Influence of nutrition in infancy on appetite characteristics, dietary intake, growth and later obesity risk

Childhood obesity is a global epidemic and public health challenge. One of the factors shown to influence later obesity is early nutrition, through a process known as programming. However, the mechanism by which early life factors affect later risk of obesity are unknown. This PhD aimed to investigate 1) the influence of early nutrition and growth on pre-school (2-5 years) obesity risk (Study 1); 2) the impact of early life factors on appetite development (Study 2) and 3) the influence of early nutrition on later diet (dietary patterns and energy & macronutrient intake) (Study 3). Data from the Optigrow infant feeding study was used to explore associations between early life factors and later obesity risk and understand the potential underlying mechanisms. Study 1 demonstrated that faster growth in infancy was associated with greater risk of obesity at pre-school age. There was no association between infant feeding and obesity risk. In Study 2, cross-sectional analyses showed that high satiety responsiveness was associated with lower risk of obesity at pre-school age. In the longitudinal analyses, high food responsiveness at 4 months increased risk of obesity at age 1 and 2. Food approach traits tracked poorly from infancy to pre-school age. Food avoidant traits did not track beyond 1 year of age. Faster infant weight gain during the first 6 months of life was associated with poor satiety responsiveness at pre-school age. Study 3 identified three dietary patterns namely: ‘health conscious’, ‘energy-dense, high meat, high-fat’ and ‘snack’ at pre-school age. ‘Energy-dense, high meat, high-fat’ pattern was associated with BMI z-score at pre-school age. There was no association between infant feeding (formula- and breast-fed) and dietary intake (energy and macronutrient intake) at pre-school age. The above findings suggests that satiety responsiveness may be an important factor linking infant growth with later obesity risk

Study of Investment Decisions and Personal Characteristics through Risk Tolerance: Moderating Role of Investment Experience

Investment decisions could be affected by behavioral biases associated with personal characteristics. This study empirically investigates the effect of personal characteristics on investors’ investment decision through risk tolerance. Furthermore, investment experience moderates the nexus between personal characteristics and risk tolerance. The scale consisting of 24 items was used related to selected constructs and variables. Data was collected form 175 individual investors of Pakistan Stock Exchange. PLS-SEM was used to make statistical analysis. The findings indicate that extraversion has substantial positive impact on investment decisions. Moreover, risk tolerance partially mediates the relationship between extroversion and investment decisions. The relationship between introversion and investment decisions is negative and risk tolerance partially mediates the aforesaid relationship. Furthermore, it is statistically proved that investment experience substantially moderates the association between extraversion and risk tolerance. However, investment experience does not play any conditional role in the association between introversion and risk tolerance. This study can be helpful for financial advisors to provide best consultancy to their clients (investors), while considering their personal characteristics

Seasonal influence on postoperative hip fracture complications: Retrospective cohort of more than 1000 patients from a tertiary-care university hospital

Background: Hip fractures account for one of the most debilitating conditions affecting the general population amongst the developed and developing nations. Investigators aimed to study the influence of the ongoing season i.e. whether patients operated upon in summer or winter, on post-operative complications occurring within 30 days of surgical procedure for hip fractures at a tertiary care hospital and level 1 trauma center.Materials and methods: Investigators conducted a non-funded, non-commercialized retrospective cohort of 1045 patients with hip fractures managed surgically. Primary exposure was surgical procedures undertaken during the summer months (April-September). Our primary outcome was determining post-operative complication rates from January 2010 to December 2018 and evaluating impact of the season through univariate and multivariable regression analyses using Cox Proportional Hazard Algorithm with STATA V15. The work has been reported in line with the STROCSS criteria.Results: Age, ASA status, type of procedure, mechanism of injury and Charlson Comorbidity Index (CCI) were identified as significant associated factors with postoperative complications after hip fracture surgery. Although overall results revealed a rising rate of complications during the summer season with a relative risk (RR; 95% CI) of 1.1(0.89-1.32), univariate and multivariable analysis did not show any significant correlations.Conclusions: The results of this study did not demonstrate a significant seasonal variability in the rate of postoperative complications for hip fracture patients operated upon during the hot months of summer. More research is required to analyze postoperative complications in order to optimize patients\u27 outcomes

Implicação do isolamento social na saúde mental durante a pandemia de Covid-19: um olhar sobre seu enfrentamento religioso e espiritual

