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Rattanawong W, Rapoport A, Srikiatkhachorn A. Medication "underuse" headache. Cephalalgia 2024; 44:3331024241245658. [PMID: 38613233 DOI: 10.1177/03331024241245658] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
BACKGROUND Many risk factors have been associated with migraine progression, including insufficient and ineffective utilization of migraine medications; however, they have been inadequately explored. This has resulted in suboptimal usage of medications without effective altering of prescribing recommendations for patients, posing a risk for migraine chronification. METHODS Our aim is to conduct a comprehensive review of the available evidence regarding the underuse of migraine medications, both acute and preventive. The term "underuse" includes, but is not limited to: (1) ineffective use of appropriate and inappropriate medication; (2) underutilization; (3) inappropriate timing of usage; and (4) patient dissatisfaction with medication. RESULTS The underuse of both acute and preventive medications has been shown to contribute to the progression of migraine. In terms of acute medication, chronification occurs as a result of insufficient drug use, including failure of the prescriber to select the appropriate type based on pain intensity and disability, patients taking medication too late (more than 60 minutes after the onset or after central sensitization has occurred as evidenced by allodynia), and discontinuation because of lack of effect or intolerable side effects. The underlying cause of inadequate effectiveness of acute medication lies in its inability to halt the propagation of peripheral activation to central sensitization in a timely manner. For oral and injectable preventive migraine medications, insufficient efficacy and intolerable side effects have led to poor adherence and discontinuation with subsequent progression of migraine. The underlying pathophysiology here is rooted in the repetitive stimulation of afferent sensory pain fibers, followed by ascending brainstem pain pathways plus dysfunction of the endogenous descending brainstem pain inhibitory pathway. Although anti-calcitonin gene-related peptide (CGRP) medications partially address pain caused by the above factors, including decreased efficacy and tolerability from conventional therapy, some patients do not respond well to this treatment. Research suggests that initiating preventive anti-CGRP treatment at an early stage (during low frequency episodic migraine attacks) is more beneficial than commencing it during high frequency episodic attacks or when chronic migraine has begun. CONCLUSIONS The term "medication underuse" is underrecognized, but it holds significant importance. Optimal usage of acute care and preventive migraine medications could potentially prevent migraine chronification and improve the treatment of migraine attacks.
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Affiliation(s)
- Wanakorn Rattanawong
- Faculty of Medicine, King Mongkut's Institute of Technology Ladkrabang, Bangkok, Thailand
| | - Alan Rapoport
- Department of Neurology, The David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Anan Srikiatkhachorn
- Faculty of Medicine, King Mongkut's Institute of Technology Ladkrabang, Bangkok, Thailand
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Ojewola RW, Tijani KH, Hassan JO, Okeke CJ, Akinyemi OJ. Quality and appropriateness of uro-surgical referrals at a Nigerian teaching hospital. Niger Postgrad Med J 2023; 30:156-160. [PMID: 37148119 DOI: 10.4103/npmj.npmj_16_23] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Introduction An effective referral system is crucial for a high-quality health system that provides safe medical care. Aim and Objectives This study aimed at evaluating the appropriateness and adequacies of information in the referral letters of patients. Materials and Methods A prospective study of referral letters of all new patients in the urology clinic. Information retrieved was socio-demographic characteristics, source of referral and presence or absence of important information in their letters. We compared the information provided to the new history taken to determine the appropriateness and adequacy using different domains of medical history. Referrals were adjudged appropriate if the diagnosis is urologic, while any referral lacking relevant information is adjudged inadequate. The results were displayed using the simple proportions in tables and charts. Results A total of 1188 referrals were reviewed. There were 997 (83.9%) males and 191 (16.1%) females. Referrals from private hospitals were the most common in 627 (52.8%) cases. Of all new referrals, 1165 (98.1%) were adjudged to be appropriate, while 23 (1.9%) were inappropriately referred. Referrals from teaching hospitals had higher proportions of good-quality referrals than those from primary healthcare and private centres. The most common deficiencies were the lack of documentation of relevant examination findings (37.8%) and provisional diagnosis (21.4%). The majority, 956 (80.5%), of letters were narrative in nature, whereas 232 (19.5%) were structured. Structured letters were found to be more informative. Conclusion A significant percentage of referral letters lacked completeness in many key areas. We recommend the use of structured forms or template letters to improve the quality of referrals.
