Articles: ninos.
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Accelerating improvements in maternal and newborn health (MNH) care is a major public health priority in Kenya. While use of formal health care has increased, many pregnant and postpartum women do not receive the recommended number of maternal care visits. Even when they do, visits are often short with many providers not offering important elements of evaluation and counseling, leaving gaps in women's knowledge and preparedness. Digital health tools have been proposed as a complement to care that is provided by maternity care facilities, but there is limited evidence of the impact of digital health tools at scale on women's knowledge, preparedness, and the content of care they receive. We evaluated a digital health platform (PROMPTS (Promoting Mothers in Pregnancy and Postpartum Through SMS)) composed of informational messages, appointment reminders, and a two-way clinical helpdesk, which had enrolled over 750,000 women across Kenya at the time of our study, on 6 domains across the pregnancy-postpartum care continuum. ⋯ Digital health tools indicate promise in addressing shortcomings in pregnant and postpartum women's health care, amidst systems that do not reliably deliver a minimally adequate standard of care. Through providing women with critical information and empowering them to seek recommended care, such tools can improve individuals' preparation for safe childbirth and receipt of more comprehensive postpartum care. Future work is needed to ascertain the impact of at-scale digital platforms like PROMPTS on health outcomes.
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Ustekinumab is an effective drug in the treatment of inflammatory bowel disease (IBD), but inadequate response or loss of response is reported in several patients. Dose escalation by intravenous reinduction or interval shortening may be a suitable option to recapture response. We undertook a systematic review and meta-analysis to assess the efficacy of dose escalation in IBD patients receiving ustekinumab. ⋯ This systematic review and meta-analysis showcased promising results, in terms of clinical response and remission, in IBD patients receiving dose escalation of ustekinumab.
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Sodium-glucose cotransporter 2 (SGLT2) inhibitors, glucagon-like peptide-1 (GLP-1) receptor agonists, and dipeptidyl peptidase 4 (DPP4) inhibitors improve hyperglycemia, and SGLT2 inhibitors and GLP-1 receptor agonists reduce the risk of major adverse cardiovascular events (MACEs) among individuals with type 2 diabetes. It is not clear whether efficacy varies by age or sex. ⋯ The SGLT2 inhibitors and GLP-1 receptor agonists were associated with lower risk of MACEs. Analysis of age × treatment interactions suggested that SGLT2 inhibitors were more cardioprotective in older than in younger people despite smaller reductions in HbA1c; GLP-1 receptor agonists were more cardioprotective in younger people.
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The aims of this study were to compare concentration maximum (Cmax), time to Cmax, area under the curve, mean concentration over 4 minutes, and frequency and time to return of spontaneous circulation (ROSC) by group. ⋯ The Cmax and area under the curve were significantly higher in the IV Group compared to the 0.1 mg/kg ET Group (P < .05). The time to Cmax was significantly longer in the 0.1 mg/kg Group than the 1 mg IV Group (P = .03). The mean concentration of the 1 mg IV Group was higher than the 0.1 mg/kg ET Group until 180 and 240 seconds. There was no significant difference between the groups relative to time to ROSC (P > .05). Return of spontaneous circulation frequencies were: 0.1 mg/kg ET Group (7 of 8); 1 mg IV Group (5 of 8); and 2 mg ET Group (1 of 8), and both CPR + defib and CPR-Only (0 out of 8). This study challenges the current guidelines relative to ET epinephrine administration. Based on our ROSC data, the 0.1 mg/kg dose of epinephrine by ET should be used as a first-line intervention.
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Deployments are stressful for both service members and their families. To promote the overall health and welfare of those impacted by military deployment, it is important to identify individual resilience-building resources that service members can employ to strengthen their own well-being, the well-being of their families, and the readiness of the force. This pilot study examines different resilience-building skills that may impact individual well-being, relationship quality, and family satisfaction post-deployment. ⋯ The strengths and resources reported as contributing the most to family effectiveness and well-being were personal character traits, external relationship skills, emotional maturity, and the ability to work. The results identified unique individual resilience-building resources for service members, which contribute to their well-being and the well-being of their families. Findings suggest that training on individual resilience-building resources for service members can offer support to the entire family system following military deployment.