Search Results (343)

Background/Objectives: Globally, momentum is building around antenatal multiple micronutrient supplementation (MMS), with evidence that it is as effective as iron–folic acid supplementation in preventing maternal anemia and more effective in improving birth outcomes. In line with the World Health Organization 2020 recommendation and as part of a broader implementation research project, this study examines MMS acceptability, pregnant women (PW)’s adherence practices and experiences, and facilitators and barriers to acceptability, adherence, and provision of MMS within public ANC services in Pakistan and Nigeria. Methods: Following introduction of MMS by the Government of Pakistan in April 2022 (Swabi District) and the Government of Nigeria in December 2023 (Bauchi State), mixed-methods research was conducted using cross-sectional surveys (one in each country), focus group discussions (6 in Pakistan, 9 in Nigeria), and in-depth interviews (7 in Pakistan, 10 in Nigeria) with PW, family members, and facility- and community-based healthcare providers (HCPs). Results: Findings in both settings showed that MMS is widely accepted, and almost all women (>97%) started consuming the MMS they received. Adherence levels, assessed using both pill-count and self-reported measures, exceeded 70%. In both countries, perceived benefits were identified as a key enabler to MMS acceptability and adherence among PW, whereas perceived negative effects acted as a barrier. Facilitators of MMS provision included trusting relationships between PW and HCPs, while delayed antenatal care (ANC) initiation, anemia screening, and limited agency of PW were identified as barriers. Conclusions: This study provides findings to inform MMS scale-up across public ANC platforms in two low- and middle-income countries and contributes to global evidence on context-specific considerations for MMS implementation. Full article

Background/Objectives: Vitamin D deficiency and malnutrition may lead to poor outcomes in colorectal cancer (CRC) patients. This study aims to perform an integrative analysis of serum vitamin D, nutritional status, anthropometric parameters and biochemical profiles in advanced CRC patients. Methods: The study included 58 advanced CRC patients. Serum vitamin D levels were measured by a chemiluminescence immunoassay. Nutritional status was evaluated with the Mini Nutritional Assessment (MNA). Body composition profiles were assessed using a bioelectrical impedance analyzer, and handgrip strength was measured with a handgrip dynamometer. Biochemical and clinical parameters were retrieved from an electronic database. Correlation, regression and receiver operating characteristic (ROC) analyses were performed. Results: Abnormal nutritional status and vitamin D deficiency were diagnosed in 55.17% and 50.00% of patients, respectively. Sarcopenia was diagnosed in 29.31%. Serum vitamin D concentrations were negatively correlated with absolute neutrophil counts (ANC). MNA scores showed significant negative correlations with ANC, platelet count, alkaline phosphatase and carcinoembryonic antigen. In multivariable regression models, albumin remained statistically associated with both serum vitamin D levels (β 7.049; 95% CI: 1.686–12.413; p = 0.011) and MNA score (β 6.951; 95% CI: 4.623–9.278; p < 0.001). Furthermore, albumin showed exploratory performance in ROC analyses for malnutrition and vitamin D deficiency (AUC^ROC 0.814 and 0.725, respectively), which should be interpreted cautiously given potential overlap with MNA-defined nutritional status and the limited sample size. Conclusions: Vitamin D deficiency, malnutrition and systemic inflammation commonly co-occur and are closely interrelated in patients with advanced CRC. A comprehensive assessment of nutritional status in a CRC supportive care setting is recommended. Full article

