Length of the treatment and number of doses per day as major determinants of child adherence to acute treatment

Serologic, endoscopic and pathologic findings in pediatric celiac disease: A single center experience in a low/middle income country

BACKGROUND

Studies in Africa, Asia, and Latin America are needed to provide a comprehensive picture of the global incidence of celiac disease (CD).

AIM

To describe the serology, endoscopic and histological findings in typical and atypical presentations of pediatric CD at a tertiary referral hospital in an African low/middle income country (LMIC).

METHODS

This observational study was conducted on 199 patients with CD from 2010 to 2019. The patients were divided into typical and atypical groups according to the presenting symptoms including 120 and 79 patients respectively. Serology, upper gastrointestinal endoscopy with duodenal biopsy were performed for patients who had symptoms suggestive of CD. The severity of the intestinal damage was graded according to the histo-pathologic Marsh-Oberhuber classification.

RESULTS

Chronic diarrhea was the main intestinal presentation in the typical group. Anemia was the most common extraintestinal symptom in both the typical and atypical group. Marsh-Oberhuber type 3b and 3c was significantly higher in the seropositive patients with a P value of 0.007. A significant correlation was observed between the histological grade of the biopsied duodenal mucosa and the clinical presentation (P < 0.001). Age was significantly higher in the atypical group (P value < 0.001).

CONCLUSION

Although typical CD was observed in 120 patients in this study, the clinical variability of the condition was frequently observed. Age only was a significant predictor for the appearance of atypical CD. Therefore, CD presentations in LMIC are not different from industrialized countries.

Weaning age and post-weaning nursery feeding regime are important in improving the performance of lightweight pigs

The aim was to investigate the effect of weaning age, weaning weight, and nursery feeding regime on post-weaning performance. The focus was on pigs weaned light, as they may be better off when weaned at a later age and/or offered a specialist nursery feeding regime. Piglets (n = 1,448) from one farrowing batch of 110 sows that farrowed over 2 wk were individually weighed and their morphometric measurements were taken at birth. Pigs were weaned on the same day, but variation in birth date resulted in variable weaning ages (mean age day 34.1, SD = 2.5). The youngest 50% at weaning were classified Y and the oldest 50% as O; within an age class, the lightest 50% were classified L, the heaviest 50% as H, and housed accordingly. Pigs were individually weighed at weaning, 7 and 15 wk post-weaning. At weaning, Y were 6 d younger and 1.4 kg lighter than O pigs, whereas L were 3.2 kg lighter than H pigs. Pigs were randomly allocated to a 3-stage superior (SUP) or control (CON) nursery feeding regime, with SUP pigs having a 65% greater allowance (on a kg/pig basis) of the first and second stage feeds than the CON. Pigs weaned Y had a higher mortality rate from weaning to 7 wk post-weaning than pigs weaned O (9.14% vs. 4.98%; P = 0.046). As expected, age and weight significantly (P < 0.001) affected performance to both 7 and 15 wk post-weaning: at 15-wk pigs weaned Y were 5.5 kg lighter than pigs weaned O; pigs weaned L were 9.0 kg lighter than H pigs. It was estimated that pigs weaned YL needed ~4 d more (P = 0.018) to reach 60 kg BW than pigs weaned OL. Feed intake was not affected by feeding regime, age and weight, or their interactions. Performance was not affected by feeding regime (P > 0.05), but was affected by the weight × feeding regime interaction (P = 0.044) to 7 wk post-weaning: L pigs on SUP were 1.2 kg heavier than L pigs on the CON regime; this was not the case for the H pigs. Performance up to 7 wk post-weaning was positively associated with birth weight to cranial circumference ratio and weaning weight (P < 0.05) for both YL and OL pigs; for the latter, additional performance predictors were weaning age (P = 0.044) and feeding (P = 0.027). Improved growth for L pigs up to 7 wk post-weaning could be obtained by a greater allowance of the nursery diets. However, weaning at a later age benefitted the performance of L pigs to a common BW, suggesting that this might be a strategy with longer term benefits.

Interventions to improve treatment adherence among adolescents: A meta-analysis

AIM: To examine the overall effectiveness of interventions designed to improve medical treatment adherence among adolescent patients.

METHODS: PubMed and PsycINFO databases were searched to retrieve and analyze empirical journal articles (from 1948-2013). Only peer-reviewed, English language journals that defined a measure of adherence (or compliance), assessed an intervention aimed at improving adherence among adolescents, and provided information to calculate an r effect size were included. Studies were excluded if they lacked assessment of the effectiveness of interventions on improving adherence in adolescents as compared to no interventions or standard care. Case studies or journal articles that examined substance abuse or psychological disorders were also excluded. Analyses were conducted with fixed and random-effects methods, and moderators of intervention efficacy were also examined.

RESULTS: For each study that met the inclusion criteria (n = 45), an effect size r, reflecting the strength and direction of the interventions’ relationship to adherence was recorded; a positive r indicated that the intervention increased adolescent adherence, whereas a negative r indicated that the intervention decreased adolescent adherence. The overall effectiveness of adolescent adherence interventions was positive and significant (unweighted mean r = 0.27, 95%CI: 0.21-0.33, P = 0.001). Moderator analyses at the fixed effects level revealed that interventions were less effective when adolescents reported their adherence behaviors, when the type of adherence regimen was a medication regimen, and when the type of intervention was cognitive-modification based.

CONCLUSION: These findings contribute to understanding interventions for enhancing adolescent adherence. Future research should continue to examine the specific challenges faced by adolescents and create targeted interventions.