bluuebunny/crossref_metadata_2025_split huggingface dataset:
Unexpected radiation pneumonitis after SIRT with significant decrease in DLCO with internal radiation exposure: a case report
Authors: Kesim Selin , Ones Tunc , Eryuksel Emel , Baltacioglu Feyyaz , Tureli Derya , Ozguven Salih , Erdil Tanju Yusuf 
Published: May 2020

Abstract
Background
In the last years, Selective Internal Radiation Therapy (SIRT), using biocompatible Yttrium-90 (90Y) labeled microspheres have emerged for the treatment of malignant hepatic tumors. Unfortunately, a significant part of 90Y-labeled microspheres may shunt to the lungs after intraarterial injection. It can be predictable by infusing technetium-99 m-labeled macro-aggregated albumin particles through a catheter placed in the proper hepatic artery depending on the lobe to be treated with performing a quantitative lung scintigraphy. Radiation pneumonitis (RP) can occur 1 to 6 months after the therapy, which is a rare but severe complication of SIRT. Prompt timing of steroid treatment is important due to its high mortality rate. On the other hand, pulmonary diffusion capacity measured by carbon monoxide (DLCO) is an excellent way to measure the diffusing capacity because carbon monoxide is present in minimal amount in venous blood and binds to hemoglobin in the same manner as oxygen. Some authors reported that the most consistent changes after radiation therapy (RT) are recorded with this quantitative reproducible test. The relationship between the proportional reductions in DLCO and the severity of RP developing after this therapy may prove to be clinically significant.

Case presentation
We herein present a patient who developed RP after SIRT that could be quantified using DLCO. To the best of our knowledge, this case is the first who developed unexpected RP after SIRT with significant decrease in DLCO with internal radiation exposure.

Conclusions
RP is a very rare complication and may lead to a fatal outcome. Decline in DLCO could be a valuable parameter for follow-up and to identify potential candidates for RP and could be also another trigger for administration of steroid therapy with prompt timing in this patient group.
Childhood socioeconomic status, comorbidity of chronic kidney disease risk factors, and kidney function among adults in the midlife in the United States (MIDUS) study
Authors: Surachman Agus , Daw Jonathan , Bray Bethany C. , Alexander Lacy M. , Coe Christopher L. , Almeida David M. 
Published: May 2020

Abstract
Background
There is a lack of empirical effort that systematically investigates the clustering of comorbidity among known risk factors (obesity, hypertension, diabetes, hypercholesterolemia, and elevated inflammation) of chronic kidney disease (CKD) and how different types of comorbidity may link differently to kidney function among healthy adult samples. This study modeled the clustering of comorbidity among risk factors, examined the association between the clustering of risk factors and kidney function, and tested whether the clustering of risk factors was associated with childhood SES.

Methods
The data were from 2118 participants (ages 25–84) in the Midlife in the United States (MIDUS) Study. Risk factors included obesity, elevated blood pressure (BP), high total cholesterol levels, poor glucose control, and increased inflammatory activity. Glomerular filtration rate (eGFR) was estimated from serum creatinine, calculated with the CKD-EPI formula. The clustering of comorbidity among risk factors and its association with kidney function and childhood SES were examined using latent class analysis (LCA).

Results
A five-class model was optimal: (1) Low Risk (class size = 36.40%; low probability of all risk factors), (2) Obese (16.42%; high probability of large BMI and abdominally obese), (3) Obese and Elevated BP (13.37%; high probability of being obese and having elevated BP), (4) Non-Obese but Elevated BP (14.95%; high probability of having elevated BP, hypercholesterolemia, and elevated inflammation), and (5) High Risk (18.86%; high probability for all risk factors). Obesity was associated with kidney hyperfiltration, while comorbidity between obesity and hypertension was linked to compromised kidney filtration. As expected, the High Risk class showed the highest probability of having eGFR < 60 ml/min/1.73 m2 (P = .12; 95%CI = .09–.17). Finally, higher childhood SES was associated with reduced probability of being in the High Risk rather than Low Risk class (β = − 0.20, SE = 0.07, OR [95%CI] = 0.82 [0.71–0.95]).

