| 1. |
- Sysoev, Oleg, 1981-, et al.
(författare)
-
PSICA : Decision trees for probabilistic subgroup identification with categorical treatments
- 2019
-
Ingår i: Statistics in Medicine. - : Wiley. - 0277-6715 .- 1097-0258. ; 38:22, s. 4436-4452
-
Tidskriftsartikel (refereegranskat)abstract
- Personalized medicine aims at identifying best treatments for a patient with given characteristics. It has been shown in the literature that these methods can lead to great improvements in medicine compared to traditional methods prescribing the same treatment to all patients. Subgroup identification is a branch of personalized medicine, which aims at finding subgroups of the patients with similar characteristics for which some of the investigated treatments have a better effect than the other treatments. A number of approaches based on decision trees have been proposed to identify such subgroups, but most of them focus on two-arm trials (control/treatment) while a few methods consider quantitative treatments (defined by the dose). However, no subgroup identification method exists that can predict the best treatments in a scenario with a categorical set of treatments. We propose a novel method for subgroup identification in categorical treatment scenarios. This method outputs a decision tree showing the probabilities of a given treatment being the best for a given group of patients as well as labels showing the possible best treatments. The method is implemented in an R package psica available on CRAN. In addition to a simulation study, we present an analysis of a community-based nutrition intervention trial that justifies the validity of our method.
|
|
| 2. |
|
|
| 3. |
- Berhane, Hanna Y, et al.
(författare)
-
Mixed blessings: : A qualitative exploration of mothers' experience of child care and feeding in the rapidly urbanizing city of Addis Ababa, Ethiopia
- 2018
-
Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 13:11
-
Tidskriftsartikel (refereegranskat)abstract
- Many studies have drawn attention to the vital role mothers have in safeguarding the health and nutritional wellbeing of their children. However, little is known about mothers' experiences and the challenges they face in fulfilling this role in rapidly urbanizing cities in Africa. This study aims to explore child care and feeding practices of mothers with children under five years of age in Addis Ababa, Ethiopia. This qualitative study was conducted using a semi-structured interview guide. A total of thirty-six interviews were conducted with purposively selected participants. All interviews were audio recorded, transcribed verbatim and translated for analysis. We used a thematic analysis approach, which was guided by a resilience framework. The findings are presented as three major themes. 1) 'Mixed blessings-balancing motherhood's expectations'. While mothers identified positively with the social recognition and sense of fulfillment of being a 'good mother', they were ambivalent/torn about earning the necessary income from outside work and fulfilling their duties at home. 2) 'Instabilities due to rampant urban sprawl'. While women expressed a keen desire to balance work and motherhood, the disintegrating social capital, due to large in-migration, market fluctuations and abrupt/forced resettlements to new housing units had left mothers without support for childcare, stressed and exhausted. 3) 'Anchored by faith: a source of resilience to cope with adversities'. In the face of the multiple adversities, mothers cited their strong faith as their most reliable foundation for their resilience. In summary, the societal and environmental changes accompanying the rapid urbanization in low income settings makes combining child care and working outside the home very challenging for mothers. As a result they suffer from fatigue and feelings of isolation. Efforts to improve child feeding and care in urban low-income settings need to consider context appropriate strategies that support mothers with small children.
|
|
| 4. |
- Berhane, Hanna Y, et al.
(författare)
-
What Influences Urban Mothers' Decisions on What to Feed Their Children Aged Under Five-The Case of Addis Ababa, Ethiopia
- 2018
-
Ingår i: Nutrients. - : MDPI AG. - 2072-6643. ; 10:9
-
Tidskriftsartikel (refereegranskat)abstract
- Mothers carry the prime responsibility for childcare and feeding in low-income countries. Understanding their experiences in providing food for their children is paramount to informing efforts to improve the nutritional status of children. Such information is lacking in Sub-Saharan Africa. To understand what influences urban mothers' food acquisition and their motivations for selecting food for their children, 36 in-depth interviews were carried out with mothers having children under five years of age. Interviews were conducted in the local language, audio-recorded, transcribed, and translated into English. Data were analyzed using thematic analysis which led to the identification of four major themes: mothers give-in to a child-driven diet; quick-fix versus the privilege of planning; keen awareness on food safety, nutrition, and diet diversity; and social, familial, and cultural influences. The findings indicate that child feeding practices are influenced by interlinked social and environmental factors. Hence, nutrition education campaigns should focus on targeting not only families but also their children. Attention should also be given to food safety regulations, as well as to the much-needed support of mothers who are struggling to ensure their children's survival in low-income countries.
|
|
| 5. |
- Brandström, Josef, et al.
