bluuebunny/crossref_metadata_2025_split huggingface dataset:
Identifying Targets for the Prevention of Childhood Undernutrition in a Resource-Limited Peri-Urban Ecuadorian Community
Authors: Attia Suzanna L. , Schmidt Wolf-Peter , Osorio Janeth Ceballos , Young Thomas , Schadler Aric , Plasencia Julie 
Published: May 2021

Background: In middle-income countries, malnutrition concentrates in marginalized populations with a lack of effective preventive strategies. Objective: Identify risk factors for undernutrition in a peri-urban Ecuadorian community of children aged 12 to 59 months. Methods: Data from a cross-sectional survey in 2011 of children 1 to 5 years were analyzed including demographic data, medical history and examination, food frequency questionnaire (FFQ), anthropometric measurements, and blood for complete blood count, C-reactive protein, vitamin A, iron, and zinc levels. Dietary Diversity Score (DDS) was calculated from FFQ. Bivariate and multivariate analysis assessed effects on primary outcome of undernutrition by DDS, vitamin deficiencies, and demographic and nutritional data. Results: N = 67, 52.2% undernourished: 49.3% stunted, 25.4% underweight, and 3% wasted; 74.6% (n = 50) were anemic and 95.1% (n = 39) had low serum zinc. Dietary Diversity Score was universally low (mean 4.91 ± 1.36, max 12). Undernutrition was associated with lower vitamin A levels (20 306, IQR: 16605.25-23973.75 vs 23665, IQR: 19292-26474 ng/mL, P = .04); underweight was associated with less parental report of illness (43.8%, n = 7 vs 80% n = 40, P = .005) and higher white blood count (13.7, IQR: 11.95-15.8 vs 10.9, IQR: 7.8-14.23 × 109/L, P = .02). In multiple regression, risk of undernutrition decreased by 4% for every $10 monthly income increase (95 CI%: 0.5%-7.4%, P = .02, n = 23); risk of underweight decreased by 0.06 for every increased DDS point (adjusted odds ratio: 0.06; 95 CI%: 0.004-0.91, P = .04, n = 23). Conclusions: In this peri-urban limited-resource, mostly Indigenous Ecuadorian community, stunting exceeds national prevalence, lower monthly income is the strongest predictor of undernutrition, lower DDS can predict some forms of undernutrition, and vitamin deficiencies are associated with but not predictive of undernutrition.
The impact of ocrelizumab on health-related quality of life in individuals with multiple sclerosis
Authors: Glanz Bonnie I , Zurawski Jonathan , Casady Emily C , Shamah Rebecca , Weiner Mira , Chitnis Tanuja , Weiner Howard L , Healy Brian C 
Published: May 2021

Background Ocrelizumab is approved for the treatment of both relapsing and progressive multiple sclerosis (MS). Objective To examine the impact of ocrelizumab on health-related quality of life (HRQOL) in individuals with MS. Methods Ninety-eight individuals with relapsing and 32 with progressive MS were enrolled. Participants were administered a battery of patient-reported outcome (PRO) measures at their first ocrelizumab infusion, and infusions at 6 and 12 months. PRO measures included the Medical Outcomes Study SF-36 and Neuro-QoL. Results At baseline, participants had low mean scores across HRQOL domains. After 12 months, increases were observed on SF-36 Role-Physical, General Health, Vitality, Role-Emotional, Mental health and Mental Component Summary. On Neuro-QoL, improvements were seen in Positive Affect, Anxiety, Emotional and Behavioral Dyscontrol and Fatigue. Several demographic and clinical characteristics were associated with HRQOL at baseline. The strongest associations were between physical HRQOL measures and measures of MS disability. Associations between the longitudinal change in HRQOL scores and baseline demographic and clinical characteristics were mild. Conclusions We observed significant improvements across multiple mental HRQOL domains at 12 months in individuals treated with ocrelizumab. These findings support the use of HRQOL measures to provide a subjective measure of treatment impact that complements traditional outcomes.
Heavy metal pollutants and their spatial distribution in surface sediments from Thondi coast, Palk Bay, South India
Authors: Perumal Karthikeyan , Antony Joseph , Muthuramalingam Subagunasekar 
Published: May 2021

