Estimated lifetime effective dose to hunters and their families in the three most contaminated counties in Sweden after the Chernobyl nuclear power plant accident in 1986 – A pilot study

Publication date: October 2017
Source:Journal of Environmental Radioactivity, Volume 177
Author(s): Martin Tondel, Christopher Rääf, Robert Wålinder, Afrah Mamour, Mats Isaksson
Hunters and their families were one of the most exposed subpopulations in Sweden after the Chernobyl nuclear power plant accident in 1986. In this pilot study we used existing registries and whole-body measurements to develop algorithms to calculate lifetime effective doses and collective doses to some hunters in Sweden.Ten hunters and their family members were randomly selected from each of the three most contaminated counties in Sweden (Västernorrland, Uppsala, Gävleborg) using the register for hunting weapons from the Police Authority in 1985. Hence, this design can be regarded as a closed cohort only including hunters and their family members living in these three counties at the time of the accident. Statistics Sweden matched these individuals (n = 85) with their dwelling coordinates onto the digital map produced by the Swedish Radiation Safety Authority after aerial measurements of ¹³⁷Cs (kBq m⁻²). Internal effective doses were estimated using aggregated transfer factors from ground deposition to in-vivo body concentration for ¹³⁴Cs and ¹³⁷Cs in hunters (Bq kg⁻¹). External effective doses were also calculated on the dwelling coordinate for ¹³⁴Cs, ¹³⁷Cs and short-lived nuclides in these three counties. Annual effective doses for external and internal doses were then cumulated up to a life expectancy of 80 years for men and 84 years for women, respectively.The total lifetime effective doses to the members of the hunter families in this cohort were on average 8.3 mSv in Västernorrland, 4.7 mSv in Uppsala and 4.1 mSv in Gävleborg. The effective dose to men were about 40% higher than in women. In all counties the internal dose was about 75% of the total lifetime effective dose. The collective dose for all hunters with family members, in total about 44,000 individuals, in these three counties could be approximated at about 256 manSv.This study shows it is possible to use register data to develop algorithms for calculating lifetime effective dose commitments for hunters with relatively accuracy.



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Rapid gamma spectrometric analysis of soil samples after radioactive fallout using a “conjugate view” technique

Publication date: October 2017
Source:Journal of Environmental Radioactivity, Volume 177
Author(s): M. Isaksson, M. Fahlström, N. Ossipova, K. Rosén
A method for fast determination of the activity in soil samples by measuring a fresh soil core sample from both ends with an HPGe-detector is proposed. The method was tested by simulations, as well as by measurements on spiked soil samples. Both simulations and measurements showed that the geometrical mean of the count rates when the sample is measured twice, with the bottom and the top end, respectively, facing the detector closely resembles the count rate from a measurement on a homogenized sample. Therefore, an efficiency calibration for homogenized samples could be used even if the activity is highly inhomogeneous in the soil core, as is the case with fresh fallout.It was also shown that by studying the ratio between the two measurements, a rough estimation of the extent of penetration of the radionuclide in the soil can be found. This will enhance the possibility to make rapid estimations of the soil inventory by field gamma spectrometry.



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Utilization of manipulative treatment for spine and shoulder conditions between different medical providers in a large military hospital

Publication date: Available online 14 July 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Daniel Rhon, Tina Greenleee, Julie Fritz
ObjectiveDescribe the use of manipulative treatment for shoulder and spine conditions between various provider types.DesignRetrospective observational cohortSettingSingle military hospitalParticipantsConsecutive sample of 7,566 patients seeking care for an initial spine or shoulder condition from 1 January to 31 December 2009.InterventionsManipulative treatment (e.g. manual therapy, spinal and joint manipulation, etc).Main Outcome MeasureManipulation treatment was identified with procedure billing codes in medical records. Spine and shoulder conditions were identified by use of International Classification of Diseases, 9th edition codes. All data were abstracted from the Department of Defense Military Health System Management and Analysis Tool.ResultsOf 7,566 total patients seeking care, 2,014 (26.6%) received manipulative treatment at least once, and 1870 of those received this treatment in a military facility (24.7%). Manipulative treatment was utilized most often for thoracic and least often for shoulder conditions (50.8% and 24.2% of all patients). There was a total of 6,706 unique medical visits with a manipulative treatment procedure (average of 3.3 manipulative treatment procedure visits per patient).ConclusionsManipulative treatment utilization rates for shoulder and spine conditions ranged from 26.6% to 50.2%. Chiropractors utilized manipulation the most, and physical therapists the least.



