The clinical and anthropometric profile of undernourished children aged under 5 admitted to Nyangabgwe Referral Hospital in Botswana

BACKGROUND. Although Botswana is a middle-income country, undernutrition among children younger than 5 years of age is still seen in various parts of the country. There is little information on the clinical and anthropometric profile of undernourished children in this age group admitted to hospitals in Francistown, Botswana. PURPOSE. To determine the clinical profile and the severity of anthropometric failure of undernourished children aged under 5 admitted to Nyangabgwe Referral Hospital in Francistown. METHOD. Data were collected from 113 caregiver-child pairs using a researcher-administered questionnaire targeting caregivers together with the children’s hospital records. The children’s anthropometric measurements were taken. Data were analysed using the WHO Anthro 2006 software and Stata 10. Proportions were then calculated. RESULTS. The median age of the children was 14 months and 55% were boys. The majority of the caregivers were single, younger than 30 years and lived in rural villages. The most common symptoms on admission were oedema (50%) and coughing (35%). Ten per cent of the children were HIV-infected and the HIV status of half the children was unknown. The majority (87%) did not present with secondary diagnoses. Severe wasting (<-3 standard deviations (SD)) (73%) was found in all age groups. Stunting (<-2 SD) was prevalent in 68% of the boys, and 95% of the children were severely underweight (<-3 SD). CONCLUSION. Oedematous undernutrition was common and 73% of the children presented with severe wasting (<-3 SD). In order to prevent severe forms of undernutrition, avoid the necessity for complicated care and improve the chances of survival, health education to caregivers on various forms of undernutrition is crucial.The Directorate General for Development Cooperation (DGDC) through the Flemish Interuniversity Council (VLIR-OUS).http://www.sajch.org.za/index.php/SAJCHam201

Challenging perspectives on the cellular origins of lymphoma.

Both B and T lymphocytes have signature traits that set them apart from other cell types. They actively and repeatedly rearrange their DNA in order to produce a unique and functional antigen receptor, they have potential for massive clonal expansion upon encountering antigen via this receptor or its precursor, and they have the capacity to be extremely long lived as 'memory' cells. All three of these traits are fundamental to their ability to function as the adaptive immune response to infectious agents, but concurrently render these cells vulnerable to transformation. Thus, it is classically considered that lymphomas arise at a relatively late stage in a lymphocyte's development during the process of modifying diversity within antigen receptors, and when the cell is capable of responding to stimulus via its receptor. Attempts to understand the aetiology of lymphoma have reinforced this notion, as the most notable advances to date have shown chronic stimulation of the antigen receptor by infectious agents or self-antigens to be key drivers of these diseases. Despite this, there is still uncertainty about the cell of origin in some lymphomas, and increasing evidence that a subset arises in a more immature cell. Specifically, a recent study indicates that T-cell lymphoma, in particular nucleophosmin-anaplastic lymphoma kinase-driven anaplastic large cell lymphoma, may originate in T-cell progenitors in the thymus.T.I.M.M. was supported by a Bloodwise Gordon Piller Studentship.This is the final version of the article. It first appeared from The Royal Society via https://doi.org/10.1098/rsob.16023

The clinical and anthropometric profile of undernourished children aged under 5 admitted to Nyangabgwe Referral Hospital in Botswana

BACKGROUND. Although Botswana is a middle-income country, undernutrition among children younger than 5 years of age is still seen in various parts of the country. There is little information on the clinical and anthropometric profile of undernourished children in this age group admitted to hospitals in Francistown, Botswana. PURPOSE. To determine the clinical profile and the severity of anthropometric failure of undernourished children aged under 5 admitted to Nyangabgwe Referral Hospital in Francistown. METHOD. Data were collected from 113 caregiver-child pairs using a researcher-administered questionnaire targeting caregivers together with the children’s hospital records. The children’s anthropometric measurements were taken. Data were analysed using the WHO Anthro 2006 software and Stata 10. Proportions were then calculated. RESULTS. The median age of the children was 14 months and 55% were boys. The majority of the caregivers were single, younger than 30 years and lived in rural villages. The most common symptoms on admission were oedema (50%) and coughing (35%). Ten per cent of the children were HIV-infected and the HIV status of half the children was unknown. The majority (87%) did not present with secondary diagnoses. Severe wasting (<-3 standard deviations (SD)) (73%) was found in all age groups. Stunting (<-2 SD) was prevalent in 68% of the boys, and 95% of the children were severely underweight (<-3 SD). CONCLUSION. Oedematous undernutrition was common and 73% of the children presented with severe wasting (<-3 SD). In order to prevent severe forms of undernutrition, avoid the necessity for complicated care and improve the chances of survival, health education to caregivers on various forms of undernutrition is crucial.The Directorate General for Development Cooperation (DGDC) through the Flemish Interuniversity Council (VLIR-OUS).http://www.sajch.org.za/index.php/SAJCHam201