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Affiliation(s)
- Rufus Wale Ojewola
- Department of Surgery, Faculty of Clinical Sciences, College of Medicine, University of Lagos; Department of Surgery, Urology Unit, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Kehinde Habeeb Tijani
- Department of Surgery, Faculty of Clinical Sciences, College of Medicine, University of Lagos; Department of Surgery, Urology Unit, Lagos University Teaching Hospital, Lagos, Nigeria
| | | | - Chike John Okeke
- Department of Urology, Epsom and St. Helier University Hospitals NHS Trust, London, United Kingdom
| | - Opeoluwa Jesuyemi Akinyemi
- Department of Surgery, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Lagos, Nigeria
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Envuladu EA, Issaka AI, Dhami MV, Sahiledengle B, Agho KE. Differential Associated Factors for Inadequate Receipt of Components and Non-Use of Antenatal Care Services among Adolescent, Young, and Older Women in Nigeria. Int J Environ Res Public Health 2023; 20:ijerph20054092. [PMID: 36901102 PMCID: PMC10001685 DOI: 10.3390/ijerph20054092] [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] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 02/21/2023] [Accepted: 02/21/2023] [Indexed: 05/10/2023]
Abstract
Nigerian women continue to die in childbirth due to inadequate health services such as antenatal care (ANC). Among other factors, the inadequate receipt or non-use of ANC appears to be associated with the age of women, remoteness, and poor households. This cross-sectional study aimed to compare the factors associated with inadequate receipt of the components and non-use of ANC among pregnant adolescents, and young and older women in Nigeria. Data for this study were from the 2018 Nigeria Demographic and Health Survey (NDHS) and covered a weighted total of 21,911 eligible women. Survey multinomial logistic regression analyses that adjusted for cluster, and survey weights were conducted to examine factors associated with adolescent, young, and older women. Adolescent women reported a higher prevalence of inadequate receipts and non-use of ANC than young and older women. Increased odds of inadequate receipt of the components of ANC were associated with residence in the North-East region and rural areas for all three categories of women. For adolescent women, the increased odds of inadequate receipt of the components of ANC were associated with delivering a baby at home and a big problem with distance to health facilities. Limited education or no schooling was associated with the increased odds of receiving inadequate ANC among older women. Implementing interventions to improve maternal and child health care should focus on the factors associated with the increased odds of receipt of inadequate or non-use of ANC services among Nigerian adolescent women, particularly those living in rural areas in the North-East region.
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Affiliation(s)
- Esther Awazzi Envuladu
- Department of Community Medicine, College of Health Sciences, University of Jos, Jos 930003, Nigeria
| | - Abukari Ibrahim Issaka
- School of Health Sciences, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia
| | - Mansi Vijaybhai Dhami
- The Children’s Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145, Australia
- Translational Health Research Institute (THRI), Western Sydney University, Penrith, NSW 2571, Australia
| | - Biniyam Sahiledengle
- Department of Public Health, Madda Walabu University Goba Referral Hospital, Bale-Goba 4540, Ethiopia
| | - Kingsley Emwinyore Agho
- School of Health Sciences, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia
- Translational Health Research Institute (THRI), Western Sydney University, Penrith, NSW 2571, Australia
- African Vision Research Institute, Westville Campus, University of KwaZulu-Natal, Durban 3629, South Africa
- Correspondence: ; Tel.: +61-2-4620-3635
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Nagpal N, Nagpal N, Kataria N, Parikh P. Violence against Health Care Professionals and Facilities-Local Insights about a Global Malady. South Asian J Cancer 2021; 9:257-260. [PMID: 34131577 PMCID: PMC8197649 DOI: 10.1055/s-0041-1726137] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Acts of violence against health care professionals (especially doctors) as well as facilities are a growing global problem. In our country, it has taken an unfortunate dramatic turn of the involvement of a mob—a ragtag group of persons who organize and perpetrate the crime based on community, caste, religion, or political affiliations. This crucial factor is the fundamental difference in what we face as compared with the so-called Yi Nao phenomenon of China. In India, the mob gathers and indulges in acts of violence, intimidation, and blackmail at the behest of its “leader,” often having no direct relationship with the deceased patient. It is premeditated and systematic vandalism. Often it is also associated with financial gain to the perpetrators through extortion and blackmail, adding to the woes of the health care professionals and hospital facility. We discuss what is the primary goal and what is a byproduct in this cycles of violence against the people who are doing their best to save the lives of patients. Unless the governments and the courts take this matter seriously as well as follow-up with corrective measures, the future looks bleak for all stakeholders.
