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Kusinski LC, Tobolska P, Jones DL, Atta N, Turner EH, Lewis HB, Oude Griep LM, Gribble FM, Meek CL. Towards Novel Nutritional Strategies in Gestational Diabetes: Eating Behaviour and Obesity in Women with Gestational Diabetes Compared with Non-Pregnant Adults. Nutrients 2023; 15:4141. [PMID: 37836424 PMCID: PMC10574012 DOI: 10.3390/nu15194141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 09/20/2023] [Accepted: 09/24/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Gestational diabetes is associated with increased risk of obesity, type 2 diabetes and cardiovascular disease. Effective nutritional strategies are needed to reduce BMI and improve long-term maternal cardiometabolic health, but the relative contribution of maternal eating behaviour, a potential barrier to dietary change, has not been explored. We compared eating behaviour in women with gestational diabetes with that of men and non-pregnant women with comparable risk factors, and tested associations between eating behaviour traits and BMI in women with gestational diabetes. We hypothesized that eating behaviour would be unfavourable in gestational diabetes and would be associated with BMI. METHODS Participants (n = 417) including 53 men, 164 non-pregnant women and 200 women with gestational diabetes (singleton pregnancy; 29 weeks' gestation) were recruited into three prospective studies assessing weight loss interventions, with similar entry criteria. The three-factor eating questionnaire (TFEQ-R18) assessed uncontrolled eating, emotional eating and cognitive restraint at study enrolment. Associations between BMI at study enrolment and TFEQ-R18 (% maximum score) were assessed using linear regression. RESULTS Women with gestational diabetes had significantly lower uncontrolled eating scores vs. men (53% vs. 65%; p < 0.001) and non-pregnant women (53% vs. 66%; p < 0.001), lower emotional eating scores vs. non-pregnant women (60% vs. 71%; p < 0.001) and higher cognitive restraint (p < 0.001 vs. men and non-pregnant women). In women with gestational diabetes, emotional eating scores were positively associated with BMI at study enrolment (beta coefficient 7.8 (95% CI 3.9 to 11.7), p < 0.001). CONCLUSIONS Women with gestational diabetes have favourable eating behaviour compared with other population groups. Because BMI at study enrolment was associated with emotional eating, nutritional strategies which reduce emotional eating may provide new opportunities to improve long-term maternal health after gestational diabetes.
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Affiliation(s)
- Laura C. Kusinski
- Wellcome-Trust MRC Institute of Metabolic Science, University of Cambridge, Cambridge CB2 0QQ, UK; (L.C.K.); (P.T.); (D.L.J.); (N.A.); (E.H.T.)
| | - Patrycja Tobolska
- Wellcome-Trust MRC Institute of Metabolic Science, University of Cambridge, Cambridge CB2 0QQ, UK; (L.C.K.); (P.T.); (D.L.J.); (N.A.); (E.H.T.)
| | - Danielle L. Jones
- Wellcome-Trust MRC Institute of Metabolic Science, University of Cambridge, Cambridge CB2 0QQ, UK; (L.C.K.); (P.T.); (D.L.J.); (N.A.); (E.H.T.)
| | - Nooria Atta
- Wellcome-Trust MRC Institute of Metabolic Science, University of Cambridge, Cambridge CB2 0QQ, UK; (L.C.K.); (P.T.); (D.L.J.); (N.A.); (E.H.T.)
| | - Elizabeth H. Turner
- Wellcome-Trust MRC Institute of Metabolic Science, University of Cambridge, Cambridge CB2 0QQ, UK; (L.C.K.); (P.T.); (D.L.J.); (N.A.); (E.H.T.)
| | - Hannah B. Lewis
- Wellcome-Trust MRC Institute of Metabolic Science, University of Cambridge, Cambridge CB2 0QQ, UK; (L.C.K.); (P.T.); (D.L.J.); (N.A.); (E.H.T.)
| | | | - Fiona M. Gribble
- Wellcome-Trust MRC Institute of Metabolic Science, University of Cambridge, Cambridge CB2 0QQ, UK; (L.C.K.); (P.T.); (D.L.J.); (N.A.); (E.H.T.)
| | - Claire L. Meek
- Wellcome-Trust MRC Institute of Metabolic Science, University of Cambridge, Cambridge CB2 0QQ, UK; (L.C.K.); (P.T.); (D.L.J.); (N.A.); (E.H.T.)