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Long-Term Disease Course and Pregnancy Outcomes in Women with Inflammatory Bowel Disease: An Indian Cohort Study

Abstract

Background

The literature on interaction between pregnancy and inflammatory bowel disease (IBD) is inconsistent, and there are no reports on this aspect from Asia. This study evaluated the impact both IBD and pregnancy have on each other in a large cohort of Indian patients.

Methods

In total, 514 females with ulcerative colitis (UC) or Crohn's disease (CD) aged between 18 and 45 years attending IBD clinic, at our institute, from July 2004 to July 2013 were screened, and patients with data on pregnancy status were included (n = 406). Pregnancies were categorized as either before, after or coinciding with disease onset. Long-term disease course was ascertained from prospectively maintained records. Pregnancy and fetal outcomes were recorded from antenatal records or individual interviews.

Results

Of 406 patients (UC: 336, CD: 70), 310 became pregnant (UC: 256, CD: 54), with a total of 597 pregnancies (UC: 524, CD: 73). More UC patients with pregnancies were in long-term remission than non-pregnant patients (56.7 vs. 43.4 %, p = 0.04). Long-term remission was less frequent in UC patients in whom pregnancy coincided with disease onset than patients with pregnancies before and after/pregnancy after the disease onset (41.4 vs. 62.5 %, p = 0.023). Pregnancies after the disease onset were associated with more cesarean sections and adverse fetal outcomes than pregnancies before disease onset in both UC and CD patients.

Conclusions

Long-term disease course in UC patients was better in pregnant as compared to non-pregnant patients. Among pregnant UC patients, disease course was worst when pregnancy coincided with disease onset. Pregnancy and fetal outcomes were worse in pregnancy after disease onset than pregnancy before disease onset.

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Pregnancy and IBD: Timing Is Everything

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The Use of Temporary Fecal Diversion in Colonic and Perianal Crohn’s Disease Does Not Improve Outcomes

Abstract

Aims

To determine whether temporary fecal diversion for refractory colonic and/or perianal Crohn's disease can lead to clinical remission and restoration of intestinal continuity after optimization of medical therapy.

Methods

We retrospectively reviewed our prospectively maintained database of patients treated at the University of Maryland for Crohn's disease between May 2004 and July 2014. Patients with colonic, perianal, or colonic and perianal Crohn's disease, who had fecal diversion for control of medically refractory and/or severe disease, were included. Outcomes, including disease activity and rate of ileostomy reversal, were evaluated up to 24 months from stoma formation.

Results

Thirty patients were identified. Fecal diversion was performed for perianal disease in 37%, colonic disease in 33%, and both in 30% of patients. Twelve (40%) patients underwent ileostomy reversal. Twenty-five percent of patients with perianal disease had their ostomies reversed compared to 70% of patients with colonic disease alone. More patients with complex compared to simple perianal disease remained diverted (p = 0.02). Six (20%) patients required colectomy. Of these, 50% had complex perianal disease, all had received two or more biologics, and two-thirds were on combination therapy pre-diversion.

Conclusions

Our study found that nearly two-thirds of patients with medically refractory colonic and/or severe perianal Crohn's disease treated with fecal diversion and optimization of postoperative medical therapy remain diverted or require colectomy within two years after ileostomy formation. In patients with severe, refractory perianal disease and those treated with combination therapy and >1 biologic exposure pre-diversion, colectomy rather than temporary fecal diversion should be considered.

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Nutritional Therapy in Very Early-Onset Inflammatory Bowel Disease: A Case Report

Abstract

Inflammatory bowel disease (IBD) is a chronic inflammatory disease of the gastrointestinal tract caused by a dysregulated immune response to the fecal microbiota. Very early-onset inflammatory bowel disease (VEO-IBD) refers to a subgroup of pediatric patients with IBD diagnosed before 6 years of age. This subgroup is often characterized by increased severity, aggressive progression, strong family history of IBD, and often poor response to conventional treatments. Nutritional therapies have been utilized to treat IBD, but their role in VEO-IBD is unclear. Disease behavior in VEO-IBD is often different from disease in adolescents and adults, as it is often restricted to the colon and refractory to standard medical therapies. Up to 25% of VEO-IBD patients have an identified underlying immunodeficiency, which may impact response to therapy. While specific mutations in interleukin 10 (IL-10), the IL-10 receptor (IL-10R), and mutations in NCF2, XIAP, LRBA, and TTC7 have been identified in VEO-IBD, polymorphisms in these genes are also associated with increased risk of developing IBD in adolescence or adulthood. We describe two cases in which infants presenting with VEO-IBD achieved clinical remission using exclusive enteral nutrition, a formula-based diet which has been shown to induce remission in older children with active Crohn's disease.