Data Quality and Study Compliance Among College Students Across 2 Recruitment Sources: Two Study Investigation

Background: Models of satisficing suggest that study participants may not fully process survey items and provide accurate responses when survey burden is higher and when participant motivation is lower. Participants who do not fully process survey instructions can reduce a study’s power and hinder generalizability. Common concerns among researchers using self-report measures are data quality and participant compliance. Similarly, attrition can hurt the power and generalizability of a study. Objective: Given that college students comprise most samples in psychological studies, especially examinations of student issues and psychological health, it is critical to understand how college student recruitment sources impact data quality (operationalized as attention check items with directive instructions and correct answers) and retention (operationalized as the completion of follow-up surveys over time). This examination aimed to examine the following: whether data quality varies across recruitment sources, whether study retention varies across recruitment sources, the impact of data quality on study variable associations, the impact of data quality on measures of internal consistency, and whether the demographic qualities of participants significantly vary across those who failed attention checks versus those who did not. Methods: This examination was a follow-up analysis of 2 previously published studies to explore data quality and study compliance. Study 1 was a cross-sectional, web-based survey examining college stressors and psychological health (282/407, 69.3% female; 230/407, 56.5% White, 113/407, 27.8% Black; mean age 22.65, SD 6.73 years). Study 2 was a longitudinal college drinking intervention trial with an in-person baseline session and 2 web-based follow-up surveys (378/528, 71.6% female; 213/528, 40.3% White, 277/528, 52.5% Black; mean age 19.85, SD 1.65 years). Attention checks were included in both studies to assess data quality. Participants for both studies were recruited from a psychology participation pool (a pull-in method; for course credit) and the general student body (a push-out method; for monetary payment or raffle entry). Results: A greater proportion of participants recruited through the psychology pool failed attention checks in both studies, suggesting poorer data quality. The psychology pool was also associated with lower retention rates over time. After screening out those who failed attention checks, some correlations among the study variables were stronger, some were weaker, and some were fairly similar, potentially suggesting bias introduced by including these participants. Differences among the indicators of internal consistency for the study measures were negligible. Finally, attention check failure was not significantly associated with most demographic characteristics but varied across some racial identities. This suggests that filtering out data from participants who failed attention checks may not limit sample diversity. Conclusions: Investigators conducting college student research should carefully consider recruitment and include attention checks or other means of detecting poor quality data. Recommendations for researchers are discussed. JMIR Form Res 2022;6(12):e3948

Dietary quality and patterns and non-communicable disease risk of an Indian community in KwaZulu-Natal, South Africa

BACKGROUND : Limited data exist on the South African Indian diet despite their high prevalence of non-communicable diseases. This study attempted to determine the dietary quality and patterns of an Indian population in KwaZulu-Natal with reference to the high prevalence of non-communicable disease METHODS : Two-hundred-and-fifty apparently healthy Indians, aged 35–55 years participated in a cross-sectional study where diet was assessed using a validated quantitative food frequency questionnaire. Mean intakes were compared to the World Health Organization goals. Dietary quality was determined by index construction and dietary patterns by factor analysis. RESULTS : The mean daily percentage of energy (%E) from n-3 fatty acids (0.24 %E), dietary fibre (18.4 g/day) and fruit and vegetable intakes (229.4 g/day) were below the World Health Organization goals. Total fat (36.1 %E), polyunsaturated fatty acids (11.8 %E), n-6 fatty acids (11 %E) and free sugars (12.5 %E) exceeded the goals. The means for the deficient index reflected a moderate diet quality whereas, the excess index reflected good diet quality. The Pearson partial correlation coefficients between the deficient index and risk markers were weak whilst, the excess index was inversely correlated with waist circumference for the whole sample. Two factors were identified, based on the percentage of fat that contributed to each food group: factor 1 (meat and fish versus legume and cereal pattern), which accounted for added fat through food preparation; and Factor 2 (nuts and seeds versus sugars and visible fat pattern), which accounted for obvious fat. The medians for waist circumference, blood glucose, cholesterol and triglyceride levels showed significant decreasing trends for factor 1 (p < 0.05). The medians for blood glucose and cholesterol showed significant decreasing trends for factor 2 (p < 0.01). CONCLUSION : A shortfall of fruit and vegetable, fibre and n-3 fatty acid intake in the diet is highlighted. When assessing the diet quality and patterns, guidance on the prudent use of added fats may lead to a healthier lifestyle reducing the prevalence of non-communicable diseases.Grants from the South African Medical Research Council, National Research Foundation; Thuthuka and North-West University.am201

