bluuebunny/crossref_metadata_2025_split huggingface dataset:
Feel4Diabetes healthy diet score: development and evaluation of clinical validity
Authors:   on behalf of the Feel4Diabetes research group, Virtanen Eeva , Kivelä Jemina , Wikström Katja , Lambrinou Christina-Paulina , De Miguel-Etayo Pilar , Huys Nele , Vraukó-Tóth Katalin , Moreno Luis A. , Usheva Natalya , Chakarova Nevena , Rado Sándorné A. , Iotova Violeta , Makrilakis Konstantinos , Cardon Greet , Liatis Stavros , Manios Yannis , Lindström Jaana 
Published: May 2020

Abstract
Background
The aim of this paper is to present the development of the Feel4Diabetes Healthy Diet Score and to evaluate its clinical validity.

Methods
Study population consisted of 3268 adults (63% women) from high diabetes risk families living in 6 European countries. Participants filled in questionnaires at baseline and after 1 year, reflecting the dietary goals of the Feel4Diabetes intervention. Based on these questions the Healthy Diet Score was constructed, consisting of the following components: breakfast, vegetables, fruit and berries, sugary drinks, whole-grain cereals, nuts and seeds, low-fat dairy products, oils and fats, red meat, sweet snacks, salty snacks, and family meals. Maximum score for each component was set based on its estimated relative importance regarding T2DM risk, higher score indicating better quality of diet. Clinical measurements included height, weight, waist circumference, heart rate, blood pressure, and fasting blood sampling, with analyses of glucose, total cholesterol, HDL-cholesterol, LDL-cholesterol, and triglycerides.
Analysis of (co) variance was used to compare the Healthy Diet Score and its components between countries and sexes using baseline data, and to test differences in clinical characteristics between score categories, adjusted for age, sex and country. Pearson’s correlations were used to study the association between changes from baseline to year 1 in the Healthy Diet Score and clinical markers. To estimate reproducibility, Pearson’s correlations were studied between baseline and 1 year score, within the control group only.

Results
The mean total score was 52.8 ± 12.8 among women and 46.6 ± 12.8 among men (p <  0.001). The total score and its components differed between countries. The change in the Healthy Diet Score was significantly correlated with changes in BMI, waist circumference, and total and LDL cholesterol. The Healthy Diet Score as well as its components at baseline were significantly correlated with the values at year 1, in the control group participants.

Conclusion
The Feel4Diabetes Healthy Diet Score is a reproducible method to capture the dietary information collected with the Feel4Diabetes questionnaire and measure the level of and changes in the adherence to the dietary goals of the intervention. It gives a simple parameter that associates with clinical risk factors in a meaningful manner.

Trial registration
Clinicaltrials.gov NCT02393872. Registered March 20, 2015.
Knowledge and attitude of reproductive age group (15–49) women towards Ethiopian current abortion law and associated factors in Bahir Dar city, Ethiopia
Authors: Bantie Getasew Mulat , Aynie Amare Alamirew , Assefa Mihret kassa , Kasa Ayele Semachew , Kassa Tigabu Birhan , Tsegaye Gebiyaw Wudie 
Published: May 2020

Abstract
Background
Unsafe abortion accounts for nearly 60% of all gynecologic admissions and almost 30% of all obstetric and gynecologic admissions. Studies on abortion in Ethiopia have given less attention to women’s perceptions and experiences of abortion laws. Although the 2005 revised abortion law allows women to access safe abortion services, still unsafe abortion is one of the leading causes of pregnancy-related deaths. Therefore, the current study aimed to assess women’s knowledge and attitude towards the Ethiopian current abortion law in Bahir Dar City Administration.

Methods
A community-based cross-sectional study using a systematic random sampling technique was carried out among 403 randomly selected reproductive age women using a pre-tested structured questionnaire in Bahir Dar City Administration from May to June /2017. Data were entered into Epi data version 3.1 and analyzed using SPSS version 21.0 software. Logistic regression was done to identify the possible factors associated with women’s knowledge and attitude towards the Ethiopian current abortion law.