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Impedance-pH Monitoring for Diagnosis of Reflux Disease: New Perspectives

Abstract

Heartburn is the most specific symptom of gastroesophageal reflux disease (GERD). In clinical practice, heartburn relief by a proton pump inhibitor (PPI) trial does suffice to confirm GERD. However, an objective diagnosis of GERD is required before anti-reflux endoscopic or surgical interventions, independently from PPI response. Thus, since normal findings at upper endoscopy are detected in the majority of patients with heartburn, reflux monitoring is often required. When traditional catheter-based or wireless pH tests are used, reflux episodes are conventionally identified by pH drops below 4.0 units. Combined impedance-pH monitoring has the advantage to provide a comprehensive assessment of both physical and chemical properties of refluxate and the distinction between acid and weakly acidic refluxes, both proven to cause heartburn. Unfortunately, the conventional impedance-pH parameters, namely acid exposure time and number of reflux events, are characterized by suboptimal diagnostic sensitivity, and the reliability of symptom–reflux association indexes remains questionable. Therefore, novel impedance parameters, namely the post-reflux swallow-induced peristaltic wave (PSPW) index and the mean nocturnal baseline impedance (MNBI), have recently been proposed in order to achieve a better diagnostic yield. In fact, they proved to be highly accurate in distinguishing reflux-related from reflux-unrelated heartburn, off- as well as on-PPI therapy. Currently, manual review of impedance-pH tracings is needed because of the modest accuracy of available software tools for automated analysis. PSPW index and MNBI are highly applicable and reproducible, and their calculation requires a few additional minutes during the manual review of impedance-pH tracings. So far, we believe that PSPW index and MNBI are ready for prime time and should become part of the standard analysis of impedance-pH tracings for GERD diagnosis in patients with endoscopy-negative heartburn.

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Green Sludge: Intraductal Papillary Mucinous Neoplasm of the Bile Duct Presenting with Intermittent Biliary Obstruction Due to Abundant Mucus

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Direct Downregulation of B-Cell Translocation Gene 3 by microRNA-93 Is Required for Desensitizing Esophageal Cancer to Radiotherapy

Abstract

Background

Esophageal squamous carcinoma (ESC) is one of the most fatal malignancies worldwide with increasing occurrences yet poor outcome. MicroRNAs were reported to play roles in ESC.

Aims

We aimed to understand how miRNAs affect the radiotherapy resistance of ESC.

Methods

MicroRNA assays, real-time PCR, and Western blot were performed for expression analysis of miR-93 and BTG3. Luciferase activity assay was conducted with mutated B-cell translocation gene 3 (BTG3) 3′-UTR sequence in the 3′ end of luciferase sequence with miR-93 inhibitor. ESC cells were treated with irradiation (IR) and clonogenic assay was utilized to detect the cell viability. Human ESC xenograft mouse model was established and subjected to target IR treatment followed by tumor size analysis.

Results

MiR-93 was decreased and BTG3 was increased in ESC cells, with negative correlation of their expression in ESC tissues. MiR-93 directly targeted BTG3 3′-UTR by luciferase activity assay. Either miR-93 inhibition or BTG3 overexpression decreased radiation resistance. Furthermore, miR-93 inhibition suppressed radiation resistance through BTG3.

Conclusions

Direct downregulation of BTG3 by miR-93 is able to render ESC resistant to radiotherapy, and both BTG3 and miR-93 may potentially serve as clinical markers for ESC and contribute to the treatment of ESC.

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HIV Knowledge Among Pregnant Latinas in Rural South Carolina

Abstract

To inform and strengthen culturally-tailored HIV perinatal prevention, we assessed HIV knowledge among pregnant Latinas receiving prenatal care in rural South Carolina. We administered an 11 item HIV knowledge scale (n = 171). Women who answered 8 of 11 (73 %) items correctly were categorized as having "high" knowledge; <8 items correct was categorized as "low" knowledge. Seventy-six percent of participants had low HIV knowledge; only 37 % knew that there is medicine to prevent mother-to-child HIV transmission. In multivariate analyses, high HIV knowledge was more likely among women who had ≥high school education compared with women with elementary school education only (Adjusted Odds Ratio 10.5, 95 % Confidence Interval 3.3–33.6). These findings highlight the need for targeted educational interventions to better inform Latinas regarding perinatal HIV prevention and transmission risks. Enhancing efforts with patients and providers is aligned with national goals for HIV prevention and elimination of perinatal transmission.