Abstract
Background
The concentration of heavy metals and their spatial distribution in surface sediments collected from the Thondi coast, Palk Bay, South India were analysed in this study. The sediment grain size, pH, EC, and major elements (Fe, and Al), heavy metal concentrations (Mn, Cr, Zn, Cd, Ni, Cu, and Pb) were determined and the values for the geoaccumulation index (Igeo), enrichment factor (EF), potential contamination index (Cp), potential ecological risk index (RI), contamination factor (CF), modified contamination degree (mCd), degree of contamination (Cd), and potential contamination factors (Cp) were calculated based on their background values to determine the pollution level of the study area. Multivariate analysis such as Pearson’s correlation coefficient, principal component analysis/factor analysis (PCA/FA), cluster analysis, and regression analysis are a versatile method for identifying heavy metal sources and determining the relationship between pollutants in marine sediment.

Results
The pollution indices, namely EF, CF, Cd, mCd, CP, RI, and Igeo, revealed that the heavy metal contamination was due to Cd, while a moderate level of contamination was caused by Cu, Zn, Pb, and Cr. The principal component analysis and correlation matrix analysis showed a strong positive loading for Cd due to its high level of contamination in the study area. Anthropogenic inputs such as municipal wastewater, domestic sewage discharge, fishing harbour activities, and industrial and aquaculture wastes led to the increased Cd concentration in the study area. Moreover, the pollution load index revealed that the sediments were polluted by heavy metals.

Conclusion
The findings of this study revealed that the increased concentration of heavy metals in the study area increases the toxicity in the marine environment, thus affecting the ecosystem.
Healthcare workers’ compliance and its potential determinants to prevent COVID-19 in public hospitals in Western Ethiopia
Authors: Etafa Werku , Gadisa Gosa , Jabessa Shibiru , Takele Tagay 
Published: May 2021

Abstract
Background
Globally, Coronavirus disease-19 has created unprecedented challenges to public health. Healthcare workers (HCWs) are at risk of COVID-19 because of their profession. There are limited studies conducted in Ethiopia among HCWs regarding their compliance with COVID-19 preventive measures. Therefore, this study intended to assess HCWs’ compliance with measures to prevent COVID-19, and its potential determinants in public hospitals in Western Ethiopia.

Methods
A self-administered, multicenter hospital-based cross-sectional survey was proposed to 422 randomly selected HCWs working in seven public hospitals in Western Ethiopia identified as COVID-19 referral centers. Data were entered into Epi Data version 3.1 and analyzed using SPSS version 24. Binary logistic regression was used to identify potential determinants of outcome variables at p-value < 0.05.

Results
Out of 422 completed questionnaires, the overall HCWs’ compliance with COVID-19 prevention is 22% (n = 404). In multivariate regression analysis, factors such as spending most of caring time at bedside (AOR = 1.94, 95%CI, 1.06–3.55), receiving training on infection prevention/COVID-19 (AOR = 1.86, 95%CI, 1.04–3.33), reading materials on COVID-19 (AOR = 2.04, 95%CI, 1.14–3.63) and having support from hospital management (AOR = 2.09, 95%CI, 1.20–3.64) were found to be significantly associated with COVID-19 preventive measures. Furthermore, inadequate supplies of appropriate personal protective equipment (83.2%), insufficient supportive medications (78.5%), and lack of provision of adequate ventilation (77.7%) were the barriers to COVID-19 prevention most frequently mentioned by participants.

Conclusion
Our findings highlight HCWs’ poor compliance with COVID-19 preventive measures. Providing information and refreshing training to improve the level of healthcare workers’ adherence with COVID-19 prevention is as imperative as increasing staff commitment to supply resources necessary to protect HCWs and to reduce healthcare-associated infections transmission of SARS-COV-2.
Referring patients with chronic kidney disease back to primary care: a criteria-based analysis in outpatient renal clinics
Authors: van Dipten Carola , van Dam Davy Gerda Hermina Antoin , de Grauw Wilhelmus Joannes Carolus , ten Dam Marcus Antonius Gerard Jan , Hermans Marcus Matheus Hendrik , Assendelft Willem Jan Jozef , Haan Nynke Dorothea Scherpbier-de , Wetzels Jacobus Franciscus Maria 
Published: May 2021

Abstract
Background
The increased demand for nephrology care for patients with chronic kidney disease (CKD) necessitates a critical review of the need for secondary care facilities and the possibilities for referral back to primary care. This study aimed to evaluate the characteristics and numbers of patients who could potentially be referred back to primary care, using predefined criteria developed by nephrologists and general practitioners.

