Quality of stroke guidelines in low- and middle-income countries: a systematic review.

OBJECTIVE: To identify gaps in national stroke guidelines that could be bridged to enhance the quality of stroke care services in low- and middle-income countries. METHODS: We systematically searched medical databases and websites of medical societies and contacted international organizations. Country-specific guidelines on care and control of stroke in any language published from 2010 to 2020 were eligible for inclusion. We reviewed each included guideline for coverage of four key components of stroke services (surveillance, prevention, acute care and rehabilitation). We also assessed compliance with the eight Institute of Medicine standards for clinical practice guidelines, the ease of implementation of guidelines and plans for dissemination to target audiences. FINDINGS: We reviewed 108 eligible guidelines from 47 countries, including four low-income, 24 middle-income and 19 high-income countries. Globally, fewer of the guidelines covered primary stroke prevention compared with other components of care, with none recommending surveillance. Guidelines on stroke in low- and middle-income countries fell short of the required standards for guideline development; breadth of target audience; coverage of the four components of stroke services; and adaptation to socioeconomic context. Fewer low- and middle-income country guidelines demonstrated transparency than those from high-income countries. Less than a quarter of guidelines encompassed detailed implementation plans and socioeconomic considerations. CONCLUSION: Guidelines on stroke in low- and middle-income countries need to be developed in conjunction with a wider category of health-care providers and stakeholders, with a full spectrum of translatable, context-appropriate interventions

Meta-Analysis of Rumen-Protected Methionine in Milk Production and Composition of Dairy Cows

This study aims to evaluate the influence of rumen-protected methionine (RPM) on the milk yield and milk compositions of dairy cows by employing a meta-analysis method. The articles in the publication databases between January 2010 and January 2022 which reported on various concentrations of RPM supplements in dairy cow diets and then monitored the milk yield and milk compositions were searched. A total of 14 studies were included, covering 27 treatments with a total of 623 dairy cows. Comprehensive Meta-Analysis V3 was used for statistical analysis, the forest map was drawn by the standard mean difference (SMD) with a 95% confidence interval (95% CI), and the SMD was calculated by a random effect model. The dose effect curve was drawn by fitting the SMD and RPM dose of each study to explore the optimal dosage of RPM. Compared with the basal diet, the RPM supplement significantly increased the percentages of milk fat (SMD (95% CI): 1.017% [0.388, 1.646]) and milk protein (SMD (95% CI): 0.884 [0.392, 1.377]). However, the milk yield (SMD (95% CI): 0.227 kg/d [−0.193, 0.647]) and lactose concentration (SMD (95% CI): 0.240% [−0.540, 1.020]) were not affected. The subgroup analysis found that the effect of the RPM supplement on the milk fat and milk protein was greater in the high-protein feed than in the low-protein feed. Multiple regression analysis showed that feeding RPM significantly improved the milk yield and milk protein percentage of dairy cows. The results of the dose–effect analysis show that the optimal range for the RPM was 7.5–12.5 g/d. RPM supplements in a dairy diet can improve the milk protein percentages and milk fat percentages of dairy cows

A cross-sectional study of the epidemic situation on COVID-19 in Gansu Province, China - a big data analysis of the national health information platform

Background: In December 2019, a pneumonia caused by SARS-CoV-2 emerged in Wuhan, China and has rapidly spread around the world since then. This study is to explore the patient characteristics and transmission chains of COVID-19 in the population of Gansu province, and support decision-making. Methods: We collected data from Gansu Province National Health Information Platform. A cross-sectional study was conducted, including patients with COVID-19 confirmed between January 23 and February 6, 2020, and analyzed the gender and age of the patients. We also described the incubation period, consultation time and sources of infection in the cases, and calculated the secondary cases that occurred within Gansu for each imported case. Results: We found thirty-six (53.7%) of the patients were women and thirty-one (46.3%) men, and the median ages were 40 (IQR 31-53) years. Twenty-eight (41.8%) of the 67 cases had a history of direct exposure in Wuhan. Twenty-five (52.2%) cases came from ten families, and we found no clear reports of modes of transmission other than family clusters. The largest number of secondary cases linked to a single source was nine. Conclusion: More women than men were diagnosed with COVID-19 in Gansu Province. Although the age range of confirmed cases of COVID-19 in Gansu Province covered almost all age groups, most patients with confirmed COVID-19 tend to be middle aged persons. The most common suspected mode of transmission was through family cluster. Gansu and other settings worldwide should continue to strengthen the utilization of big data in epidemic control

Primary stroke prevention worldwide: translating evidence into action

Stroke is the second leading cause of death and the third leading cause of disability worldwide and its burden is increasing rapidly in low-income and middle-income countries, many of which are unable to face the challenges it imposes. In this Health Policy paper on primary stroke prevention, we provide an overview of the current situation regarding primary prevention services, estimate the cost of stroke and stroke prevention, and identify deficiencies in existing guidelines and gaps in primary prevention. We also offer a set of pragmatic solutions for implementation of primary stroke prevention, with an emphasis on the role of governments and population-wide strategies, including task-shifting and sharing and health system re-engineering. Implementation of primary stroke prevention involves patients, health professionals, funders, policy makers, implementation partners, and the entire population along the life course