China was the center of Covid-19 which rapidly spread out all over the world. The rapid outbreak of Covid-19 in Asian countries has severely affected psychological and social life of people. Which also has a great influence on religion and faith. Spiritual and religious copping is an effective approach for mental relaxation and belief on the creator specifically during the Covid-19 outbreak. The main purpose of this study is observing the situation of Asian countries existing literature on human psychology and social life further it also explores religious and spiritual coping during Covid-19. Different studies were retrieved from online sources. In which the published articles were classified according to three themes such as human psychology, religious and spiritual coping and social life during Covid-19. It is evident from the literature that covid-19 has a great influence on human psychology. Majority people suffered from anxiety and depression in these tough days of life. Also, most of the people suffered from fear, depression, stress, loneliness during lockdown which effects their social life. The positive point was found that religion and spirituality helping people to reduce their stress and create positivity in their life. Spirituality helps out people in mental relaxation at times of crisis and epidemic situations while religious copings and strong believe on creator reduce anxiety and depression.China fue el centro de la Covid-19, que se extendió rápidamente por todo el mundo. El rápido surto de Covid-19 en los países asiáticos ha afectado gravemente la vida psicológica y social de las personas, una situación que ha hecho del afrontamiento espiritual y religioso un enfoque eficaz para la relajación mental. El objetivo principal de este artículo es observar cómo se abordó el tema en los países asiáticos. Por ello, seleccionamos diferentes estudios publicados en fuentes digitales. Es evidente por los textos que el Covid-19 tuvo un gran impacto en la vida de las personas. La mayoría de ellas comenzó a sufrir ansiedad, depresión, miedo, estrés, soledad durante el aislamiento, afectando su vida individual y social. El punto positivo encontrado fue que la espiritualidad pasó a contribuir para que las personas tuvieran una relajación mental en las situaciones más críticas de la pandemia, reduciendo la ansiedad y la depresión y afrontando situaciones con más fe y esperanza en el Creador.A China foi o centro da Covid-19, que rapidamente se espalhou por todo o mundo. O rápido surto de Covid-19 nos países asiáticos afetou gravemente a vida psicológica e social das pessoas, situação que tornou o enfrentamento espiritual e religioso uma abordagem eficaz para o relaxamento mental. O objetivo principal deste artigo é observar como a questão foi abordada nos países asiáticos. Para tanto, foram selecionados diferentes estudos publicados em fontes digitais. É evidente nos textos que a Covid-19 teve um grande impacto na vida das pessoas. A maioria delas passou a sofrer de ansiedade, depressão, medo, estresse, solidão durante o isolamento, afetando a sua vida individual y social. O ponto positivo encontrado foi a espiritualidade teria contribuído para que as pessoas tivessem um relaxamento mental nas situações mais críticas da pandemia, reduzindo a ansiedade e a depressão e enfrentando as situações com mais fé e esperança no Criador

Does early surgery prevent Postoperative ICU admission after surgery for the fracture of the hip. Nested case control study of 911 patients

Introduction: Since most hip fractures are treated surgically, it is imperative to find an optimum fracture-to-surgery time to decrease the potential complications and enhance postoperative outcomes. In comparison to the vast plethora of literature available on surgical delay and its implications on mortality, very little, if any, research is available on the impact of delayed surgery on postoperative ICU admission. The primary objective of our study is to examine the factors influencing post-surgical ICU admission in order to work on preventive strategies to reduce the potential associated morbidity.Material and methods: Investigators did a nested case control study in a university hospital. A case was defined as a patient who had postoperative ICU admission while controls were patients who did not have postoperative ICU admission after hip fracture surgery. The primary outcome variable was postoperative ICU admission. The exposure variable was defined as the time to surgery which was categorized into two categories; early and late; the early surgery included patients who were operated within ≤ 48 h and the late included patients who had their surgery \u3e48 h. Information on potential confounders including age, type of the procedure and comorbidities were also obtained. Result reported in-line with STROCSS criteria.Results: A total cohort of 1084 hip fracture surgeries were performed from January 2010 to December 2018. After screening for eligibility criteria, 911 patients were eligible for the final simple logistic regression analysis (48 cases and 863 controls). Our exposure variable i.e. time from admission to surgery showed no difference between cases and controls. The odds of being treated with Hemiarthroplasty among cases admitted in ICU was 2.42 times as compared to controls (aOR = 2.42; 95% C.I. 1.21-4.86).Conclusion: Our study did not find an association between surgical delay and post-operative ICU admission after accounting for other covariates and potential confounders

Electrocardiographic features of immune checkpoint inhibitor associated myocarditis.

BACKGROUND: Myocarditis is a highly morbid complication of immune checkpoint inhibitor (ICI) use that remains inadequately characterized. The QRS duration and the QTc interval are standardized electrocardiographic measures that are prolonged in other cardiac conditions; however, there are no data on their utility in ICI myocarditis. METHODS: From an international registry, ECG parameters were compared between 140 myocarditis cases and 179 controls across multiple time points (pre-ICI, on ICI prior to myocarditis, and at the time of myocarditis). The association between ECG values and major adverse cardiac events (MACE) was also tested. RESULTS: Both the QRS duration and QTc interval were similar between cases and controls prior to myocarditis. When compared with controls on an ICI (93±19 ms) or to baseline prior to myocarditis (97±19 ms), the QRS duration prolonged with myocarditis (110±22 ms, p CONCLUSIONS: The QRS duration is increased in ICI myocarditis and is associated with increased MACE risk. Use of this widely available ECG parameter may aid in ICI myocarditis diagnosis and risk-stratification