Measuring micronutrient intakes at different levels of sugar consumption in a population in transition : the Transition and Health during Urbanisation in South Africa (THUSA) study

OBJECTIVE: The objective was to investigate the absolute micronutrient intake and the possibility of micronutrient dilution of added sugar in the diets of an African population in nutritional transition. DESIGN: A cross-sectional, comparative, population-based design was used. Respondents who consumed sugar were divided into four quartiles of percentage of added sugar intake. SETTING: The setting was 37 randomly selected rural and urban areas of the North West province. SUBJECTS: The subjects were 1 742 adult volunteers (739 men and 1 003 women), aged between 15-65 years. After exclusion of low-energy reporters, the sample comprised 1 045 subjects (472 men and 573 women). OUTCOME MEASURES: The outcomes measures were the macronutrient and micronutrient intakes of subjects in different quartiles of added sugar intake and body mass index (BMI). RESULTS: The average intake of added sugar was 10.01% of total energy (67.12 g) in men and 11.2% total energy (67.10 g) in women. Respondents who consumed the most added sugar had significantly lower mean intakes of alcohol, but higher intakes of energy, macronutrients and most micronutrients. The diets of those in the highest sugar intake group contained significantly less thiamine, riboflavin, niacin, vitamin B12, pantothenic acid, biotin, magnesium, phosphorus and zinc per 4.18 MJ. At every level of added sugar consumption, the mean intakes of fibre (men only), folate, ascorbic acid and calcium (men and women) did not meet the dietary reference intakes [estimated average requirements (EAR)] and pantothenic acid and biotin (women only) did not meet the adequate intake. There were no significant differences in mean BMI across the quartiles of added sugar intakes in men, but the mean BMI of women who consumed the most added sugar was significantly higher than that of those who consumed less sugar. Respondents who consumed the most added sugar had significantly higher intakes of fruit (men only), bread and soft drinks, and lower intakes of maize meal and alcohol (men and women). CONCLUSION: Absolute intakes of most micronutrients were significantly higher in consumers with a high sugar intake [Quartile (Q) 4] compared with the lowest consumers of sugar (Q1). The lowest percentages of participants whose micronutrient intakes fell below the EAR were in Q4 and Q3. However, expression of micronutrient intake per 4.18 kJ (micronutrient dilution) revealed significantly less of most micronutrients per 4.18 MJ for men and women who consumed the most added sugar, compared with those who consumed the least.http://www.sajcn.co.za/index.php/SAJC

Critical implications of IVDR for innovation in diagnostics: input from the BioMed alliance diagnostics task force

With the implementation of Regulation (European Union [EU]) 2017/746 on in vitro diagnostic medical devices (IVDR), from May 26, 2022, onwards, the development and use of diagnostic tests will be governed by a vastly expanded and upgraded EU regulatory framework. We provide here an overview of the amended transition timelines, the role of notified bodies, EU reference laboratories, expert panels, and the Medical Device Coordination Group (MDCG). We also describe the implications of the IVDR for innovative laboratory medicine by explaining the exemption for in-house devices (IH-IVDs). Two key challenges faced by the academic diagnostic sector are: (1) the stipulation on equivalence of tests (article 5.5d), which poses a new condition for the use of IH-IVDs and (2) the gray area between CE marked in vitro diagnostics (CE-IVDs), modified CE-IVDs, Research Use Only (RUO) tests, and IH-IVDs. Furthermore, the results of a questionnaire on current diagnostic practice conducted by European medical societies collaborating in the BioMed Alliance indicate widespread use of IH-IVDs in diagnostic laboratories across Europe and emphasize the need for support and guidance to comply with the IVDR. Diagnostic equivalents of the European Reference Networks (ERNs) for rare diseases could help ensure affordable and equal access to specialized diagnostics across the EU. Concerted action by clinical and laboratory disciplines, regulators, industry, and patient organizations is needed to support the efficient and effective implementation of the IVDR in a way that preserves innovation and safeguards the quality, safety, and accessibility of innovative diagnostics.Peer reviewe

