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exclusive enteral nutrition versus corticosteroids for treatment of pediatric Crohn's disease: a meta-analysis

World Journal of Pediatrics 2019年第1期15卷 26-36页

作者： Yu Yu Kang-Chen Chen Jie Chen Department of Gastroenterology Children's HospitalZhejiang University School of Medicine3333 Binsheng RoadBinjiang DistrictHangzhou 310051China First Affiliated Hospital Zhejiang University School of Medicine79 Qingchun RoadShangcheng DistrictHangzhou 310002China

Background Many studies have examined the effects of exclusive enteral nutrition (EEN) in children with Crohn's disease (CD),but corticosteroids are considered a superior therapy and are frequently used in China.This meta-analysis aims to compare the efficacy of EEN with corticosteroids in treating pediatric CD.Methods A comprehensive retrieval from medical databases,including PubMed,EMBASE,MEDLINE,Web of Science,Wanfang data,VIP and CNKI,was performed using the search terms 'diet therapy','exclusive enteral nutrition','Crohn's disease','inflammatory bowel diseases','child' and 'pediatrics' from January 1990 to April 2017.Results We included 18 studies from 1329 identified sources in this meta-analysis.EEN was as effective as corticosteroids in inducing remission rate of children suffering from CD (OR =1.35;95% CI 0.90,2.10;P =0.14).Nevertheless,patients who received EEN were more likely to achieve both endoscopic mucosal healing (OR =5.24;95% CI 2.06,13.37;P =0.0005)and histological mucosal healing (OR =4.78;95% CI 1.89,12.08;P=0.0009) than those who received corticosteroids;the Pediatric Crohn's Disease Activity Index was lower [mean difference (MD)=-3.67;95% CI-4.91,-2.43] and weight gain was higher (MD=1.92;95% CI 0.02,3.83;P=0.05) in those patients who received EEN than in those who received corticosteroids.No difference was found in relapse rate (OR =0.57;95% CI 0.25,1.29;P=0.18),height for age or body mass index between the patients treated with EEN and corticosteroids at the 1-year end point.Conclusions This meta-analysis reveals that there is no significant difference between EEN and corticosteroids in the efficacy of inducing remission rate of CD in a pediatric population,but EEN is superior to corticosteroids in improving short-term mucosal inflammation and reducing the PCDAI index.

关键词： Children Corticosteroids Crohn's disease exclusive enteral nutrition Inflammatory bowel disease Nutrition

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Factors associated with exclusive breastfeeding in relation to knowledge,attitude and practice of breastfeeding mothers in Rabigh community,Western Saudi Arabia

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World Journal of Pediatrics 2019年第6期15卷 601-609页

作者： Moustafa A.Hegazi Mousa Allebdi Mohammed Almohammadi Abdulelah Alnafie Lama Al-Hazmi Shahad Alyoubi Pediatric Department Faculty of Medicine in RabighKing Abdulaziz UniversityP.O.80205Jeddah 21589Saudi Arabia Pediatric Department Mansoura University Children's HospitalP.O.35516MansouraEgypt Faculty of Medicine in Rabigh King Abdulaziz UniversitySaudi Arabia

Background There is much concern about declining rates of exclusive breastfeeding(EBF)all over the world including Saudi Arabia which deprives infants from many immunological,nutritional,and psychosocial benefits.This study was per-formed to determine EBF prevalence and factors influencing EBF in relation to knowledge,attitude and practice(KAP)of breastfeeding mothers(BFM)in Rabigh,Western Saudi Arabia.Methods Data about factors that could be associated with EBF and KAP of BFM were collected by cross-sectional ques-tionnaire-based study from 420 BFM.Results Prevalence of EBF for 6 months was 27.6%which is far below World Health Organization recommendations.Demographic,socioeconomic,biomedical as well as most studied variables of KAP of 50%to over 90%of participating mothers were adequate to account for low EBF rate.Proper knowledge about benefits of colostrum and continuation of breastfeeding for 2 years was given by only 86.2%and 36.7%of BFM,respectively.The most significant independent factors associated with EBF were perception of sufficient human milk[adjusted odds ratio(AOR)2.89;95%confidence interval(CI)1.72-4.89],absence of nipple pain(AOR 2.77;95%CI 1.72-4.45)and mothers without university education(AOR 1.86;95%CI 1.15-3.01).Early introduction of formula in hospital after birth was the main inappropriate feeding practice in 76.2%of infants of BFM.Conclusion Findings of this study should be utilized by Rabigh community and other national or worldwide communities with similar characters to promote EBF by targeted educational programs after identification of significant factors inltuenc-ing EBF and gaps in KAP of BFM.