Conclusion
These results highlight the importance of considering the impact of childhood SES on risk factors known to be associated with CKD.
Andersen’s model on determining the factors associated with antenatal care services in Nepal: an evidence-based analysis of Nepal demographic and health survey 2016
Authors: Neupane Bidusha , Rijal Sujan , G.C. Srijana , Basnet Til Bahadur 
Published: May 2020

Abstract
Background
With the formulation of the National Safe Motherhood Policy in 1998, safe motherhood has forever been a priority program in Nepal. Under the safe motherhood program, every woman is provided with essential maternal health care services until now through the four-tire district health care system. There is a considerable increase in the utilization of antenatal care (ANC) by a skilled health provider from 2011 to 2016, 58 to 84%, respectively. However, inequality, exclusion, and under-utilization in health care services continue in many regions of Nepal. The present study aimed to explore the different types of socio-demographic factors associated with current ANC service utilization in Nepal.

Methods
A cross-sectional study was conducted using the Nepal Demographic and Health Surveys data (DHS-7, 2016–2017). We estimated the latest pregnancy and live births in recent 5 years with the utilization of ANC services, and socio-economic differentials in these indicators under the framework of the Andersen behavioral model.

Results
Two in three (69.8%) with last birth accessed at least four ANC visits. The rate of live birth was about 98.6% in the ANC4+ group, higher than that of 96.8% in the ANC4- group (χ2: 14.742, P <  0.001). In the multilevel logistic regression analysis, we found that women from province 2 (OR: 0.48; 95%CI: 0.32–0.74) and province 6 (OR: 0.46; 95%CI: 0.30–0.71) were significantly less likely to visit ANC 4 or more times. Age (OR: 0.95; 95%CI: 0.93–0.96) was also significantly associated with the frequency of ANC visits. Level of Women’s education and education of her partner were both significantly associated with the ANC visits: women (OR: 4.64; 95%CI: 3.05–7.05) and her partner (OR: 1.45; 95%CI: 1.01–2.06) having higher education were most likely to go for the recommended number of ANC visits. Moreover, women having exposure to multimedia were more likely to go for four or more ANC check-ups.

Conclusions
The results highlight the need for governments and health care providers to develop special health promotion program with a focus on the vulnerable and disadvantaged and to use multi-media for maternal health literacy improvement flexibly, and maternal health system strengthening.
Postnatal home visits by health extension workers in rural areas of Ethiopia: a cross-sectional study design
Authors: Tesfau Yemane Berhane , Kahsay Alemayehu Bayray , Gebrehiwot Tesfay Gebregzabher , Medhanyie Araya Abrha , Godefay Hagos 
Published: May 2020

Abstract
Background
In low-income countries like Ethiopia, where families have poor access to or do not utilize the services of formal health care systems, community health workers provide postnatal care services through home visits. However, the extent and effectiveness of home-based postnatal visits by community health workers such as the Ethiopian health extension workers (HEWs) are not well explored. This community -based study aimed to determine the coverage, contents of postnatal home visits and associated factors by health extension workers in Northern Ethiopia.

Methods
We conducted a community based cross-sectional study in the rural Districts in Northern Ethiopia from August to September 2018. A total of 705 mothers who gave a live birth in the year preceding the survey were selected using multistage random sampling. A structured questionnaire was applied to collect data by interviewing the mothers. Data were analyzed using SPSS version 22 statistical software. Association of postnatal home visits with possible explanatory variables was investigated using logistic regression.

Results
One hundred and two (14.5%) mothers and newborns received PNC home visit within three days after birth from HEW and 170(24.1%) reported postnatal home visits within 42 days. Among the mothers who received postnatal home visits, 6.5% measured their blood pressure, 11.2% measured their temperature, 20% counseled about family planning, 16.5% counseled on newborn danger signs, 11.2% counseled on the skin to skincare of the newborn and 14.1% of their newborns were measured their weight at home. Mothers who received at least one home visit during pregnancy (AOR, 7.49; CI 3.55–15.80), participated in pregnant women forum (AOR, 3.16; CI 1.67–5.99), notified their birth (AOR, 6.16; CI 3.50–10.84) and those members of community health insurance (AOR, 1.87; CI 1.13–3.10) were factors associated with postnatal home visit by a health extension worker.