Method
We organised a consensus meeting with eight nephrologists and two general practitioners to define the back referral (BR) criteria, and performed a retrospective cohort study reviewing records from patients under nephrologist care in three hospitals.

Results
We reached a consensus about the BR criteria. Overall, 78 of the 300 patients (26%) in the outpatient clinics met the BR criteria. The characteristics of the patients who met the BR criteria were: 56.4% male, a median age of 70, an average of 3.0 outpatients visits per year, and a mean estimated glomerular filtration rate of 46 ml/min/1,73m2. Hypertension was present in 67.9% of this group, while 27.3% had diabetes and 16.9% had cancer. The patients who could be referred back represented all CKD stages except stage G5. The most common stage (16%) was G3bA2 (eGFR 30 ≤ 44 and ACR 3 ≤ 30).

Conclusion
A substantial proportion of patients were eligible for referral back to primary care. These patients often have a comorbidity, such as hypertension or diabetes. Future research should focus on generalisability of the BR criteria, the feasibility of actual implementation of the back referral, follow-up assessments of renal function and patient satisfaction.
MRI-based early diagnosis: a diabetic Charcot spine case report
Authors: Nedel Barbara Limberger , Duarte Juliana Avila , Gerchman Fernando 
Published: May 2021

Abstract
Background
Spinal neuroarthropathy (SNA), also known as Charcot spine, is an uncommon aggressive arthropathy, secondary to loss of proprioceptive and nociceptive feedback from the spine. A diagnosis of SNA is frequently delayed due to the scarcity of symptoms in its early stages, leading to significant neurological deterioration. Therefore, prompt suspicion of the disease is critical to providing better outcomes. This case assembles two rare characteristics of SNA: diabetic aetiology and a precocious time of diagnosis, and aims to highlight the magnetic resonance imaging (MRI) findings that allowed for the diagnosis.

Case presentation
A 44-year-old woman, with long-term type 1 diabetes, presented with a two-month history of progressive lumbar pain, difficulty in maintaining an upright position, and discrete trunk forward-leaning. Diabetes-related vasculopathy and nephropathy were already known, and laboratory test results did not show any new abnormalities. A lumbar MRI revealed extensive signal intensity changes of the L2 and L3 vertebral bodies associated with marginal areas of enhancement and the involvement of regions adjacent to interapophyseal articulations and spinous processes from L2–L3 to L5–S1, in association with degenerative changes of the thoracolumbar spine. These findings were identified by the radiologist as suggestive of SNA. To rule out neoplastic and infectious disease, a bone biopsy at the L2–L3 level was executed. The pathology report revealed intervertebral disc material and fragments of fibrous tissue, with a complete absence of inflammatory cells. It was decided to perform a six-month MRI follow-up, which showed stability of the findings, confirming the hypothesis of Charcot spine. The patient was under clinical and radiological follow-up and did not require surgical fixation at the moment of diagnosis. After 2.5 years from the initial diagnosis, a new MRI revealed progression of the lesions with oedema and enlarged paravertebral soft tissues; these findings are compatible with the patient’s latest complaints of lumbar pain recurrence.

Conclusion
To the best of our knowledge, this is the first case report of an MRI-based early diagnosis of diabetic SNA, a rare disease with nonspecific symptoms in its initial stages and a wide spectrum of differential diagnoses. The MRI findings, distinctly the involvement of both anterior and posterior spinal elements, were the key to allowing for the proper diagnosis. A precocious diagnosis, although challenging, is fundamental to providing early intervention and to preventing further neurological impairment.
Production losses attributable to suicide deaths in European Union
Authors: Łyszczarz Błażej 
Published: May 2021

Abstract
Background
Suicide is an important public health problem with multidimensional consequences for societies. One of the under-researched areas of suicide consequences are cross-country analyses of production losses associated with these deaths. The aim of this study was to estimate the production losses (indirect cost) of suicide deaths in 28 European Union states (EU-28) in 2015.

Methods
The study used societal perspective and human capital approach to investigate production losses due to suicide mortality at working age. Eurostat’s data on the number of deaths was used to identify suicide mortality burden in terms of years of potential productive life lost. Labour and economic indicators were applied to proxy the discounted value of potential economic output lost. A one-way deterministic sensitivity analysis was conducted to test the robustness of the estimates.

