Multimodal interventions to enhance adherence to secondary preventive medication after stroke: a systematic review and meta-analyses

Summary: Introduction: Nonadherence to secondary preventative medications after stroke is common and is associated with poor outcomes. Numerous strategies exist to promote adherence. We performed a systematic review and meta-analysis to describe the efficacy of strategies to improve adherence to stroke secondary prevention. Methods: We created a sensitive search strategy and searched multiple electronic databases (MEDLINE, EMBASE, CINAHL, PsycINFO, CENTRAL, and Web of Knowledge) for studies of interventions that aimed to enhance adherence to secondary preventative medication after stroke. We assessed quality of included studies using the Cochrane tool for assessing risk of bias. We performed narrative review and performed meta-analysis where data allowed. Results: From 12,237 titles, we included seventeen studies in our review. Eleven studies were considered to have high risk of bias, 3 with unclear risk, and 3 of low risk. Meta-analysis of available data suggested that these interventions improved adherence to individual medication classes (blood pressure-lowering drugs – OR, 2.21; 95% CI (1.63, 2.98), [P < 0.001], lipid-lowering drugs – OR, 2.11; 95% CI (1.00, 4.46), [P = 0.049], and antithrombotic drugs – OR, 2.32; 95% CI (1.18, 4.56, [P = 0.014]) but did not improve adherence to an overall secondary preventative medication regimen (OR, 1.96; 95% CI (0.50, 7.67), [P = 0.332]). Conclusion: Interventions can lead to improvement in adherence to secondary preventative medication after stroke. However, existing data is limited as several interventions, duration of follow-up, and various definitions were used. These findings need to be interpreted with caution

Alcohol: from Mesopotamia to Modern Iraq.

An understanding of alcohol's place in Iraq's history and society can help inform alcohol policy responses in that country and other Muslim majority countries. This article describes the history of alcohol in Iraq from ancient to modern times, with reflection on the challenges facing Iraqi youth today. A search was undertaken to identify peer-reviewed and gray literature that describes alcohol-related practices, norms, and values across the millennia in Iraq. A historical overview is provided of alcohol's use and context, with more detail on recent times. Alcohol was an important commodity in Iraq until the rise of Islam in the seventh century CE. Despite the subsequent Islamic restrictions on alcohol, alcohol remained present in Iraq's society and cultures. Recent studies provide varying descriptions of the prevalence of alcohol consumption, and there are challenges in researching this sensitive topic. External forces shaping alcohol use in Iraq include direct and indirect alcohol promotion, globalized media, and conflict and violence with its associated stress and trauma. Alcohol research and policy development in Iraq must consider the country's unique cultural, religious, historical, and political context. Iraq's youth may be subject to pressures to increase consumption, and thus policies must be informed by an understanding of the complex set of current perspectives and pressures

The Effect of Different Freezing Temperatures and Long-Term Storage on The Stability of Peaches

Freezing is a simple method to preserve foods especially fruits. The purpose of this research is to determine the impact of long-term freezing storage on peaches quality (physical and chemical attributes). Peaches (Prunus persica) were purchased from a local store and cut into 8 lengthwise slices and dipped in 2% of ascorbic acid for 2 minutes. The slices were then drained and packaged using Whirl Pak (Nasco). The bags were closed, and tab were folded over three times. Fresh and pre-frozen peaches treatments were placed randomly into freezers at different freezing temperatures (-7°C), (-12°C), (-18°C), (-29°C) and (-77°C) for 360 days. Quality measurements included freeze, thaw and weight loss, lightness, firmness, moisture content, pH, ascorbic acid equivalent antioxidant capacity (AAEAC), hexanal detection using gas chromatography (GC), scanning electron microscopy (SEM) and sensory evaluation. The results showed that -77°C and -29°C kept the quality of peaches samples after freezing. However, all samples after thawing turned to brown color because of the enzyme activity. Therefore, it is better to use the peaches after freezing. Freezer of -7°C had a negative impact on peaches quality through times. Fresh and pre-frozen peaches were disliked by the sensory panelist’s members in day 270 and 360

Downgrading Financial Service Delivery and Institutional Sustainability: A Case Study of Akwapim Rural Bank, Ghana

Rural financial markets in the developing world are faced with the problem of information asymmetry and are monopolistically competitive. Based on this, one policy option to enhance rural clients’ access is for formal financial institutions to mimic products and services of informal intermediaries. Empirical evidence on impact of mimicry on institutional sustainability can help improve policy choices, yet there is a dearth of studies on this. Using time series data to analyse trends in selected financial ratios and means this study examines the impact that the mimicking of an informal financial product by a formal financial institution (Rural Bank) has on the outreach and sustainability. The time series data was collected from the bank’s financial statements and returns to the central bank between 1996 and 2005. It was found that adoption of informal financial product enhanced outreach and sustainability of the bank. This study, demonstrates that the mimicry policy option if adopted by formal financial institutions can enhance availability of financial services to the productive poor and also lead to long-term sustainability of financial institutions.Key Words: Downgrading, Rural Finance, Informal Financial Products, Institutional Sustainability, Financial Products and Service

Investing in late-life Brain Capital

Within many societies and cultures around the world, older adults are too often undervalued and underappreciated. This exacerbates many key challenges that older adults may face. It also undermines the many positive aspects of late life that are of tremendous value at both an individual and societal level. We propose a new approach to elevate health and well-being in late life by optimizing late-life Brain Capital. This form of capital prioritizes brain skills and brain health in a brain economy, which the challenges and opportunities of the 21st-century demands. This approach incorporates investing in late-life Brain Capital, developing initiatives focused on building late-life Brain Capital

Predicting the likelihood of heart failure with a multi level risk assessment using decision tree

Heart failure comes in the top causes of death worldwide. The number of deaths from heart failure exceeds the number of deaths resulting from any other causes. Recent studies have focused on the use of machine learning techniques to develop predictive models that are able to predict the incidence of heart failure. The majority of these studies have used a binary output class, in which the prediction would be either the presence or absence of heart failure. In this study, a multi-level risk assessment of developing heart failure has been proposed, in which a five risk levels of heart failure can be predicted using C4.5 decision tree classifier. On the other hand, we are boosting the early prediction of heart failure through involving three main risk factors with the heart failure data set. Our predictive model shows an improvement on existing studies with 86.5% sensitivity, 95.5% specificity, and 86.53% accuracy

Women’s Utilisation, Experiences and Satisfaction with Postnatal Follow-up Care: Systematic literature review

Postnatal follow-up care is reported to be the ‘underutilised’ aspect of the maternity care continuum. This review explores women’s utilisation of early and late postnatal follow-up and their experiences and satisfaction with it. Five online databases were searched for English or Arabic articles published between 2011 and 2021. Methodological quality of included studies was assessed using the Mixed Methods Appraisal Tool; the Andersen healthcare utilisation model was the framework for data analysis. A total of 19 articles met all inclusion criteria. Utilisation facilitators included complications, travel distance, knowledge of the importance for attending and being offered a telephonecall and home visit or clinic visit as options for follow-up. Impediments included lack of perceived need and notbeing provided with information about postnatal care. Comprehensive discussions with and examination by health providers were reported as positive experiences and influenced repeat utilisation. Dissatisfaction was associated with inconsistent information provided by health providers.Keywords: Postpartum Period; Postnatal Care; Women; Literature Review