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Affiliation(s)
- Neeraj Nagpal
- Department of Medico Legal, Medicos Legal Action Group Trust, Chandigarh, India
| | - Nimisha Nagpal
- Department of Cornea, Sankara Netralaya Hospital, Chennai, Tamil Nadu, India
| | - Nilanshu Kataria
- Department of Radiology, Sri Guru Ram Das Institute of Medical Sciences & Research, Amritsar, Punjab, India
| | - Purvish Parikh
- Department of Oncology, Shalby Cancer & Research Institute, Mumbai, Maharashtra, India
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Poller DN, Doyle V, Trimboli P, Bongiovanni M. Rates of Thy 1-non-diagnostic thyroid fine needle aspiration using the UK Royal College of Pathologists Thy Terminology. A systematic review of the literature comparing patients who undergo rapid on-site evaluation and those who do not. Cytopathology 2020; 31:502-508. [PMID: 32003044 DOI: 10.1111/cyt.12804] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 01/08/2020] [Accepted: 01/27/2020] [Indexed: 12/30/2022]
Abstract
INTRODUCTION The UK Royal College of Pathologists (RCPath) Thy terminology is an internationally recognised system for reporting thyroid fine needle aspiration. The terminology has been used throughout the UK and Ireland, in some parts of Italy and Switzerland, and elsewhere in the world. There is no systematic review of the literature specifically addressing the use of the non-diagnostic for cytological diagnosis-Thy1/Thy 1c category in the UK RCPath terminology. METHODS A comprehensive literature search of online databases was conducted in October 2019 specifically examining overall reported rates of Thy1 and Thy1c in aspirates classified according to the UK Thy terminology. RESULTS Twenty-five articles were identified showing a Thy1 rate of 13.4% (2540/18 920). The studies were then stratified according to whether or not the patients underwent rapid on-site evaluation (ROSE): 6.0% (353/5841; range 3.0%-10.9%) of ROSE aspirates were Thy1 whereas 18.5% (2072/11 204; range 7.9%-43.3%) of non-ROSE patients were Thy1; (P < .05). Three studies from 2016 reported Thy1c rates of 5.4%, 6.5% and 10.6%, respectively, implying Thy1 rates excluding Thy1c aspirates of 20.9%, 8.7% and 12.7%, respectively. CONCLUSION This systematic review of the literature shows relatively high rates of aspirates non-diagnostic for cytological diagnosis-Thy1 in the peer-reviewed published literature using the UK terminology. Utilisation of ROSE appears to produce lower rates of Thy1 aspirates and ROSE should be considered if rates of non-diagnostic for cytological diagnosis-Thy1/Thy 1c are high.
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Affiliation(s)
- David N Poller
- Department of Pathology, Queen Alexandra Hospital, Cosham, Portsmouth, UK
| | - Victoria Doyle
- Department of Pathology, Queen Alexandra Hospital, Cosham, Portsmouth, UK
| | - Pierpaolo Trimboli
- Clinic for Nuclear Medicine and Competence Centre for Thyroid Diseases, Imaging Institute of Southern Switzerland, Cantonal Hospital Authority, Bellinzona, Switzerland.,Faculty of Biomedical Sciences, Universita della Svizzera Italiana (USI), Lugano, Switzerland
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Akgul G, Ozgur Yeniova A, Ozsoy Z, Yenidogan E, Kefeli A, Dasıran MF, Daldal E, Akbas A, Okan İ. Effect and Tolerability of Same-Day Repeat Colonoscopy. J INVEST SURG 2018; 33:459-465. [PMID: 30380338 DOI: 10.1080/08941939.2018.1513611] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Purpose/Aim of the study: The main purpose of the colonoscopy is screening for colorectal cancers and diagnosis of colorectal disease The cost-effectiveness of colonoscopy directly depend on the adequate bowel preparation. Inadequate colonoscopy is recommended to be re-scheduled within 1 year. Re-scheduling is an economic and patient burden. Thus instead of re-scheduling, another strategy may be attempted. The purpose of this study was to examine the usefulness and effect of the same day repeat colonoscopy after administration of an additional laxative dose. Materials and Methods: Patients with inadequate colonoscopy were enrolled in the study. The patients eligible for the enrollment were instructed to consume an additional laxative and scheduled in afternoon. The demographic data of the patient, the details of the index and repeat procedures were obtained by a questionnaire. Results: A total of 60 patients were enrolled in the study. The rate of adequate colonoscopy was 80%. Cecum intubation rate was 83.3%. There were no complications due to colonoscopy itself and additional laxatives. The polyp detection rate was 26.6%. The withdrawal time was 6.7 ± 1.34 min. Conclusion: The results of the present study showed that same day repeat colonoscopy with additional laxative dose can be a safe and effective method for repeat procedure of an inadequate colonoscopy. The patients tolerated and were satisfied with the same day protocol. Quality indicators of colonoscopy such as adenoma detection rate and cecum intubation rate were achieved. Same day bowel cleansing method may be considered as an alternative way rather than re-scheduling inadequate colonoscopy for a later time.
