Interventions to support women with overweight or obesity or gestational diabetes mellitus to initiate and continue breastfeeding: Systematic review and meta-analysis.

Exclusive breastfeeding is recommended for the first 6 months of life and benefits both mother and child. Women with overweight/obesity or gestational diabetes are at risk for poor breastfeeding outcomes. This review evaluates the efficacy of breastfeeding interventions in these at-risk populations. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Five databases were searched for interventions from inception to May 2020. Nineteen trials including 2,740 participants, 226 of which were dyads, were included. Intervention increased any breastfeeding at ≥6 months (OR 1.43, 95% CI [1.05-1.95]), and women in the intervention group were 90% more likely to exclusively breastfeed at 1-2 weeks (OR 1.9, 95% CI [1.17-3.09]) and more than twice as likely to exclusively breastfeed at 4-6 weeks (OR 2.23, 95% CI [1.27-3.90]) within the sensitivity analysis. These findings support breastfeeding interventions improving exclusive early postpartum breastfeeding and any breastfeeding from 6 months in women with gestational diabetes or obesity/overweight. Further randomized controlled trials with harmonized breastfeeding outcome reporting are needed to confirm efficacy.

A rare case of metastatic uterine lymphoma in a renal transplant patient.

Primary and disseminated lymphoma of the female reproductive tract are rare types of lymphoma. However, in the setting of solid organ transplant, recipients have an approximately doubled risk of acquiring and dying from malignancy. Multiple treatment modalities are available for post-transplant lymphoproliferative diseases (PTLD), including chemotherapy, radiotherapy, surgery, and immunosuppression radiotherapy. We report a case of a 61-year-old female with multifocal nodal diffuse large B-cell lymphoma and a history of a renal transplant secondary to IgA nephropathy who developed metastatic diffuse large B-cell lymphoma to the uterus. While the baseline incidence of PTLD is elevated when compared with lymphoma in the general population, metastatic uterine lymphoma is rare. Awareness of reproductive organ involvement by lymphomas and increased malignancy risk in organ transplant patients are important considerations for diagnostic evaluation, including radiologic assessment.

Classification of Geriatric Low Back Pain Based on Hip Characteristics With a 12-Month Longitudinal Exploration of Clinical Outcomes: Findings From Delaware Spine Studies.

OBJECTIVE: The purpose of this study is to identify geriatric chronic low back pain (LBP) subgroups based on the presence of potentially modifiable hip impairments, using Latent Variable Mixture Modeling (LVMM), and to examine the prospective relationship between these subgroups and key outcomes over time. METHODS: Baseline, 3-month, 6-month, and 12-month data were collected from a prospective cohort of 250 community-dwelling older adults with chronic LBP. Comprehensive hip (symptoms, strength, range of motion, and flexibility), LBP (intensity and disability), and mobility function (gait speed and 6-Minute Walk Test) examinations were performed at each timepoint. Baseline hip measures were included in LVMM; observed classes/subgroups were compared longitudinally on LBP and mobility function outcomes using mixed models. RESULTS: Regarding LVMM, a model with 3 classes/subgroup fit best. Broadly speaking, subgroups were differentiated best by hip strength and symptom presence: subgroup 1 = strong and nonsymptomatic, subgroup 2 = weak and nonsymptomatic, and subgroup 3 = weak and symptomatic (WS). Regarding longitudinal mixed models, all subgroups improved in most outcomes over time. Specifically, over 12 months, the nonsymptomatic subgroups had lower LBP intensity and disability levels compared with the WS subgroup, whereas the strong and nonsymptomatic subgroup had better mobility function than the 2 "weak" subgroups. CONCLUSION: These subgroup classifications may help in tailoring specific interventions in future trials. Special attention should be given to the WS subgroup given their consistently poor LBP and mobility function outcomes. IMPACT: Among older adults with chronic low back pain, there are 3 hip subgroups: "strong and nonsymptomatic," "weak and nonsymptomatic," and "weak and symptomatic." People in these subgroups demonstrate different outcomes and require different treatment; proper identification will result in tailored interventions designed to benefit individual patients. In particular, people in the WS subgroup deserve special attention, because their outcomes are consistently poorer than those in the other subgroups.