Conclusion
The coverage of postnatal home visits by health extension workers remains low in rural districts of Northern Ethiopia. The existing health systems should consider interventions that improve pregnancy and birth notification strategies and more efforts should be made at improving community-based participation and linkages with community health workers.
Stereotactic body radiotherapy (SBRT) in patients with lung metastases - prognostic factors and long-term survival using patient self-reported outcome (PRO)
Authors: Kessel Kerstin A. , Grosser Rebekka C. E. , Kraus Kim Melanie , Hoffmann Hans , Oechsner Markus , Combs Stephanie E. 
Published: May 2020

Abstract
Objectives
The present study aims to evaluate long-term side-effects and outcomes and confirm prognostic factors after stereotactic body radiotherapy (SBRT) of pulmonary lesions. This is the first work that combines the investigated data from patient charts and patient-reported outcome (PRO) up to 14 years after therapy.

Materials and methods
We analyzed 219 patients and 316 lung metastases treated between 2004 and 2019. The pulmonary lesions received a median dose and dose per fraction of 35 Gy (range: 14–60.5 Gy) and 8 Gy (range: 3–20 Gy) to the surrounding isodose. During the last 1.5 years of monitoring, we added PRO assessment to our follow-up routine. We sent an invitation to a web-based survey questionnaire to all living patients whose last visit was more than 6 months ago.

Results
Median OS was 27.6 months. Univariate analysis showed a significant influence on OS for KPS ≥90%, small gross tumor volume (GTV) and planning target volume (PTV), the absence of external metastases, ≤3 pulmonary metastases, and controlled primary tumor. The number of pulmonary metastases and age influenced local control (LC) significantly.
During follow-up, physicians reported severe side-effects ≥ grade 3 in only 2.9% within the first 6 months and in 2.5% after 1 year. Acute symptomatic pneumonitis grade 2 was observed in 9.7%, as grade 3 in 0.5%.
During PRO assessment, 39 patients were contacted, 38 patients participated, 14 participated twice during follow-up. Patients reported 15 cases of severe side effects (grade ≥ 3) according to PROCTCAE classification. Severe dyspnea (n = 6) was reported mostly.

Conclusion
We could confirm excellent local control and low toxicity rates. PROs improve and complement follow-up care. They are an essential measure in addition to the physician-reported outcomes. Future research must be conducted regarding the correct interpretation of PRO data.
Prevalence and associated factors of acute diarrhea among under-five children in Kamashi district, western Ethiopia: community-based study
Authors: Fenta Adugna , Alemu Kassahun , Angaw Dessie Abebaw 
Published: May 2020

Abstract
Background
Diarrheal diseases are the second major cause of death among under-five children globally. It kills about 2.5 million people each year, with 60–70% of them being children under 5 years of age. It is also the second leading cause of morbidity in Ethiopia, with Benishangul Gumuz region bearing burden the highest with 169/1000 under five. This study aimed to determine the prevalence and associated factors of acute diarrhea among under 5 years of age children in Kamashi district, western Ethiopia, 2018.

Method
A community based cross-sectional study design was used. A two-stage systematic random sampling technique was used to select 8 kebeles and 717 study units. Binary logistic regression model to identify the association between dependent and independent variables.

Results
The prevalence of acute diarrhea was 14.5% (95% CI: (12.3, 17.3%)). Poor latrine hygiene (AOR = 11.48, 95%CI: 5.64–23.35)), had no handwashing facilities near latrines (AOR = 7.07, 95%CI:3.84–13.03), poor handwashing practice at a critical time (AOR = 5.92, 95%CI: 2.58–13.70), who stored water at home in Jerricans (AOR = 8.6, 95%CI: 1.51–48.84) and complementary feeding before 6 months (AOR = 6.49, 95%CI: 2.01–20.96) had a significant association with acute diarrhea.