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A Community Standard: Equivalency of Healthcare in Australian Immigration Detention

Abstract

The Australian government has long maintained that the standard of healthcare provided in its immigration detention centres is broadly comparable with health services available within the Australian community. Drawing on the literature from prison healthcare, this article examines (1) whether the principle of equivalency is being applied in Australian immigration detention and (2) whether this standard of care is achievable given Australia's current policies. This article argues that the principle of equivalency is not being applied and that this standard of health and healthcare will remain unachievable in Australian immigration detention without significant reform. Alternate approaches to addressing the well documented issues related to health and healthcare in Australian immigration detention are discussed.

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HIV-Related Stigma Among Spanish-speaking Latinos in an Emerging Immigrant Receiving City

Abstract

HIV-related stigma has been associated with a reluctance to test for HIV among Latinos. This study assessed community HIV-related stigma within an emerging Latino immigrant receiving city. We conducted a brief survey among a convenience sample of 312 Spanish-speaking Latinos in Baltimore, Maryland. HIV-related stigma was assessed through six items. Associations between stigma items, socio-demographic characteristics, and HIV testing history were considered. Gender, education, and religiosity were significantly associated with stigmatizing HIV-related beliefs. For example, men were 3.4 times more likely to hold more than three stigmatizing beliefs than women, and were also twice as likely as women to report feeling hesitant to test for HIV for fear of people's reaction if the test is positive. These findings can help inform future stigma interventions in this community. In particular, we were able to distinguish between drivers of stigma such as fear and moralistic attitudes, highlighting specific actionable items.

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Engaging African and Caribbean Immigrants in HIV Testing and Care in a Large US City: Lessons Learned from the African Diaspora Health Initiative

Abstract

The lifting in 2010 of the HIV entry ban eliminated an access point for HIV testing of the foreign-born. The African Diaspora Health Initiative (ADHI) was developed to examine alternative pathways to testing for African and Caribbean persons. The ADHI consists of Clinics Without Walls (CWW) held in community settings. HIV testing is offered to participants along with hypertension and diabetes screening. A survey is administered to participants. Descriptive data were analyzed using SAS 9.2. Between 2011 and 2015, 4152 African and Caribbean individuals participated in 352 CWW. Participants were mostly (67.7 %) African. HIV rates were lowest in Caribbean women (0.4 %) and highest in Caribbean men (8.4 %). Efforts to engage African and Caribbean communities in HIV testing are important given the elimination of the HIV entry ban and continued immigration to the US from areas of higher prevalence. The ADHI offers a successful model of engagement.

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Medicaid Expansion and Healthcare Access: Lessons from Asian American and Pacific Islander Experiences in California

Abstract

Medicaid coverage increases access to care and improves health outcomes for disadvantaged populations. Yet disparities in enrollment and access to care persist. To understand the facilitators and barriers of Medicaid enrollment and accessing care under the Affordable Care Act for disadvantaged Asian Americans and Pacific Islanders. Focus groups and key informant interviews were conducted. Informational barriers to accessing care were pervasive among most new enrollees. Immigrants with limited English proficiency experienced disproportionate difficulties in enrolling and accessing care post enrollment. The simplified, income-based Medicaid eligibility streamlined the enrollment process, but system errors in determining Medicaid eligibility denied coverage for some eligible individuals. To improve access to care, health plans, government agencies, and community organizations might coordinate more closely. Federal and state laws that mandate language assistance by health plans might be enforced to improve access to care for linguistic minorities.

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Evidence of Local HIV Transmission in the African Community of King County, Washington

Abstract

Little is known about the frequency of ongoing HIV transmission within U.S. African immigrant communities. We used HIV surveillance and partner services data to describe African-born persons newly reported with HIV infection in King County (KC), WA from 1/1/2010 to 12/31/2013. We performed phylogenetic clustering analysis of HIV-1 pol to identify putative transmission events within this population. From 2010 to 2013, 1148 KC adults were reported with HIV, including 102 (9 %) born in Africa. Forty-one African-born cases were interviewed and reported diagnosis after arrival in the U.S. Fourteen (34 %) reported ≥1 negative test prior to diagnosis, and 9 (26 %) reported ≥1 negative test after U.S. arrival. Pol genotypes were available for seven of these nine. For two of these seven, a KC case was the nearest phylogenetic neighbor; two others were infected with subtype B virus. We found substantial evidence of ongoing HIV transmission in the African community of KC.