Background/Objectives: This study aimed to evaluate the antidiabetic potential of five extracts/sub-extracts and five known cycloartane saponins [astragalosides (AST) I, II, III, IV, and cyclocanthoside E] from Astragalus noeanus (AN), using four specific diabetes-related molecular targets. Methods: Four diabetes-associated in vitro and in silico targets—protein tyrosine phosphatase 1B (PTP1B), dipeptidyl peptidase IV (DPP IV), α-amylase, and advanced glycation end-products (AGEs)—were employed to obtain comprehensive antidiabetic activity profiles. Additionally, the antioxidant and prebiotic capacities of the extracts/sub-extracts were assessed in vitro. A cycloartane saponin was isolated and structurally characterized. Quantitative analyses of total flavonoids, total saponins, and high-performance thin-layer chromatography (HPTLC) were performed to profile the chemical constituents of the plant material. Results: Among the extracts/sub-extracts, the aqueous extract (ANW) exhibited the highest inhibitory effects against all four diabetes-related targets, with inhibition percentages ranging from 83.70% to 93.49%. The methanol extract (ANM) demonstrated significant prebiotic activity comparable to standard controls on two Lactobacillus strains. The chloroform extract (ANC) showed the highest flavonoid content and exhibited the strongest antioxidant activity across all assays. ANM yielded the highest saponin content (3250 mg escin equivalent/g). HPTLC quantification revealed that AST IV was the predominant saponin in ANM (14.28 μg/mg) after cyclocanthoside E (117.27 ± 6.71 μg/mg). Among the saponins, AST IV displayed the most potent inhibition in diabetes-related enzyme assays, surpassing reference drugs acarbose and vildagliptin at equivalent concentrations. AST III also demonstrated considerable activity, ranking just below AST IV. Molecular docking studies identified AST II and AST III as the most promising ligands, exhibiting superior binding affinities and stronger hydrogen bonding and hydrophobic interactions with target proteins. Cyclocanthoside E was isolated from A. noeanus and evaluated for its antidiabetic effects for the first time, with its structure confirmed by NMR and LC-HRMS analyses. Conclusions: This study highlights Astragalus noeanus as a promising source for safe and effective antidiabetic agents. The potent activity of the aqueous extract, along with AST IV and AST III, warrants further investigation through clinical trials to validate their therapeutic potential in diabetes management. Full article

Background: Pregnant adolescents are at higher risk of adverse birth outcomes. Tailoring antenatal care (ANC) to adolescents’ unique needs may be a way to reduce adverse maternal and child outcomes within this population. This systematic review aimed to evaluate ANC services for pregnant adolescents and their impact on maternal and infant outcomes. Methods: Two reviewers independently searched five electronic databases (September 2024) to evaluate existing ANC services that are tailored to adolescents and the impact they have on maternal and infant outcomes. Studies were assessed for quality using the NICE quality appraisal tool and a narrative synthesis was carried out to present the findings. In addition, a survey was disseminated through the Global Adolescent Nutrition Network (GANN) to gain further insights into stakeholder views and experiences of tailored ANC for adolescents. Results: 11,236 articles were reviewed, with 14 studies included for analysis. Interventions as part of ANC for pregnant adolescents included micronutrient supplementation, supplementary feeding, community-based delivery, group-delivery, tailored nutrition education, and additional support and counselling. Outcomes such as birthweight, preterm birth, and gestational age were reported, with most studies (11/14) demonstrating positive effects. Of 103 survey responses, 100% agreed that ANC for pregnant adolescents need to be delivered in a youth-friendly manner, and 57% indicated that providing both youth-friendly delivery and additional support are crucial. Inclusive and supportive care, tailored educational support, tailored nutrition care, and mental health support were most commonly mentioned as key components for tailored ANC. Conclusions: The systematic review and survey data concur in identifying key elements of adolescent-tailored ANC. Some of these have already been shown to be effective; however, due to the high heterogeneity of the study designs, a stronger evidence-base is needed. Specific elements of future ANC packages for pregnant adolescents might include group ANC delivery, community-based services, increased confidentiality measures, mental health support and counselling, health education, and nutrition care tailored to adolescents’ physiological and emotional needs. Full article