Conclusion
The prevalence of acute diarrhea was still high. Latrine cleanness, availability of handwashing facilities around latrine, hand washing practice at the critical time for handwashing, storage of water by “Jerrican” and time of initiation of supplementary food were the determinant factors of diarrheal diseases.
Stunting diagnostic and awareness: impact assessment study of sociodemographic factors of stunting among school-going children of Pakistan
Authors: Ponum Mahvish , Khan Saadia , Hasan Osman , Mahmood Muhammad Tahir , Abbas Asad , Iftikhar Mehwish , Arshad Reema 
Published: May 2020

Abstract
Background
Stunting is a major public health issue in most of developing countries. Although, its worldwide prevalence is decreasing slowly but the number of stunted children is still rising in Pakistan. Stunting is highly associated with several long-term consequences, including higher rate of mortality and morbidity, deficient cognitive growth, school performance, learning capacity, work capacity and work productivity. To prevent stunting, we proposed Stunting Diagnostic and Education app. This app includes detailed knowledge of stunting and it’s all forms, symptoms, causes, video tutorials and guidelines by the Pediatricians and Nutritionists.

Methods
A cross-sectional study has been conducted in schools of Multan District, Pakistan for the period of January 2019 to June 2019. Sample data of 1420 children, aged 4 to 18 years using three age groups, were analyzed by using SPSS version 21.0 to assess the prevalence of stunting and to analyze the risk factors associated with it in children under and over 5 age. Chi square test was applied in comparison with rural and urban participants and p-value < 0.05 was considered as significant. This study includes distribution of sociodemographic characteristics, parental education, working status of mothers, dietary patterns of school going children and prevalence of stunting in school going children. After getting study results, Stunting Diagnostic and Education app was developed according to the instructions of child experts and nutritionists.

Results
354 (24.93%) participants were stunted out of 1420, 11.9% children were obese and 63.17% children were normal. Out of 354 stunted children, higher ratio of stunting was found in the age group of 8–11 years children with 51.98 percentage. 37.85% stunted children were found in the age group of 4–7 years and 10.17% stunting was found in the age group of 12–18 years children. It was observed in the study that male children were highly stunted than female with 57.91 and 42.09% respectively. Children living in rural areas were more stunted affected as compared to the children living in urban society with percentage 58.76 and 41.24 respectively.

Conclusions
Our study concluded that 24.93% children were stunted, out of which, age group of 8–11 years children were highly stunted. The study showed that the literacy of mother or caregiver had high impact on children’s health. Therefore, Stunting Diagnostic and Education app was developed to educate mothers to diagnose stunting and to teach about the prevention of stunting.
Compliance with the guidelines on recommended immunization schedule in patients with inflammatory bowel disease: implications on public health policies
Authors: García-Serrano Cristina , Mirada Glòria , Marsal Josep R , Ortega Marta , Sol Joaquim , Solano Rubén , Artigues Eva M , Estany Pepi 
Published: May 2020

Abstract
Background
Patients with inflammatory bowel disease (IBD) have a higher risk of developing opportunistic infections due to either the disease itself or to treatment with immunosuppressants. This risk can be reduced through vaccination. The aim of this study was to determine the prevalence of compliance with the guidelines on recommended immunization schedule in patients with IBD in the health district of Lleida, Spain.

Methods
Descriptive, cross-sectional, retrospective study of data at December 31, 2016. The reference population was formed by adults with a clinical diagnosis of IBD. The dependent variable was “compliance with the guidelines on recommended immunization schedule”. Variables were sex, age, residence, diagnosis, vaccination against measles, mumps, rubella, varicella, tetanus-diphtheria, influenza, pneumococcus, meningococcus C, hepatitis B, and hepatitis A. Data were obtained from electronic medical records. For the data analysis, mean (standard deviation), prevalence with 95% confidence intervals, χ2 test and Mann-Whitney test were used.

