BackgroundA birth dose strategy using a neonatal rotavirus vaccine to target early prevention of rotavirus disease may address remaining barriers to global vaccine implementation.MethodsWe conducted a randomized, placebo-controlled trial in Indonesia to evaluate the efficacy of an oral human neonatal rotavirus vaccine (RV3-BB) to prevent rotavirus gastroenteritis. Healthy newborns received three doses of RV3-BB administered in a neonatal schedule at 0-5 days, 8 and 14 weeks or infant schedule at 8, 14 and 18 weeks, or placebo. Laboratory-confirmed rotavirus gastroenteritis was graded using a modified Vesikari score. The primary analysis was efficacy against severe rotavirus gastroenteritis from two weeks after all doses to 18 months in the combined vaccine group (neonatal and infant schedule) compared with placebo.ResultsVaccine efficacy against severe rotavirus gastroenteritis to 18 months was 63% in the combined vaccine group (95% CI 34, 80; p<0.001), 75% in the neonatal vaccine group (95% confidence interval [CI] 44, 91; p<0.001) and 51% in the infant vaccine group (95% CI 7, 76; p=0.03) in the per protocol analysis, with similar results in the intention-to-treat analysis. Vaccine efficacy to 12 months was 94% in the neonatal vaccine group (95%CI 56, 99; p=0.006). Vaccine take occurred in 78/83 (94%) in the neonatal vaccine group and 83/84 (99%) in the infant vaccine group. The vaccine was well tolerated, with similar incidence of adverse events in vaccine and placebo recipients.ConclusionRV3-BB was efficacious, immunogenic and well-tolerated when administered in a neonatal or infant schedule in Indonesia.
Annual mammography remains the gold standard of asymptomatic breast cancer screening for women starting at the age of 40. However, Indonesia has not designated mammography as its national screening program. To help policymakers decide whether mammography should be introduced into a national program, it is important to comprehensively understand the knowledge and acceptance of both consumers and providers. A total of 25 subjects including a range of women and health care professionals (HCPs) in Yogyakarta Province were recruited using purposive, maximum variation sampling and then interviewed in-depth. The interviews were recorded and all data were taken and transcribed from the audio recording, which were subsequently translated to English and analyzed thematically. Almost all of Yogyakarta women had heard about the term of mammography. However, only few of them have let themselves be screened, mainly because of their perceived lack of urgency to screen for asymptomatic breast cancer. Another important reason was the high cost of mammography. Meanwhile, several HCPs believed that breast cancer has not been a priority for the government and hence the government limited mammography screening's access and excluded it from the national insurance coverage. Most women in Yogyakarta have a good understanding about breast cancer screening, but their acceptance of mammography as a breast cancer screening tool is significantly influenced by high cost, limited access, and lack of urgency.
Background: There is a need for a type of physical activity that could address the challenging cycle of physical inactivity, impaired health-related fitness, and type 2 diabetes mellitus (T2DM) conditions. Yoga could be one type of exercise to overcome the barriers to adhere to regular physical activity. The current study aimed to systematically review the effect of yoga on health-related fitness, including cardiorespiratory fitness, muscle strength, body composition, balance, and flexibility, among patients with T2DM. Methods: We systematically searched four databases and two registries (Pubmed, Scopus, Cochrane, Embase, WHO-ITCRP, and Clinicaltrials.gov) in September 2021, following a registered protocol on PROSPERO (CRD42022276225). Study inclusion criteria were T2DM patients with or without complication, yoga intervention as a single component or as a complement compared to other kinds of exercise or an inactive control, health-related fitness, and a randomized, controlled trial or quasi-experimental with control group design. The ROBINS-I tool and ROB 2.0 tool were used to assess the risk of bias in the included studies. A vote-counting analysis and meta-analysis computed using random effects’ models were conducted. Results: A total of 10 records from 3 quasi-experimental and 7 randomized, controlled trials with 815 participants in total were included. The meta-analysis favored yoga groups compared to inactive controls in improving muscle strength by 3.42 (95% confidence interval 2.42 to 4.43), repetitions of chair stand test, and improving cardiorespiratory fitness by 6.6% (95% confidence interval 0.4 to 12.8) improvement of baseline forced vital capacity. The quality of evidence for both outcomes was low. Conclusion: Low-quality evidence favored yoga in improving health-related fitness, particularly muscle strength and cardiorespiratory fitness, among patients with T2DM. Funding: All authors in this systematic review received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
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