Background: Monitoring and managing gestational weight gain (GWG) during antenatal care (ANC) is linked to better maternal and neonatal outcomes. The Institute of Medicine (IOM) guidelines are based on pre-pregnancy BMI and reduce obstetric risks. Pregnant women’s views and healthcare providers’ (HCPs) practices are key to effective GWG counseling. This study aims to: (1) investigate the proportion of women who received GWG advice per IOM guidelines, and (2) explore HCP practices and views on GWG counseling. Methods: This is a cross-sectional study of Saudi pregnant women who delivered within one year of the study and HCPs who provided ANC. Women provided data on demographics, pre-pregnancy BMI, recall of GWG advice, and their target GWG. HCPs rated their knowledge and counseling practices. Results: Of 1151 women, 48.8% were pre-pregnancy overweight or obese, 47.6% were normal weight, and 3.6% were underweight. Most women (74.5%) received no GWG advice, and only 8.8% followed IOM guidelines. Women with obesity and overweight were more likely to receive correct advice (15.5% and 11.5%), compared to 5.3% of normal-weight and 2.4% underweight women. Overweight and obese women were more likely to define the correct GWG (AOR = 2.84 and 5.85). Receiving proper advice greatly increased the likelihood of proper GWG definition (AOR = 7.13). Among 28 HCPs, 53.6% reported that women rarely ask about the GWG target. Nearly 93% of them weigh women at each visit, but only 21.4% set personalized GWG targets. Most HCPs (82.2%) viewed discussing GWG as a high priority, and 70% felt confident providing guidance on GWG, diet, and exercise. Conclusions: Many women receive no GWG guidance, and most advice does not align with IOM guidelines. Enhancing Saudi women’s knowledge regarding GWG targets through health education, in conjunction with ongoing medical education for healthcare professionals concerning guidelines for GWG, represents modifiable factors and a critical opportunity to foster healthier pregnancy outcomes. Full article

Background/Objectives: Emerging evidence suggests that multiple micronutrient supplements (MMS) provide additional benefits for maternal and neonatal health compared with iron and folic acid (IFA) supplements. To achieve effective coverage, acceptability, and adherence—and to inform a nationwide rollout of MMS—it is essential to understand the context-specific factors that shape implementation. This study evaluated the pilot implementation of MMS in Rwanda to identify key enablers, areas for improvement, and challenges related to antenatal care (ANC) attendance and MMS use. Methods: Data were collected through a survey of 3257 women who attended ANC services, seven focus group discussions with 35 ANC attendees, and key informant interviews with 20 ANC nurses and 21 community health workers. Results: Pregnant women reported high ANC attendance (74%) and MMS consumption (79%), largely driven by strong motivation and awareness of MMS benefits. Strategies to remember daily intake and to manage side effects supported adherence, as did reminders, motivation, and information from family members and healthcare providers. Limited patient-centered counselling, financial constraints, barriers to accessing ANC services, and product stock-outs were key areas for strengthening service delivery in Rwanda. Conclusions: Sustaining high ANC attendance and MMS adherence as the program transitions from the pilot phase to national scale-up is essential. Improving counseling quality and strengthening supply chains may reinforce ANC services and support sustained MMS adherence, with benefits for maternal and child health. Full article

Breastfeeding is universally regarded as the cornerstone of infant feeding, as it is the ideal infant feeding choice for optimal nutrition and development. Socio-structural factors of breastfeeding in child health play an important role in guiding women’s decisions on options to feed their babies. A cross-sectional study was conducted among mothers with infants aged 0–6 months in Mthatha, Eastern Cape, with the aim of assessing the role of socio-structural factors in shaping feeding intentions and practices among mothers with infants. Written Informed consent was obtained in accordance with the Declaration of Helsinki from the participants prior to data collection. Data was gathered with a validated designed questionnaire as well as analyzed using Social Sciences (SPSS) version 29. A total of 181 mothers were enrolled. Only 45.9% reported that they exclusively breastfed their babies, of which the highest proportion of exclusive breastfeeding (EBF) was observed among the 21–29 age group at 51.8%, and the lowest among those aged 20 years and below (3.6%). Marital status (p = 0.005) and employment status (p < 0.001) were significantly associated with exclusive breastfeeding, with higher EBF rates observed among married mothers and those who were self-employed. Both the EBF mothers and non-EBF mothers shared a common belief that colostrum was not beneficial for infants (p = 0.854), whereas their views differed significantly on the amount of water given to infants before they reached six months (p = 0.001). There was no significant relationship between EBF status and having a family member who had breastfed in the past six months (p = 0.815); also, a weak association was noted for having a friend who had breastfed recently (p = 0.057). The difference in EBF practice between those receiving antenatal care (ANC) breastfeeding education and those not receiving it was not statistically significant (p = 0.591). A statistically significant association was found between the support level and exclusive breastfeeding status (p < 0.001). This study highlights that the successful practice of exclusive breastfeeding (EBF) is strongly associated with high levels of social support. Interventions are needed to engage active partners, family members, and community members in creating a supportive environment for breastfeeding mothers. Full article

