Risk factors of anaemia and iron deficiency in Somali children and women: Findings from the 2019 Somalia Micronutrient Survey

There are limited data on the prevalence of anaemia and iron deficiency (ID) in Somalia. To address this data gap, Somalia's 2019 micronutrient survey assessed the prevalence of anaemia and ID in children (6–59 months) and non-pregnant women of reproductive age (15–49 years). The survey also collected data on vitamin A deficiency, inflammation, malaria and other potential risk factors for anaemia and ID. Multivariable Poisson regressions models were used to identify the risk factors for anaemia and ID in children and women. Among children, the prevalence of anaemia and ID were 43.4% and 47.2%, respectively. Approximately 36% and 6% of anaemia were attributable to iron and vitamin A deficiencies, respectively, whereas household possession of soap was associated with approximately 11% fewer cases of anaemia. ID in children was associated with vitamin A deficiency and stunting, whereas inflammation was associated with iron sufficiency. Among women, 40.3% were anaemic, and 49.7% were iron deficient. In women, ID and number of births were significantly associated with anaemia in multivariate models, and approximately 42% of anaemia in women was attributable to ID. Increased parity was associated with ID, and incubation and early convalescent inflammation was associated with ID, whereas late convalescent inflammation was associated with iron sufficiency. ID is the main risk factor of anaemia in both women and children and contributed to a substantial portion of the anaemia cases. To tackle both anaemia and ID in Somalia, food assistance and micronutrient-specific programmes (e.g. micronutrient powders and iron supplements) should be enhanced.     

A Mixed Methods Review of Male Nursing Students' Challenges during Nursing Education and Strategies to Tackle these Challenges

BackgroundCalls to action have been placed for recruitment of more men to address nursing shortage and to achieve a better balance and diversity in workforce. Studies also indicated patients' demand for male nurses. Despite this, male nursing students experience challenges during their education resulting in their attrition. No reviews have explored this research area. This review explored the challenges of male nursing students during their education and identified strategies used to tackle these challenges.MethodsLiterature was searched within three databases using indexed search phrases and 1 mixed-methods, six quantitative, and 36 qualitative studies (n = 43), published from December 1990 to May 2018, were reviewed. The qualitative and quantitative data were separately extracted and analyzed using thematic synthesis and narrative summaries, and then compared using joint displays.Findings“Call me a nurse” and “Male nurses understand us better: Need more men in nursing” were the prominent themes. An array of educational and clinical challenges was identified. Students used appraisal-focused, problem-focused, and social support strategies to tackle these challenges.ConclusionConsidering the identified challenges, the lack of support and efforts from educators and institutions, we reiterate calls to action for strategic policies to help male nursing students adapt to educational and clinical learning environments and to increase their recruitment and retention in nursing.     

Interplay of vitamin D,vitamin B12, homocysteine and bone mineral density in postmenopausal females

ABSTRACT

Osteoporosis is most common age related, multifactorial disease. The aim of the researchers were to discover the association between serum homocysteine, vitamin D, vitamin B₁₂ and bone mineral density in postmenopausal non-osteoporotic and osteoporotic females. In this cross- sectional study, 156 postmenopausal females between 50–70 years of age were recruited and divided into two groups, non-osteoporotic (n = 52) and osteoporotic (n = 104). There was significant negative correlation of homocysteine with vitamin D and B₁₂ in postmenopausal non-osteoporotic and homocysteine with vitamin B₁₂ in postmenopausal osteoporotic females. Serum homocysteine levels were predicted by vitamin D in postmenopausal non-osteoporotic and vitamin B₁₂ in postmenopausal osteoporotic females.     

Association of serum leptin with bone mineral density in postmenopausal osteoporotic females

Objective: Present study was designed to find out whether leptin is a predictor of bone mass density (BMD) in premenopausal women (PMW) and postmenopausal osteoporotic women (PMOPW) or it has no association with BMD.

Methods: One hundred and ninety two women (98 PMOPW and 94 PMW) were recruited for this study. The control group was BMI matched with osteoporotic subjects. BMD assessment was done on calcaneus by peripheral ultrasound bone densitometry and T scores were determined. Serum leptin levels were measured by enzyme-linked immunosorbent assay (ELISA).

Results: Serum leptin and BMD values were significantly different in both groups (leptin, 18.56?±?8.65?ng/ml versus 21.64?±?9.80?ng/ml, p?=?0.02) and (BMD, ?0.70?±?0.19 versus ?3.17?±?0.59, p?=?0.000), respectively. In PMOPW serum leptin and BMD were considerably correlated with weight (lep, r?=?0.53, p?=?<0.001; BMD, r?=??0.21, p?=?0.02), BMI (lep, r?=?0.52, p =?<0.001; BMD, r?=??0.27, p?=?0.005), waist circumference (lep, r?=?0.61, p?=?<0.001; BMD, r?=?0.18, p?=?0.04), hip circumference (lep, r?=?0.58, p?=?<0.001).

Multivariate linear stepwise regression analysis showed that weight and BMI in PMW and PMOPW were independent predictors of BMD. Serum leptin level was not found to be the predictor of BMD in both groups.

Conclusion: The present results indicate that body weight and BMI have an impact on BMD while serum leptin is not associated with BMD in PMW and PMOPW.     

Modified Continuous Mucosal Connell Suture for the Pharyngeal Closure After Total Laryngectomy: Zipper Suture

Objectives

Pharyngocutaneous fistula is a serious complication after total laryngectomy, and there are some risk factors stated in the literature. The surgical suture techniques are not studied so much. The aim of this study is to evaluate the effectiveness of ''modified continuous mucosal Connell suture'' on the incidence of pharyngocutaneous fistula after total laryngectomy.

Methods

This is a retrospective case series study based at a tertiary center with 31 patients who underwent total laryngectomy between July 2011 and December 2013. Pharyngocutaneous fistula formation after total laryngectomy was evaluated with the patients who underwent modified continuous mucosal Connell suture for pharyngeal repair.

Results

Pharyngocutaneous fistula was observed in only one patient (3.2%) who had a history of previous radiotherapy, and it was spontaneously healed within 6 days by conservative treatment.

Conclusion

We defined a new suture technique for the pharyngeal repair after total laryngectomy. This technique is a simple modification of continuous mucosal Connell suture. We named it as zipper suture. It is effective in the prevention of pharyngocutaneous fistula for pharyngeal reconstruction after total laryngectomy.