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Affiliation(s)
- Giray Akgul
- Department of General Surgery, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Abdullah Ozgur Yeniova
- Department of Internal Medicine and Gastroenterology, Faculty of Medicine, Gaziosmanpaşa University, Tokat, Turkey
| | - Zeki Ozsoy
- Department of General Surgery, Faculty of Medicine, Gaziosmanpaşa University, Tokat, Turkey
| | - Erdinc Yenidogan
- Department of General Surgery, Faculty of Medicine, Gaziosmanpaşa University, Tokat, Turkey
| | - Ayse Kefeli
- Department of Internal Medicine and Gastroenterology, Faculty of Medicine, Gaziosmanpaşa University, Tokat, Turkey
| | - Mehmet Fatih Dasıran
- Department of General Surgery, Faculty of Medicine, Gaziosmanpaşa University, Tokat, Turkey
| | - Emin Daldal
- Department of General Surgery, Faculty of Medicine, Gaziosmanpaşa University, Tokat, Turkey
| | - Ahmet Akbas
- Department of General Surgery, Faculty of Medicine, Gaziosmanpaşa University, Tokat, Turkey
| | - İsmail Okan
- Department of General Surgery, Faculty of Medicine, Gaziosmanpaşa University, Tokat, Turkey
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Sørbye SW, Pedersen MK, Ekeberg B, Williams MEJ, Sauer T, Chen Y. Can an inadequate cervical cytology sample in ThinPrep be converted to a satisfactory sample by processing it with a SurePath preparation? Cytojournal 2017; 14:20. [PMID: 28900466 PMCID: PMC5583701 DOI: 10.4103/cytojournal.cytojournal_34_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 03/14/2017] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The Norwegian Cervical Cancer Screening Program recommends screening every 3 years for women between 25 and 69 years of age. There is a large difference in the percentage of unsatisfactory samples between laboratories that use different brands of liquid-based cytology. We wished to examine if inadequate ThinPrep samples could be satisfactory by processing them with the SurePath protocol. MATERIALS AND METHODS A total of 187 inadequate ThinPrep specimens from the Department of Clinical Pathology at University Hospital of North Norway were sent to Akershus University Hospital for conversion to SurePath medium. Ninety-one (48.7%) were processed through the automated "gynecologic" application for cervix cytology samples, and 96 (51.3%) were processed with the "nongynecological" automatic program. RESULTS Out of 187 samples that had been unsatisfactory by ThinPrep, 93 (49.7%) were satisfactory after being converted to SurePath. The rate of satisfactory cytology was 36.6% and 62.5% for samples run through the "gynecology" program and "nongynecology" program, respectively. Of the 93 samples that became satisfactory after conversion from ThinPrep to SurePath, 80 (86.0%) were screened as normal while 13 samples (14.0%) were given an abnormal diagnosis, which included 5 atypical squamous cells of undetermined significance, 5 low-grade squamous intraepithelial lesion, 2 atypical glandular cells not otherwise specified, and 1 atypical squamous cells cannot exclude high-grade squamous intraepithelial lesion. A total of 2.1% (4/187) of the women got a diagnosis of cervical intraepithelial neoplasia 2 or higher at a later follow-up. CONCLUSIONS Converting cytology samples from ThinPrep to SurePath processing can reduce the number of unsatisfactory samples. The samples should be run through the "nongynecology" program to ensure an adequate number of cells.
