Interpreting the Results of Trials of BCG Vaccination for Protection Against COVID-19.

BCG vaccination has beneficial off-target ("nonspecific") effects on nonmycobacterial infections. On this premise, trials set out to investigate whether BCG provides off-target protection against coronavirus disease 2019 (COVID-19). A literature search identified 11 randomized "BCG COVID-19" trials, with conflicting results. These trials and the differences in their study design are discussed using the PICOT (participants, intervention, control, outcome, and timing) framework to highlight the factors that likely explain their inconsistent findings. These include participant age, sex and comorbid conditions, BCG vaccination strain and dose, outcome measure and duration of follow-up. Understanding how to control these factors to best exploit BCG's off-target effects will be important in designing future trials and intervention strategies.

Postdischarge interventions for children hospitalized with severe acute malnutrition: a systematic review and meta-analysis.

BACKGROUND: Children hospitalized with severe acute malnutrition (SAM) have poor long-term outcomes following discharge, with high rates of mortality, morbidity, and impaired neurodevelopment. There is currently minimal guidance on how to support children with SAM following discharge from inpatient treatment. OBJECTIVES: This systematic review and meta-analysis aimed to examine whether postdischarge interventions can improve outcomes in children recovering from complicated SAM. METHODS: Systematic searches of 4 databases were undertaken to identify studies of interventions delivered completely or partially after hospital discharge in children aged 6-59 mo, following inpatient treatment of SAM. The main outcome of interest was mortality. Random-effects meta-analysis was undertaken where ≥2 studies were sufficiently similar in intervention and outcome. RESULTS: Ten studies fulfilled the inclusion criteria, recruiting 39-1781 participants in 7 countries between 1975 and 2015. Studies evaluated provision of zinc (2 studies), probiotics or synbiotics (2 studies), antibiotics (1 study), pancreatic enzymes (1 study), and psychosocial stimulation (4 studies). Six studies had unclear or high risk of bias in ≥2 domains. Compared with standard care, pancreatic enzyme supplementation reduced inpatient mortality (37.8% compared with 18.6%, P < 0.05). In meta-analysis there was some evidence that prebiotics or synbiotics reduced mortality (RR: 0.72; 95% CI: 0.51, 1.00; P = 0.049). Psychosocial stimulation reduced mortality in meta-analysis of the 2 trials reporting deaths (RR: 0.36; 95% CI: 0.15, 0.87), and improved neurodevelopmental scores in ≥1 domain in all studies. There was no evidence that zinc reduced mortality in the single study reporting deaths. Antibiotics reduced infectious morbidity but did not reduce mortality. CONCLUSIONS: Several biological and psychosocial interventions show promise in improving outcomes in children following hospitalization for SAM and require further exploration in larger randomized mortality trials. This study was registered with PROSPERO as CRD42018111342 (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=111342).

Effects of conditioning on physical fitness and club head speed in mature golfers.

The purpose of this study was to evaluate the effects of an 8-wk. conditioning program on selected measures of physical fitness and golf performance for 12 male and 5 female recreational golfers (M age = 52.4 yr., SD = 6.7 yr.). Measurements were made at baseline and following the intervention. The twice-per-week program consisted of strength training, flexibility, and plyometric exercises. Analysis of the pre- and posttest scores showed that conditioning was associated with significant increases in muscular strength, flexibility, and club head speed. Without a control group, the data suggest conditioning may be a worthwhile activity for mature golfers.

A socioeconomic comparison of patients receiving prostheses in a two-tier delivery system.

It has been theorized that the legalization of providers of denture care other than dentists would make dentures more affordable to and therefore more often obtained by individuals of lower socioeconomic status. The delivery of dental prostheses by nondentists (denturists) has been legalized in Arizona, Colorado, Idaho, Maine, Montana, and Oregon. This study compares the socioeconomic and utilization patterns of two groups of patients receiving prostheses: (1) those whose prosthetic services were provided by dentists and (2) those whose services were provided by denturists. The sample included 135 participants; 31 individuals with 54 prostheses made by denturists and 104 individuals with 165 prostheses made by dentists. Application of the chi-square test and the Hollingshead Two-Factor Index of Social Position revealed no statistically significant correlation, (p less than 0.05) between the provider-based groups and standard socioeconomic variables. The history and pattern of choice of provider as well as level of satisfaction were also remarkable for the similarity displayed by the two groups. It would appear that the two groups are actually one homogeneous group served by two levels of providers.