Feeding Practices and Growth of Children Under 20 Months of Age in Madrid.

The feeding habits of 344 children under 20 months of age were obtained from mothers using the dietary history method supplemented with questions on milk feeding and weaning. Infants were remarkably similarly fed. No relations were found between breast-feeding and socioeconomic group, age of the mother or sex of the baby. Neither did socioeconomic group, sex or birth weight of the baby influence the timing of complementary feeding; however, the latter was significantly correlated to both mother's age and feeding method at the age of three months. In addition, six anthropometric measurements of the children were taken. These anthropometric results showed that the children were, on average, taller and heavier, but leaner than those of relevant national and international growth references. Fifty one samples of home-prepared baby meals together with 46 food diaries of infants of seven and eight months were collected. The meals were analysed chemically and the diaries were calculated for daily intake of energy, macronutrients and six minerals. The meals had high protein but low fat content, with accordingly a low energy density. The children's mean daily nutrient intake showed also high protein and low fat levels due to the meals; nevertheless, intakes of energy and minerals were adequate. About 20% of the baby meals had a high sodium level. Children in this study were apparently well-fed and thriving. Compliance with present guidelines on infant nutrition is high, just minor changes are needed to improve actual practices: breast-feeding should last longer, complementary foods should be introduced later and salt and sugar should be avoided in baby meals. Mothers, particularly those in the low socioeconomic group, need better understanding of gluten and its introduction into the infant's diet

Foliicolous lichens from Suriname and Guyana: new records and three new species

Sampling of foliicolous lichens by the first author in Suriname in 2014 resulted in 103 records of lichenized and lichenicolous fungi for Suriname, including 89 first records for the country and one undescribed species. Fieldwork in Guyana by the second author in 1992 and 1997 brought 29 new records, including a new chemical strain for Loflammea epiphylla and two undescribed species. A full list for Suriname is presented (130 taxa), the additions for Guyana are listed, and the new species Calenia surinamensis, Enterographa paruimae and Strigula transversoundulata are described.

Societal burden and quality of life in patients with Lisfranc Injuries

Background: The incidence of Lisfranc fractures is rising, along with the incidence of foot fractures in general. These injuries can lead to long-term healthcare use and societal costs. Current economic evaluation studies are scarce in Lisfranc fracture research, and only investigate the healthcare costs. The aim of the present study was to accurately measure the monetary societal burden of disease and quality of life in the first 6 months after the injury in patients with Lisfranc fractures in the Netherlands. Materials and methods: This study used a prevalence-based, bottom-up approach. Patients were included through thirteen medical centres in the Netherlands. Both stable and unstable injuries were included. The societal perspective was used. The costs were measured at baseline, 12 weeks and 6 months using the iMTA MCQ and PCQ questionnaires. Reference prices were used for valuation. Quality-of-life was measured using the EQ-5D-5 L and VAS scores. Results: 214 patients were included. The mean age was 45.9 years, and 24.3% of patients had comorbidities. The baseline questionnaires yielded approximately €2023 as the total societal costs in the 3 months prior to injury. The follow-up questionnaires and surgery costs assessment yielded approximately €17,083 as the total costs in the first 6 months after injury. Of these costs, approximately two thirds could be attributed to productivity losses. The EQ-5D-5 L found a mean index value of 0.449 at baseline and an index value of 0.737 at the 6-month follow-up. Conclusion: The total monetary societal costs in the first 6 months after injury are approximately €17,083. Approximately two thirds of these costs can be attributed to productivity losses. These costs appear to be somewhat higher than those found in other studies. However, these studies only included the healthcare costs. Furthermore, the baseline costs indicate relatively low healthcare usage before the injury compared to the average Dutch patient. The mean QoL index was 0.462 at baseline and 0.737 at 6 months, indicating a rise in QoL after treatment as well as a long-lasting impact on QoL. To our knowledge, this is only the first study investigating the societal costs of Lisfranc injuries, so more research is needed.</p

Intrahepatic cholangiocarcinoma in a non-cirrhotic liver in a patient with homozygous ZZ alpha-1 antitrypsin deficiency