The bifunctional glutathione synthase (GshF) is able to catalyze glutathione synthesis and is favored for industrial application due to its lack of product inhibition. However, its practical use is limited by moderate catalytic efficiency and poor thermostability. Here, we applied ancestral sequence reconstruction (ASR) to engineer a more robust ancestral GshF (Anc427) with thermal denaturation temperature of 56.2 ± 0.2 °C, representing an increase of 10.8 ± 0.2 °C over the probe enzyme (St-GshF). Additionally, Anc427 exhibited a thermal half-life (t_1/2) of 3465.7 min at 40 °C, representing a 20-fold increase over that of St-GshF. Under optimal conditions (pH 7.0, 37 °C), Anc427 displayed a specific activity of 3.3 ± 0.02 U·mg⁻¹, representing a 20% enhancement compared to St-GshF. Structural modeling and molecular dynamics simulations indicated that the improved stability can be attributed to increased structural rigidity in Anc427. These findings demonstrate that ASR effectively enhances both thermostability and catalytic activity of GshF, significantly advancing its potential for industrial biocatalysis. Full article

The article analyses the direction and intensity of changes occurring in agriculture in mountain areas in Europe between 2000 and 2022. For the calculations, the ESA CCI Land Cover global land-use map set was used. This dataset was established by the European Space Agency (ESA) through the classification of satellite images from sources (MERIS, AVHRR, SPOT, PROBA, and Sentinel-3). In the next step, the organisational features and economic performance of farms located in mountain areas of the European Union were determined for the period 2004–2022. For this purpose, data from the European Farms Accountancy Data Network (FADN-FSDN) were used. Subsequently, using Poland as a case study, the capacity of mountain agriculture to implement key environmental interventions under the Common Agricultural Policy (CAP) 2023–2027 was assessed. The results highlight the varying directions and intensity of organisational changes occurring in mountain agriculture across Europe. They also show that farms can operate successfully in these areas, although their economic situation varies between EU countries. The findings indicate the need for further adaptation of CAP instruments to better reflect the ecological and economic conditions of mountain areas. Strengthening support mechanisms for these regions within the current and future CAP is of crucial importance for protecting biodiversity, promoting sustainable land use, and maintaining the socio-environmental functions of rural mountain landscapes. Our study highlights that the CAP for mountain farms should be targeted, long-term, and compensatory, so as to compensate for the naturally unfavorable farming conditions and support their multifunctional role. The most important assumptions of CAP for mountain farms are a fair system of compensatory payments (LFA/ANCs), support for local and high-quality production, income diversification, and investments adapted to mountain conditions. Full article

The oxidation of sulfide minerals in the presence of oxygen and water, facilitated by microbes, is the principal cause of acid mine drainage (AMD). Static testing for the quantitative assessment of the acidic potential and acid-neutralizing capacity of mineral samples has been thoroughly investigated; the extent of its accuracy remains uncertain. This study involved 329 ore samples from 34 drill holes from abandoned mining sites and conducted laboratory static tests and mineralogical analysis. Static testing and mineralogical characterization identified a significant positive correlation between total sulfur and net acid generation (NAG), confirming that sulfide oxidation is the dominant mechanism for acid production. Furthermore, the strong positive correlation between calcium content and acid-neutralizing capacity (ANC) demonstrates that the buffering capacity stems mainly from carbonate dissolution, with negligible contribution from silicate weathering. The effectiveness of a detailed acid-generating potential discrimination chart was also assessed. Through the examination of acid drainage samples and groundwater from the research area, with their stable isotope and Deuterium excess (D-excess) properties, hydrochemical classifications were established, and sources of acid drainage were evaluated. This comprehensive method pinpoints the main “acid-generating sources” in the abandoned mining sites, elucidating the geochemical origins of acid drainage in the research area. It offers a case study and analytical framework for employing static test findings from abandoned mining sites to evaluate acid-generating potential in those areas. Full article