关键词： exclusive breastfeeding Factors Rabigh Saudi Arabia

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exclusive enteral nutrition in children with crohn＇s dis

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World Journal of Gastroenterology 2015年第22期21卷 6809-6816页

作者： AndrewSDay RobertNLopez DepartmentofPaediatrics UniversityofOtagoChristchurch8140NewZealand Department ChristchurchHospitalChristchurch8140NewZealand

exclusive enteral nutrition involves the use of acomplete liquid diet, with the exclusion of normaldietary components for a defined period of time,as a therapeutic measure to induce remission inactive Crohn＇s disease （CD）. This very efficaciousapproach leads to high rates of remission, especiallyin children and adolescents newly diagnosed withCD. This intervention also results in mucosal healing,Abstractexclusive enteral nutrition involves the use of acomplete liquid diet, with the exclusion of normaldietary components for a defined period of time,as a therapeutic measure to induce remission inactive Crohn＇s disease （CD）. This very efficaciousapproach leads to high rates of remission, especiallyin children and adolescents newly diagnosed withCD. This intervention also results in mucosal healing,

关键词： Children Crohn's disease exclusive enteralnutrition Nutrition Outcomes Mechanisms

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exclusive Breastfeeding Practice and Its Factors in Rural Areas of Burkina Faso

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Open Journal of Epidemiology 2018年第2期8卷 67-75页

作者： Lé on G. Blaise Savadogo Bernard Ilboudo Maurice Kinda Department of Epidemiology and Public Health—Child and Mother Health Nutrition and Survival Unit—Institut Sup&eacute rieur des Sciences de la Santé Bobo Dioulasso Burkina Faso

Background: The recommendation of the WHO and UNICEF is that all infants should be exclusively breastfed up to 6 months of age. Identifying associated factors to exclusively breastfeeding is crucial to improve this key public health intervention. The objectives of the study were to investigate rates of exclusive breastfeeding and to identify potential associated factors. Methods: A Community based cross-sectional study design was conducted in three health districts. Cluster sampling was used. For the community based cross-sectional study, a total of 1832 infants was included. exclusive breastfeeding have been investigated among the 563 under 6 month’s infants. The associations between exclusive breastfeeding and independent variables were tested using the Chi-square test. Crude Odds ratios with 95 % confidence intervals were used to investigate the factors independently associated with exclusively breastfeeding. Results: Proportion of infant 0 - 5.9 months of age who are fed exclusively with breastmilk was 40.0%. Ear of age for mother was found to be more likely to practice exclusive breastfeeding, COR [95CI%] = 2.11 [1.24 - 3.60] for 15 - 20 years of age and 2.0 [1.22 - 3.26]. Receiving advices, on exclusive breastfeeding was found to be more likely to practice exclusive breastfeeding, COR: 2.07, 95% CI: [1.44 - 2.98]. Mothers who have practice early initiation to breastfeeding were found to be more likely to practice exclusive breastfeeding COR: 1.62, 95% CI: [1.15 - 2.27]. Skilled delivery was found to be more likely to practice exclusive breastfeeding than non-skilled deliveries, COR: 1.66, 95% CI: [1.16 - 2.35]. Low numbers of living children by mother, young children, were found to be more likely to practice exclusive breastfeeding. Conclusions: exclusive breastfeeding continues to be low in rural areas of Burkina Faso. As exclusive breastfeeding is associated to lower morbidity and mortality risk, improving the skills of health providers to give adequate feeding support to the mothers is critical for promo