Alpha-1 antitrypsin (AAT) deficiency, which is an under-recognised metabolic genetic disorder, is known to cause severe lung disease and liver cirrhosis in about 10%-15% of cases. Patients with AAT deficiency are at a higher risk for developing hepatocellular carcinoma, both in cirrhotic and in non-cirrhotic livers. In this case report, a 48-year-old woman with homozygous ZZ AAT deficiency presented with abdominal pain, and by imaging, an abnormal area in the liver was found. The initial differential diagnosis consisted of benign abnormalities but a malignancy could not be ruled out. Finally, this abnormality turned out to be an intrahepatic cholangiocarcinoma (iCCA) in a non-cirrhotic liver. Since this type of tumour has been very infrequently described to be associated with AAT deficiency, the question remains whether alpha-1 trypsin accumulation in the hepatocytes was responsible for the development of iCCA. However, other associated factors for developing an iCCA were ruled out

Bayesian clustering of multiple zero-inflated outcomes

Several applications involving counts present a large proportion of zeros (excess-of-zeros data). A popular model for such data is the hurdle model, which explicitly models the probability of a zero count, while assuming a sampling distribution on the positive integers. We consider data from multiple count processes. In this context, it is of interest to study the patterns of counts and cluster the subjects accordingly. We introduce a novel Bayesian approach to cluster multiple, possibly related, zero-inflated processes. We propose a joint model for zero-inflated counts, specifying a hurdle model for each process with a shifted Negative Binomial sampling distribution. Conditionally on the model parameters, the different processes are assumed independent, leading to a substantial reduction in the number of parameters as compared with traditional multivariate approaches. The subject-specific probabilities of zero-inflation and the parameters of the sampling distribution are flexibly modelled via an enriched finite mixture with random number of components. This induces a two-level clustering of the subjects based on the zero/non-zero patterns (outer clustering) and on the sampling distribution (inner clustering). Posterior inference is performed through tailored Markov chain Monte Carlo schemes. We demonstrate the proposed approach on an application involving the use of the messaging service WhatsApp. This article is part of the theme issue 'Bayesian inference: challenges, perspectives, and prospects'

Lecania makarevicziae, a new lichen species from Iran

A new for science species Lecania makarevicziae differing from L. pallida in having knobby to squamulose, blastidiate thallus, in having larger apothecia, in having a dark violet-brown disc, in having a plane disc, in having (1–2–)3-septate ascospores with slightly distinct constrictions at the septum, as well as in the lack of dense bluish pruina on apothecium disc, from Iran and Turkmenistan, is described, compared with closely related taxa

Psychosocial support interventions to improve treatment outcomes for people living with tuberculosis: a mixed methods systematic review and meta-analysis

BACKGROUND: People with tuberculosis (TB) face multi-dimensional barriers when accessing and engaging with care. There is evidence that providing psychosocial support within people-centered models of care can improve TB outcomes, however, there is limited consensus on what works. It remains important for such interventions to be rigorously assessed, and mixed methods systematic reviews are one way of synthesising data for policy makers to be able to access such evidence. Mixed methods reviews take a complexity perspective, with qualitative data being used to contextualise the quantitative findings and giving an insight into how interventions are contingent on variations in design and context. METHODS: Five electronic databases were searched from January 1 2015 to 14 January 2023 for randomised controlled trials, quasi-experimental trials, cohort studies and qualitative studies of interventions providing psychosocial support (material and/or psychological-based support) to adults with any clinical form of active TB. Studies with inpatient treatment as the standard of care were excluded. Quantitative studies reporting pre-specified standard TB outcomes were eligible. In line with established mixed methods review methodology, a convergent parallel-results synthesis design was followed: quantitative and qualitative syntheses were distinct and carried out using appropriate methods. A convergent coding matrix was then used to integrate the results. The protocol was registered on PROSPERO (CRD42021235211). FINDINGS: Twenty-three studies of interventions were included (12 quantitative, 10 qualitative, and 1 mixed methods study). Most studies were conducted in low-and middle-income countries with a high-burden of TB. Three explanatory and contextual middle-range theories from the integration of qualitative and quantitative data were developed: effective interventions provide multi-dimensional support; psychological-based support is transformative but there is insufficient evidence that it improves treatment outcomes on its own; intervention delivery shapes a logic of care. INTERPRETATION: This review takes a complexity perspective to provide actionable and timely insight to inform the design and implementation of locally-appropriate and people-centered psychosocial support interventions within national TB programmes. FUNDING: There was no funding source for this study