malnutrition policy makers in this country may consider interventions based on socio-demographic determinants, and spatio-temporal variations presented in this paper.

Associations between socio-demographics, nutrition knowledge, nutrition competencies and attitudes in community-dwelling healthy older adults in Singapore: findings from the SHIELD study

Background Nutrition literacy refers to an individual’s knowledge, motivation and competencies to access, process and understand nutrition information to make nutrition-related decisions. It is known to influence dietary habits of individuals including older adults. This cross-sectional study was designed to: (1) understand the nutrition knowledge, competencies and attitudes of community-dwelling older adults in Singapore, (2) examine the differences between their nutrition knowledge, and socio-demographic factors, competencies and attitudes and (3) identify factors associated with better nutrition knowledge in older healthy adults in Singapore. Methods A total of 400 (183 males and 217 females) nourished community-dwelling older adults aged 65 years and above took part in this study. Malnutrition Universal Screening Tool (MUST) was used to determine individuals who were at low risk of undernutrition. Nutrition knowledge, competencies, attitudes and sources of nutrition information were measured using a locally developed scale. Nutrition knowledge scores were summed to form the nutrition knowledge index (NKI). Associations between NKI, competencies, attitudes and socio-demographic variables were examined using Chi-square and Fisher’s exact tests. Factors associated with NKI were determined using a stepwise regression model with resampling-based methods for model averaging. Results Bivariate analyses found significant differences in NKI scores for gender, monthly household earnings, type of housing, the self-reported ability to seek and understand nutrition information and having access to help from family/friends. Females had higher NKI scores compared to males (p < 0.001). Compared to females, more males left food decisions to others (p < 0.001), and fewer males reported consuming home-cooked food (p = 0.016). Differences in educational level were found for competencies like the self-reported ability to seek (p < 0.001) and verify nutrition information (p < 0.001). Stepwise regression analysis showed that being female, Chinese, self-reported ability to understand nutrition information and having access to help from family/friends were associated with higher NKI scores. Conclusions Our study revealed that nutrition knowledge of older males in Singapore was lower than females and more left food decisions to others. Nutrition education programs could be targeted at both the older male, their caregivers and minority ethnic groups. Trial Registration This study was registered on 7 August 2017 at clinicaltrials.gov (ref. NCT03240952).

Determinants of adherence to anti-TB treatment and associated factors among adult TB patients in Gondar city administration, Northwest, Ethiopia: based on health belief model perspective

Background Adherence is crucial in treating Tuberculosis to achieve the required treatment success rate. However, due to the longer treatment duration, adherence to Tuberculosis treatment is the most challenging factor affecting Tuberculosis control. Furthermore, although several studies have reported the determinants of Tuberculosis treatment adherence, few of them have used Health Belief Model (HBM) as the guiding principle to determine the individual perception of health-related decisions as much or more than medical concerns with Tuberculosis treatment adherence. Therefore, this study aims to assess adherence to anti-Tuberculosis treatment and associated factors among adult Tuberculosis patients in Gondar city, Northwest Ethiopia, in 2020. Methods Institution-based cross-sectional study was conducted among Tuberculosis patients following anti-Tuberculosis treatment in Gondar city health facilities from February 20 to March 26, 2020. A total of 265 Tuberculosis patients were selected by systematic random sampling techniques that include patients who were on treatment follow up for ≥ 1 month and whose age is ≥ 18 years. Data were collected by trained data collectors using interviewer administer and structured questionnaires. EPI DATA version 4.2 was used for data entry and SPSS version 24 for analysis. The logistic regression model was used to indicate the association between independent variables with adherence to anti Tuberculosis treatment. Results The overall rate of adherence to anti-Tuberculosis treatment was 90.6% within the last 4 weeks and 96.6% within the last 4 days. Multivariable analysis revealed that having treatment supporter [AOR = 3.51, 95% CI (1.15, 10.75)], difficulties in taking TB drugs regularly [AOR = 0.07, 95% CI (0.01, 0.31)], perceived benefit [AOR = 3.45, 95% CI (1.07, 11.08)] and perceived self-efficacy [AOR = 0.22, 95% CI (0.07, 0.63)] were independently associated with adherence to anti-Tuberculosis treatment. Conclusion The treatment adherence rate of the patients was low in the last month before the data survey. Treatment supporters, difficulties in taking anti Tuberculosis drugs regularly, perceived benefit, and perceived self-efficacy were identified as affecting adherence to anti-TB treatment.

Prevalence and predicting factors of perceived stress among Bangladeshi university students using machine learning algorithms