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Acceptability of Rapid HIV Testing Among Latinos in Washington Heights, New York City, New York, USA

Abstract

In the United States, human immunodeficiency virus (HIV) has a disproportionately large impact on Latino Americans. This study assessed the acceptability of rapid HIV testing among a sample of Latinos from New York City. A cross-sectional study was conducted with 192 participants from The Washington Heights/Inwood Informatics Infrastructure for Community-Centered Comparative Effectiveness Research (WICER) study. Participants were interviewed and offered rapid HIV testing and post-test counseling. Seventy-five percent (n = 143) accepted rapid HIV testing when offered. More religious participants were less likely than less religious participants to undergo testing (RR = 0.73; 95% CI 0.54–0.99). Participants tested for HIV within the past year were less likely than those who had not been tested within the past year to agree to undergo testing (RR = 0.27; 95% CI 0.11–0.66). Community-based rapid HIV testing is feasible among Latinos in urban environments. Outreach efforts to engage religious individuals and encouraging routine testing should be reinforced.

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Health Benefits Mandates and Their Potential Impacts on Racial/Ethnic Group Disparities in Insurance Markets

Abstract

Addressing racial/ethnic group disparities in health insurance benefits through legislative mandates requires attention to the different proportions of racial/ethnic groups among insurance markets. This necessary baseline data, however, has proven difficult to measure. We applied racial/ethnic data from the 2009 California Health Interview Survey to the 2012 California Health Benefits Review Program Cost and Coverage Model to determine the racial/ethnic composition of ten health insurance market segments. We found disproportional representation of racial/ethnic groups by segment, thus affecting the health insurance impacts of benefit mandates. California's Medicaid program is disproportionately Latino (60 % in Medi-Cal, compared to 39 % for the entire population), and the individual insurance market is disproportionately non-Latino white. Gender differences also exist. Mandates could unintentionally increase insurance coverage racial/ethnic disparities. Policymakers should consider the distribution of existing racial/ethnic disparities as criteria for legislative action on benefit mandates across health insurance markets.

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Self-efficacy for HIV Prevention Among Refugee Hispanic Women in South Florida

Abstract

The number of refugees increased in recent years due to factors worldwide, including violence, wars, political strife, and natural disasters. Refugees who are Hispanic women (RHW) in South Florida are a vulnerable population at risk of acquiring HIV infection. Although studies have shown a relationship between self-efficacy for HIV prevention and behavior changes, none have studied RHW. The purpose of this study was to assess whether predictors suggested by the literature were related to self-efficacy for HIV prevention in a sample of RHW. The study is a secondary analysis that uses baseline data from a randomized controlled experimental study, SEPA. A total of 99 refugee Hispanic women from South Florida, 18–50 years of age, participated in the study. There were two predictors of self-efficacy. HIV knowledge was positively related to self-efficacy, and living with a partner was inversely related to self-efficacy for HIV prevention. Culturally competent sexual health education interventions in this population may impact self-efficacy for HIV prevention.

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U.S. Citizen Children of Undocumented Parents: The Link Between State Immigration Policy and the Health of Latino Children

Abstract

We examine Latino citizen children in mixed-status families and how their physical health status compares to their U.S. citizen, co-ethnic counterparts. We also examine Latino parents' perceptions of state immigration policy and its implications for child health status. Using the 2015 Latino National Health and Immigration Survey (n = 1493), we estimate a series of multivariate ordered logistic regression models with mixed-status family and perceptions of state immigration policy as primary predictors. We find that mixed-status families report worse physical health for their children as compared to their U.S. citizen co-ethnics. We also find that parental perceptions of their states' immigration status further exacerbate health disparities between families. These findings have implications for scholars and policy makers interested in immigrant health, family wellbeing, and health disparities in complex family structures. They contribute to the scholarship on Latino child health and on the erosion of the Latino immigrant health advantage.

