Craven Wolff (heartsleet5)

Acute gastroenteritis is a common childhood disease with substantial medical and indirect costs, mostly because of referral, hospitalization and parental absence from work. To determine the cost-effectiveness of adding oral ondansetron to care-as-usual for children with acute gastroenteritis in out-of-hours primary care. A pragmatic randomised controlled trial at three out-of-hours primary care centres, with a follow-up of 7 days. Inclusion criteria were 1) age 6 months to 6 years; 2) diagnosis of acute gastroenteritis; 3) at least four reported episodes of vomiting 24 hours before presentation, whereof; 4) at least one in the 4 hours before presentation; and 5) written informed consent from both parents. Children were randomly allocated in a 11 ratio to either care-as-usual (oral rehydration therapy) or care-as-usual plus one dose of 0.1 mg/kg oral ondansetron. In total, 194 children were included for randomisation. One dose of oral ondansetron decreased the proportion of children who continued vomiting within the first 4 hours from 42.9% to 19.5%, with an odds ratio of 0.4 (95% CI = 0.2-0.7, NNT 4). Total mean costs in the ondansetron group were 31.2% lower (€488 vs €709), and the total incremental mean costs for an additional child free of vomiting in the first 4 hours was -€9 (95% confidence interval, -€41 to €3). A single oral dose of ondansetron for children with acute gastroenteritis, given in out-of-hours primary care settings, is both clinically beneficial and cost-effective. A single oral dose of ondansetron for children with acute gastroenteritis, given in out-of-hours primary care settings, is both clinically beneficial and cost-effective. Early breastfeeding has numerous benefits for both the mother and her baby. Previous research typically analyzes breastfeeding initiation in binary terms (within the first hour or day). Although delays are associated with cesarean delivery and skin-to-skin contact may facilitate early breastfeeding, a more nuanced understanding of these relationships is needed. With data from 31 countries that had a Demographic and Health Survey since 2015, we described breastfeeding initiation among babies most recently born in the last 2 years to women aged 15-49 years. In a subset of 21 countries, we conducted survival analysis with multivariable log-logistic accelerated failure time (AFT) regressions to examine factors associated with time to initiation of breastfeeding, specifically the mode of delivery and skin-to-skin contact, controlling for receipt of health care as well as socioeconomic and demographic characteristics of mothers and babies. Babies in most countries began breastfeeding within a few hours after birth. check details The mean time to initiation of breastfeeding ranged from 1.7 hours in Burundi to 32 hours in Pakistan and 40 hours in Chad. In most countries (24 of 31), the median time was 0.5 hours. Median time to initiation was greater for births by cesarean delivery compared with vaginal births at health facilities. After controlling for covariates, AFT models showed significant delays in breastfeeding among cesarean deliveries in most countries, with as much as a 9-fold delay in Senegal. Immediate skin-to-skin contact was significantly associated with a shorter time to initiation. Efforts to promote early breastfeeding should encourage skin-to-skin and target cesarean deliveries. Efforts to promote early breastfeeding should encourage skin-to-skin and target cesarean deliveries. Growing demand from an ageing population, chronic preventable disease and multimorbidity has resulted in complex health and social care needs requiring more integrated services. Integrating primary care with social services could more efficiently utilise resources, and improve experiences for patients, their families and carers. There is limited evidence on progress including k