Background Stress-related mental health problems are one of the most common causes of the burden in university students worldwide. Many studies have been conducted to predict the prevalence of stress among university students, however most of these analyses were predominantly performed using the basic logistic regression (LR) model. As an alternative, we used the advanced machine learning (ML) approaches for detecting significant risk factors and to predict the prevalence of stress among Bangladeshi university students. Methods This prevalence study surveyed 355 students from twenty-eight different Bangladeshi universities using questions concerning anthropometric measurements, academic, lifestyles, and health-related information, which referred to the perceived stress status of the respondents (yes or no). Boruta algorithm was used in determining the significant prognostic factors of the prevalence of stress. Prediction models were built using decision tree (DT), random forest (RF), support vector machine (SVM), and LR, and their performances were evaluated using parameters of confusion matrix, receiver operating characteristics (ROC) curves, and k-fold cross-validation techniques. Results One-third of university students reported stress within the last 12 months. Students’ pulse rate, systolic and diastolic blood pressures, sleep status, smoking status, and academic background were selected as the important features for predicting the prevalence of stress. Evaluated performance revealed that the highest performance observed from RF (accuracy = 0.8972, precision = 0.9241, sensitivity = 0.9250, specificity = 0.8148, area under the ROC curve (AUC) = 0.8715, k-fold accuracy = 0.8983) and the lowest from LR (accuracy = 0.7476, precision = 0.8354, sensitivity = 0.8250, specificity = 0.5185, AUC = 0.7822, k-fold accuracy = 07713) and SVM with polynomial kernel of degree 2 (accuracy = 0.7570, precision = 0.7975, sensitivity = 0.8630, specificity = 0.5294, AUC = 0.7717, k-fold accuracy = 0.7855). Overall, the RF model performs better and authentically predicted stress compared with other ML techniques, including individual and interaction effects of predictors. Conclusion The machine learning framework can be detected the significant prognostic factors and predicted this psychological problem more accurately, thereby helping the policy-makers, stakeholders, and families to understand and prevent this serious crisis by improving policy-making strategies, mental health promotion, and establishing effective university counseling services.

Assessment the effect of vitamin D supplementation on plasma vitamin D levels, inflammation, and oxidative stress biomarkers based on vitamin D receptor genetic variation in breast cancer survivors: a protocol for clinical trial

Background Both human genes and environmental exposures, due to complex interplay, play important role in the cancer etiology. Vitamin D is associated with a reduced risk of incidence and mortality of several human cancers. This study will aim to investigate the possible effects of individual polymorphisms in vitamin D receptor (VDR) as well as effects of VDR haplotypes on response to vitamin D supplementation in breast cancer survivors. Methods This is an interventional study in which the effects of vitamin D supplementation on plasma vitamin D levels, inflammatory and antioxidant biomarkers and factors associated with cell proliferation, differentiation, damage, and apoptosis will be investigated stratified by variations in VDR genotype. The present study will be conducted on breast cancer survivors referred to the Shohadaye Tajrish hospital and its associated clinics. One hundred ninety-eight breast cancer survivors will receive 4000 IU of vitamin D3 daily for 12 weeks. VDR Fok1, ApaI, TaqI, BsmI, and Cdx-2 genotype will be determined at the end of the study and responses to vitamin D supplements (inflammatory, antioxidant, cell proliferation, differentiation, damage, and apoptosis biomarkers) will be compared between the three subgroups of each VDR polymorphism as well as different VDR haplotype categories. Discussion Genetic variation is a fundamental factor influencing individuals’ divergent responses to diet, nutritional status, metabolic response, and diet-related health disorders. Furthermore, studies of gene and environment interactions will provide a precise and accurate assessments of individuals’ dietary requirements by considering both the genetic and environmental aspects simultaneously. The results of the current study, to some extent, will highlight the discrepancies existing in the findings of different studies regarding vitamin D, VDR, and cancer by considering both the genetic and environmental aspects simultaneously. If responses to vitamin D supplementation could be modified by VDR SNPs, determining the distribution of VDR polymorphisms in both breast cancer survivors and healthy populations will provide a new insight into the vitamin D requirements of individuals to prevent cancer and its related mortality based on their genotypes. Trial registration This trial has been registered on Iranian Registry of Clinical Trials (IRCT) under the identification code: IRCT2017091736244N1, registration date: 2017-11-10, http://www.irct.ir/trial/27153

First-time mothers’ experiences of foetal reduction in pregnancy following assisted reproductive technology treatment in Taiwan: a qualitative study

Background Foetal reduction—removal of one or more foetuses to reduce the number of foetuses in multiple conceptions—is a procedure used for improving pregnancy outcomes following assisted reproductive technology (ART) treatment. While there is a recognition of the importance of understanding the experiences of women who undergo foetal reduction to offer appropriate help and support, studies that provide relevant insights are sparse. Our aim was to gain an in-depth understanding about first-time mothers’ experiences of foetal reduction following ART treatment in Taiwan. Methods We adopted a qualitative design based on a phenomenological approach for this study. In-depth semi-structured interviews were conducted with seven first-time mothers who underwent foetal reduction following ART treatment at a fertility centre in Taipei, Taiwan. All interviews were recorded, transcribed and analysed using the Colaizzi strategy. Results The views and experiences relating to foetal reduction reflected five key themes: hesitation, ambivalence and distress; the guilt of knowingly terminating a life; rituals and ceremonies to ease the sense of guilt; persuading oneself to consider the ‘big picture’; and wishing for a reunion in next pregnancy. Mothers often regretted that they took clinical advice to implant multiple embryos and then having had to resort to foetal reduction. There was a sense of hesitation, ambivalence and distress reflected in the views from all participants. They believed that they ended the fetuses’ lives knowingly and expressed strong feelings of guilt. Mothers often tried to persuade themselves to look at foetal reduction within the ‘big picture’ of the overall pregnancy outcome. Losing their unborn babies was as an unforgettable incident for most mothers, and they wished for a reunion with the lost baby in the next pregnancy. Conclusion Findings indicate the need for ART providers to undertake a more sensitive approach that involves detailed discussions with women and their families to tailor the embryo transfer processes to suit individual needs. Women who undergo foetal reduction should be provided with tailored interventions towards enhancing their coping strategies before and after foetal reduction taking into account the cultural and religious context.