关键词： Prevalence exclusive Breastfeeding Rural Areas Burkina Faso

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Use of exclusive enteral nutrition in adults with Crohn's disease: A review

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World Journal of Gastroenterology 2013年第43期19卷 7652-7660页

作者： Catherine L Wall Andrew S Day Richard B Gearry Department of Paediatrics University of OtagoChristchurch 8140New Zealand Department of Medicine University of OtagoChristchurch 8140New Zealand

exclusive enteral nutrition(EEN)is well-established as a first line therapy instead of corticosteroid(CS)therapy to treat active Crohn’s disease(CD)in children.It also has been shown to have benefits over and above induction of disease remission in paediatric populations.However,other than in Japanese populations,this intervention is not routinely utilised in adults.To investigate potential reasons for variation in response between adult studies of EEN and CS therapy.The Ovid database was searched over a 6-mo period.Articles directly comparing EEN and CS therapy in adults were included.Eleven articles were identified.EEN therapy remission rates varied considerably.Poor compliance with EEN therapy due to unpalatable formula was an issue in half of the studies.Remission rates of studies that only included patients with previously untreated/new CD were higher than studies including patients with both existing and new disease.There was limited evidence to determine if disease location,duration of disease or age of diagnosis affected EEN therapy outcomes.There is some evidence to support the use of EEN as a treatment option for a select group of adults,namely those motivated to adhere to an EEN regimen and possibly those newly diagnosed with CD.In addition,the use of more palatable formulas could improve treatment compliance.

关键词： exclusive enteral nutrition Crohn’s disease Adults

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Production of a heavy quarkonium with a photon or via ISR at Z peak in e^+e^- collider

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Science China(Physics,Mechanics & Astronomy) 2010年第11期53卷 2031-2036页

作者： CHANG ChaoHsi Department of Physics Chongqing University CCAST (World Laboratory) Institute of Theoretical Physics Chinese Academy of Sciences

Considering the possibility to build an e + e-collider at the energies around Z-boson resonance with a luminosity so high as L ∝ 10 34 cm-2 s-1 (even higher) and the abilities of a modern synthesis detector,we systematically calculate the exclusive two body processes of the heavy quarkonium production: e + eannihilates into a heavy quarkonium and a photon,involving the initial state radiation (i.e.ISR) cases,at the energies around the Z-boson resonance.Since the couplings of Z-boson to quarks contain an axial vector term as well as a vector one,a charmonium such as J/ψ or η c or h c or χ cJ ···,or a bottomonium such as Υ or η b or h b or χ bJ ···,associating with a photon,may be produced respectively via Z-boson annihilation.If we call such a collider with so high luminosity and running around the Z-boson resonance as a Z-factory,then our results obtained here indicate that experimental studies of the various heavy quarkona (their ground and excited states) via the two-body processes at a Z-factory have outstanding advantages,especially,the production of the possible states with quantum numbers J PC = 1-via ISR.

关键词： heavy quarkonium exclusive two-body production Z-factory

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Determinates of Childhood Pneumonia and Diarrhea with Special Emphasis to exclusive Breastfeeding in North Achefer District, Northwest Ethiopia: A Case Control Study

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Open Journal of Epidemiology 2015年第2期5卷 107-112页

作者： Molla Gedefaw Resom Berhe GAMBY College of Medical Science Bahir Dar Ethiopia Health Education and Behavioral Sciences Unit Institute of Public Health University of Gondar Gondar Ethiopia