(författare)
-
Individually dosed omalizumab facilitates peanut oral immunotherapy in peanut allergic adolescents
- 2019
-
Ingår i: Clinical and Experimental Allergy. - : Wiley. - 0954-7894 .- 1365-2222. ; 49:10, s. 1328-1341
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Peanut oral immunotherapy (pOIT) has showed good short-term outcomes, but allergic reactions may prevent effective up-dosing and is a major cause of stopping OIT. In placebo-controlled trials, omalizumab has been shown to facilitate allergen immunotherapy and increase tolerance to peanut.Objective: We hypothesized that by combining omalizumab with pOIT, and monitor treatment effects with basophil allergen threshold sensitivity tests (CD-sens), peanut allergic patients could safely initiate pOIT and thereafter slowly withdraw omalizumab.Methods: This is the 2nd part of a one-armed open phase-2 study where peanut allergic adolescents (n = 23) started pOIT after an individualized omalizumab treatment. The pOIT dose was increased from 280 to 2800 mg peanut protein in 8 weeks followed by an individualized step-wise withdrawal of omalizumab, based on clinical symptoms and CD-sens levels. pOIT continued for 12 weeks followed by an open peanut challenge. Peanut CD-sens and allergen-binding activity (ABA) and IgE-ab, IgG-ab and IgG4-ab to peanut and its components were measured during the study.Results: All 23 patients successfully reached the 2800 mg maintenance dose. Moderate/systemic allergic reactions were rare while receiving full-dose omalizumab. Eleven of 23 (48%) successfully continued with pOIT after omalizumab was stopped. Compared to treatment failures, median baseline IgE-ab to peanut components Ara h 1-3 and CD-sens to peanut were significantly lower among successfully treated patients and IgG4-ab to peanut, Ara h 2 and 6 increased significantly more during treatment.Conclusions and clinical relevance: This study indicates that omalizumab is an effective adjunctive therapy for initiation and rapid up-dosing of pOIT; however, adverse events from pOIT become more frequent as omalizumab doses are decreased.
|
|
| 6. |
- Chola, Lumbwe, et al.
(författare)
-
Cost-Effectiveness of Peer Counselling for the Promotion of Exclusive Breastfeeding in Uganda.
- 2015
-
Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 10:11
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Community based breastfeeding promotion programmes have been shown to be effective in increasing breastfeeding prevalence. However, there is limited data on the cost-effectiveness of these programmes in sub-Saharan Africa. This paper evaluates the cost-effectiveness of a breastfeeding promotion intervention targeting mothers and their 0 to 6 month old children.METHODS: Data were obtained from a community randomized trial conducted in Uganda between 2006-2008, and supplemented with evidence from several studies in sub-Saharan Africa. In the trial, peer counselling was offered to women in intervention clusters. In the control and intervention clusters, women could access standard health facility breastfeeding promotion services (HFP). Thus, two methods of breastfeeding promotion were compared: community based peer counselling (in addition to HFP) and standard HFP alone. A Markov model was used to calculate incremental cost-effectiveness ratios between the two strategies. The model estimated changes in breastfeeding prevalence and disability adjusted life years. Costs were estimated from a provider perspective. Uncertainty around the results was characterized using one-way sensitivity analyses and a probabilistic sensitivity analysis.FINDINGS: Peer counselling more than doubled the breastfeeding prevalence as reported by mothers, but there was no observable impact on diarrhoea prevalence. Estimated incremental cost-effectiveness ratios were US$68 per month of exclusive or predominant breastfeeding and U$11,353 per disability adjusted life year (DALY) averted. The findings were robust to parameter variations in the sensitivity analyses.CONCLUSIONS: Our strategy to promote community based peer counselling is unlikely to be cost-effective in reducing diarrhoea prevalence and mortality in Uganda, because its cost per DALY averted far exceeds the commonly assumed willingness-to-pay threshold of three times Uganda's GDP per capita (US$1653). However, since the intervention significantly increases prevalence of exclusive or predominant breastfeeding, it could be adopted in Uganda if benefits other than reducing the occurrence of diarrhoea are believed to be important.