Impulsive noise poses a significant challenge to broadband feedforward active noise control (ANC) systems, particularly in sensitive environments such as infant incubators. This paper presents an adaptive impulsive noise cancellation approach based on the Kalman filter, designed to improve noise attenuation performance under nonstationary and impulsive interference. The proposed framework integrates impulsive noise detection with a Kalman filter-based suppression scheme. Simulation studies are conducted to evaluate the performance of the combined system in comparison to traditional ANC methods, such as Filtered-x Least Mean Square (FxLMS) and Filtered-x Normalized LMS (FxNLMS). Results demonstrate that the Kalman filter can effectively reduce the influence of impulsive disturbances without degrading overall broadband noise cancellation. A case study involving an infant incubator illustrates the practical effectiveness and robustness of the proposed technique in a real-world healthcare application. The findings support the integration of Kalman filter-based adaptive control in future ANC designs targeting impulsive noise environments. Full article

Male partner involvement (MPI) is recognised as an important strategy for improving maternal health, yet little is known about women’s preferences for how men should participate in antenatal care (ANC) and childbirth. This study explored Sesotho-speaking women’s preferences for MPI and identified the forms of involvement that they considered to be appropriate and beneficial using a concurrent mixed-methods design. A survey was conducted with 513 women who had children under six years, and eight focus group discussions were held with 64 women of reproductive age. Quantitative data were analysed using descriptive statistics and binomial logistic linear regression, while qualitative data were analysed using inductive thematic analysis. Survey findings revealed that 95.7% of women supported male attendance at ANC visits, while 78% favoured male presence during delivery. Support for MPI during delivery was associated with prior male attendance at ANC and previous birth, as well as older maternal age. Qualitative findings highlighted that women valued emotional and practical support and appreciated men’s improved knowledge about pregnancy and childbirth. However, some women expressed concerns about privacy, cultural expectations, male anxiety, and potential verbal abuse. The combined findings reveal the complexity of women’s perspectives on MPI, underscoring the importance of context-sensitive interventions that prioritise women’s voices while promoting constructive male engagement in maternal health. Full article

Background/Objectives: Children receiving chemotherapy are highly susceptible to infection, and bloodstream infection (BSI) is a major cause of morbidity in febrile neutropenia. Post-transfusion fever represents a specific diagnostic dilemma, where febrile non-hemolytic transfusion reactions may be clinically indistinguishable from early BSI. We aimed to develop and internally validate a simple bedside score to predict BSI in children presenting to the ED with post-transfusion fever. Methods: We performed a retrospective, single-center diagnostic prediction study of consecutive ED encounters between 2015 and 2024 in a tertiary children’s hospital. Eligible encounters involved patients ≤ 18 years with an underlying malignancy receiving systemic chemotherapy who presented with fever within 24 h of red blood cell or platelet transfusion, had neutropenia, and with at least one blood culture obtained. BSI was defined as growth of a clinically significant pathogen within 48 h; episodes with only contaminants or colonizing flora were classified as non-BSI. Multivariable logistic regression with four prespecified predictors—transfusion-to-ED arrival interval, body temperature, absolute neutrophil count (ANC), and C-reactive protein (CRP)—was used to develop the model and derive a 0–5 point bedside score. Performance was assessed using AUC, diagnostic indices at prespecified cut-offs, calibration, and bootstrap internal validation. Results: Of 507 screened encounters, 287 met inclusion criteria; 39 (13.6%) were adjudicated as BSI. The full model showed good discrimination (AUC 0.82). The derived score (2 points for ANC = 0/µL; 1 point each for temperature ≥ 38.5 °C, CRP ≥ 2.5 mg/dL, and transfusion-to-ED interval ≥ 7 h) achieved an AUC of 0.84. At a cut-off ≥2, sensitivity was 97.4% and negative predictive value 98.8%, misclassifying 1 of 39 BSIs as low risk; at ≥3, specificity was 59.7% with sensitivity 89.7%. Bootstrap-corrected AUC was 0.83. Conclusions: In children receiving chemotherapy who present with post-transfusion fever, a simple 0–5 point bedside score based on temperature, ANC, CRP, and transfusion-to-ED interval provided useful early stratification of BSI risk in this single-center cohort. Prospective multicenter validation is needed before clinical implementation. Full article