Studies showed that exclusive breast feeding reduced infant morbidity and mortality. In low income countries such as Ethiopia where under-five mortality is very high, the role of exclusively breastfeeding could be even more critical. However, studies assessing the place of exclusive breast freeing in the prevention of childhood illnesses in our area are scarce. The aim of the study was to identify determinant factors of childhood pneumonia and diarrhoea. An institution based case control study was conducted in Achefer District in July, 2012. The cases were 122 children of 7 - 24 months old who had repeated attack of diarrhoea or pneumonia over three months prior to the survey while controls were 122 children who visited well baby clinic for vaccination. Data were collected by using pre-tested and structured questionnaire, and analysed using SPSS version 16 for windows. Logistic regression was performed, and strength of associations was estimated using odds ratio and 95% confidence interval. About 83% of the controls and only 12.3% of the cases were exclusively breast fed. Children who were exclusively breast fed were 83 times less likely to develop pneumonia or diarrhea than those who were not exclusively fed. Marital status, monthly income, prelacteal feeding, and late initiation of breast feeding were found to have statistically significant association with childhood diarrhea and pneumonia. This study brought local evidence that exclusive breast feeding had a protective effect against common childhood infectious diseases—pneumonia and diarrhoea—in the study area. Therefore, culture sensitive and plausible health education is recommended to strengthen exclusive breast feeding practices in order to decrease mortality and morbidity of infants and children from pneumonia and diarrhoea.

关键词： exclusive Breast Feeding Determinant Factors Childhood Pneumonia Diarrhea Ethiopia

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The Practice of exclusive Breastfeeding and Its Sociodemographic Determinants amongst Nursing Mothers at a Tertiary Health Care Institution in South East, Nigeria

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Open Journal of Preventive Medicine 2017年第4期7卷 63-73页

作者： Henry N. Chineke Anthony C. Iwu Kevin C. Diwe Chukwuma B. Duru Kenechi A. Uwakwe Eyitayo E. Emmanuel Uche R. Oluoha Ugochukwu C. Madubueze Emmanuel U. Ndukwu Ikechi Ohale Department of Family Medicine Imo State University Teaching Hospital Orlu Nigeria Department of Community Medicine Imo State University Teaching Hospital Orlu Nigeria Department of Community Medicine Imo State University Owerri Nigeria Department of Epidemiology and Community Health Ekiti State University Ado Ekiti Nigeria Department of Community Medicine Federal Teaching Hospital Abakaliki Nigeria

Background: Breastfeeding is a natural and critical act that provides nutrients and energy for the infant and young child;and through a public health intervention such as exclusive breastfeeding, it improves the survival rates of the infant. Objective: To determine the breastfeeding practices and the sociodemographic determinants of exclusive breastfeeding amongst nursing mothers present at the Imo state university teaching hospital Orlu. Methods: A cross sectional analytical study design was used that included all nursing mothers present within a 4 week study period. Data was collected using a structured questionnaire. Descriptive analyses were done with frequencies and summary statistics. Chi square statistics were computed to determine significant associations and binary logistic regression was used to determine sociodemographic predictors of exclusive breastfeeding practice. P value was set at 0.05 significant level. Results: While most of the respondents were aware of exclusive breastfeeding (92.5%), only 24% of the respondents were practicing exclusive breastfeeding. Work and school activities, and the feeling that breast milk was insufficient for the needs of the baby were the reasons for not practicing exclusive breastfeeding for a majority of the respondents (56.6%). Furthermore, 61% of those that were practicing non-exclusive breast feeding gave a cereal or infant formula in addition to the breast milk for 3 to 6 months. It was further revealed that there were statistically significant relationships between breastfeeding practice and maternal age (p = 0.003), level of maternal education (p = 0.005) and maternal occupation (p = 0.006). Conclusion: Understanding and taking into cognizance the sociodemographic characteristics will enable the design, and adequate delivery of appropriate and effective strategies that improve exclusive breastfeeding practice.