|
|
| 7. |
- Contreras, Mariela, 1979-
(författare)
-
Child nutrition in rural Nicaragua : Population-based studies in a transitional society
- 2015
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Emerging favourable as well as unfavourable nutrition patterns are observed in societies undergoing rapid social and economic change. The aim of this thesis is to analyse the associations between household and maternal resources and infant and young child feeding habits and nutritional status in rural Nicaragua, a low-income transitional society.All households (n=1,500) in Los Cuatro Santos with at least one child (0-3 y) were visited to collect information on feeding of the youngest child. Children´s anthropometry was also measured using standardised World Health Organisation (WHO) techniques. Validated instruments were used to assess household and maternal resources. All instruments had been adapted to the local context and piloted in a nearby community. The education of the mother showed more independent variation in the studied outcomes. The odds for exclusive breastfeeding were highest in infants aged 0 to 5 months of mothers with the lowest education. Further, children aged 6 to 35 months with lowest educated mothers were less likely to consume highly processed snacks (HP snacks) and sugar-sweetened beverages (SSBs). They were also less likely to be exposed to a double burden of suboptimal feeding (concurrent unmet WHO recommended feeding practices and consumption of HP snacks or SSBs). However, children aged 6 to 35 months were more prone to infrequently meet dietary diversity and to more shortness. Children in the same age group with lower educated mothers were also shorter in households with the lowest housing quality.Higher level of maternal education contributed both favourably and unfavourably to child feeding and nutrition. This was reflected in more and less frequent practice of the WHO feeding indicators, but also in more frequent children´s consumption of HP snacks and SSBs. Higher maternal education was associated with taller children, even in households with the lowest housing quality.
|
|
| 8. |
- Contreras, Mariela, 1979-, et al.
(författare)
-
Consumption of highly processed snacks, sugar-sweetened beverages and child feeding practices in a rural area of Nicaragua
- 2016
-
Ingår i: Maternal and Child Nutrition. - : Wiley. - 1740-8695 .- 1740-8709. ; 12:1, s. 164-176
-
Tidskriftsartikel (refereegranskat)abstract
- Appropriate feeding behaviours are important for child growth and development. In societies undergoing nutrition transition, new food items are introduced that may be unfavourable for child health. Set in rural Nicaragua, the aim of this study was to describe the infant and young child feeding (IYCF) practices as well as the consumption of highly processed snack foods (HP snacks) and sugar-sweetened beverages (SSBs). All households with at least one child 0- to 35-month-old (n = 1371) were visited to collect information on current IYCF practices in the youngest child as well as consumption of SSBs and HP snacks. Breastfeeding was dominant (98%) among 0- to 1-month-olds and continued to be prevalent (60%) in the second year, while only 34% of the 0- to 5-month-olds were exclusively breastfed. Complementary feeding practices were deemed acceptable for only 59% of the 6- to 11-month-old infants, with low dietary diversity reported for 50% and inadequate meal frequency reported for 30%. Consumption of HP snacks and SSBs was frequent and started early; among 6- to 8-month-olds, 42% and 32% had consumed HP snacks and SSBs, respectively. The difference between the observed IYCF behaviours and World Health Organization recommendations raises concern of increased risk of infections and insufficient intake of micronutrients that may impair linear growth. The concurrent high consumption of SSBs and HP snacks may increase the risk of displacing the recommended feeding behaviours. To promote immediate and long-term health, growth and development, there is a need to both promote recommended IYCF practices as well as discourage unfavourable feeding behaviours.
|
|
| 9. |
- Contreras, Mariela, 1979-, et al.