Results
Three hundred eighty-six respondents partook with a response rate of 95.7%. The study showed that 43% had good knowledge and 38% had a favorable attitude towards the Ethiopian current abortion law. Women’s in the age group of 25–29 years (AOR = 2.7, 95% CI: 1.02, 6.9), partner’s educational status of primary (AOR = 2.9, 95% CI: 1.19, 7.08), secondary (AOR = 5.5, 95% CI: 2.09, 14.4) and college and above (AOR = 8.2, 95% CI: 2.3, 28.6) were significantly associated with good knowledge of the Ethiopian current abortion law. While partner’s educational status; college and above (AOR = 6.15, 95% CI: 1.87, 20.22) was significantly associated with the favorable attitude towards the Ethiopian current abortion law.

Conclusions
43% of respondents had good knowledge and 38% had a favorable attitude towards the Ethiopian current abortion law. Forty-nine respondents had a history of abortion of which, 8 occurred through induction. Woman’s age and partner’s education determine the status of knowledge while merely; the partner’s educational status of college and above was significantly associated with the attitude towards Ethiopian current abortion law, respectively.
Traditional and complementary medicine use among Ebola survivors in Sierra Leone: a qualitative exploratory study of the perspectives of healthcare workers providing care to Ebola survivors
Authors: James Peter Bai , Wardle Jon , Steel Amie , Adams Jon , Bah Abdulai Jawo , Sevalie Stephen 
Published: May 2020

Abstract
Background
Considerable number of patients, including Ebola survivors, in Sierra Leone, are using traditional and complementary medicine (T&CM). Healthcare providers’ (HCPs) views about T&CM is crucial in addressing the increased need for T&CM among patients. However, healthcare providers’ views about T&CM in Sierra Leone is unknown. Our study explores healthcare providers’ knowledge of and perception towards T&CM and how that influence their personal and professional T&CM use, communication with Ebola survivors about T&CM as well as its integration into the healthcare system in Sierra Leone.

Methods
We employed a qualitative exploratory study design using semi-structured interviews to collect data from 15 conveniently sampled HCPs in all four geographical regions of Sierra Leone. We analysed our data using thematic network analysis framework.

Results
Healthcare providers perceived their knowledge about T&CM to be low and considered T&CM to be less effective and less safe than conventional medicine as well as not evidence-based. HCPs perception of T&CM as non-scientific and their lack of knowledge of T&CM were the key barriers to HCPs’ self-use and recommendation as well as their lack of detailed discussion about T&CM with Ebola survivors. HCPs are open to T&CM integration into mainstream healthcare in Sierra Leone although at their terms. However, they believe that T&CM integration could be enhanced by effective professional regulation of T&CM practice, and by improving T&CM evidenced-based knowledge through education, training and research.

Conclusion
Changing HCPs’ negative perception of and increasing their knowledge about T&CM is critical to promoting effective communication with Ebola survivors regarding T&CM and its integration into the healthcare system in Sierra Leone. Strategies such as educational interventions for HCPs, conducting rigorous T&CM research, proper education and training of T&CM practitioners and effective professional regulation of T&CM practice could help in that direction.
20-Hydroxyecdysone ameliorates metabolic and cardiovascular dysfunction in high-fat-high-fructose-fed ovariectomized rats
Authors: Buniam Jariya , Chukijrungroat Natsasi , Rattanavichit Yupaporn , Surapongchai Juthamard , Weerachayaphorn Jittima , Bupha-Intr Tepmanas , Saengsirisuwan Vitoon 
Published: May 2020

Abstract
Background
Ecdysteroids are polyhydroxylated steroids present in invertebrates and plants. 20-Hydroxyecdysone (20E) is the most common and the main biologically active compound of ecdysteroids. Previous studies have demonstrated anabolic and metabolic effects of 20E in mammals. However, it is unknown whether 20E has a positive effect on all aspects of cardiometabolic syndrome. The aims of this study were to investigate the favorable effect and possible underlying mechanisms of 20E in a rat model of cardiometabolic syndrome (CMS) induced by a high-calorie diet combined with female sex hormone deprivation.