Markers of Cardiovascular Health in Older Adults with and Without Chronic Low Back and Radicular Leg Pain: A Comparative Analysis.

OBJECTIVES: There is considerable overlap in risk profiles between chronic low back pain with radiculopathy (CLBPR) and cardiovascular health among older adults; obesity and smoking are related to both conditions and may largely drive the potential relationship. We sought to explore the impact of CLBPR on cardiovascular health outcomes, independent of body mass index (BMI) and current smoking status. METHODS: Age- and sex-matched older adults (60-85 years of age) with (n = 21) and without (n = 21) CLBPR were recruited. Current smokers were excluded. Blood samples were collected to measure cholesterol levels and pro-inflammatory markers (i.e., C-reactive protein and interleukin-6). Vascular endothelial function, a marker of cardiovascular health, was evaluated by measuring brachial artery flow-mediated dilation (FMD). General linear models with multifactorial designs were evaluated; group membership, BMI, education, and their respective two-way interaction terms were included as independent variables. RESULTS: Older adults with CLBPR had significantly higher BMIs (P = 0.004) and lower educational levels (P = 0.013) than did those without pain. There was a significant group-by-education interaction effect (P = 0.049) for endothelial function. Older adults without pain who were highly educated had higher FMD values, indicating better endothelial function (9.2%), whereas the following combinations all had lower FMD values: no pain plus low education, CLBPR plus high education, and CLBPR plus low education (5.9%, 6.1%, and 6.6%, respectively). CONCLUSIONS: Among older adults, CLBPR is linked with worse endothelial function, regardless of educational level and independent of BMI and smoking. These findings suggest that older adults with CLBPR may be at a higher risk of cardiovascular disease.

Overweight and obesity in shift workers: associated dietary and lifestyle factors.

BACKGROUND: Approximately 17% of the European Union workforce is engaged in shift work. Shift work has been associated with a number of chronic conditions, including obesity and obesity-related metabolic diseases. The aim of this study was to explore the dietary and lifestyle behaviours of shift workers with a healthy vs. overweight/obese body mass index (BMI). METHODS: A cross-sectional study was conducted on 1080 shift workers using a 15-min, telephone-administered questionnaire developed from qualitative research on Irish shift workers and national dietary intake data. Demographic and work-related factors, as well as dietary and lifestyle behaviours were recorded. BMI was calculated using self-reported height and weight. Univariate and multivariate logistic regression methods were used to analyze data according to BMI category. RESULTS: Over 40% of shift workers were classified as overweight or obese. Multivariate analysis indicated that being male [P < 0.001, aOR = 2.102, 95% CI (1.62-2.73)] and middle- or older-aged were independently associated with overweight and obesity [P < 0.001, aOR = 2.44 95% CI (1.84-3.24) and P < 0.001, aOR = 2.9 95% CI (1.94-4.35), respectively]. Having a medium-high consumption of fried foods was independently associated with overweight and obesity [aOR = 1.38, 95% CI (1.06-1.8)]. CONCLUSIONS: Similar to the general population, overweight and obesity were strongly associated with male sex and middle- or older-age. Male shift workers may benefit from targeted dietary and lifestyle advice specifically focused on limiting fried foods to help protect against overweight and obesity.

Adherence to dietary and physical activity guidelines among shift workers: associations with individual and work-related factors.

