Cultural hierarchies in health: Does inherited sociocultural position (biraderi) shape diet and nutrition among British Pakistani children? Protocol for a mixed-methods study.

This study aims to explore links between biraderi-a form of identity-based social grouping and stratification which cuts across religions among South Asians-and infant and child nutrition among British Pakistanis using data from the Born in Bradford cohort study. The study will entail a mixed-methods approach to (i) develop an operational framework of biraderi for epidemiologic analyses and apply it to longitudinal data from the Born in Bradford cohort study, (ii) quantify and describe child nutrition and dietary patterns for biraderi sub-groups, and (iii) investigate whether known mechanisms of identity-based segregation, graded inequality, and network effects operate through diet and nutrition in the UK. Using Krieger's ecosocial theory as an integrative framework we will (iv) re-conceptualise and interpret the role of biraderi / caste in the social construction and embodied experience of how infants and children eat in the UK. Following a literature review on biraderi and health, we will convene and consult a lay consultation group in Bradford through focus groups and academic experts through a Delphi study to guide planning, implementation, interpretation and dissemination of our secondary data analysis. In addition to being the first study to look at biraderi-based nutritional inequalities in the UK, our study is innovative in that we will formally involve experts and users in the design and interpretation of our quantitative analyses. Findings will be applicable in any part of the world where children experience disadvantage linked to sociocultural hierarchy and identity. Our findings will be of particular use in (i) identifying women and children at particular risk of suboptimal breastfeeding practices, poor complementary feeding, and unhealthy diets in primary school in the UK, and (ii) elucidating the sociocultural pathways through which inequalities in population health nutrition outcomes are expressed.

Global elective breast- and colorectal cancer surgery performance backlogs, attributable mortality and implemented health system responses during the COVID-19 pandemic: A scoping review.

Globally, 28.4 million non-emergent ('elective') surgical procedures have been deferred during the COVID-19 pandemic. This study evaluated the impact of the COVID-19 pandemic on elective breast- or colorectal cancer (CRC) procedure backlogs and attributable mortality, globally. Further, we evaluated the interaction between procedure deferrals and health systems, internationally. Relevant articles from any country, published between December 2019-24 November 2022, were identified through searches of online databases (MEDLINE, EMBASE) and by examining the reference lists of retrieved articles. We organised health system-related findings thematically per the Structures-Processes-Outcomes conceptual model by Donabedian (1966). Of 337 identified articles, we included 50. Eleven (22.0%) were reviews. The majority of included studies originated from high-income countries (n = 38, 76.0%). An ecological, modelling study elucidated that global 12-week procedure cancellation rates ranged from 68.3%-73%; Europe and Central Asia accounted for the majority of cancellations (n = 8,430,348) and sub-Saharan Africa contributed the least (n = 520,459). The percentage reduction in global, institutional elective breast cancer surgery activity ranged from 5.68%-16.5%. For CRC, this ranged from 0%-70.9%. Significant evidence is presented on how insufficient pandemic preparedness necessitated procedure deferrals, internationally. We also outlined ancillary determinants of delayed surgery (e.g., patient-specific factors). The following global health system response themes are presented: Structural changes (i.e., hospital re-organisation), Process-related changes (i.e., adapted healthcare provision) and the utilisation of Outcomes (i.e., SARS-CoV-2 infection incidence among patients or healthcare personnel, postoperative pulmonary complication incidence, hospital readmission, length of hospital stay and tumour staging) as indicators of health system response efficacy. Evidence on procedure backlogs and attributable mortality was limited, partly due to insufficient, real-time surveillance of cancer outcomes, internationally. Elective surgery activity has decreased and cancer services have adapted rapidly, worldwide. Further research is needed to understand the impact of COVID-19 on cancer mortality and the efficacy of health system mitigation measures, globally.

The social media diet: A scoping review to investigate the association between social media, body image and eating disorders amongst young people.