关键词： exclusive Breastfeeding Sociodemographic Determinants Nigeria

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Practice environment related barriers to exclusive breastfeeding among HIV-positive mothers in Blantyre, Malawi

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Health 2013年第9期5卷 1412-1421页

作者： Ursula K. Kafulafula Mary K. Hutchinson Susan Gennaro Sally Guttmacher Ellen Chirwa Boston College of Nursing Boston USA New York University New York USA University of Malawi Kamuzu College of Nursing Blantyre Malawi

Rates of exclusive breastfeeding in Malawi remain low despite the acknowledged benefits of exclusive breastfeeding for the infant’s wellbeing and the prevention of mother-to-child transmission of HIV. Creating an environment supportive of exclusive breastfeeding is critical to increase the rate of exclusive breastfeeding among HIV-positive mothers. However, little is known on factors that influence the environment within which HIV-positive mothers in Malawi practise exclusive breastfeeding. Therefore, the exploratory qualitative study on which this article is based was conducted at the Chatinkha maternity unit of Queen Elizabeth Central Hospital in Malawi from April 16, 2009 to May 8, 2009 to explore perceived practice environment related barriers to exclusive breastfeeding among HIV-positive mothers. Data were obtained through indepth interviews with 16 purposively selected breastfeeding HIV-positive mothers between 18 and 35 years old and two focus group discussions with women of unknown HIV status. Semi-structured interview and focus group guides were utilised. Content analysis of data was done. Five main themes emerged regarding factors that may influence the environment within which exclusive breastfeeding was practised: 1) availability of resources;2) societal norms and cultural practices;3) mother-baby proximity;4) health workers’ attitudes and 5) disclosure of the mothers’ HIV status. A multi-sectoral approach to promote exclusive breastfeeding is suggested. This?should include community involvement because it is in the community where breastfeeding norms and cultural practices associated with breast-feeding are propagated.

关键词： Barriers Practice Environment exclusive Breastfeeding HIV-Positive Mothers Malawi

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Impact of Educational Materials on the Duration of exclusive Breastfeeding Assured by Women Who Delivered at the Souissi Maternity Hospital in Rabat

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Open Journal of Obstetrics and Gynecology 2017年第13期7卷 1300-1318页

作者： Amina Bennis Fatima Zahra Laamiri Anas Ansari Chebguiti Hassan Aguenaou Mustapha Mrabet Aicha Kharbach Amina Barkat Research Team in Maternal and Child Health and Nutrition Faculty of Medicine and Pharmacy Mohammed V University Rabat Morocco Higher Institute of Nursing Professions and Technical Health Rabat Morocco Department of Obstetrics Gynaecology and High Risk Pregnancies Maternity Hospital Souissi—Ibn Sina Teaching Hospital of Rabat-Salé Rabat Morocco Moroccan Association of Infant Nutrition Rabat Morocco Mixed Research Unit in Nutrition and Food URAC 39 (University Ibn Tufail-CNESTEN) Designated Regional Center of Nutrition Associate AFRA/IAEA Kenitra Morocco

Background: The practice of exclusive breastfeeding (EB) in Morocco has witnessed a worrying decline in recent decades, contrary to the recommendations of the World Health Organization (WHO) which advocates it during the first six months as a significant public health tool. The present study aims to assess the impact of educational materials on mothers’ behaviour with regard to keeping up EB as long as six months, at least. Methods: This is a cohort study with a prospective collection of data over a period of one year, through a questionnaire-based survey of 500 women who delivered at the Souissi Maternity Hospital in Rabat. The subjects were divided into an intervention group sensitized, during the medical visit, by means of information delivered orally about breastfeeding and a booklet containing instructions on breastfeeding management and the benefits of EB, especially when extended for the first six months;and a control group attending the same operation with no awareness-rising through educational materials. To assess EB rates, the subjects had been followed for six months through telephone. Results: 372 women who delivered were followed, 194 from the intervention group and 178 from the control group. The remaining 128 women not followed were lost sight of. A higher percentage of mothers in the intervention group exclusively breastfed their babies up to the age of six months compared to the control group, 55.2% against 38.8% (p = 0.002). The main reason produced by most mothers who ceased to exclusively breastfeed their babies is milk insufficiency. Conclusion: The postnatal nutritional education strategy based on the distribution of educational materials has considerably raised the number of women who exclusively breastfed their babies until the age of six months.

关键词： exclusive Breastfeeding Educational Material Duration Postnatal Period Breastfeeding Practices

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