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Affiliation(s)
| | | | - Bente Ekeberg
- Department of Pathology, Akershus University Hospital, Lørenskog, Norway
| | | | - Torill Sauer
- Department of Pathology, Akershus University Hospital, Lørenskog, Norway
| | - Ying Chen
- Department of Pathology, Akershus University Hospital, Lørenskog, Norway
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Issaka AI, Agho KE, Page AN, Burns PL, Stevens GJ, Dibley MJ. The problem of suboptimal complementary feeding practices in West Africa: what is the way forward? Matern Child Nutr 2016; 11 Suppl 1:53-60. [PMID: 26364791 DOI: 10.1111/mcn.12195] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The objective of this paper was to review the policy implications of inadequate complementary feeding among children aged 6-23 months in West Africa. The review was undertaken from the initial results and findings from a series of studies on the comparison of complementary feeding indicators among children aged 6-23 months in four anglophone and seven francophone West African countries. It also examined a study of the determinants of suboptimal complementary feeding practices among children aged 6-23 months in those countries. Among the four complementary feeding indicators, it was only the introduction of solid, semi-solid or soft foods that was adequate among children in all the West African countries surveyed. The rates of the other complementary feeding indicators were found to be inadequate in all countries surveyed, although relatively better among children in the anglophone countries. Alarmingly, low rates of minimum acceptable diet were reported among children from both the anglophone and the francophone countries. Infants 6-11 months of age, children living in poor households, administrative/geographical regional differences and mothers' access to the media were some of the common risk factors for optimal complementary feeding practices in these countries. Assessing complementary feeding indicators and determinants of suboptimal complementary feeding practices in these West African countries is crucial to improving infant and young child feeding practices. It is recommended that governments and stakeholders of the West African countries studied make greater efforts to improve these critical practices in order to reduce child morbidity and mortality in the West Africa sub-region. Intervention studies on complementary feeding should target those socio-demographic factors that pose risks to optimal complementary feeding.
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Affiliation(s)
- Abukari I Issaka
- School of Medicine, University of Western Sydney, Sydney, New South Wales, Australia
| | - Kingsley E Agho
- School of Science and Health, University of Western Sydney, Sydney, New South Wales, Australia
| | - Andrew N Page
- School of Science and Health, University of Western Sydney, Sydney, New South Wales, Australia
| | - Penelope L Burns
- School of Medicine, University of Western Sydney, Sydney, New South Wales, Australia
| | - Garry J Stevens
- School of Medicine, University of Western Sydney, Sydney, New South Wales, Australia
| | - Michael J Dibley
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
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Manyanga T, da Silva DF, Ferraro ZM, Harvey ALJ, Wilson S, Ockenden HN, Adamo KB. The effects of culture on guideline discordant gestational weight gain: a systematic review protocol. Syst Rev 2015; 4:145. [PMID: 26527534 PMCID: PMC4630828 DOI: 10.1186/s13643-015-0132-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 10/12/2015] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND A significant proportion of women exceeds or does not meet the Institute of Medicine's gestational weight gain (GWG) guidelines. Inadequate, excessive GWG or weight loss during pregnancy is associated with an increased risk of negative maternal and fetal outcomes. Among the many determinants of GWG identified in the 2009 Institute of Medicine guidelines, culture was named as one of the few whose influence has not been fully explored. Some cultural beliefs may erroneously promote overeating as "eating for two" and discourage physical activity during pregnancy, but there is lack of empirical evidence on how culture affects GWG. The purpose of this systematic review is to examine the effects of culture on GWG. METHODS/DESIGN Ten electronic databases will be searched to identify studies reporting on the effects of culture on GWG. Grey literature, published conference abstracts, websites of relevant organizations and reference lists of included studies will also be searched. Studies that report on effects of culture, acculturation, ethnicity, race, nationality, ancestry and identity on GWG in adult women will be included. Quality of evidence will be evaluated using the grading of recommendations, assessment, development and evaluations (GRADE) approach to rating evidence. Study selection, data extraction and risk of bias assessment will be conducted by two independent reviewers, with disagreements being resolved by consensus or third party adjudication as needed. Formal meta-analyses will be conducted among included studies that are sufficiently statistically and clinically homogeneous. DISCUSSION This review will provide a comprehensive assessment and synthesis of current evidence and will draw attention to potential gaps where future research on the effects of culture on guideline discordant gestational weight gain remains to be conducted. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42015023399.