BACKGROUND: Eating disorders are a group of heterogenous, disabling and deadly psychiatric illnesses with a plethora of associated health consequences. Exploratory research suggests that social media usage may be triggering body image concerns and heightening eating disorder pathology amongst young people, but the topic is under-researched as a global public health issue. AIM: To systematically map out and critically review the existing global literature on the relationship between social media usage, body image and eating disorders in young people aged 10-24 years. METHODS: A systematic search of MEDLINE, PyscINFO and Web of Science for research on social media use and body image concerns / disordered eating outcomes published between January 2016 and July 2021. Results on exposures (social media usage), outcomes (body image, eating disorders, disordered eating), mediators and moderators were synthesised using an integrated theoretical framework of the influence of internet use on body image concerns and eating pathology. RESULTS: Evidence from 50 studies in 17 countries indicates that social media usage leads to body image concerns, eating disorders/disordered eating and poor mental health via the mediating pathways of social comparison, thin / fit ideal internalisation, and self-objectification. Specific exposures (social media trends, pro-eating disorder content, appearance focused platforms and investment in photos) and moderators (high BMI, female gender, and pre-existing body image concerns) strengthen the relationship, while other moderators (high social media literacy and body appreciation) are protective, hinting at a 'self-perpetuating cycle of risk'. CONCLUSION: Social media usage is a plausible risk factor for the development of eating disorders. Research from Asia suggests that the association is not unique to traditionally western cultures. Based on scale of social media usage amongst young people, this issue is worthy of attention as an emerging global public health issue.

Effects of community youth teams facilitating participatory adolescent groups, youth leadership activities and livelihood promotion to improve school attendance, dietary diversity and mental health among adolescent girls in rural eastern India (JIAH trial): A cluster-randomised controlled trial.

Objectives: To evaluate whether and how community youth teams facilitating participatory adolescent groups, youth leadership and livelihood promotion improved school attendance, dietary diversity, and mental health among adolescent girls in rural India. Design: A parallel group, two-arm, superiority, cluster-randomised controlled trial with an embedded process evaluation. Setting intervention and participants: 38 clusters (19 intervention, 19 control) in West Singhbhum district in Jharkhand, India. The intervention included participatory adolescent groups and youth leadership for boys and girls aged 10-19 (intervention clusters only), and family-based livelihood promotion (intervention and control clusters) between June 2017 and March 2020. We surveyed 3324 adolescent girls aged 10-19 in 38 clusters at baseline, and 1478 in 29 clusters at endline. Four intervention and five control clusters were lost to follow up when the trial was suspended due to the COVID-19 pandemic. Adolescent boys were included in the process evaluation only. Primary and secondary outcome measures: Primary: school attendance, dietary diversity, and mental health; 12 secondary outcomes related to education, empowerment, experiences of violence, and sexual and reproductive health. Results: In intervention vs control clusters, mean dietary diversity score was 4·0 (SD 1·5) vs 3·6 (SD 1·2) (adjDiff 0·34; 95%CI -0·23, 0·93, p = 0·242); mean Brief Problem Monitor-Youth (mental health) score was 12·5 (SD 6·0) vs 11·9 (SD 5·9) (adjDiff 0·02, 95%CI -0·06, 0·13, p = 0·610); and school enrolment rates were 70% vs 63% (adjOR 1·39, 95%CI 0·89, 2·16, p = 0·142). Uptake of school-based entitlements was higher in intervention clusters (adjOR 2·01; 95%CI 1·11, 3·64, p = 0·020). Qualitative data showed that the community youth team had helped adolescents and their parents navigate school bureaucracy, facilitated re-enrolments, and supported access to entitlements. Overall intervention delivery was feasible, but positive impacts were likely undermined by household poverty. Conclusions: Participatory adolescent groups, leadership training and livelihood promotion delivered by a community youth team did not improve adolescent girls' mental health, dietary diversity, or school attendance in rural India, but may have increased uptake of education-related entitlements. Trial registration: ISRCTN17206016.

Smartphone-Based mHealth and Internet of Things for Diabetes Control and Self-Management.