Results
The production losses attributable to suicide deaths in EU-28 in 2015 were €9.07 billion. The per suicide indirect cost of these deaths was €231,088 for the whole EU-28 population; Luxembourg experienced the highest per suicide burden of €649,148. The per capita production losses of suicides in EU-28 was €17.80 and Ireland experienced the highest per capita burden of €48.57. The losses constituted an economic burden of 0.061% of EU-28’s GDP and this share ranged from 0.018% in Cyprus to 0.161% in Latvia. Most of the losses (71–91%) were due to men’s deaths. The results of the sensitivity analysis exhibit a large variation of losses; the highest (lowest) cost was identified with no adjustment for lower employment rates among those dying by suicide (adjustment for minimum productivity) and was 92.3% higher (59.7% lower) on average than in the base scenario.

Conclusion
Public health actions aimed at prevention of suicides might reduce their health burden but also contribute to the economic welfare of European societies.
Life-threatening hemoptysis accompanied by internal thoracic artery aneurysms in a 28-year-old perinatal woman: a case report
Authors: Li Yujun , Wang Yuyao , Liang Zhike , Pan Chuzhi , Huang Xiaomei , Mo Zexun , Chen Guodong , Zhu Dongliang , Zhao Ziwen , Wei Shuquan 
Published: May 2021

Abstract
Background
Life-threatening hemoptysis presents an immediate diagnostic and therapeutic challenge, especially during the perinatal period.

Case presentation

A 28-year-old perinatal woman with no significant past medical or surgical history presented with repeating hemoptysis and respiratory failure. Computed tomography revealed a 2.1 × 3.2 cm2 inhomogeneous tumorous lesion in the right superior mediastinum and a right main bronchus obstruction along with atelectasis of the right lung. Bronchoscopy showed a tumorous protrusion blocking the right main bronchus with active hemorrhage, and malignancy was suspected. Bronchial artery embolization (BAE) was performed to control the bleeding. The arteriogram revealed tortuosity, dilation and hypertrophy of the right bronchial arteries and aneurysms of the internal thoracic artery (ITA). The bleeding completely stopped after BAE. Bronchoscopy was performed again to remove residual blood clots. The patient recovered soon after the procedure and was discharged.

Conclusions
Life-threatening hemoptysis concomitant with ITA aneurysms, which may have a misleading clinical diagnosis and treatment options, has not been reported previously in perinatal women. BAE could be used as a first-line treatment irrespective of the underlying causes.
Evaluations of the curative efficacy of G. fruticosus solvent extracts in experimentally induced nephrolithiatic Wistar male rats
Authors: Alelign Tilahun , Tessema Tesfaye Sisay , Debella Asfaw , Petros Beyene 
Published: May 2021

AbstractBackgroundIn Ethiopian folk medicine, there is a claim that medicinal plants can treat urolithiasis although there is insufficient scientific evidence. The objective of this study was to evaluate the curative efficacy ofGomphocarpus fruticosusextracts in experimentally induced nephrolithiatic rats.MethodsUrolithiasis was induced in male Wistar rats by feeding ethylene glycol in drinking water for 28 days. The curative effects were evaluated after oral administrations of 200 mg/kg of the extracts from 15 to 28 days. Urine samples were collected 1 day before sacrificing the rats. Blood, liver and kidney samples were gathered under anaesthetic condition at day 28. Crystals in the urine were also analyzed by light microscopy.ResultsG. fruticosusEtOAc extract reduced significantly the level of sodium (P < 0.001), whereas it was significantly elevated the levels of magnesium and citrate (P < 0.01) compared to lithiatic control.G. fruticosusBuOH extract lowered the levels of potassium (P < 0.01), calcium and phosphate in urolithiatic rats. It was also observed thatG. fruticosusEtOAc extract decreased the level of oxalate in the urine (P < 0.001), whereas it was increased the levels of magnesium (P < 0.05) and citrate (P < 0.01) in serum analysis after exposure to BuOH extract. In the kidneys, CaOx crystal deposits were reduced significantly byG. fruticosusEtOAc extract (P < 0.01).ConclusionIt has been noted thatG. fruticosusEtOAc extract was potent in treating urolithiasis. However, further study is required to assess the efficacy of the active compounds against urolithiasis.
Multicopy targets for Plasmodium vivax and Plasmodium falciparum detection by colorimetric LAMP
Authors: Nolasco Oscar , Montoya Jhoel , Rosales Rosas Ana L. , Barrientos Scarlett , Rosanas-Urgell Anna , Gamboa Dionicia 
Published: May 2021

Abstract
Background
Loop-mediated isothermal amplification (LAMP) for malaria diagnosis at the point of care (POC) depends on the detection capacity of synthesized nucleic acids and the specificity of the amplification target. To improve malaria diagnosis, new colorimetric LAMP tests were developed using multicopy targets for Plasmodium vivax and Plasmodium falciparum detection.

