The impact of combined nutraceutical supplementation on work-related stress, mood and eating disorders during the menopausal transition: A pilot study

Objectives: Menopause represents a "window of vulnerability" in women's life. This transition comprehends many changes: Physical, metabolical and psychological. It could, also, cause difficulties at work and the most problematic symptoms are poor concentration and memory, tiredness, feeling depressed and lowered confidence. Moreover food becomes, often, a practical, easy and fast solution to manage negative emotions. The aims of this pilot study were: To analyze the existence of a possible link between menopausal transition, mood, eating behavior and well-being perception on the workplace and to verify the possible influence of nutraceutical supplementation on the above mentioned factors. Method: 40 women, with mean age 52 years old and mean BMI 33.27 were enrolled and divided into two groups: Diet + behavioral advices (D), or diet + behavioral advices and a nutraceutical compound (D+N) (Assist Forte Retard\uae 1 cp in the evening) for four months. The following psychological questionnaires were administrated at the beginning and after four months: Zung depression scale, (ZDS); Binge Eating Scale (BES); Job Content Questionnaire ( JCQ) used to measure the investigate job related stress. After the test, each woman had an individual psychological interview aimed to investigate her personal experiences, related to what come out from the results. Results: After four months: women (D+N) achieved a statistically significant improvement in both tests (ZDS p <0.0001 Bes p <0.0083). The women (D) had no statistically significant changes in BES, even if there was better management of feeding behavior, and ZDS did not show an improvement in mood. JCQ analysis showed: women (D+N) had a moderate increase of decision-making capacity (DL 64 to 66) compared with an unchanged workload ( JD 33 to 33.5); social-support perception (SS ) showed a slight improvement even if it remained below the median line of the reference sample. In the (D) group we observed a slight increase of the workload , accompanied by a reduction of the decision-making capacity (DL 74 to 69) and by a tiny lowering of the perception of the social support (SS). Conclusions: The combination of a diet program, behavioural advice and nutraceuticals, compared to the sole diet, made it possible to relieve the emotional and eating disturbs related to the menopause and to improve the perception of a satisfactory work

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Background: Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. // Methods: We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. // Findings: We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middle-income countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in low-income countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. // Interpretation: Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between low-income, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030