Correction to: Determinants of exclusive breastfeeding in infants of six months and below in Malawi: a cross sectional study.

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

Determinants of exclusive breastfeeding in infants of six months and below in Malawi: a cross sectional study.

BACKGROUND: UNICEF and WHO recommend that all children should be exclusively breastfed for the first 6 months of life as breastmilk contains all the nutrients an infant needs during this period. In Malawi, exclusive breastfeeding has been declining from 72% (2009), 70.2% (2014) and 61% in the most recent survey (2015-16). We aimed to determine factors associated with exclusive breastfeeding in Malawi. METHODS: We used data from the Malawi Demographic and Health Survey (MDHS) 2015-2016. Survey records for 2059 mothers of children aged 6 months and below were identified and potential factors influencing infant feeding were examined. Logistic regression analysis was carried out to model determinants of exclusive breastfeeding (EBF). RESULTS: EBF declined in proportion to the age of the infant. Significant associations with continuing EBF were age of the mother, ethnicity of the mother, sex of infant and number of siblings. Members of the Tumbuka (OR = 1.71, CI. 1.13-2.59) and Ngoni (OR = 2.05, CI. 1.38-3.05) communities were more likely to practice EBF. In addition, mothers with female babies (OR = 1.35, CI. 1.08-1.70) and those with 3-4 children (OR = 1.47, CI. 1.04-2.08) were more likely to engage in EBF. CONCLUSION: We identify important variations in EBF practices among population sub-groups in Malawi that need to be considered when framing health education messaging. Work is needed to assess the impact of more targeted messaging, whether delivered via 'ten steps' to successful breastfeeding under Baby Friendly Hospital Initiative (BFHI) programming or other health education and awareness campaigns to sensitize communities on implications of some cultural practices on the lives of babies. The potential role for mass media, targeted Health Surveillance Assistants' (HSA) home visits and male involvement also require exploration.

Skeletonized vs Pedicled Internal Mammary Artery Graft Harvesting in Coronary Artery Bypass Surgery: A Post Hoc Analysis From the COMPASS Trial.

Importance: The relative safety and patency of skeletonized vs pedicled internal mammary artery grafts in patients undergoing coronary artery bypass graft (CABG) surgery are unknown. Objective: To investigate the association of skeletonized vs pedicled harvesting with internal mammary artery graft patency and clinical outcomes 1 year after CABG surgery. Design, Setting, and Participants: This study was a post hoc analysis of the multicenter, randomized, double-blind, placebo-controlled Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) clinical trial, which enrolled 27 395 patients from 602 centers in 33 countries from March 2013 through May 2016. Eligibility criteria for the trial included CABG surgery for coronary artery disease with at least 2 grafts implanted and an estimated glomerular filtration rate of at least 30 mL/min. A total of 1002 of 1448 patients were randomized to the CABG arm of the COMPASS trial and underwent skeletonized (282 [28.1%]) or pedicled (720 [71.9%]) internal mammary artery harvesting. The patients had evaluable angiography results 1 year after surgery. Data were analyzed from October 11, 2019, to May 14, 2020. Interventions: Patients underwent graft harvesting with either the pedicled technique or skeletonized technique. Main Outcomes and Measures: The primary outcome was graft occlusion 1 year after CABG surgery, as assessed by computed tomography angiography. Results: A total of 1002 patients underwent skeletonized (282 [28.1%]; mean [SD] age, 65.9 [8.1] years; 229 men [81.2%]; 194 White patients [68.8%]) or pedicled (720 [71.9%]; mean [SD] age, 64.8 [7.6] years; 603 men [83.8%]; 455 White patients [63.2%]) internal mammary artery harvesting. Rates of internal mammary artery graft occlusion 1 year after CABG surgery were higher in the skeletonized group than in the pedicled group (33 of 344 [9.6%] vs 30 of 764 [3.9%]; graft-level adjusted odds ratio, 2.41; 95% CI, 1.39-4.20; P = .002), including the left internal mammary artery to left anterior descending artery (21 of 289 [7.3%] vs 25 of 725 [3.4%]; graft-level adjusted odds ratio, 2.10; 95% CI, 1.14-3.88, P = .02). After a mean follow-up of 23 months, skeletonized graft harvesting was also associated with a higher rate of major adverse cardiovascular events (20 [7.1%] vs 15 [2.1%]; adjusted hazard ratio, 3.19; 95% CI, 1.53-6.67; P = .002) and repeated revascularization (14 [5.0%] vs 10 [1.4%]; adjusted hazard ratio, 2.75; 95% CI, 1.10-6.88; P = .03). Conclusions and Relevance: This post hoc analysis of the COMPASS randomized clinical trial found that harvesting of the internal mammary artery during CABG surgery using a skeletonized technique was associated with a higher rate of graft occlusion and worse clinical outcomes than the traditional pedicled technique. Future randomized clinical trials are needed to establish the safety and patency of the skeletonized technique. Trial Registration: ClinicalTrials.gov Identifier: NCT01776424.

[Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries in a case-control study based on the INTERHEART study]. / A módosítható kockázati tényezok hatása a szívizominfarktus kialakulására 52 országra kiterjedo eset-kontroll vizsgálat az INTERHEART tanulmány alapján.

An international, standardised case-control study was established to assess the importance of risk factors for coronary heart disease worldwide. From 52 countries representing every inhabited continent 15152 cases and 14820 controls were enrolled. The relation of smoking, history of hypertension and/or diabetes, waist/hip ratio, dietary patterns, physical activity, consumption of alcohol, blood apolipoproteins and psychosocial factors to myocardial infarction was reported. Odds ratios and their 99% confidence limits for the association of risk factors to acute myocardial infarction and their population attributable risks were calculated. Smoking (odds ratio 2.87 for current vs never, population attributable risk 35.7% for current and former smoker vs never), raised apolipoprotein B / apolipoprotein A1 ratio (3.25 for top vs lowest quintile, population attributable risk 49.2 for top four quintiles vs lowest quintile), history of hypertension (1.91, 17.9%), diabetes (2.37, 9.9%), abdominal obesity (1.12 for top vs lowest tertile and 1.62 for middle vs lowest tertile, 20.1% for top two tertiles vs lowest tertile), psychosocial factors (2.67, 32.5), daily consumption of fruits and vegetables (0.70, 13.7% for lack of daily consumption), regular alcohol consumption (0.91, 6.7%), and regular physical activity (0.86, 12.2%) were all significantly related to acute myocardial infarction (p < 0.0001 for all risk factors, and p = 0.03 for alcohol). These associations were noted in men and women, old and young and in all regions of the world. Collectively these nine risk factors accounted for 90% of the population attributable risk in men and 94% in women. This finding suggests that approaches to prevention can be based on similar principles worldwide.