In patients with chronic diseases condition, mobile health monitoring facility proves to play a significant role in providing significant assistance toward personal management. This research examined the use of smartphones by diabetes patients and their intentions to apply them for self-care and monitoring as well as management. This cross-sectional survey-based study was conducted in Jul-Aug 2021 with 200 diabetic patients (especially type 2) who were visiting specialized clinics and hospitals of Gujrat state, India. A validated questionnaire survey was designed to collect data, which included questions about demographics, information pertaining to other, use of cellphones, the Internet, and the intention to implement smartphones for diabetes monitoring, self-care, and self-management. A highest number of studied participants have mobile phone (97.5%) and smartphones (87%) and access the Internet on daily basis (83.5%). Younger participants were more inclined to use smartphone apps and have also shown more interest for continuous use in the future (p < 0.01). The majority of participants used apps for nutritional planning (85.5%), to monitor glucose control (76.5%), and for scheduling of diabetes appointments on the calendar (90.5%). Recommendations to use mobile app by doctors or healthcare profession were reported by 20.5% of the participants and attitude and future intention to use mobile apps were reported by the majority of participants. The majority of type 2 diabetes patients choose to use their cellphones and the internet or mobile phone reminder system for medication as well as to plan their diets, monitor their blood sugar levels, and communicate with their doctors. The findings of this research can be used to develop strategies and implement mHealth-based therapies to assist patients with type 2 diabetes to efficiently manage their health and might contribute to reducing patients' out-of-pocket expenditure as well as reducing disability-adjusted life years (DAILY) attributed by DM.

Palliative chemotherapy with or without cetuximab in recurrent or metastatic squamous cell carcinoma of the head and neck: Indian tertiary care retrospective analysis.

BACKGROUND: We report our experience with Indian patients who received palliative chemotherapy with/without cetuximab for recurrent/metastatic squamous cell carcinoma of the head and neck (R/M SCCHN). METHODS: Data from 229 R/M SCCHN patients treated with cetuximab and chemotherapy (n = 140) or chemotherapy alone (n = 89) were retrospectively analyzed for response rate (RR), progression-free survival (PFS), overall survival (OS), and safety. RESULTS: Patients receiving cetuximab with chemotherapy demonstrated significant increase in RR (77.1% vs 44.9%, P = .0001), PFS (8.1 vs 6.1 months, P = .039), and OS (11.8 vs 8.0 months, P = .002) compared with patients receiving chemotherapy alone. Continuing cetuximab and changing chemotherapy combination (second line and beyond) in fit patients doubled OS (13.5 vs 6.1 months, P = .001). Adverse effects, except skin reactions (more in the cetuximab with chemotherapy group; P = .001), were similar in both groups. CONCLUSION: Adding cetuximab to chemotherapy improved ORR, PFS, and OS in Indian R/M SCCHN patients, and cetuximab was well tolerated.

Community youth teams facilitating participatory adolescent groups, youth leadership activities and livelihood promotion to improve school attendance, dietary diversity and mental health among adolescent girls in rural eastern India: protocol for a cluster-randomised controlled trial.

BACKGROUND: Improving the health and development of adolescents aged 10-19 years is a global health priority. One in five adolescents globally live in India. The Rashtriya Kishor Swasthya Karyakram (RKSK), India's national adolescent health strategy, recommends supporting community-based peer educators to conduct group meetings with boys and girls. Groups aim to give adolescents a space to discuss the social and health issues affecting them and build their capacity to become active community members and leaders. There have been no evaluations of the community component of RKSK to date. In this protocol, we describe the evaluation of the Jharkhand Initiative for Adolescent Health (JIAH), a community intervention aligned with RKSK and designed to improve school attendance, dietary diversity and mental health among adolescent girls aged 10-19 years in rural Jharkhand, eastern India. METHODS: The JIAH intervention is delivered by a community youth team consisting of yuva saathis (friends of youth), youth leadership facilitators and livelihood promoters. Teams conduct (a) peer-led Participatory Learning and Action meetings with girls and boys, mobilising adolescents, parents, health workers, teachers and the wider community to make changes for adolescent health and development; (b) group-based youth leadership activities to build adolescents' confidence and resilience; and (c) livelihood promotion with adolescents and their families to provide training and practical skills. We are evaluating the JIAH intervention through a parallel-group, two-arm, superiority, cluster-randomised controlled trial. The unit of randomisation is a geographic cluster of ~1000 people. A total of 38 clusters covering an estimated population of 40,676 have been randomised to control or intervention arms. Nineteen intervention clusters have adolescent groups, youth leadership activities and livelihood promotion. Nineteen control clusters receive livelihood promotion only. Study participants are adolescent girls aged 10-19 years, married or unmarried, in or out of school, living in the study area. Intervention activities are open to all adolescent boys and girls, regardless of their participation in surveys. We will collect data through baseline and endline surveys. Primary trial outcomes are school attendance, dietary diversity and internalising and externalising mental health problems. Secondary outcomes include access to school-related entitlements, emotional or physical violence, self-efficacy and resilience. TRIAL REGISTRATION: ISRCTN17206016. Registered on 27 June 2018.