- Cambridge Universities NHS Foundation Trust, Cambridge CB2 0QQ, UK
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Saadaat R, Abdul-Ghafar J, Haidary AM, Atta N, Ali TS. Esophageal Carcinoma and Associated Risk Factors: A Case-control Study in Two Tertiary Care Hospitals of Kabul, Afghanistan. Cancer Manag Res 2022; 14:2445-2456. [PMID: 35975105 PMCID: PMC9375978 DOI: 10.2147/cmar.s372883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 08/03/2022] [Indexed: 12/24/2022] Open
Abstract
Purpose Esophageal cancer (EC) is the most common cancer among males in Afghanistan, thus we aimed to conduct a case-control study to determine the associated risk factors with EC in two tertiary care hospitals of Kabul, Afghanistan. Patients and Methods We enrolled 132 EC cases and 132 controls and used conditional logistic regression to estimate the odds ratio (OR) with consideration of 95% confidence interval (CI). Results The results of our study revealed that esophageal squamous cell carcinoma (ESCC) was the predominant type of EC constituting 75.8% of the cases. The results of the multivariate logistic analysis showed that males and older ages were at increased risk of developing EC (OR: 4.62, 95%CI, p-value=0.026) and (OR: 1.070, 95%CI, p-value <0.001), respectively. In addition, living in rural areas (OR: 46.64, 95%CI, p-value <0.001), being uneducated (OR: 13.94, 95%CI, p-value=0.042), using oral snuff (OR: 6.10, 95%CI, p-value=0.029), drinking hot tea (OR: 5.719, 95%CI, p-value=0.005), lack of physical exercise (OR: 32.548, 95%CI, p-value=0.001), less fresh fruit consumption (OR: 93.18, 95%CI, p-value<0.001) and family history of cancer (OR: 14.50, 95%CI, p-value=0.003) were significantly associated with the development of EC, while body mass index (BMI), smoking, alcohol drinking, consumption of spicy food and pickled vegetables did not have a significant association with EC. Moreover, the majority of the cases (83.3%) in our study were from to low-income families and the majority were unemployed (93.9%), of whom (50%) were farmers, who did not show statistically significant association. Conclusion Our study concluded that EC risk was higher in older ages, males, rural residents, uneducated people, oral-snuff users, hot tea drinkers, fewer fresh fruit consumers, lack of physical exercise, and family history of cancer. Further detailed studies and screening policies of the affected groups are suggested to further elaborate on the subject.
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Affiliation(s)
- Ramin Saadaat
- Department of Pathology and Clinical Laboratory, French Medical Institute for Mothers and Children (FMIC), Kabul, Afghanistan
| | - Jamshid Abdul-Ghafar
- Department of Pathology and Clinical Laboratory, French Medical Institute for Mothers and Children (FMIC), Kabul, Afghanistan
| | - Ahmed Maseh Haidary
- Department of Pathology and Clinical Laboratory, French Medical Institute for Mothers and Children (FMIC), Kabul, Afghanistan
| | - Nooria Atta
- Department of Gynecology and Obstetrics, Kabul University of Medical Science (KUMS), Kabul, Afghanistan
| | - Tazeen Saeed Ali
- School of Nursing and Midwifery and Department of Community Health Sciences, Aga Khan University (AKU), Karachi, Pakistan
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Saadaat R, Abdul-Ghafar J, Haidary AM, Rahmani S, Atta N. Age distribution and types of breast lesions among Afghan women diagnosed by fine needle aspiration cytology (FNAC) at a tertiary care centre in Afghanistan: a descriptive cross-sectional study. BMJ Open 2020; 10:e037513. [PMID: 32873674 PMCID: PMC7467514 DOI: 10.1136/bmjopen-2020-037513] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES In Afghanistan, breast diseases are a common reason for women to visit hospitals. This is the first study in Afghanistan aimed to describe the age distribution and types of breast diseases among patients diagnosed by fine needle aspiration cytology. DESIGN Descriptive cross-sectional study. SETTING French Medical Institute for Mothers and Children, Kabul, Afghanistan. PARTICIPANTS The study included 650 patients with breast lesions between 1 April 2015 and 1 April 2019. RESULTS The mean age of diagnosis was 35.38 (SD ±13.11) years, ranging from 15 to 75 years. The most common diagnosis was cancer (24% of all cases). The second most common diagnosed lesion was fibroadenoma, constituting 22.4%, and the third most common lesion was fibrocystic changes, with 15.4% of cases. Inflammatory conditions were diagnosed in 9.7% of cases, granulomatous inflammation in 9.1%, lesions only suspicious for malignancy in 5.5%, lipoma in 2.8% and miscellaneous benign lesions in 11.1%. Cancer was diagnosed at the youngest age of 20 years. Cancer was more common on the left side (62%), and only one case (0.9%) was bilateral. CONCLUSION Our study showed that cancer was the most commonly diagnosed lesion and was reported at younger ages too. This suggests that physicians should not ignore any breast lump in younger patients and that the possibility of cancer must be considered. Further country-wide studies are suggested to assess breast cancer and associated risk factors.
