Under-five mortality before and after implementation of the Liberia National Community Health Assistant (NCHA) program: A study protocol.

Between 2018 and 2022 the Liberian Government implemented the National Community Health Assistant (NCHA) program to improve provision of maternal and child health care to underserved rural areas of the country. Whereas the contributions of this and similar community health worker (CHW) based healthcare programs have been associated with improved process measures, the impact of a governmental CHW program at scale on child mortality has not been fully established. We will conduct a cluster sampled, community-based survey with landmark event calendars to retrospectively assess child births and deaths among all children born to women in the Grand Bassa District of Liberia. We will use a mixed effects Cox proportional hazards model, taking advantage of the staggered program implementation in Grand Bassa districts over a period of 4 years to compare rates of under-5 child mortality between the pre- and post-NCHA program implementation periods. This study will be the first to estimate the impact of the Liberian NCHA program on under-5 mortality.

The effect of interviewer-respondent age difference on the reporting of sexual activity in the Demographic and Health Surveys: Analysis of data from 21 countries.

Background: Interviewer effects can have consequential impacts on survey data, particularly for reporting sensitive attitudes and behaviours such as sexual activity and drug use, yet these effects remain understudied in low- and middle-income countries. The Demographic and Health Surveys (DHS) present a unique opportunity to study interviewer effects on the self-report of sensitive topics in low- and middle-income countries by including interviewer characteristics data. This paper aims to narrow the gap in research on interviewer effects by studying the effects that age difference between interviewer and respondent and interviewer survey experience have on the reporting of ever having sexual intercourse. Methods: We used DHS data from 91 066 women and 56 336 men in 21 countries where the standard DHS was implemented among all women of reproductive age, and interviewer characteristics were included in the data set. Using a Bayesian cross-classified model with random intercepts for interviewer and cluster, we assessed whether the effect of an age difference of 10 years or greater was associated with a difference in self-report of ever having sexual intercourse, adjusting for respondent demographics. Results: There was a meaningful association between an age difference of greater than ten years and reporting of ever having had sexual intercourse in most countries for both genders after adjusting for interviewer age and experience, rural or urban cluster, and individual-level characteristics. Among women, the marginal posterior probability of reporting ever having sexual intercourse if the interviewer was ten years or more years older was lower for 17 of 19 countries (countries ranged from -12.50 to 3.90 percentage points). Among men, the marginal posterior probability was lower for 16 of 20 countries, ranging from -18.30 to 17.10 percentage points. Conclusions: In most countries, women and men were less likely to report ever having sexual activity if the interviewer was ten or more years older than them, adjusting for potential confounders. These findings have important implications for interpreting numerous sexual health indicators, such as unmet family planning needs and human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) risk. Survey administrators may consider more careful interviewer-respondent characteristic matching or novel approaches like Audio Computer Assisted Self Interview to minimize interviewer-induced variance.

Traumatic Brain Injury in United States Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Hispanic Veterans-A Review Using the PRISMA Method.

Traumatic brain injury (TBI) is commonly defined by Menon et al. as an "alteration of the brain function, or other evidence of brain pathology, caused by an external force." TBI can be caused by penetrating trauma to the head in which the magnitude of the injury is dependent on the magnitude of the forces that are applied to the head. The consequences of TBI can range from minimal to severe disability and even death. The major objectives of this systematic review are to survey the current literature on Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) Hispanic veterans with TBI. To complete this analysis, the Preferred Reporting Items for Systematic Reviews and MetaAnalysis (PRISMA) identified 875 articles in common and retrieved a total of 34 articles that met the inclusion criteria, consisted of OEF/OIF Hispanic veterans, reported quantitative data, and were conducted with adult U.S. veterans living in the United States. Since TBI diagnosis was unclear in most articles, only five articles that used the VATBIST instrument were analyzed. The results suggested that there is a lack of research on OEF/OIF Hispanic veterans and Hispanic subgroups. Future studies need to be conducted to consider minority groups while analyzing data involving TBI.

Assessing the Risk of Hospital-Acquired Clostridium Difficile Infection With Proton Pump Inhibitor Use: A Meta-Analysis.

BACKGROUND Clostridium difficile is the principal infectious cause of antibiotic-associated diarrhea and accounts for 12% of hospital-acquired infections. Recent literature has shown an increased risk of C. difficile infection (CDI) with proton pump inhibitor (PPI) use. OBJECTIVE To conduct a systematic assessment of the risk of hospital-acquired CDI following exposure to PPI. METHODS We searched multiple databases for studies examining the relationship between PPI and hospital-acquired CDI. Pooled odds ratios were generated and assessment for heterogeneity performed. RESULTS We found 23 observational studies involving 186,033 cases that met eligibility criteria. Across studies, 10,307 cases of hospital-acquired CDI were reported. Significant heterogeneity was present; therefore, a random effects model was used. The pooled odds ratio was 1.81 (95% CI, 1.52-2.14), favoring higher risk of CDI with PPI use. Significant heterogeneity was present, likely due to differences in assessment of exposure, study population, and definition of CDI. DISCUSSION This meta-analysis suggests PPIs significantly increase the risk of hospital-acquired CDI. Given the significant health and economic burden of CDI and the risks of PPI, optimization of PPI use should be included in a multifaceted approach to CDI prevention. Infect Control Hosp Epidemiol 2016;1408-1417.

Quantifying accurate calorie estimation using the "think aloud" method.

OBJECTIVE: Clients often have limited time in a nutrition education setting. An improved understanding of the strategies used to accurately estimate calories may help to identify areas of focused instruction to improve nutrition knowledge. METHODS: A "Think Aloud" exercise was recorded during the estimation of calories in a standard dinner meal (415 kcal) in 15 nutrition-trained and 15 untrained subjects. Accuracy of participant estimation was assessed, and estimation strategies were compared in accurate vs inaccurate estimators. RESULTS: Accurate participants were more likely to demonstrate an ability to convert between common portion size measurements and serving sizes, possess some knowledge of energy density, and properly implement basic math skills. CONCLUSIONS AND IMPLICATIONS: The "Think Aloud" methodology was informative in assessing the cognitive processes behind a nutrition exercise, and further use is warranted. Focused instruction in portion size conversion, energy density, and the use of math skills may enhance calorie estimation accuracy.