Long-term outcomes and health-related quality of life 20 years after pediatric liver transplantation.

Pediatric liver transplantation is a challenging surgical procedure requiring complex post-transplant patient management. Liver transplantation in children should ensure long-term survival and good health-related quality of life (HR-QOL), but data in the literature are conflicting. With the aim of investigating survival and psychosocial outcomes of patients transplanted during childhood, we identified 40 patients with ≥ 20-year follow-up after liver transplantation regularly followed up at our Institution. Clinical charts were reviewed to retrieve patients' data. Psychosocial aspects and HR-QOL were investigated by an in-person or telephonic interview and by administering the WHOQOL-BREF questionnaire through an online form. Ten- and 20-year patient survival was 97.5% (95% CI 92.8-100%), whereas 10- and 20-year graft survival was 77.5% (65.6-91.6%) and 74.8% (62.5-89.6%), respectively. At last follow-up visit, 31 patients (77.5%) were receiving a tacrolimus-based immunosuppression. Twelve (32.4%) patients obtained a university diploma or higher, whereas 19 (51.4%) successfully completed high school. 81.1% of patients were active workers or in education, 17.5% had children, and 35% regularly practiced sport. 25 patients answered to the WHOQOL-BREF questionnaire. More than 60% of respondents did not report any disability and the perceived physical status was invariably good or very good. Median scores for physical health, psychological health, social relationships, and environment were 16.6, 14.7, 16, and 15, respectively. Pediatric liver transplantation is associated with excellent long-term survival and good HR-QOL. Psychological health and environment represent areas in which support would be needed to further improve HR-QOL.

Correction to: Effectiveness of a multi-level intervention to reduce men's perpetration of intimate partner violence: a cluster randomised controlled trial.

An amendment to this paper has been published and can be accessed via the original article.

Effectiveness of a multi-level intervention to reduce men's perpetration of intimate partner violence: a cluster randomised controlled trial.

BACKGROUND: Men's perpetration of intimate partner violence (IPV) limits gains in health and wellbeing for populations globally. Largely informal, rapidly expanding peri-urban settlements, with limited basic services such as electricity, have high prevalence rates of IPV. Evidence on how to reduce men's perpetration, change social norms and patriarchal attitudes within these settings is limited. Our cluster randomised controlled trial aimed to determine the effectiveness of the Sonke CHANGE intervention in reducing use of sexual and/or physical IPV and severity of perpetration by men aged 18-40 years over 2 years. METHODOLOGY: The theory-based intervention delivered activities to bolster community action, including door-to-door discussions, workshops, drawing on the CHANGE curriculum, and deploying community action teams over 18 months. In 2016 and 2018, we collected data from a cohort of men, recruited from 18 clusters; nine were randomised to receive the intervention, while the nine control clusters received no intervention. A self-administered questionnaire, using audio-computer assisted software, asked about sociodemographics, gender attitudes, mental health, and the use and severity of IPV. We conducted an intention-to-treat analysis at the cluster level comparing the expected risk to observed risk of using IPV while controlling for baseline characteristics. A secondary analysis used latent classes (LCA) of men to see whether there were differential effects of the intervention for subgroups of men. RESULTS: Of 2406 men recruited, 1458 (63%) were followed to 2 years. Overall, we saw a reduction in men's reports of physical, sexual and severe IPV from baseline to endpoint (40.2% to 25.4%, 31.8% to 15.8%, and 33.4% to 18.2%, respectively). Intention-to-treat analysis showed no measurable differences between intervention and control clusters for primary IPV outcomes. Difference in the cluster-level proportion of physical IPV perpetration was 0.002 (95% confidence interval [CI] - 0.07 to 0.08). Similarly, differences between arms for sexual IPV was 0.01 (95% CI - 0.04 to 0.06), while severe IPV followed a similar pattern (Diff = 0.01; 95% CI - 0.05 to 0.07). A secondary analysis using LCA suggests that among the men living in intervention communities, there was a greater reduction in IPV among less violent and more law abiding men than among more highly violent men, although the differences did not reach statistical significance. CONCLUSION: The intervention, when implemented in a peri-urban settlement, had limited effect in reducing IPV perpetrated by male residents. Further analysis showed it was unable to transform entrenched gender attitudes and use of IPV by those men who use the most violence, but the intervention showed promise for men who use violence less. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02823288. Registered on 30 June 2016.