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Affiliation(s)
- Ramin Saadaat
- Department of Pathology and Clinical Laboratory, French Medical Institute for Mothers and Children (FMIC), Kabul, Afghanistan
| | - Jamshid Abdul-Ghafar
- Department of Pathology and Clinical Laboratory, French Medical Institute for Mothers and Children (FMIC), Kabul, Afghanistan
| | - Ahmed Maseh Haidary
- Department of Pathology and Clinical Laboratory, French Medical Institute for Mothers and Children (FMIC), Kabul, Afghanistan
| | - Soma Rahmani
- Department of Pathology and Clinical Laboratory, French Medical Institute for Mothers and Children (FMIC), Kabul, Afghanistan
| | - Nooria Atta
- Department of Gynecology and Obstetrics, Kabul University of Medical Sciences (KUMS), Kabul, Afghanistan
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Saeed KMI, Atta N, Nazri T. Investigation and control of measles outbreak in Puli-Khumri and Baghlan-Markazi Districts, Baghlan province, Afghanistan: a teaching case-study. Pan Afr Med J 2020. [DOI: 10.11604/pamj.supp.2020.36.1.24761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Atta N, Kilickap S, Yuce D, Hayran M. Reproductive cancer risk factors among relatives of cancer patients in a tertiary oncology center. BMC Cancer 2019; 19:154. [PMID: 30770749 PMCID: PMC6377741 DOI: 10.1186/s12885-019-5350-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 02/04/2019] [Indexed: 12/02/2022] Open
Abstract
Background The aim of this study was to evaluate the prevalence of some gynecological cancer risk factors in a population of female relatives of cancer patients in Hacettepe University Oncology Hospital. Additionally, what are the levels of the women’s awareness /behavior toward available screening tools? Methods An individual cancer risk assessment questionnaire has been developed in the Department of Preventive Oncology, which questions the medical history, health behaviors and cancer awareness, as well as their behavior toward available cancer screening tools. Results The mean age of the study population was 45.7 ± 12.2 years. Median age at menarche was 13 years (IQR, 12–14), 6.9% of the women reported their menarche was before age of 12. About 11.1% of the women had intercourse before age of 18. The median age at first delivery was 22 years. Median BMI was 24.9, with 18.3% of population having obesity. Of the women 65% were current/past smokers. Sixty-two percent of the women had never used condom. About 8% of the women were unaware about mammography and 17.7% about the Pap test. Conclusions This study has documented high tobacco use, low protective condom use and low rates of physical activity. Percentage of some risk factors like early menarche was lower than what was suggested for general Turkish population. Awareness and behavior of the women were better about mammography when compared to the Pap test. Considering our results, some measures should be put in place to increase people’s awareness, and to modify their behavior toward cancer prevention.