OBJECTIVES: Shift work is associated with adverse effects on the health and lifestyle behaviours of employees. This study aimed to examine factors associated with adherence among shift workers to selected indicators of dietary and physical activity guidelines. METHODS: A cross-sectional study was conducted on 1300 shift workers. Data were collected using a 15 minute telephone-administered questionnaire. Logistic regression methods were used for data analysis. RESULTS: Male shift workers (p<0.001, OR=0.55, 95% CI 0.40 to 0.74) and those of lower socioeconomic status (p=0.046, OR=0.75, 95% CI 0.57 to 0.99) were significantly less likely to consume five or more daily servings of fruits and vegetables. Shift workers with access to workplace vending machines were significantly more likely to consume soft drinks at least weekly (p=0.003, OR=1.64, 95% CI 1.18 to 2.27). Middle-aged shift workers (p=0.012, OR=0.65, 95% CI 0.46 to 0.91) and those reporting insufficient break times at work (p=0.026, OR=0.69, 95% CI 0.49 to 0.96) were significantly less likely to be sufficiently active. CONCLUSIONS: Individual, work schedule and workplace environment related factors were independently associated with selected indicators of adherence to dietary and physical activity guidelines in this cohort of shift workers.

Palliative care made visible: Developing a rural model for the Western Cape Province, South Africa.

INTRODUCTION: Caring for people with life-threatening illnesses is a key part of working in health care. While South Africa launched the National Policy Framework and Strategy for Palliative Care 2017-2022, integrating palliative care into existing public health care is in its infancy. Most patients in the Western Cape have poor access to palliative care, an inequality felt hardest by those living in rural areas.Building the model: In 2018, with district wide institutional managerial support, a palliative care model for rural areas was initiated in the Western Cape. The process involved setting up hospital- and community-based multi-professional palliative care teams, initiating weekly palliative care ward rounds, training champions in palliative care and raising awareness of palliative care and its principles. DISCUSSION: Establishing regular ward rounds has changed the way patients needing palliative care are managed, particularly in challenging the mindsets of specialist departments. The emergence of the multi-professional team listening and planning together at the patient's bedside has restored some of the dignity and ethos of patient-centred care, which is a core principle of the provincial Health Care 2030 vision. CONCLUSION: In a short time period, we have managed to build a service that aims to improve care for palliative patients in rural areas. Its strength lies in a multi-professional patient-centred approach and improved communication between different components of the health system, providing a more seamless service that supports patients when they need it most.

Retrograde viral vector-mediated inhibition of pontospinal noradrenergic neurons causes hyperalgesia in rats.

Pontospinal noradrenergic neurons form a component of an endogenous analgesic system and represent a potential therapeutic target. We tested the principle that genetic manipulation of their excitability can alter nociception using an adenoviral vector (AVV-PRS-hKir(2.1)) containing a catecholaminergic-selective promoter (PRS) to retrogradely transduce and inhibit the noradrenergic neurons projecting to the lumbar dorsal horn through the expression of a potassium channel (hKir(2.1)). Expression of hKir(2.1) in catecholaminergic PC12 cells hyperpolarized the membrane potential and produced a barium-sensitive inward rectification. LC neurons transduced by AVV-PRS-hKir(2.1) in slice cultures also showed barium-sensitive inward rectification and reduced spontaneous firing rate (median 0.2 Hz; n = 19 vs control 1.0 Hz; n = 18, p < 0.05). Pontospinal noradrenergic neurons were retrogradely transduced in vivo by injection of AVV into the lumbar dorsal horn (L4-5). Rats transduced with AVV-PRS-hKir(2.1) showed thermal but not mechanical hyperalgesia. Similar selective augmentation of thermal hyperalgesia was seen in the CFA-inflammatory pain model after AVV-PRS-hKir(2.1). In the formalin test, rats transduced with hKir(2.1) showed enhanced nocifensive behaviors (both Phase I and II, p < 0.05, n = 11/group) and increased c-Fos-positive cells in the lumbar dorsal horn. Transduction with AVV-PRS-hKir(2.1) before spared nerve injury produced no change in tactile or cold allodynia. Thus, the selective genetic inhibition of approximately 150 pontospinal noradrenergic neurons produces a modality-specific thermal hyperalgesia, increased nocifensive behaviors, and spinal c-Fos expression in the formalin test, but not in the spared nerve injury model of neuropathic pain, indicating that these neurons exert a selective tonic restraining influence on in vivo nociception.