Non-Hodgkin Lymphoma in Children and Adolescents: Progress Through Effective Collaboration, Current Knowledge, and Challenges Ahead

Non-Hodgkin lymphoma is the fourth most common malignancy in children, has an even higher incidence in adolescents, and is primarily represented by only a few histologic subtypes. Dramatic progress has been achieved, with survival rates exceeding 80%, in large part because of a better understanding of the biology of the different subtypes and national and international collaborations. Most patients with Burkitt lymphoma and diffuse large B-cell lymphoma are cured with short intensive pulse chemotherapy containing cyclophosphamide, cytarabine, and high-dose methotrexate. The benefit of the addition of rituximab has not been established except in the case of primary mediastinal B-cell lymphoma. Lymphoblastic lymphoma is treated with intensive, semi-continuous, longer leukemia-derived protocols. Relapses in B-cell and lymphoblastic lymphomas are rare and infrequently curable, even with intensive approaches. Event-free survival rates of approximately 75% have been achieved in anaplastic large-cell lymphomas with various regimens that generally include a short intensive B-like regimen. Immunity seems to play an important role in prognosis and needs further exploration to determine its therapeutic application. ALK inhibitor therapeutic approaches are currently under investigation. For all pediatric lymphomas, the intensity of induction/consolidation therapy correlates with acute toxicities, but because of low cumulative doses of anthracyclines and alkylating agents, minimal or no long-term toxicity is expected. Challenges that remain include defining the value of prognostic factors, such as early response on positron emission tomography/computed tomography and minimal disseminated and residual disease, using new biologic technologies to improve risk stratification, and developing innovative therapies, both in the first-line setting and for relapse

An exploratory cluster randomised controlled trial of knowledge translation strategies to support evidence-informed decision-making in local governments (The KT4LG study)

Background: Childhood overweight and obesity is the most prevalent and, arguably, politically complex child health problem internationally. Governments, communities and industry have important roles to play, and are increasingly expected to deliver an evidence-informed system-wide prevention program. However, efforts are impeded by a lack of organisational access to and use of research evidence. This study aims to identify feasible, acceptable and ideally, effective knowledge translation (KT) strategies to increase evidence-informed decision making in local governments, within the context of childhood obesity prevention as a national policy priority.Methods/Design: This paper describes the methods for KT4LG, a cluster randomised controlled trial which is exploratory in nature, given the limited evidence base and methodological advances. KT4LG aims to examine a program of KT strategies to increase the use of research evidence in informing public health decisions in local governments. KT4LG will also assess the feasibility and acceptability of the intervention. The intervention program comprises a facilitated program of evidence awareness, access to tailored research evidence, critical appraisal skills development, networking and evidence summaries and will be compared to provision of evidence summaries alone in the control program. 28 local governments were randomised to intervention or control, using computer generated numbers, stratified by budget tertile (high, medium or low). Questionnaires will be used to measure impact, costs, and outcomes, and key informant interviews will be used to examine processes, feasibility, and experiences. Policy tracer studies will be included to examine impact of intervention on policies within relevant government policy documents.Discussion: Knowledge translation intervention studies with a focus on public health and prevention are very few in number. Thus, this study will provide essential data on the experience of program implementation and evaluation of a system-integrated intervention program employed within the local government public health context. Standardised programs of system, organisational and individual KT strategies have not been described or rigorously evaluated. As such, the findings will make a significant contribution to understanding whether a facilitated program of KT strategies hold promise for facilitating evidence-informed public health decision making within complex multisectoral government organisations.<br /