(författare)
-
Socio-economic resources, young child feeding practices, consumption of highly processed snacks and sugar-sweetened beverages : a population-based survey in rural northwestern Nicaragua
- 2015
-
Ingår i: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 15
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Socio-economic resources may be associated with infant feeding in complex patterns in societies undergoing a nutrition transition. This study evaluates associations of housing quality, food security and maternal education to the World Health Organization (WHO) feeding recommendations and to consumption of highly processed snacks (HP snacks) and sugar-sweetened beverages (SSBs) in rural Nicaragua. Methods: Data were collected from May to November 2009, with mothers of 0- to 35-month-olds being asked about young child feeding using a food frequency questionnaire. A validated questionnaire was used to assess household food insecurity and data were collected on maternal education and housing quality. Pearson's chi-squared test was used to compare proportions and determine associations between the resources and young child feeding. The three socio-economic resources and other confounders were introduced to multivariate logistic regression analyses to assess the independent contribution of the resources to the feeding practices and consumption of HP snacks and SSBs. Results: Mothers with the lowest education level were more likely to be exclusively breastfeeding (EBF) their infants (OR not EBF: 0.19; 95% CI: 0.07, 0.51), whilst mothers of 6- to 35-month-olds in the lowest education category had more inadequate dietary diversity (DD) (OR for not meet DD: 2.04; 95% CI: 1.36, 3.08), were less likely to consume HP snacks (OR for HP snacks: 0.47; 95% CI: 0.32, 0.68) and SSBs (OR for SSBs: 0.68; 95% CI: 0.46, 0.98), compared to mothers with the highest level of education. Similarly, children residing in households with the highest food insecurity were also more prone to have inadequate dietary diversity (OR for not meet DD: 1.47; 95% CI: 1.05, 2.05). The odds for double burden of suboptimal feeding (concurrent inadequate diet and consumption of HP snacks/SSBs) were significantly lower in children of least educated mothers (OR: 0.64; 95% CI: 0.44, 0.92). Conclusions: Higher level of education was associated with both more and less adherence to the WHO recommended feeding practices as well as with more consumption of HP snacks and SSBs. Regardless of educational strata, the children in the community were exposed to suboptimal feeding practices conducive to both under-as well as overnutrition.
|
|
| 10. |
- Ekström, Eva-Charlotte, et al.
(författare)
-
Effects of prenatal micronutrient and early food supplementation on metabolic status of the offspring at 4.5 years of age. The MINIMat randomized trial in rural Bangladesh.
- 2016
-
Ingår i: International Journal of Epidemiology. - : Oxford University Press (OUP). - 0300-5771 .- 1464-3685. ; 45:5, s. 1656-1667
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Fetal nutritional insults may alter the later metabolic phenotype. We hypothesized that early timing of prenatal food supplementation and multiple micronutrient supplementation (MMS) would favourably influence childhood metabolic phenotype.METHODS: Pregnant women recruited 1 January to 31 December 2002 in Matlab, Bangladesh, were randomized into supplementation with capsules of either 30 mg of iron and 400 μg of folic acid, 60 mg of iron and 400 μg of folic acid, or MMS containing a daily allowance of 15 micronutrients, and randomized to food supplementation (608 kcal) either with early invitation (9 weeks' gestation) or usual invitation (at 20 weeks). Their children (n = 1667) were followed up at 4.5 years with assessment of biomarkers of lipid and glucose metabolism, inflammation and oxidative stress.RESULTS: Children in the group with early timing of food supplementation had lower cholesterol (difference -0.079 mmol/l, 95% confidence interval (CI) -0.156; -0.003), low-density lipoprotein (LDL) (difference -0.068 mmol/l, 95% CI -0.126; -0.011) and ApoB levels (difference -0.017 g/l, 95% CL -0.033; -0.001). MMS supplementation resulted in lower high-density lipoprotein (HDL) (difference -0.028 mmol/l, 95% CL -0.053; -0.002), lower glucose (difference -0.099 mmol/l, 95% CL -0.179; -0.019) and lower insulin-like growth factor 1 (IGF-1) (difference on log scale -0.141 µg/l, 95% CL -0.254; -0.028) than 60 mg iron and 400 μg folic acid. There were no effects on markers of inflammation or oxidative stress.CONCLUSIONS: Findings suggest that in a population where malnutrition is prevalent, nutrition interventions during pregnancy may modify the metabolic phenotype in the young child that could have consequences for later chronic disease risks.
|
|