Methods
The cytochrome oxidase I (COX1) mitochondrial gene and the non-coding sequence Pvr47 for P. vivax, and the sub-telomeric sequence of erythrocyte membrane protein 1 (EMP1) and the non-coding sequence Pfr364 for P. falciparum were targeted to design new LAMP primers. The limit of detection (LOD) of each colorimetric LAMP was established and assessed with DNA extracted by mini spin column kit and the Boil & Spin method from 28 microscopy infections, 101 malaria submicroscopic infections detected by real-time PCR only, and 183 negatives infections by both microscopy and PCR.

Results
The LODs for the colorimetric LAMPs were estimated between 2.4 to 3.7 parasites/µL of whole blood. For P. vivax detection, the colorimetric LAMP using the COX1 target showed a better performance than the Pvr47 target, whereas the Pfr364 target was the most specific for P. falciparum detection. All microscopic infections of P. vivax were detected by PvCOX1-LAMP using the mini spin column kit DNA extraction method and 81% (17/21) were detected using Boil & Spin sample preparation. Moreover, all microscopic infections of P. falciparum were detected by Pfr364-LAMP using both sample preparation methods. In total, PvCOX1-LAMP and Pfr364-LAMP detected 80.2% (81 samples) of the submicroscopic infections using the DNA extraction method by mini spin column kit, while 36.6% (37 samples) were detected using the Boil & Spin sample preparation method.

Conclusion
The colorimetric LAMPs with multicopy targets using the COX1 target for P. vivax and the Pfr364 for P. falciparum have a high potential to improve POC malaria diagnosis detecting a greater number of submicroscopic Plasmodium infections.
What are the factors influencing the aversion of students towards reptiles?
Authors: da Silva Moacyr Xavier Gomes , Braga-Pereira Franciany , da Silva Mikaela Clotilde , de Oliveira José Valberto , de Faria Lopes Sérgio , Alves Rômulo Romeu Nóbrega 
Published: May 2021

AbstractBackgroundReptiles form a paraphyletic group with significant roles for human society, including species that are considered important for food, medicinal and mystical use and as pets. Some species are considered to be aversive, whereas others are captivating among people. Aversion is an important factor which should be considered in the conservation policies of these animals. As such, here, we investigate the demographic, educational, perceptives and behavioural factors of students related to their aversion and non-conservationist attitudes directed towards different reptile species and evaluated the effect of educational exhibition of animals as a strategy of mitigating these attitudes.MethodsThe data were obtained through forms on the aversion and conservation of reptiles represented by three species, a chelonian, a snake and a lizard. The form was given in two instances, before and after a visit to a private zoo (Museu Vivo Répteis da Caatinga), where the students had contact with the aforementioned species. A total of 133 students participated in the study, among these, 43 from elementary school (21 females and 22 males), 29 from high school (16 females and 13 males), 37 from university biology students (22 females and 15 males) and 24 university mathematics students (6 females and 18 males).ResultsAmong all evaluated species, snakes were considered to be the most aversive species. The aversion attitudes differed between the three evaluated species when correlated to age and type of university courses. However, this pattern did not differ between student sexes. Older students had a lower aversion to the chelonian compared to the younger ones, but for snakes and lizards, the aversion was high among students of all ages. The university biology students had a lower aversion compared to the university mathematics students for the three species. The recognition and handle of the tested species and previous visits to educational exhibitions of animals were negatively related to aversion. The comparative analysis of the forms applied before and after the visit to the Museu Vivo Répteis da Caatinga showed that this visit influenced the decrease of aversion, but not in non-conservationist attitudes, for which the attitude scores had always been low.ConclusionsWe conclude that reptile aversion varies in accordance with the taxon, being snakes the most disliked by students. The visit to the educational exhibition of animals contributed to the reduction of the observed aversion. This is especially true when the acquisition of educational information about species is associated with practical activities which includes contact with the animals. Finally, the fact that non-conservationist attitudes had been low towards all species perhaps demonstrates a conservationist tendency even for the most aversive species.