Infant feeding mode and its association with the use of healthcare services in the first year of life

This research had two goals. First, a systematic review was conducted to examine the relationship between mode of infant feeding and risk of hospitalization due to respiratory tract infections in healthy full-term infants. Second, a cross-sectional study was conducted in the Eastern Region of Newfoundland and Labrador to evaluate differences in healthcare use by feeding mode in infants in the first year of life. Chapter one includes an introduction and chapter four provides a summary and discussion of the findings. Chapters two and three include versions of the systematic review manuscript and the cross-sectional study manuscript, respectively. The systematic review demonstrated breastfeeding reduced the risk of hospitalization due to a respiratory tract infection in the first year of life and the cross-sectional study revealed that exclusively formula-fed infants had significantly more emergency department and hospital visits compared to exclusively breastfed infants or mixed-fed infants in their first year of life

Risk and Return Analysis of Closed-End Mutual Fund in Bangladesh

This study attempts to conduct a five-year performance assessment by analyzing all 24 closed-end mutual funds that had been trading at Dhaka Stock Exchange from December 2011 to January 2017. While analyzing the risk-return profile, the research incorporated both market price and net asset value (NAV) of the mutual funds.NAV depends on the price of securities included in a fund's portfolio whereas, the market price is determined by demand and supply forces. Thus, the market price of a fund is not always equal to its NAV. The study uses market price as a basis for analyzing the risk-return profile of the funds for evaluating the performance of the funds in the market. With the purpose of assessing the performance of asset managers, the study uses NAV as a basis for computing Jensen's α and M squared measure. While assessing performance the study focuses on Jensen’s α and M squared measure as other measures like Sharpe and Treynor do not work with negative numerators and do not provide information on whether the mutual fund outperformed the market portfolio. Both Jensen’s α and M squared measure can independently describe whether a fund beat the market or not. A positive value of Jensen’s α and M squared measure indicates that the fund outperformed the market considering respectively β and σ as a measure of risk. SEBL1STMF, POPULAR1MF, and IFILISLMF1 were among top four funds considering both M2 and Jensen’s alpha measures based on both market price and NAV. The M2 measure, a coefficient of variation, Sharpe ratio, and Treynor ranked SEBL1STMF as the best performer in the market. This fund also topped while assessing performance by M2 measure on the basis of NAV. On the basis of market price and NAV, 21 funds and 22 funds could produce positive M2 respectively. In the year 2012, 2013 and 2014 mutual funds provided negative annualized return on an average (On the basis of market price). The average annualized return rebounded on 2015 and further increased on 2016. All mutual funds provided a positive return in 2016. A different picture was found while calculating annualized return on the basis of NAV, asset managers could generate positive annualized returns on an average in 2013, 2014, 2015 and 2016

Factors influencing the individual investors of Bangladesh to opt for investment in ṣukūk

Purpose – This study aims to identify the factors that influence the willingness of Bangladeshi retail investors to invest in ṣukūk. Design/methodology/approach – The authors surveyed Bangladeshi retail investors using a structured questionnaire to understand their perspectives on potential investment in ṣukūk. The authors considered the behavioral aspects of retail investors and the desired ṣukūk features to analyze the demand side. Factors and regression analyses were performed to identify the persuading factors. Findings – The results indicate that investor awareness is a fundamental factor in potential investments in ṣukūk. Investors perceive the security represented by government and third-party guarantees as a persuasive feature of ṣukūk. The tradability and tenor of ṣukūk also affect the investment intention. Sharīʿah consciousness of the investors also plays a significant role in their investment decisions. Research limitations/implications – One limitation of this study is that it incorporates potential individual investors only, and precludes institutional investors. In the future, there is scope for research to explore the demand factors impacting institutional investors of ṣukūk in Bangladesh. Practical implications – The authors expect that the study will aid policymakers and ṣukūk issuers in crafting strategies to cater to the needs of Bangladeshi retail investors. Originality/value – This study is the earliest research conducted in Bangladesh to determine the factors impacting the willingness of individual investors to make their potential investments in ṣukūk. To the best of the authors' knowledge, no study has analyzed the desired ṣukūk features from the perspective of Bangladeshi retail investors

Somatic, mood, and vasomotor symptoms at midlife in relation to family structure and household workloads in Sylhet, Bangladesh

The purpose of this study was to test whether the frequencies of vasomotor, somatic, and emotional symptoms at midlife were associated with household composition or workloads. Patrilocal family arrangements are common in Bangladesh and, since mothers-in-law hold a position of power vis-à-vis their daughters-in-law, we hypothesized that living with a mother-in-law would increase the likelihood of symptoms at midlife, while living with a daughter-in-law would decrease likelihood of symptoms. We also hypothesised that women with high levels of household workloads would be more likely to report symptoms associated with midlife. Women aged 35-59 living in Sylhet, Bangladesh, (n=157) participated in interviews and anthropometric measures. Symptom frequencies during the past two weeks were collected. Household workloads were computed as minutes spent in housework, caring for dependents, and cooking. Daily values were multiplied by times per week the activity was carried out. Logistic regression was used to evaluate the association between family composition, workloads, and symptoms. Dizzy spells, nervous tension, lack of energy, aches/stiffness in joints, and trouble sleeping were most frequent. Hot flashes were reported by 46% of participants. Women spent more hours caring for dependents than cooking or doing housework. The likelihood of hot flashes increased with time spent in housework and cooking, with daughters in the household, and with chewing betel nut. Daughters-in-law in the household decreased the likelihood of hot flashes. The likelihood of nervous tension increased with peri-menopausal status, stress, and sons in the household, and decreased with more hours spent caring for dependents. The frequency of somatic symptoms and depressed mood exceeded the frequency of hot flashes. Household composition and workloads were more important than menopausal status in explaining variation in symptom frequencies. After controlling for other variables, the presence of mothers-in-law did not increase the likelihood of reporting symptoms at midlife; however, the presence of a daughter-in-law reduced the likelihood of hot flashes, perhaps because of fewer hours spent on housework and cooking