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Affiliation(s)
- Taru Manyanga
- Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, K1H 8L1, Canada. .,School of Human Kinetics, University of Ottawa, Faculty of Health Sciences, Ottawa, ON, K1H 8L6, Canada.
| | - Danilo F da Silva
- Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, K1H 8L1, Canada. .,Department of Physical Education, State University of Maringa, Maringa, PR, 87020-900, Brazil.
| | - Zachary M Ferraro
- Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, K1H 8L1, Canada. .,Division of Maternal-Fetal Medicine, The Ottawa Hospital, General Campus, Ottawa, ON, K1H 8L6, Canada. .,Faculty of Medicine, University of Ottawa, Ottawa, ON, K1H 8L6, Canada.
| | - Alysha L J Harvey
- Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, K1H 8L1, Canada. .,School of Human Kinetics, University of Ottawa, Faculty of Health Sciences, Ottawa, ON, K1H 8L6, Canada.
| | - Shanna Wilson
- Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, K1H 8L1, Canada.
| | - Holly N Ockenden
- Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, K1H 8L1, Canada. .,School of Human Kinetics, University of Ottawa, Faculty of Health Sciences, Ottawa, ON, K1H 8L6, Canada.
| | - Kristi B Adamo
- Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, K1H 8L1, Canada. .,School of Human Kinetics, University of Ottawa, Faculty of Health Sciences, Ottawa, ON, K1H 8L6, Canada. .,Department of Pediatrics, University of Ottawa, Faculty of Medicine, Ottawa, ON, K1H 8L6, Canada.
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Datta J, Lewis RS, Mamtani R, Stripp D, Kelz RR, Drebin JA, Fraker DL, Karakousis GC, Roses RE. Implications of inadequate lymph node staging in resectable gastric cancer: a contemporary analysis using the National Cancer Data Base. Cancer 2014; 120:2855-65. [PMID: 24854027 DOI: 10.1002/cncr.28780] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 03/20/2014] [Accepted: 04/16/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND National guidelines recommend examination of ≥ 15 lymph nodes for adequate staging of resectable gastric adenocarcinoma (GA). The relevance of these guidelines, which were established before the increasing use of multimodality therapy, and the impact of inadequate lymph node staging (LNS) in a contemporary cohort have not been extensively explored. METHODS Stage I-III GA patients who underwent gastrectomy from 1998 to 2011 were identified using the National Cancer Data Base. Trends in LNS adequacy, predictors of inadequate LNS (< 15 LN examined) and the relationship between LNS and overall survival (OS) were analyzed. RESULTS In 22,409 patients, compliance with LNS guidelines was poor (inadequate LNS in 61.2% of cases, median LN harvested in 11.0%). Subtotal/partial gastrectomy was the strongest predictor of inadequate LNS (OR = 2.01, P < .001). Survival analyses included 9139 patients with minimum 5 years follow-up; median, 1-year, and 5-year survival was 35.6 months, 75.5%, and 39.7%, respectively. LN positivity (HR = 1.90) and age > 76 years (HR = 1.73) were the strongest predictors of worse OS (both P < .001). Inadequate LNS was independently associated with worse OS (HR = 1.33, P < .001). Median OS after inadequate compared to adequate LNS was significantly worse (33.3 months versus 42.0 months, P < .001), regardless of AJCC clinical stage subgroup or tumor T classification (both P < .001). CONCLUSIONS Adequate LNS is achieved in a minority of patients. Inadequate LNS was independently associated with worse OS. Examination of ≥ 15 LN is a reproducible prognosticator of gastric cancer outcomes in the United States and should continue to serve as a benchmark for quality of care.
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Affiliation(s)
- Jashodeep Datta
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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Abstract
There is an ongoing increase in the availability of foods fortified with micronutrients and dietary supplements. This may result in differing intakes of micronutrients within the population and perhaps larger differences in intakes. Insight into population micronutrient intakes and evaluation of too low or too high intakes is required to see whether there are potential problems regarding inadequacy or excessive intakes. Too low population intakes are evaluated against an estimated average requirement; potential too high population intakes are evaluated against a tolerable upper intake level (UL). Additional health effects, seriousness, and incidence of these health effects are not considered but these can be taken into account in a benefit-risk assessment. Furthermore, authorities would like to regulate food fortification and supplementation in such a way that most of the population is not at risk of potentially high intakes. Several models are available for estimating maximum levels of micronutrients for food fortification and dietary supplements. Policy makers and risk managers need to decide how to divide the 'free space' between food fortification and/or dietary supplements, while protecting populations from adverse health effects.
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