Do new trainees pose a threat to postoperative complications after hip fracture surgeries? Retrospective cohort of 1045 patients over a decade at a university hospital

Introduction: Induction of new residents and surgical trainees in most institutes occurs once a year. Fresh residents with no experience, may pose a threat to the surgical procedure outcome and there can be a potential increase in patients\u27 morbidity and mortality as a result of this turnover. Literature is inconclusive about this effect. Our aim was to study the new residents\u27 induction effect on postoperative complications after hip fracture surgeries.Methodology: This is non funded non commercialized study from a university hospital. Investigators studied a retrospective cohort of 1045 adult hip fracture patients who were operated at our tertiary care and level 1 trauma centre of a metropolitan city between 2008 and 2018. We defined primary exposure as the time period of new resident\u27s induction (January-March) with the primary outcome in-hospital and 30days postoperative complications. Cox proportional hazard algorithm analysis was done at univariate and multivariable levels reporting Crude Relative Risk (RR) and Adjusted Relative Risk (aRR), respectively. Results were reported in line with STROBE criteria.Results: There were 274 (26%) patients in exposed group out of whom 109 (40%) developed postoperative complications. Interestingly, patients who had their surgeries during the induction period of new residents had 8% less risk of developing postoperative complications. However, result was statistically insignificant at both univariate and multivariable levels with RR; 95% C.I of 0.9 (0.78-1.22) and aRR; 95% C.I of 0.9 (0.78-1.22) after adjusting for the all other independent variables.Conclusion: The association of new residents\u27 induction on postoperative hip fracture surgery complications, although protective, was insignificant after controlling for the potential confounding effect of patients\u27 background and demographic characteristics. We recommend further multi-centre high powered studies to analyze this

Root-Cause Analysis of Persistently High Maternal Mortality in a Rural District of Indonesia: Role of Clinical Care Quality and Health Services Organizational Factors

Background: Despite significant reduction in maternal mortality, there are still many regions in the world that suffer from high mortality. District Kutai Kartanegara, Indonesia, is one such region where consistently high maternal mortality was observed despite high rate of delivery by skilled birth attendants.Method: Thirty maternal deaths were reviewed using verbal autopsy interviews, terminal event reporting, medical records\u27 review, and Death Audit Committee reports, using a comprehensive root-cause analysis framework including Risk Identification, Signal Services, Emergency Obstetrics Care Evaluation, Quality, and 3 Delays.Findings: The root causes were found in poor quality of care, which caused hospital to be unprepared to manage deteriorating patients. In hospital, poor implementation of standard operating procedures was rooted in inadequate skills, lack of forward planning, ineffective communication, and unavailability of essential services. In primary care, root causes included inadequate risk management, referrals to facilities where needed services are not available, and lack of coordination between primary healthcare and hospitals.Conclusion: There is an urgent need for a shift in focus to quality of care through knowledge, skills, and support for consistent application of protocols, making essential services available, effective risk assessment and management, and facilitating timely referrals to facilities that are adequately equipped

Frequency of Chemotherapy-Induced Myalgia in Cancer Patients using The Visual Analogue Scale

AbstractObjective: The aim of the study was to find the frequency of chemotherapy-induced myalgia inpatients with cancer in Lahore.Methodology: This cross-sectional study was conducted over a period of six months after ethicalapproval from February to July 2021. Using a non-probability convenient sampling technique,seventy eligible patients between 45-55 years of age with cancer were included in this study fromboth public and private hospital settings on the basis of predefined eligibility criteria. A self-structured questionnaire including a visual analogue pain scale was used for data collection. Datawas analyzed using SPSS version 21. The qualitative variables were presented with pie charts andquantitative variables are tabulated with frequencies and percentages.Results: Mean age±SD of participants was 53±6.9 years. Out of 70 participants, 90% were females. Thesignificant outcome variables included the presence of myalgia, painful girdle, intensity of pain(visual analogue scale), duration of treatment with the chemotherapy drug, dose of chemotherapydrug and chemotherapy sessions. Chemotherapy-induced myalgia was 94.3% among target cancerpatients in Lahore.Conclusion: In our study, chemotherapy-induced myalgia is alarmingly high in patients withcancers. The pain is mostly moderate in nature and affects the shoulder region. Measures should beadopted to mitigate the chemotherapy-induced myalgia as it adversely affects the patient's alreadydeteriorating quality of life.Keywords: Myalgia, Cancer, Cancer Pain, Palliative care, Chemotherapy

INSPIRE : Vol 3, Issue 1

Content Message From the Chair Global Fund TB Audit-Reviewing diagnostic algorithms used for clinical diagnosis of TB Student Research Forum’s 5th Journal Club Medicine at National and International Forums Featured Faculty: Ms Safia Awan “Don’t ever give up on your dreams.” What are Academics Around the World Reading This Month? Publicationshttps://ecommons.aku.edu/inspire/1026/thumbnail.jp