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Factors Associated with Hepatitis B Knowledge Among Vietnamese Americans: A Population-Based Survey

Abstract

Vietnamese Americans have high rates of hepatitis B virus (HBV) infection but low rates of knowledge and screening. A population-based survey conducted in 2011 of Vietnamese Americans in two geographic areas (n = 1666) was analyzed. The outcome variables were having heard of HBV and a score summarizing knowledge of HBV transmission. Most respondents (86.0%) had heard of HBV. Correct knowledge of transmission ranged from 59.5% for sex, 68.1% for sharing toothbrushes, 78.6% for during birth, and 85.0% for sharing needles. In multivariable analyses, factors associated with having heard of HBV and higher knowledge included Northern California residence, longer U.S. residence, higher education, family history of HBV, and discussing HBV with family/friends. Higher income was associated with having heard of HBV. English fluency and being U.S.-born were associated with higher knowledge. Interventions to increase knowledge of HBV transmission are needed to decrease this health disparity among Vietnamese Americans.

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Tuberculosis Among Incarcerated Hispanic Persons in the United States, 1993–2014

Abstract

We examined the National tuberculosis surveillance system to describe Hispanic persons who were incarcerated at time of tuberculosis (TB) diagnosis and to compare their characteristics with those of non-Hispanic incarcerated TB patients. After declines between 1993 and 2002, the annual proportion of Hispanic TB patients who were incarcerated grew from 4.9% in 2003 to 8.4% in 2014. During 2003–2014, 19% of incarcerated US-born TB patients were Hispanic, and 86% of the foreign-born were Hispanic. Most incarcerated TB patients were in local jails, but about a third of all foreign-born Hispanics were in the facility category that includes Immigration and Customs Enforcement detention centers. Foreign birth and recent U.S. arrival characterized many Hispanic persons receiving a TB diagnosis while incarcerated. Hispanic patients had twice the odds of being in federal prisons. Systematic efforts to identify TB infection and disease might lead to early diagnoses and prevention of future cases.

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Social Support and HIV Risks Among Migrant and Non-Migrant Market Workers in Almaty, Kazakhstan

Abstract

Migration processes are listed within the primary factors facilitating the heterosexual spread of HIV. The study examines the relationship between social support, sexual HIV risk behaviors and sexually transmitted infections (STIs) among 1342 male migrant and non-migrant market workers from Barakholka Market in Almaty, Kazakhstan. Results: (1) higher level of perceived social support [Enhancing Recovery in Coronary Heart Disease (ENRICHD) Social Support Instrument (ESSI score)] was associated with a lower likelihood of having sex with a female sex worker (FSW) [OR = 0.952 (0.927, 0.978) p < .001]; (2) higher availability of friends was associated with a higher likelihood of having STIs [OR = 1.244 (1.007, 1.537), p < .05]; (3) larger network size was associated with a higher likelihood of having STIs [OR = 1.201 (1.026, 1.407), p < .05]; (4) loneliness was associated with an increased likelihood of having unprotected sex with any female partner [RR = 1.102 (1.027, 1.182), p < .05]. Results suggest that social support factors should be considered as a component of HIV and STI prevention programs for male migrant workers from Central Asia in Kazakhstan.

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The State of Essential Newborn Care by Delivery Location in Bangladesh

Abstract

Introduction Essential newborn care (ENC) around the time of birth is critical in improving neonatal survival. There is currently a gap in our knowledge of the use of ENC by place of delivery in Bangladesh. This study assesses the provision of ENC and examines the odds of newborns receiving ENC by different levels of delivery care in Bangladesh. Methods Descriptive statistics and logistic regressions were performed on ENC practices from the 2011 Bangladesh Demographic and Health Survey dataset. ENC practices included nonapplication of substances to the cord; application of antiseptic to the cord; drying newborn within 5 min; wrapping newborn within 5 min; delaying first bath until the first 72 h; and breastfeeding within 1 h. Key predictors included home delivery with a lay attendant, delivery with primary healthcare services and delivery with higher-level healthcare services. Results Coverage of ENC practices was low. Women who delivered with primary and higher-level healthcare services generally reported greater odds of their newborns receiving recommended ENC than women who had home delivery with a lay attendant, the referent category. However, the odds of delayed first bath until 72 h and breastfeeding within 1 h were not statistically different for newborns who were delivered with primary healthcare services. Discussion These findings have significant public health implications as primary healthcare facilities are the first point of entry into the healthcare system. Provision of ENC, particularly delayed first bath until 72 h and breastfeeding within 1 h, should be encouraged for all healthy mother-newborn pairs in Bangladesh.

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Incidence of and Risk Factors for Pancreatic Cancer in Chronic Pancreatitis: A Cohort of 1,656 Patients

Risk of pancreatic cancer may increase in chronic pancreatitis patients.

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