Although COVID-19 is associated with significant thrombo-inflammatory complications, reliable biomarkers to guide antithrombotic therapy remain limited. Immature platelet fraction (IPF) reflects platelet turnover and may indicate heightened thrombotic risk. We retrospectively analyzed 133 hospitalized COVID-19 patients (median age 68 years) at a single center. IPF and inflammatory markers (WBC, ANC, D-dimer, LDH, CRP) were measured on admission. Correlations between IPF and these biomarkers were assessed overall and in clinical subgroups (age, sex, disease severity, comorbidities, and treatment). We found that IPF was positively correlated with WBC and ANC in patients less than 70 years old (r = 0.36 and 0.33, respectively; p < 0.05), males, and those with moderate-to-severe disease. Among patients with congestive heart failure, IPF correlated strongly with D-dimer (r = 0.78, p = 0.013). Similar associations were observed in patients requiring enoxaparin or antiplatelet therapy. No significant correlations were found in patients age 70 or older. Based on these findings, we conclude that elevated IPF is associated with increased inflammatory and thrombotic activity in hospitalized COVID-19 patients, especially in younger, male, and more severe cases. These findings suggest IPF may serve as a dynamic marker for thrombo-inflammation and help identify patients who might benefit from more intensive antithrombotic therapy. Larger studies are warranted to validate IPF as a biomarker for personalized management of COVID-19. Full article

Introduction: Exclusive breastfeeding (EBF) is vital for optimal infant health, reducing the risk of infections and enhancing cognitive development. Despite WHO’s recommendation of EBF for the first six months of life, global adherence remains suboptimal, particularly in low-resource settings. This study evaluates the impact of mobile health (mHealth) interventions on exclusive breastfeeding (EBF) among mothers in South Ethiopia. Methods: A cluster randomized controlled trial was conducted in the Gamo Gofa zones, South Ethiopia, involving 20 health facilities (10 intervention and 10 control). The study included 680 pregnant mothers recruited using simple random sampling from antenatal care (ANC) registers and family folders. Mothers in the intervention group received mHealth support, including breastfeeding information and reminders, while the control group received standard care. Participants were followed from the second trimester to six months postpartum. Multilevel survival analysis was applied to assess EBF duration, and multilevel logistic regression was used to evaluate complementary feeding within the first month. Results: The intervention group had a significantly higher probability of maintaining EBF at six months than the control group (AHR = 0.40, 95% CI: 0.26–0.62, p < 0.001). The secondary outcome also shows higher odds of early breastfeeding initiation in the intervention group (AOR = 4.71, 95% CI: 3.10–7.16, p < 0.001). ANC frequency was associated with a lower hazard of stopping EBF (AHR = 0.87, 95% CI: 0.79–0.97, p <0.05). The presence of diarrhea was associated with a high hazard of EBF (AHR = 1.47, 95% CI: 1.07–2.02, p < 0.05). College and above partner education was associated with high hazards of EBF (AHR = 2.41, 95% CI: 1.01–5.78, p < 0.05). The random effects variance (Var = 0.10, 95% CI: 0.01–0.07) indicated significantly lowered cluster-level variability. Conclusion and Recommendations: The mHealth intervention significantly improved EBF adherence and early breastfeeding initiation among mothers in South Ethiopia. Early breastfeeding, ANC frequency, and family size were protective factors, while high partner education and diarrhea disease increased the risk of early cessation of EBF. These findings highlight the potential of mHealth in addressing key barriers to EBF. Scaling up similar interventions, focusing on high-risk groups, could enhance adherence to WHO’s breastfeeding recommendations and improve maternal and child health outcomes in resource-limited settings. Full article