The Global Nutrition Report 2014: actions and accountability to accelerate the world's progress on nutrition.

In 2013, the Nutrition for Growth Summit called for a Global Nutrition Report (GNR) to strengthen accountability in nutrition so that progress in reducing malnutrition could be accelerated. This article summarizes the results of the first GNR. By focusing on undernutrition and overweight, the GNR puts malnutrition in a new light. Nearly every country in the world is affected by malnutrition, and multiple malnutrition burdens are the "new normal." Unfortunately, the world is off track to meet the 2025 World Health Assembly (WHA) targets for nutrition. Many countries are, however, making good progress on WHA indicators, providing inspiration and guidance for others. Beyond the WHA goals, nutrition needs to be more strongly represented in the Sustainable Development Goal (SDG) framework. At present, it is only explicitly mentioned in 1 of 169 SDG targets despite the many contributions improved nutritional status will make to their attainment. To achieve improvements in nutrition status, it is vital to scale up nutrition programs. We identify bottlenecks in the scale-up of nutrition-specific and nutrition-sensitive approaches and highlight actions to accelerate coverage and reach. Holding stakeholders to account for delivery on nutrition actions requires a well-functioning accountability infrastructure, which is lacking in nutrition. New accountability mechanisms need piloting and evaluation, financial resource flows to nutrition need to be made explicit, nutrition spending targets should be established, and some key data gaps need to be filled. For example, many UN member states cannot report on their WHA progress and those that can often rely on data >5 y old. The world can accelerate malnutrition reduction substantially, but this will require stronger accountability mechanisms to hold all stakeholders to account.

Primary testicular non-Hodgkin's lymphoma--a review article.

Primary testicular non-Hodgkin's lymphoma was first described as a clinical entity in 1866. It is a rare disease and accounts for 1% of all non-Hodgkin's lymphoma, 2% of all extranodal lymphomas and 5% of all testicular neoplasms. It is the most common testicular tumor in males between sixty and eighty years of age. Testicular non-Hodgkin's lymphoma is unique in its high incidence of bilateral involvement (8-38%), and it is also the most common bilateral testicular tumor. Testicular non-Hodgkin's lymphoma has a predilection for spreading to non-contiguous extranodal sites, especially the central nervous system. Advanced-stage disease is usually managed with doxorubicin-based chemotherapy. For early-stage disease, opinion is divided regarding systemic chemotherapy following orchidectomy. The high incidence of spreading, especially to the central nervous system, leads to advocacy of the use of central nervous system prophylaxis with intrathecal chemotherapy. Prospective multicenter trials incorporating a large number of patients may lead to better guidelines for optimal management of this subtype of non-Hodgkin's lymphoma.

Isolated intraorbital metastasis in breast carcinoma.

We report a case of metastases to the eye, in a 30 year old lady with carcinoma breast leading to isolated metastatic involvement of the lateral rectus muscle with no evidence of metastases at any other site in the body after a follow up of one year after completion of chemotherapy.

