Population modifiable risk factors associated with neonatal mortality in 35 sub-Saharan Africa countries: analysis of data from demographic and health surveys.

Background: Sub-Saharan Africa (SSA) has the highest burden of neonatal mortality in the world. Identifying the most critical modifiable risk factors is imperative for reducing neonatal mortality rates. This study is the first to calculate population-attributable fractions (PAFs) for modifiable risk factors of neonatal mortality in SSA. Methods: We analysed the most recent Demographic and Health Surveys data sets from 35 SSA countries conducted between 2010 and 2022. Generalized linear latent and mixed models were used to estimate odds ratios (ORs) along with 95% confidence intervals (CIs). PAFs adjusted for communality were calculated using ORs and prevalence estimates for key modifiable risk factors. Subregional analyses were conducted to examine variations in modifiable risk factors for neonatal mortality across Central, Eastern, Southern, and Western SSA regions. Findings: In this study, we included 255,891 live births in the five years before the survey. The highest PAFs of neonatal mortality among singleton children were attributed to delayed initiation of breastfeeding (>1 h after birth: PAF = 23.88%; 95% CI: 15.91, 24.86), uncleaned cooking fuel (PAF = 5.27%; 95% CI: 1.41, 8.73), mother's lacking formal education (PAF = 4.34%; 95% CI: 1.15, 6.31), mother's lacking tetanus vaccination (PAF = 3.54%; 95% CI: 1.55, 4.92), and infrequent antenatal care (ANC) visits (PAF = 2.45; 95% CI: 0.76, 3.63). Together, these five modifiable risk factors were associated with 39.49% (95% CI: 21.13, 48.44) of neonatal deaths among singleton children in SSA. Our subregional analyses revealed some variations in modifiable risk factors for neonatal mortality. Notably, delayed initiation of breastfeeding consistently contributed to the highest PAFs of neonatal mortality across all four regions of SSA: Central, Eastern, Southern, and Western SSA. Interpretation: The PAF estimates in the present study indicate that a considerable proportion of neonatal deaths in SSA are preventable. We identified five modifiable risk factors that accounted for approximately 40% of neonatal deaths in SSA. The findings have policy implications. Funding: None.

Integrating genomics, phenomics, and deep learning improves the predictive ability for Fusarium head blight-related traits in winter wheat.

Fusarium head blight (FHB) remains one of the most destructive diseases of wheat (Triticum aestivum L.), causing considerable losses in yield and end-use quality. Phenotyping of FHB resistance traits, Fusarium-damaged kernels (FDK), and deoxynivalenol (DON), is either prone to human biases or resource expensive, hindering the progress in breeding for FHB-resistant cultivars. Though genomic selection (GS) can be an effective way to select these traits, inaccurate phenotyping remains a hurdle in exploiting this approach. Here, we used an artificial intelligence (AI)-based precise FDK estimation that exhibits high heritability and correlation with DON. Further, GS using AI-based FDK (FDK_QVIS/FDK_QNIR) showed a two-fold increase in predictive ability (PA) compared to GS for traditionally estimated FDK (FDK_V). Next, the AI-based FDK was evaluated along with other traits in multi-trait (MT) GS models to predict DON. The inclusion of FDK_QNIR and FDK_QVIS with days to heading as covariates improved the PA for DON by 58% over the baseline single-trait GS model. We next used hyperspectral imaging of FHB-infected wheat kernels as a novel avenue to improve the MT GS for DON. The PA for DON using selected wavebands derived from hyperspectral imaging in MT GS models surpassed the single-trait GS model by around 40%. Finally, we evaluated phenomic prediction for DON by integrating hyperspectral imaging with deep learning to directly predict DON in FHB-infected wheat kernels and observed an accuracy (R2 = 0.45) comparable to best-performing MT GS models. This study demonstrates the potential application of AI and vision-based platforms to improve PA for FHB-related traits using genomic and phenomic selection.

Barriers and facilitators to self-care practices for sexual and reproductive health among women of reproductive age.

INTRODUCTION: Sexual and Reproductive Health and Rights (SRHR) have been promoted globally, yet sexual and reproductive health (SRH) interventions are seldom evaluated from the perspective of service users and service providers. Very little is known about whether and why various target groups including general women are (or are not) practicing SRH -related self-care practices. This study explored SRH self-care practices and facilitators and barriers to the adoption of SRH self-care among reproductive-age women of Nepal. METHODS: In this descriptive qualitative study, we conducted in-depth interviews in June 2022 with ten married women of reproductive age (service users) and four SRHR service providers (program managers and health service providers) in Nepal. Thematic analysis was conducted for data analysis. RESULTS: We found that commonly practiced self-care practices were self-administration of contraceptives, self-management of pain, self-monitoring of pregnancy, self-awareness and seeking medical abortions (tele-abortion), self-medication for pre-exposure prophylaxis for HIV, and self-testing for HIV and pregnancy. The multi-level barriers to SRH self-care were poor knowledge and perceived lack of need for SRH self-care, limited access, and negative behaviors from the service providers. The program-related barriers included lack of evidence, limited financial resources, lack of accountability, and limited knowledge and skills among service providers on SRH self-care measures. Peer support, an increasing number of service sites, and access to and use of digital (health) tools emerged as the facilitators of SRH self-care. CONCLUSIONS: The findings of this study suggest that addressing barriers such as poor knowledge, limited access, and negative attitudes while leveraging facilitators such as peer support and digital tools is essential for promoting and enabling effective SRH self-care among women. Population-wide awareness programs supplemented by increasing service sites are essential for increasing SRH self-care practices.

Increasing melanoma incidence with unchanged mortality: more sunshine, better treatment, increased diagnostic activity, overdiagnosis or lowered diagnostic threshold?

BACKGROUND: Increasing melanoma incidence with less increasing mortality is observed in several countries. This discrepancy is not well understood. OBJECTIVE: In this study, our aim was to discuss factors (UV exposure, melanoma treatment, diagnostic activity, overdiagnosis, pathologists' diagnostic threshold and clinicians' propensity to remove suspect skin lesions) that may influence melanoma incidence and mortality in Denmark. METHODS: This was a register study with the number of melanocyte-related lesions and melanoma mortality based on comprehensive national pathology and mortality databases for the period 1999-2019. We investigated melanocyte-related diagnoses and mortality in a population of 5.5 million with national health care system. Age adjusted melanoma mortality and age-adjusted incidence of benign nevi, atypical lesion, or melanoma-in-situ and of invasive melanoma were computed for data analysis. RESULTS: In total 1,434,798 biopsies were taken from 704,682 individuals (65% female). Mean age at biopsy was 39.8 years in men and 37.6 in women. In men and women, the incidence of invasive melanoma increased by 87% during the period 1999-2011. During the subsequent period it increased by 9% in men but remained unchanged in women. The incidence of melanoma in-situ increased by 476% in men and 357% in women during the study period, while the increases for atypical melanocytic lesions were 1928% and 1686%, respectively. Biopsy rates increased by 153% in men and 118% in women from 1999 through 2011 but fell by 20% in men and 22% in women during the subsequent period. Mortality varied slightly from year to year without any significant time trend for men or women.We identified no evidence of increased UV exposure over the latest 30 years in Denmark. Immunotherapy of advanced melanoma was introduced in Denmark in 2010 and came in general use in 2014. CONCLUSIONS: Comprehensive national data demonstrate increasing melanoma incidence correlated with increasing biopsy rates, but with no change in mortality. Previously suggested explanations for such a trend are lowered threshold of melanoma diagnosis among pathologists, increased diagnostic activity in the presence of overdiagnosis and improved melanoma treatment. Because the study is observational and because we have more explanatory factors than outcomes, the findings do not warrant conclusions about causal relationships.

Exploring the healthcare access challenges faced by visually impaired young women in Nepal: Navigating sexual harassment and stigma within healthcare settings.

Introduction: Despite global progress in gender equality, still not every woman has access to safe and the highest quality health care. Visually impaired young adult women represent one of the most vulnerable groups with a poorer ability to access necessary healthcare services. This study aims to explore and comprehend the experiences of visually impaired young adult women in accessing healthcare services in Nepal. Methods: A descriptive phenomenological study was conducted among 16 visually impaired women aged 20 to 35 years who had utilized healthcare services within the past 12 months. Face-to-face, in-depth interviews were conducted for data collection, and thematic analysis was conducted for data analysis. Results: Our study revealed a range of challenges faced by visually impaired young women that impeded their healthcare-seeking. These challenges included sexual harassment by male healthcare providers, disability-related stigma, financial difficulties, limited autonomy in decision-making, and a lack of disability-friendly healthcare facilities and services. Particularly, experiencing sexual harassment from male healthcare providers, coupled with underlying disability-related stigma, profoundly influenced the avoidance of healthcare. To navigate these challenges, some women sought support by having family members or friends accompany them or by requesting to be seen by a female healthcare provider. Nevertheless, financial dependence on families and women lacking employment and income led to a feeling of burden on the family, contributing to a reluctance among women to seek expensive healthcare. Social organization-based, collaborative efforts and peer support networks played a significant role in breaking down barriers and improving overall healthcare experiences. Conclusions: While integrating disability-friendly healthcare services and infrastructure is essential, fostering attitudinal and behavioral change-particularly among male healthcare providers-is more important to ensure safety for young women in healthcare settings. The implementation of anti-sexual harassment policies is imperative to ensure a safe and respectful environment. Community mobilizing and peer group-based programs can be tested for increasing visually impaired women's utilization of relevant healthcare services.

Increased Stigma, and Physical and Sexual Violence Against Men Who Have Sex with Men and Transgender Women in Sub-Saharan Africa: A Qualitative Evidence Synthesis Analyzing Social and Structural Barriers to HIV Testing and Coping Behaviors.

In sub-Saharan Africa, accessing HIV testing services is a significant challenge for men who have sex with men (MSM) and transgender women (TGW). In this qualitative evidence synthesis, our aim is to understand social and structural barriers and how they hinder MSM's and TGW's access to HIV testing services in sub-Saharan African countries. We searched four selective databases (PubMed, Web of Science and CINAHL complemented with Google Scholar) for qualitative studies, published in English between January 2005 and December 2023, generated 1507 articles, of which 22 were included. Thematic synthesis was conducted for data synthesis. This led to five barriers that hinder HIV test uptake among MSM and TGW, which included: non-availability of tailored HIV testing services, stigma, lack of trust among service providers, sexual and physical violence, and criminalization of same sex relationship. To navigate these social and structural barriers and cope with fears of discrimination and criminalization, MSM and TGW engaged into riskier behaviors, including avoiding HIV testing, non-disclosure, or relying on informal or alternative sources of HIV testing. Decriminalization of same-sex relationship and peer-led HIV testing services were noted to address structural barriers, including stigma and poor access, and subsequently increase the participation in HIV testing services.

Population modifiable risk factors associated with under-5 acute respiratory tract infections and diarrhoea in 25 countries in sub-Saharan Africa (2014-2021): an analysis of data from demographic and health surveys.

Background: Identifying the critical modifiable risk factors for acute respiratory tract infections (ARIs) and diarrhoea is crucial to reduce the burden of disease and mortality among children under 5 years of age in sub-Saharan Africa (SSA) and ultimately achieving the Sustainable Development Goals (SDGs). We investigated the modifiable risk factors of ARI and diarrhoea among children under five using nationally representative surveys. Methods: We used the most recent demographic and health survey (DHS) data (2014-2021) from 25 SSA countries, encompassing a total of 253,167 children. Countries were selected based on the availability of recent datasets (e.g., DHS-VII or DHS-VIII) that represent the current socioeconomic situations. Generalised linear latent mixed models were used to compute odds ratios (ORs). Population attributable fractions (PAFs) were calculated using adjusted ORs and prevalence estimates for key modifiable risk factors among ARI and diarrhoeal cases. Findings: This study involved 253,167 children, with a mean age of 28.7 (±17.3) months, and 50.5% were male. The highest PAFs for ARI were attributed to unclean cooking fuel (PAF = 15.7%; 95% CI: 8.1, 23.1), poor maternal education (PAF = 13.4%; 95% CI: 8.7, 18.5), delayed initiation of breastfeeding (PAF = 12.4%; 95% CI: 9.0, 15.3), and poor toilets (PAF = 8.5%; 95% CI: 4.7, 11.9). These four modifiable risk factors contributed to 41.5% (95% CI: 27.2, 52.9) of ARI cases in SSA. The largest PAFs of diarrhoea were observed for unclean cooking fuel (PAF = 17.3%; 95% CI: 13.5, 22.3), delayed initiation of breastfeeding (PAF = 9.2%; 95% CI: 7.5, 10.5), household poverty (PAF = 7.0%; 95% CI: 5.0, 9.1) and poor maternal education (PAF = 5.6%; 95% CI: 2.9, 8.8). These four modifiable risk factors contributed to 34.0% (95% CI: 26.2, 42.3) of cases of diarrhoea in SSA. Interpretation: This cross-sectional study identified four modifiable risk factors for ARI and diarrhoea that should be a priority for policymakers in SSA. Enhancing home-based care and leveraging female community health workers is crucial for accelerating the reduction in under-5 mortality linked to ARI and diarrhoea in SSA. Funding: None.

Study protocol for the family empowerment program: a randomized waitlist-controlled trial to evaluate the effectiveness of online Community Reinforcement and Family Training (CRAFT) on the wellbeing of family members with a relative experiencing substance dependence and mental illness.

BACKGROUND: Systematic reviews consistently show that family-focused interventions are effective at improving substance treatment engagement and outcomes across the lifespan. Yet, Australian substance use treatment services rarely incorporate family members and concerned significant others. Testing of family focussed interventions in the Australian context is required. METHODS: The trial is a randomized wait-list control trial assessing the effectiveness, feasibility and acceptability of online CRAFT with a parallel group. Participants will be randomised to receive either online CRAFT or to a wait-list control group who are provided with CRAFT related reading material during the waiting period. Outcomes will be assessed at baseline and then at 6- and 15-weeks post baseline. The primary outcome will be improved wellbeing of participating family members. The trial reporting will comply with SPIRIT guidelines. DISCUSSION: This study will focus on people living in rural areas. Substance treatment programs are limited in rural Australia. The provision of the Family Empowerment Program (CRAFT) online should make family focused substance treatment support accessible and attainable for the first time in rural areas. The outcomes of this trial could have meaningful implications for the future funding and support of family focused substance treatment services that are inclusive of people with mental health conditions. TRIAL REGISTRATION: ANZCTR, ACTRN12623000796684p, Registered 26 July 2023. Prospectively registered with protocol version 3.

Delays in seeking treatment for fever in children under five years of age in Nigeria: Evidence from the National Demographic Health Survey.

BACKGROUND: In countries with high child mortality rates, such as Nigeria, early intervention for common childhood illnesses (e.g., pneumonia and malaria) is essential for improving clinical outcomes. The timely reporting and treatment of fever is therefore critical in making a differential diagnosis and choosing an appropriate course of treatment. The present study aimed to investigate the prevalence and major risk factors associated with delays in seeking treatment for fever in children under five years of age in Nigeria. METHODS: This study used a total weighted sample of 7,466 children under five years of age from the 2018 National Nigerian Demographic and Health Survey. Multivariable binary logistic regression modelling was used to investigate the association between predisposing, enabling, need, health service and community level factors, and delay in treatment-seeking for fever. RESULTS: We report the delays in seeking treatment for childhood fever that was reported by mothers in the last two weeks prior to the national survey. The prevalence for delayed treatment was 62.1% (95% confidence interval [CI]: 60.1%, 64.1%). Our findings showed that there were fewer delays in seeking treatment in children aged 24-59 months (adjusted odds ratio [aOR] = 0.79, 95% CI: 0.68, 0.93), among mothers who were formally employed (aOR = 0.84; 95% CI: 0.73, 0.96), regularly attended antenatal services (aOR = 0.76, 95%CI: 0.66, 0.88), and for those who resided in wealthier households (aOR = 0.71; 95% CI: 0.56, 0.89). Children whose mothers resided in the North-West geopolitical zone of Nigeria were less likely to delay seeking treatment for fever (aOR = 0.55; 95% CI: 0.42, 0.73). However, mothers who had an unwanted pregnancy had a higher odds of delaying treatment for childhood fever (aOR = 1.58; 95% CI: 1.05, 2.39). CONCLUSION: There were significant delays in seeking treatment for childhood fever in poorer homes found in geopolitically unstable zones of Nigeria. Mothers who were poor, unemployed, and with younger children (<12 months) often delayed seeking treatment for their febrile child. Future health promotion strategies and microenterprise schemes should target both rural and urban mothers residing in poor households. Children under 12 months of age should be a priority.

Subjective expectation of reaching age 85: agreement with population statistics and association with behavioral and psychological factors.

BACKGROUND: It is not clearly known how well Danes estimate their chances of reaching the average life expectancy and whether identifiable population subgroups misestimate their life expectancy, and potentially also investments and savings in health and pensions. Therefore, in this study, we examined on the individual level whether subjective life expectancy is in line with the statistically calculated chance of reaching age 85, and further explored the psychological and behavioral factors associated with under or overestimation. METHODS: We opted for a cross-sectional survey design based on a sample of 5,379 Danish citizens aged 50-70 years, returning a web-based questionnaire with socio-demographic data supplemented from a national registry. Average participant estimates of their chance of reaching age 85 for each age range and sex group were compared with actuarial data. We then performed multiple linear regression analyses to examine factors associated with the subjective expectancy of reaching age 85 years. RESULTS: We found that 32% of females and 23% of males reported 100% certainty of reaching age 85, and average expected survival chance exceeded the statistically predicted survival chance for 23% of males and 16% for females in age-ranges 50-60 and 61-70. Our multivariable analysis found that health literacy, internal health locus of control, willingness to take health risks, self-rated health, and health and life satisfaction all showed a significant positive association with expectation of reaching age 85. Moreover, those on daily medications, ex- or current smokers, and heavy drinkers were significantly less optimistic about reaching age 85. CONCLUSIONS: Particularly for the population groups with inaccurate life expectancies, the significant associations with psychological and behavioral factors open a way for initiatives based on behavior change theories to reach a better agreement between subjective and statistical life expectancy.

The role of modifiable risk factors in incident cancer in transport, rescue, and security industries.

PURPOSE: Examine the risk for site-specific incident cancer across representative transport, rescue, and security industries. METHODS: This Danish nationwide register-based study included all 302,789 workers from transport, rescue and security industries in 2001-2015 and 2,230,877 individuals aged 18-64 years from a total sample of the economically active population for comparison. We used Cox models to estimate the hazard ratios (HRs) of incident cancers. We categorized site-specific cancers by using population-attributable fraction (PAF) estimates from the previous literature. RESULTS: During an average follow-up of 13.4 years, 22,116 incident cancer cases were recorded in these industries. Compared with the reference population, the age-adjusted cancer incidence with a high PAF was higher among men in seafaring (HR 1.28; 95% CI 1.14-1.43), and land transport (HR 1.32; 95% CI: 1.26-1.37), and among women in seafaring (HR 1.26; 95% CI: 1.01-1.57), land transport (HR 1.21; 95% CI: 1.12-1.32), aviation (HR 1.22; 95% CI: 1.05-1.41), and police force (HR 1.21; 95% CI: 1.04-1.40). Overall, tobacco and physical inactivity were the most significant risk factors of cancer. CONCLUSIONS: Regardless of considerable disparities in incident cancer attributable to modifiable risk factors across industries, the total incident cancer rate was elevated in all industries in both sexes.

Women's attitude towards intimate partner violence and utilization of contraceptive methods and maternal health care services: an analysis of nationally representative cross-sectional surveys from four South Asian countries.

BACKGROUND: Intimate partner violence (IPV) adversely affects women's reproductive health outcomes but to what extent women's justification of IPV affects maternal health care service utilization is unexplored. METHODS: The secondary cross-sectional datasets from multiple indicator cluster surveys of Afghanistan, Bhutan, Nepal and Pakistan conducted between 2010 and 2015 were used. We used a generalized linear mixed model with random effects, at both cluster- and country-level, to determine the odds ratio of maternal health service utilization at the regional level and a multivariable logistic regression model adjusting for complex survey design at the country level. Interaction between women's justification of IPV and residential location, and linear trend in the utilization of maternal health care services associated with increasing levels of women's justification of IPV, were examined using the Likelihood Ratio Test (LRT). RESULTS: A total of 26,029 women aged 15-49 years, living with their partners and had a pregnancy outcome 2 years prior to the survey were included. Women justifying IPV were less likely to utilize contraceptive methods (aOR) = 0.86, 95% CI 0.84, 0.88), at-least one Antenatal Care (ANC) visit (aOR = 0.80, 95% CI 0.72, 0.88), four or more ANC services (aOR = 0.81, 95% CI 0.76, 0.86), institutional delivery (aOR = 0.87, 95% CI 0.80, 0.94) and Post-natal Care (aOR = 0.76, 95% CI 0.62, 0.95) services. A decreasing linear trend was observed for four or more ANC visits (LRT P = 0.96) and institutional delivery (LRT P = 0.80) with increasing levels of IPV justification. Women justifying IPV were less likely to have at least one ANC visit in urban (aOR 0.67, 95% CI 0.60, 0.75) compared to rural areas (aOR 0.83, 95% CI 0.73, 0.94). CONCLUSIONS: Women's justification of IPV was associated with decreased odds of utilizing a wide range of maternal health care services at the regional level. Although further research that may help establish a causal link is important before formulating public health interventions, our study indicates interventions targeting women's condoning attitude toward IPV, delivered sooner rather than later, could potentially help to improve women's utilization of essential maternal health care services in the South Asian region that comprises Afghanistan, Bhutan, Nepal, and Pakistan.

Prolongation of disease-free life: When is the benefit sufficient to warrant the effort of taking a preventive medicine?

The prolongation of disease-free life (PODL) required by people to be willing to accept an offer of a preventive treatment is unknown. Quantifying the required benefits could guide information and discussions about preventive treatment. In this study, we investigated how large the benefit in prolongation of a disease-free life (PODL) should be for individuals aged 50-80 years to accept a preventive treatment offer. We used a cross-sectional survey design based on a representative sample of 6847 Danish citizens aged 50-80 years. Data were collected in 2019 through a web-based standardized questionnaire administered by Statistics Denmark, and socio-demographic data were added from a national registry. We analyzed the data with chi-square tests and stepwise multinomial logistic regression. The results indicate that the required minimum benefit from the preventive treatment varied widely between individuals (1-week PODL = 14.8%, ≥4 years PODL = 39.2%), and that the majority of individuals (51.1%) required a PODL of ≥2 years. The multivariable analysis indicate that education and income were independently and negatively associated with requested minimum benefit, while age and smoking were independently and positively associated with requested minimum benefit to accept the preventive treatment. Most individuals aged 50-80 years required larger health benefits than most preventive medications on average can offer. The data support the need for educating patients and health care professionals on how to use average benefits when discussing treatment benefits, especially for primary prevention.

Elderly care in Nepal: Are existing health and community support systems enough.

In Nepal, a few governmental and community-based programmes for elderly care are in place; however, information about successful implementation and overall effectiveness of these programmes is not well understood. In this article, we introduced these programmes and discussed existing programmes' gaps and implementation problems in light of existing grey and peer-reviewed evidence. A few notable governmental programmes, such as providing monthly allowances, pensions and free health care, have targeted specifically the elderly individuals. Yet, most health care institutions and providers are privately owned and profit-oriented, and there is a general lack of proper governmental health as well as social security systems for the elderly in the country. Generally, Nepalese communities consist of neighbourhood-based and religious-based groups that provide emotional and spiritual support to elderly individuals as well as provide support for health care access when needed. However, the influence that these groups can have on health and social well-being of elderly remains not well understood. Traditional family-based support systems may be feasible only for some families, while for others it could impose financial and psychological burdens. The role of the state is important in the effective implementation of existing programmes as well as in the development and implementation of additional programmes to ensure health and social well-being of elderly individuals. Furthermore, there is a need to establish partnerships with existing community structures and to mobilize them in the implementation of community-based programmes.

Isolated Cysticercosis of Sternocleidomastoid Muscle: Role of Ultrasonography.

Cysticercosis is considered a common healthcare problem, especially in developing countries. The invasion of muscle by the larval stage of the pork tapeworm, Taenia solium (i.e., Cysticercus cellulosae) usually occurs in association with CNS cysts, concurrent muscle cysts, or both. Isolated skeletal muscle involvement is rare and presents with nonspecific symptoms resulting in a diagnostic dilemma for the treating physician. We report a 20-year-old female with isolated cysticercosis of right sternocleidomastoid muscle presenting as a right neck swelling and mild pain for 4 months, whose diagnosis was established by ultrasonography (USG) and computed tomogram (CT) scan. She was managed conservatively with oral albendazole therapy for four weeks resulting in complete resolution.

Suspicious Case of a Body packer "Mule" in a Low Resource Country: A Case Report.

Body packing is the process of smuggling illicit drugs in the form of packages concealed within the gastrointestinal tract via ingestion or inserting into body orifices. These individuals are described as "body packers", "stuffers", "mules" or "swallowers" and resort to carrying drugs like heroin, cocaine and cannabis. They present to the hospital following the development of complications or brought dead due to the rupture of packets or directly from detention for further investigations. This case illustrates a suspected case detained from the airport who was found to be carrying 93 pellets of an illicit drug, heroin, weighing 900 grams, one of the highest quantity carried by any body packer in the country till date. This case further sheds light on the fact that a meticulous history, detailed clinical examination and radiographic investigations like abdominal radiograph and imaging are the keys to diagnose body packers in a resource limited setting.

Association between health literacy, general psychological factors, and adherence to medical treatment among Danes aged 50-80 years.

BACKGROUND: Understanding behavioral factors associated with low health literacy (HL) is relevant for health care providers to better support their patients' health and adherence to preventive treatment. In this study, we aim to study associations between low HL and socio-demographic characteristics, medication-related perceptions and experience, as well as general psychological factors among patients aged 50-80 years. METHODS: We used a cross-sectional survey design based on a representative group of 6,871 Danish citizens aged 50-80 years returning a web-based questionnaire with socio-demographic data added from a national registry. Chi-square tests were conducted to analyze associations between low HL and daily use of medication and self-rated health. Chi-square tests and binary logistic regression were conducted for analyzing data from respondents using prescribed medicines daily (N = 4,091). RESULTS: Respondents with low HL were more often on daily medications (19 % [777/4,091] vs. 16 % [436/2,775]; P < 0.001) and were more likely to have poorer self-rated health (P < 0.001). Among patients on daily medications, low HL was significantly higher among men and those with lower educational attainment and lower family income. Low HL was independently and positively associated with perceptions that taking prescribed medicines daily is difficult and time-consuming, with forgetting to take prescribed medicines, and with lower satisfaction with life and poor self-assessed health. CONCLUSIONS: Our study provides information that patients aged 50-80 years with low HL are challenged on their adherence to treatment plans which is not only related to traditional sociodemographic factors but also on perceptions related to taking medication per se.

Lingual Thyroid with Subclinical Hypothyroidism in a Young Female.

Thyroid tissue presenting as a nodule in the base of the tongue due to the embryonic failure to descend to the anterior neck is a rare clinical entity, called lingual thyroid. Clinical presentation varies depending upon the degree of obstruction caused by an enlarged nodule or features related to thyroid function. We report a case of a 27-year-old female who presented with a foreign body sensation in the throat with mild dysphagia for 3 weeks. The patient was diagnosed as lingual thyroid with subclinical hypothyroidism based on clinical findings, imaging, and fine-needle aspiration cytology. Conservative management with hormone suppression can result in size reduction of ectopic thyroid tissue improving symptoms without surgery. Lingual thyroid with mild symptoms and subclinical hypothyroidism can be managed conservatively.