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Affiliation(s)
- Nooria Atta
- Department of Obstetrics and Gynecology, Kabul Medical University, Kabul, Afghanistan. .,Department of preventive Oncology, Hacettepe University Cancer Institute, Ankara, Turkey.
| | - Saadettin Kilickap
- Department of preventive Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Deniz Yuce
- Department of preventive Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Mutlu Hayran
- Department of preventive Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
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Speakman EM, Shafi A, Sondorp E, Atta N, Howard N. Development of the community midwifery education initiative and its influence on women's health and empowerment in Afghanistan: a case study. BMC Womens Health 2014; 14:111. [PMID: 25220577 PMCID: PMC4237830 DOI: 10.1186/1472-6874-14-111] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 08/29/2014] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Political transition in Afghanistan enabled reconstruction of the destroyed health system. Maternal health was prioritised due to political will and historically high mortality. However, severe shortages of skilled birth attendants--particularly in rural areas--hampered safe motherhood initiatives. The Community Midwifery Education (CME) programme began training rural midwives in 2002, scaling-up nationally in 2005. METHODS This case study analyses CME development and implementation to help determine successes and challenges. Data were collected through documentary review and key informant interviews. Content analysis was informed by Walt and Gilson's policy triangle framework. RESULTS The CME programme has contributed to consistently positive indicators, including up to a 1273/100,000 reduction in maternal mortality ratios, up to a 28% increase in skilled deliveries, and a six-fold increase in qualified midwives since 2002. Begun as a small pilot, CME has gained support of international donors, the Afghan government, and civil society. CONCLUSION CME is considered by stakeholders to be a positive model for promoting women's education, employment, and health. However, its future is threatened by insecurity, corruption, lack of regulation, and funding uncertainties. Strategic planning and resource mobilisation are required for it to achieve its potential of transforming maternal healthcare in Afghanistan.
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Affiliation(s)
- Elizabeth M Speakman
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine (LSHTM), Tavistock Place, London, UK
| | | | - Egbert Sondorp
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine (LSHTM), Tavistock Place, London, UK
- Royal Tropical Institute (KIT), Amsterdam, The Netherlands
| | - Nooria Atta
- Kabul Medical University, Kabul, Afghanistan
| | - Natasha Howard
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine (LSHTM), Tavistock Place, London, UK
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Howard N, Woodward A, Patel D, Shafi A, Oddy L, ter Veen A, Atta N, Sondorp E, Roberts B. Perspectives on reproductive healthcare delivered through a basic package of health services in Afghanistan: a qualitative study. BMC Health Serv Res 2014; 14:359. [PMID: 25167872 PMCID: PMC4169831 DOI: 10.1186/1472-6963-14-359] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 08/19/2014] [Indexed: 12/04/2022] Open
Abstract
Background Contracting-out non-state providers to deliver a minimum package of essential health services is an increasingly common health service delivery mechanism in conflict-affected settings, where government capacity and resources are particularly constrained. Afghanistan, the longest-running example of Basic Package of Health Services (BPHS) contracting in a conflict-affected setting, enables study of how implementation of a national intervention influences access to prioritised health services. This study explores stakeholder perspectives of sexual and reproductive health (SRH) services delivered through the BPHS in Afghanistan, using Bamyan Province as a case study. Methods Twenty-six in-depth interviews were conducted with health-system practitioners (e.g. policy/regulatory, middle management, frontline providers) and four focus groups with service-users. Inductive thematic coding used the WHO Health System Framework categories (i.e. service delivery, workforce, medicines, information, financing, stewardship), while allowing for emergent themes. Results Improvements were noted by respondents in all health-system components discussed, with significant improvements identified in service coverage and workforce, particularly improved gender balance, numbers, training, and standardisation. Despite improvements, remaining weaknesses included service access and usage - especially in remote areas, staff retention, workload, and community accountability. Conclusions By including perspectives on SRH service provision and BPHS contracting across health-system components and levels, this study contributes to broader debates on the effects of contracting on perceptions and experiences among practitioners and service-users in conflict-affected countries.
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Affiliation(s)
- Natasha Howard
- London School of Hygiene and Tropical Medicine, London, UK.
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Mark HB, Atta N, Ma Y, Petticrew K, Zimmer H, Shi Y, Lunsford S, Rubinson J, Galal A. The electrochemistry of neurotransmitters at conducting organic polymer electrodes: electrocatalysis and analytical applications. ACTA ACUST UNITED AC 1995. [DOI: 10.1016/0302-4598(95)01846-7] [Citation(s) in RCA: 74] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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