Immunofluorescence pattern of antinuclear antibody and its association with autoantibody profile in systemic lupus erythematosus

Background: Antinuclear antibody (ANA) is useful in the diagnosis of systemic lupus erythematosus (SLE). Association of specific autoantibodies with the immunofluorescence pattern of ANA in SLE as noted in Western literature has been taken as reference in all over the world. However, in Bangladesh such research work or data correlating the autoantibodies and their ANA patterns is inadequate. Objective: To identify an association between immunofluorescence patterns of antinuclear antibody on HEp-2 cell and more specific antinuclear reactivities (e.g. anti-dsDNA and anti-extractable nuclear antigen) in the serum samples of SLE patients.Methods: Serum samples of 37 SLE patients who were diagnosed by ARA (American Rheumatism Association) classification criteria and laboratory tests, attending at lupus clinic of Bangabandhu Sheikh Mujib Medical University (BSMMU) during the study period of six months were subjected for ANA testing by Indirect Imrnunofluorescence (IIF) on HEp-2 cell, anti-dsDNA by ELISA and anti- extractable nuclear antigen (anti-ENA) by Dot Immunoblot. Dot blot strips were tested for anti-Sm, anti-RNP, anti-SSA/Ro, and anti-SSB/La. Results: Out of 37 SLE patients 32 (86.5%) cases were ANA positive by IIF on HEp-2 cell. ANA positive sera exhibited three fluorescence patterns such as speckled (43.7%), peripheral (34.3%) and homogenous pattern (21.8%). Peripheral pattern (100%) was strongly associated with anti-dsDNA (p<0.05) and homogenous pattern (85.7%) was also predominantly associated with anti-dsDNA (p<0.05). Speckled pattern (85.6%) was significantly associated with anti-ENA (p<0.05). Anti-dsDNA was positive in 75% of SLE cases and majority (45.8%) of which showed peripheral pattern whereas anti-ENA was positive in 48.6% cases and majority (70.5%) of which showed speckled pattern. The most commonly identified antinuclear autoreactivity was directed towards anti-RNP (22.2%) then anti-Sm (16.6%), anti-SSA (16.6%) and anti-SSB (11.1 %). Multiple anti-ENA reactivities were identified in 33.3% cases. Conclusion: Peripheral and homogenous pattern is strongly associated with anti-dsDNA therefore may be predicted that patients have active SLE and speckled pattern may predict anti-ENA (specially ribonucleoprotiens). Thus, ANA-IIF method may suffice and probably reduce the expense of detailed immunological work-up with minimal loss in diagnostic accuracy

Religious minority identity associates with stress and psychological health among Muslim and Hindu women in Bangladesh and London

This study examined the association of minority religious identification (Hindu or Muslim) with self-reported stress and psychological symptoms among sedentee and immigrant Bangladeshi women. Women, aged 35-59 (n = 531) were drawn from Sylhet, Bangladesh and London, England. Muslim immigrants in London and Hindu sedentees in Sylhet represented minority religious identities. Muslim sedentees in Sylhet and Londoners of European descent represented majority religious identities. In bivariate analyses, minority religious identity was examined in relation to self-reported measures of stress, nervous tension, and depressed mood. Logistic regression was applied to examine the relationship between these variables while adjusting for marital status, parity, daily walking, and perceived financial comfort. In bivariate analyses, religious minorities reported more stress than religious majorities in all group comparisons (p < .05), and minority Muslims reported more nervous tension and depressed mood than majority Muslims (p < .05). In logistic regression models, minority Muslims had greater odds of high stress than majority Muslims (OR 2.00, 95% CI 1.18-3.39). Minority Muslims had greater odds of stress (OR 3.05, 95% CI 1.51-6.17) and nervous tension (OR 3.37, 95% CI 1.66-6.87) than majority Londoners. Financial comfort reduced odds of stress and symptoms in all models. Socioeconomic situation, immigration history, and minority ethnicity appear to influence the relationship between religious identity and psychosomatic symptoms in Bangladeshi women. Attention to personal and socioeconomic context is important for research examining the association between religion and mental health

Infant feeding mode predicts the costs of healthcare services in one region of Canada: a data linkage pilot study

Objective: The aim is to perform a pilot study evaluating the differences in healthcare service use and its associated costs by infant feeding mode in an infant’s first year of life. Data from a prospective cohort study and administrative databases were linked to examine healthcare use in healthy full term infants (N = 160). Exposure was categorized as exclusively breastfed, mixed fed and exclusively formula fed. Outcomes included hospitalizations, emergency room and physician visits. Descriptive statistics and generalized linear modelling were performed. Results: Overall $315,235 was spent on healthcare service use for the sample of infants during their first year of life. When compared to exclusive breastfeeding, mixed feeding and exclusive formula feeding were found to be significant predictors of total healthcare service use costs (p < 0.05), driven by costs of hospital admissions. Due to the human and economic burden associated with not breastfeeding, policies and programs that support and encourage breastfeeding should be priority

Alternate wetting and drying in Bangladesh : Water saving farming practice and the socioeconomic barriers to its adoption

The compilation of this review was funded by a grant given to the authors by the University of Aberdeen.Peer reviewedPublisher PD

Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial

Background Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. Methods In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283. Findings Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. Interpretation Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset. Funding London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation