Malnutrition is still a widespread public health problem worldwide. The objective of this review is to identify the most effective nutrition programs used in the prevention and management of child malnutrition in children under five years. Also, it is to suggest courses of action to improve interventions in the fight against malnutrition. The promotion of exclusive breastfeeding and food diversification improves the mothers’ knowledge and contributes to prevention of malnutrition. Food supplementation increases the weight/height ratio of malnourished children. The two programs combined bring better results on mothers’ feeding practices and children’s anthropometric data. This review has highlighted the importance of food supplementation and nutritional education in the management and prevention of child malnutrition. In addition, the combination of several approaches to good dietary practices brings better results. Finally, primary prevention can protect children from the harmful consequences of malnutrition.

Background: Clinical judgment is a specific role that establishes a professional identity. The purpose of this paper is to prepare nursing students to make better judgments in the clinical setting and realign learning and teaching. Methods: We used six steps to arrive at a competent clinical judgment suggested by the National Council State Board of Nursing (NSCBN) as a clinical judgment model 1) recognizing cues, 2) analyzing cues, 3) prioritizing hypotheses, 4) generating solutions, 5) taking an action, and 6) evaluating outcomes during the head-to-toe examination of the patient. Results: The primary outcomes are stabilization of the hemodynamics of the patient and prevention of further blood loss. Fluids are being given to help keep the vascular volume from being depleted, but they cannot solve the underlying problem. Continued assessment, intervention, and monitoring of vital signs through the course of the hospital stay ending with the patient’s discharge. Discussion: Survivors of sexual assault are unique for a nurse to provide care. The nurse needs to assess, intervene, monitor, and pay attention to detail of the 6 steps to clinical judgment, resulting in positive outcomes for their patient. Conclusions: Forensic nursing is a field of nursing that focuses on sexual assault survivor care and works to make the aftermath of their tragic situation easier to cope with. Strengthening clinical judgment skills could remedy significant mistakes made by novice forensic nurses. Critical thinking and clinical ethical reasoning are the building blocks of clinical judgment.

Objective: To investigate the correlation between 5-HTTLPR (5-and serotonin transporter linked polymer region) gene polymorphism and BDNF (brain derived neural factor) gene polymorphism and PTSD (post traumatic stress disorders) in Li and Han nationalities in Hainan Province. Methods: 167 Hainan Li PTSD patients, 141 Hainan Han PTSD patients and 158 healthy volunteers (control group) were investigated by ETI, caps, Toh, WCST, TMT and WAIS-RC. The polymorphisms of rs6265 locus of 5-HTTLPR and BDNF genes were detected by PCR (polymerase chain reaction) and page (polycylamide gel electrophoresis), and the correlation with PTSD was analyzed. Logistic regression analysis was used to analyze the influencing factors of PTSD. Results: The ETI score, total PTSD score and TMT time of Li PTSD patients were significantly higher than those of Han PTSD patients (P 0.05). SS genotype of 5-HTTLPR and (GA + AA) genotype of rs6265 locus may increase the risk of PTSD in Hainan Han population. AA and GA + AA genotypes at rs6265 locus may increase the risk of PTSD in Li population (P < 0.05). Among Li PTSD patients, the ETI score, PTSD total score, TMT time, Toh planning time and execution time of AA genotype at rs6265 locus were significantly higher than those of GG genotype; the total scores of comprehension and operation IQ, and Toh in WAIS-RC were significantly lower than those in GG genotype (P < 0.05). Among Han PTSD patients, the ETI score, PTSD total score and TMT time of SS genotype of 5-HTTLPR were significantly higher than those of LL genotype, and the comprehension, arithmetic and block diagram in WAIS-RC were significantly lower than those of LL genotype; The ETI score, PTSD total score and TMT time of patients with (GA + AA) genotype at rs6265 locus were also significantly higher than those of patients with GG genotype. The comprehension and block diagram in WAIS-RC were significantly lower than those of patients with GG genotype. The number of WCST errors in patients with AA genotype was significantly higher than those of patients with GG genotype, and the operational IQ in WAIS-RC was significantly lower than those of patients with GG genotype (P < 0.05). Conclusion: The LL genotype of 5-HTTLPR and the GG genotype of rs6265 locus are related to PTSD of Li and Han nationalities in Hainan, which are important protective factors for PTSD of Li and Han nationalities in Hainan.

Background: Self-management is important for post-renal transplant recipients to resolve renal dysfunction, heart failure, and post-transplant psychosocial issues, and to maintain transplant kidney function, etc. However, because recipients may be unable to adequately self-manage, healthcare providers need to provide self-management support for recipients to improve their skills and confidence in managing their disease. However, it is difficult to comprehensively assess the self-management behaviors in a busy outpatient support setting. Furthermore, since there are no uniform standards for assessment, it is based on the experience and abilities of medical personnel. Therefore, self-management behavior of post-renal transplant recipients is not sufficiently evaluated. Objective: This study aimed to evaluate content validity of a tool that can assess self-management behaviors of adult post-renal transplant recipients, consisting of consensus components from experts familiar with the follow-up of adult post-renal transplant recipients. Methods: A three-round modified Delphi method was used to assess the self-management behaviors of adult post-renal transplant recipients by a panel of experts consisting of certified transplant recipient coordinators, physicians, outpatient nurses, and researchers familiar with the follow-up of post-renal transplant recipients. Regarding management behaviors of adult post-renal transplant recipients, the experts rated the appropriateness and validity of each item using a Likert scale. Consensus ratings from the experts were made by calculating the median, interquartile range, and interquartile range percentage. In the third round, an item-level content validity index was calculated to assess content validity. Conclusions: The 41-item self-management behavior scale for kidney transplant recipients assessed self-management behaviors in five domains: medication, exercise, fluids and diet, disease and symptom prevention and management, and psychosocial adjustment. The content validity of this tool was confirmed, and it can be used to more easily assess the recipients’ self-management behaviors in the post-renal transplant follow-up. This tool can potentially contribute to the maintenance of transplant kidney function and high QOL in recipients.

Background: Nigeria attained the milestone of being certified wild poliovirus free in the year 2020. However, a drop in the key performance indicators of polio surveillance system was across various Local Government Areas (LGAs) in Oyo State. This drop highlighted the need for an innovative way of enhancing polio surveillance in Oyo State. Methods: This study was conducted in four phases and each phase utilized a cross-sectional study design and purposive sampling technique to select eligible LGAs and participants. LGAs that met at least two of the set-out criteria (had not reported at least a case of Acute Flaccid Paralysis (AFP) 12 months preceding the survey, with decline in AFP case detection rate, had not met AFP key indicators, are densely populated, and has an international border) were selected. A concurrent mixed method of data collection was utilized, and quantitative data were collected with a semi-structured questionnaire administered using Computer Assisted Personal Interviews (CAPI) during community active case search, health facility retroactive case search (HFRACS). Qualitative data collection was done through Focus Group Discussion (FGD). Surveillance intensification activities were conducted over eight weeks period. Data were analyzed using Microsoft Excel Software; summarization was done using frequencies and percentages while presentation was done using charts and spot maps. Results: A total of 1277, 49, 259 and 632 settlements, households and health facilities respectively were visited across 24 (73%) LGAs in Oyo State. Of the 150 suspected AFP cases identified, 45 (30%) were rejected cases, 33 (22%) were missed cases and 72 (48%) were true AFP cases. Non-Polio AFP Rate (NP-AFP rate) increased from 2.7 to 6.9 (P < 0.0001) after the surveillance intensification, also, the Non-Polio Enterovirus (NPENT) isolation was increased by 40% (16% to 23%). At the end of the intensification activities, all LGAs in Oyo State had met the WHO recommended Non-Polio Acute Flaccid Paralysis (NP-AFP) rate of ≥3/100,000 population. Conclusions: Innovative strategies implemented in AFP surveillance across Oyo State have resulted in improvement in AFP surveillance performance indicators in the State. There is therefore the need for dynamic and innovative ways of conducting AFP surveillance to prevent poliomyelitis epidemics and to ensure maintenance of Nigeria polio free certification status.

Background: Six in ten sexually active adolescent women in Uganda have an unmet need for contraception yet there is limited data on what is driving its use. This study aimed to determine the associations between sociodemographic factors and modern contraceptive ever-use among adolescents in Uganda. Methods: A crossectional study was conducted among 337 adolescents aged 13 - 19 years who had ever had sex in Wakiso (urban) and Kamuli (rural) districts in Uganda. The outcome of interest was the ever-use of modern contraceptives. Generalized linear models with a Poisson link were used to examine the associations between sociodemographic factors and contraceptive ever use. Results: The weighted prevalence of ever-use of modern contraceptives was 30.9%. Contraceptive ever use was more likely among the older adolescents (adjusted Odds Ratio) aOR 1.31 (95% CI = 1.06 - 1.55), married aOR 1.67 (95% CI = 1.09 - 2.58) and the less educated were aOR 1.79 (95% CI = 1.14 - 2.83) compared to their counterparts. Adolescents living in the urban district (Wakiso) aOR 0.67 (95% CI = 0.49 - 0.92) were less likely to use modern contraceptives. In stratified analysis, the urban poor were more likely to use modern contraceptives (moderate aPR 0.35 95%CI (0.17 - 0.68) ** or high socioeconomic status aPR 0.62, 95%CI (0.28 - 1.37). Conclusions: The study shows low contraceptive ever-use among adolescents. Adolescents with low education and those from rural settings were more likely to ever-use modern contraceptives. Having good knowledge of contraception and discussing sex with parents promoted contraceptives ever-use. We recommend further studies assessing barriers to contraceptive use among adolescents in Uganda.

Background: Socioeconomic factors influence health outcomes and the distribution of health resources within and between countries globally. In Nigeria, there are various socio-economic factors that have been reported to be responsible for health inequities across the different geopolitical zones. Objective: To assess health inequities in relation to socio-economic factors that affect access to essential health care services in Nigeria, using family planning, maternal care, and childcare as indicators. Method: The study involved a cross-sectional secondary analysis of data from the 2018 Nigeria Demographic and Health Survey (NDHS) and a literature review of transdisciplinary approaches to addressing health inequities. Result: The overall result from the findings suggests a strong influence of geographical and socioeconomic factors in the distribution of healthcare services. Specifically, family planning services were more readily available and accessible in the Southern zones of Nigeria than in the Northern zone of Nigeria, which could be attributed to socio-cultural, religious, and access-related barriers. Results also showed that access to most maternal and child health care services was often skewed towards the southern zones, which could be due to the presence of more healthcare workers who provide these services coupled with higher access to maternal care, hence a higher uptake and utilization of maternal care services. Also, children in the northern zones had lesser odds of receiving basic and age-appropriate vaccination than those in other regions, which could be attributed to the supply-side disparities that exist between the northern and southern regions. Conclusion: This study concludes that level of educational attainment, wealth quintiles, as well as financial barriers, are the major socio-economic factors that influence access to maternal and childcare services.

Objective: To compare the two skeletal muscle mass index (SMI) algorithms. One is SMM [SMM(%) = total skeletal muscle mass (kg)/body weight mass (kg) × 100%]; and the other is SMH [SMH (kg/m2) = total skeletal muscle mass (kg)/height (m)2]. Methods: Body composition, body mass index (BMI) and body fat percentage (BFP) were estimated using a bioelectrical impedance analyzer. SMI was calculated by the two algorithms described above, and measurement parameters were stratified by age, BMI and levels of physical activity. Results: Levels of BMI, BFP, SMM and SMH differed significantly between the sexes. BMI and BFP were positively associated with age, while SMM was negatively associated with age (β = −0.2294, P β = −0.5340, P β = 0.7930, P β = −0.9849, P β = −0.0642, P F = 9528.32, P F = 34395.46, P F = 9706.20, P P P > 0.05). Conclusions: SMM may be a more ideal and accurate clinical algorithm for SMI because it is more tightly associated with other body composition indices, as compared with SMH.

Upon entering the military recruits are challenged physically, this is exceptionally difficult for women as their anatomy predisposes them to more impact injuries than men. Female military recruits are placed at a higher risk for shin splints, a repetition injury known in the medical field as medial tibial stress syndrome (MTSS). This review paper explores studies about MTSS, its prevalence, and expression in military recruits, particularly as its expression differs across gender. This paper will cover how the external environment of boot camp results in a higher prevalence of MTSS than the general population and how increased occurrence of MTSS in females has been attributed to specific physical attributes. This includes smaller tibial cross-sectional dimensions, greater than average hip range of motion, and differences in lower extremity mechanics during running and other repetitive physical activities. The external environment of boot camp coupled with these intrinsic factors highlight the importance of providing running education for women prior to arrival at boot camp and designing training regiments that account for these physiological differences.

Background: Our previous research concerned the relation between Sense of Coherence, workplace stress, and burnout for nurses in their first three years of work. We found that their psychological state in the first three months on the job was particularly critical to their success and retention. As workplace stress increased over their first three years, their Sense of Coherence declined, and their burnout increased. Follow-up interviews after five years revealed the importance of identifying role models early on and feeling their own growth in the responses of their patients. Based on these findings, in 2015 we instituted a program to improve new nurses’ Sense of Coherence. The present research was to evaluate the effectiveness of this training program. Purpose: The purpose of this study was to evaluate the effectiveness of a training program in raising Sense of Coherence. Method: From June of 2015 to March of 2017, we surveyed Sense of Coherence of 137 new nurses who completed our training program, comparing them to a cohort of 960 nurses whom we had studied in 2010-11 without such a training program. We analyzed their responses using SPSS Version 24.0, taking a probability of less than 5% to be significant. Results: In terms of Sense of Coherence, the training program improved new nurses’ “comprehensibility” and “manageability” in the first three months, but both dropped to levels comparable to the untrained nurses after six months. There was no significant difference in “meaningfulness”, which dropped over the first year in both groups. Categorized into three groups according to SOC score at the time of employment in the intervention group, 36 participants were classified into the low score group, 41 participants were classified into the medium score group, and 44 participants were classified into the high score group. Then changes in SOC in each group were then compared. In the LOW group, the scores for “comprehensibility”, “manageability”, and “meaningfulness” increased significantly throughout the year, while in the HIGH group, scores decreased significantly. Conclusions: Our training program did raise new nurses’ sense of growth over the first year, and significantly improved their “comprehensibility” and “manageability” over the first three months. However, the fact that their Sense of Coherence dropped to control group levels after six months suggests the need for further intervention to maintain “comprehensibility” and “manageability” over the longer term. In the LOW group, the scores for “comprehensibility”, “manageability”, and “meaningfulness” increased significantly throughout the year, however, the total SOC score for the LOW group remained low throughout the year. Thus, additional support is needed over-and-above the training presented in this study for those nurses with low SOC scores at time of employment.