Results
Compliance did not exceed 65% for any of vaccines analysed in the 1722 studied patients with ulcerative colitis or Crohn’s disease. Significant differences across age groups were found in compliance for measles, mumps, rubella, varicella, tetanus, diphtheria and influenza in both ulcerative colitis and Crohn’s disease and for meningococcus C and hepatitis A exclusively in ulcerative colitis.

Conclusions
Compliance in patients with IBD is low. Thus, prevention of immunopreventable diseases or their complications is not maximized in this kind of patients. Greater awareness of how vaccines can reduce the risk of vaccine-preventable infections is needed among both patients and healthcare professionals.
Doing exercise or sport together with one’s child is positively associated with mothers’ momentary affect in daily life, but not with higher levels of overall physical activity
Authors: Kanning Martina , Do Bridgette , Mason Tyler B. , Belcher Britni R. , Yang Chih-Hsiang , Dunton Genevieve F. 
Published: May 2020

Abstract
Background
Physical inactivity is a widespread problem with a great need for innovative intervention concepts to overcome it. Epidemiological studies have identified working women in high-income Western countries to be at greater risk for physical inactivity. The current study included working mothers and examined within-subject associations between doing exercise/sport together with one’s child and five different affective states, and with light physical activity (LPA) and moderate-to-vigorous physical activity (MVPA).

Method
During 1 week, mothers (N = 192) completed up to eight ecological momentary assessment (EMA) surveys a day to assess momentary affect and certain situational circumstances (e.g., doing exercise/sport, being together with child). Physical activity was assessed objectively with waist-worn accelerometers.

Results
Multilevel analysis showed that doing exercise/sport together with one’s child was associated with higher positive affect and lower negative affect compared to being active alone. However, greater frequency of doing exercise/sport together with children was negatively associated with MVPA.

Conclusion
Due to the positive effect on momentary affect, combining spending time together with one’s child and simultaneously doing exercise/sport might be a good strategy of pairing two relevant personal goals. However, this strategy was not associated with sufficient MVPA.
Accumulative occlusion time correlates with postoperative pulmonary complications in patients undergoing pelvic and sacrum tumor resection assisted by abdominal aortic balloon occlusion: a retrospective cohort study
Authors: Xu Junjun , Zhao Huiying , Zhang Xiaodan , Feng Yi 
Published: May 2020

Abstract
Background
Postoperative pulmonary complications (PPCs) seems to be high in patients undergoing pelvic and sacrum tumor resection assisted by abdominal aortic balloon occlusion. We hypothesized that the accumulative occlusion time (AOT) of the abdominal aortic balloon may be predictive of PPCs. The objective of the study was to identify the influence of AOT on PPCs.

Methods
Retrospectively analyzed perioperative factors of 584 patients who underwent pelvic and sacrum tumor resection assisted by abdominal aortic balloon occlusion in our hospital from January 1, 2016 to December 31, 2018. PPCs including suspected pulmonary infection, atelectasis, pulmonary edema, pleural effusion, respiratory failure were clinically diagnosed. Perioperative parameters among patients with and without PPCs were compared. A receiver operating characteristic (ROC) analysis was conducted to evaluate the discriminative power of AOT with regard to PPCs. A multivariate logistic-regression model was finally established to identify independent risk factors for PPCs.

Results
The incidence of PPCs was 15.6% (91 patients). The median AOT in PPCs group was significantly higher than that in non-PPCs group (P <  0.001). The hospital stay was significantly prolonged in PPCs group (P <  0.001). The ROC analysis showed an AOT of 119 min as the threshold value at which the joint sensitivity (88.60%) and specificity (31.87%) was maximal. Finally, AOT ≥ 119 min (P = 0.046; odds ratio (OR) = 2.074), age (P < 0.001; OR = 1.032), ASA grade III (P = 0.015; OR = 3.264), and estimated blood loss (P = 0.022; OR = 1.235) were independent risk factors of PPCs by multivariate logistic regression analysis.

Conclusion
The incidence of PPCs in patients undergoing the pelvic and sacrum tumor surgery assisted by abdominal aortic balloon occlusion was 15.6%. AOT ≥ 119 min was an independent predictor for PPCs. Surgeons should strive to minimize the AOT within 2 h.