Primary testicular non-Hodgkin's lymphoma: a review article

Primary testicular non-Hodgkin's lymphoma was first described as a clinical entity in 1866. It is a rare disease and accounts for 1 percent of all non-Hodgkin's lymphoma, 2 percent of all extranodal lymphomas and 5 percent of all testicular neoplasms. It is the most common testicular tumor in males between sixty and eighty years of age. Testicular non-Hodgkin's lymphoma is unique in its high incidence of bilateral involvement (8-38 percent), and it is also the most common bilateral testicular tumor. Testicular non-Hodgkin's lymphoma has a predilection for spreading to non-contiguous extranodal sites, especially the central nervous system. Advanced-stage disease is usually managed with doxorubicin-based chemotherapy. For early-stage disease, opinion is divided regarding systemic chemotherapy following orchidectomy. The high incidence of spreading, especially to the central nervous system, leads to advocacy of the use of central nervous system prophylaxis with intrathecal chemotherapy. Prospective multicenter trials incorporating a large number of patients may lead to better guidelines for optimal management of this subtype of non-Hodgkin's lymphoma.

O linfoma primário do testículo (LPT) foi descrito como uma entidade clínica pela primeira vez em 1866. É uma doença rara e corresponde a 1 por cento de todos os linfomas não-Hodgkin, 2 por cento de todos os linfomas extranodais e 5 por cento de todos as neoplasias testiculares. É o tumor testicular mais comum em homens entre 60 e 80 anos de idade. LPT é único em sua elevada incidência de envolvimento bilateral (8-38 por cento), sendo o tumor testicular bilateral mais comum. Tem uma predileção por disseminação para regiões extranodais não-contíguas, especialmente para o sistema nervoso central (SNC). Estágios avançados da doença são usualmente tratados com quimioterapia à base de doxorubicina. Para os estágios mais precoces, as opiniões são divergentes quanto à quimioterapia associada à orquiectomia. A alta prevalência de disseminação, especialmente para o SNC, sugere o uso de quimioterapia intratecal como profilaxia. Estudos prospectivos multicêntricos incluindo um grande número de pacientes poderiam resolver a questão com relação ao manejo deste subtipo de linfoma não-Hodgkin.

Spinal cord compression secondary to bone metastases from hepatocellular carcinoma.

Bone metastases are rare in primary hepatocellular carcinoma (HCC). Spinal cord compression (SCC) due to bone metastases occur commonly in patients with lung and breast carcinomas, and metastatic HCC is an unusual cause of SCC. Spinal cord compression is an oncologic emergency and treatment delays can lead to irreversible consequences. Thus, the awareness that SCC could be a potential complication of bone metastases due to HCC is of significance in initiation of early treatment that can improve the quality of life and survival of the patients, if diagnosed earlier. This paper describes four cases of primary HCC with varied manifestations of SCC due to bone metastases. The first patient presented primarily with the symptoms of bone pains corresponding to the bone metastases sites rather than symptoms of associated hepatic pathology and eventually developed SCC. The second patient, diagnosed as having HCC, developed extradural SCC leading to paraplegia during the course of illness, for which he underwent emergency laminectomy with posterior fixation. The third patient developed SCC soon after the primary diagnosis and had to undergo emergency laminectomy. Post laminectomy he had good neurological recovery. The Fourth patient presented primarily with radicular pains rather than frank paraplegia as the first manifestation of SCC.

Breast carcinoma with metastasis to the gallbladder: an unusual case report with a short review of literature.

Gallbladder metastases are very rare and usually arise from malignant melanoma, renal cell carcinoma and cervical carcinoma. Breast carcinoma metastatic to the gallbladder is extremely rare and only 4 cases have been reported in the English literature. We hereby report a 54-year-old lady who was diagnosed as having breast carcinoma and underwent modified radical mastectomy. One month after the operation, she developed acute abdominal pain and underwent cholecystectomy after clinical investigation. Histopathological examination revealed metastasis to the gallbladder. Being considered a patient with metastatic breast carcinoma she was subjected to taxane and anthracycline-based palliative chemotherapy. Later she had CNS involvement and died of the progressive disease soon after few months.

Bone metastases from primary hepatocellular carcinoma simulating multiple myeloma.

A 65-year-old man presented with bone pains and anemia. Skull X-ray revealed multiple osteolytic lesions. The patient was evaluated for multiple myeloma but detailed workup revealed the diagnosis of primary hepatocellular carcinoma (HCC) with osteolytic bone metastases. Thus, bone metastases due to HCC, although rare, should be considered in patients presenting with bone pains due to osteolytic lesions.