A cluster randomised controlled trial to determine the effect of community mobilisation and advocacy on men's use of violence in periurban South Africa: study protocol.

OBJECTIVE: This paper describes the design and methods of a cluster randomised controlled trial (C-RCT) to determine the effectiveness of a community mobilisation intervention that is designed to reduce the perpetration of violence against women (VAW). METHODS AND ANALYSIS: A C-RCT of nine intervention and nine control clusters is being carried out in a periurban, semiformal settlement near Johannesburg, South Africa, between 2016 and 2018. A community mobilisation and advocacy intervention, called Sonke CHANGE is being implemented over 18 months. It comprises local advocacy and group activities to engage community members to challenge harmful gender norms and reduce VAW. The intervention is hypothesised to improve equitable masculinities, reduce alcohol use and ultimately, to reduce VAW. Intervention effectiveness will be determined through an audio computer-assisted self-interview questionnaire with behavioural measures among 2600 men aged between 18 and 40 years at baseline, 12 months and 24 months. The primary trial outcome is men's use of physical and/or sexual VAW. Secondary outcomes include harmful alcohol use, gender attitudes, controlling behaviours, transactional sex and social cohesion. The main analysis will be intention-to-treat based on the randomisation of clusters. A qualitative process evaluation is being conducted alongside the C-RCT. Implementers and men participating in the intervention will be interviewed longitudinally over the period of intervention implementation and observations of the workshops and other intervention activities are being carried out. ETHICS AND DISSEMINATION: Ethical approval was obtained from the University of the Witwatersrand Human Research Ethics Committee and procedures comply with ethical recommendations of the United Nations Multi-Country Study on Men and Violence. Dissemination of research findings will take place with local stakeholders and through peer-reviewed publications, with data available on request or after 5 years of trial completion. TRIAL REGISTRATION NUMBER: NCT02823288; Pre-result.

Estructura alimentaria: valor nutritivo y aceptabilidad de preparaciones incluidas en la alimentación institucional del preescolar / Food structure, nutritive value and acceptability on meals offered in the institutional feeding of the preeschol children

El presente trabajo estudia la estructura alimentaria, valor nutritivo y aceptabilidad de las preparaciones ofrecidas en la alimentación institucional del preescolar chileno. La investigación se realizó en 426 niños de ambos sexos, de 2 a 3 años, que asistían a 16 Jardines de la Junta Nacional de Jardines Infantiles (JUNJI) en Santiago. La estructura alimentaria se definió como la contribución porcentual de los alimentos al contenido de energía, proteína, lípidos, hidratos de carbono y fibra cruda y se determinó de la composición alimentaria de las preparaciones. Se evaluaron 14 guisos con sus complementos (ensalada y postre). Se estudio la aceptabilidad de las preparaciones mediante la determinación del consumo por pesada diferencial, ofreciendo repetición en los guisos si el niño lo solicitaba. La conducta y preferencia alimentaria de los niños se estudió a través de las respuestas de un cuestionario contestado por el personal encargado de la alimentación del niño en el Jardín. En un 40% de los guisos el alimento predominante fue la papa y en un 30% el arroz; las leguminosas se proporcionaron con cereales. Se demuestra que los alimentos básicos contribuyen en una alta proporción a la estructura alimentaria de energía, hidratos de carbono, fibra. En cuanto a proteínas destaca el aporte de las leguminosas y de los alimentos de origen animal. El aceite vegetal fue un importante contribuyente de lípidos y energía en los guisos y el principal aportador en las ensaladas. El valor nutritivo de los guisos dependió de la estructura alimentaria. Los guisos con alimentos de origen animal y las combinaciones leguminosa-cereal mostraron los valores más altos de proteínas. Un 50% mostró valores de densidad energética (DE) mayores a 1 kcal/g, éstos fueron todos los guisos de leguminosa-cereal, y los que incluian alimentos de origen animal en cantidades importantes. Según la encuesta de conducta alimentaria los niños prefirieron los guisos con base en papas y en trigo, y dentro de cada grupo de preparaciones los más fluidos y con menor DE, lo que se corroboró experimentalmente en la determinación de consumo. La aceptabilidad de los guisos y de los alimentos del desayuno fue alta. Las ensaladas fueron rechazadas en promedio en un 57% y los postres en un 13%; valores que se obtuvieron ofreciendo repetición del guiso antes de la ensalada y postre. La aceptabilidad de los niños fue selectiva, siendo importante el rechazo demostrado por las ensaladas lo que amerita real