Methods
20E (5 mg/kg, 10 mg/kg, or 20 mg/kg) or pioglitazone (PIO) (10 mg/kg) was intragastrically administered to sham-operated Sprague-Dawley female rats and ovariectomized rats fed a high-fat-high-fructose diet (OHFFD) for 8 weeks. The phenotypic characteristics of CMS, including central adiposity, blood pressure, serum lipid profile, glucose tolerance, insulin action on skeletal muscle glucose transport activity and hepatic protein expression, were determined.

Results
Some CMS characteristics were improved by 20E treatment. Rats treated with 20E had lower body weight, abdominal fat accumulation than rats treated with vehicle control without changes in total caloric intake and fat-free mass. OHFFD rats exhibited high blood pressure, but 20E-treated rats maintained normal blood pressure with a lower level of low-density lipoprotein (LDL)-cholesterol. Although 20E showed no positive effect on inducing insulin-mediated glucose transport in the skeletal muscle of OHFFD rats, 20E improved whole body glucose homeostasis. Analysis of protein expression in livers from 20E-treated rats revealed significantly increased expression of pAkt Ser473, pFOXO1 Ser256, pAMPKα Thr172, and FGF21.

Conclusion
20E treatment can alleviate cardiometabolic disorder caused by a high-fat-high-fructose diet and female sex hormone deprivation. In particular, 20E helps improve whole body insulin sensitivity in OHFFD rats, and the mechanisms that underlie this favorable effect are potentially mediated by the activation of AMPK and FGF21. The present study indicates that 20E could be an alternative therapeutic option for the prevention and alleviation of cardiometabolic syndrome.
Implementation of sexual and gender minority health curricula in health care professional schools: a qualitative study
Authors: Pratt-Chapman Mandi L. 
Published: May 2020

Abstract
Background
Lesbian, gay, bisexual, transgender, queer, and intersex people—inclusively termed “sexual and gender minorities”—have unique health and health care needs that are not being met by most healthcare providers due to lack of training in health care professional schools. The purpose of this qualitative study was to examine implementation factors for advancing sexual and gender minority health professional student curricula in academic settings.

Methods
Semi-structured interviews guided by the Consolidated Framework for Implementation Research (CFIR) were conducted with sixteen curricular champions to identify factors relevant to curricular adoption, integration, and sustainment. Themes were coded using a hybrid of deductive and inductive approaches and reported using major CFIR domains.

Results
Facilitators supporting implementation of sexual and gender minority health curricula included collaboration among multiple stakeholders, alignment of formal and hidden curricula, fostering an organizational culture that valued inclusion and diversity, engagement with external subject matter experts or faculty with content expertise, and thoughtful and inclusive planning.

Conclusion
This study contributes to health care professional education research as well as to implementation science. Facilitators that were identified in this study can be used to increase the adoption, integration, and sustainment of sexual and gender minority health curricula in diverse academic settings.
GP trainees’ perceptions on learning EBM using conversations in the workplace: a video-stimulated interview study
Authors: Welink Lisanne S. , de Groot Esther , Pype Peter , Van Roy Kaatje , van den Wittenboer Iris D. , Bartelink Marie-Louise E. L. , Damoiseaux Roger A. M. J. 
Published: May 2020

Abstract
Background
To be able to practice evidence-based medicine (EBM) when making decisions for individual patients, it is important to learn how to combine the best available evidence with the patient’s preferences and the physician’s clinical expertise. In general practice training, these skills can be learned at the workplace using learning conversations: meetings between the supervising general practitioner (GP) and GP trainee to discuss medical practice, selected topics or professional performance. This study aimed to give insight into the perceptions of GP trainees on their EBM learning processes during learning conversations.

Methods
We held semi-structured video-stimulated elicitation interviews (n = 22) with GP trainees affiliated to GP training institutes in the Netherlands and Belgium. GP trainees were shown fragments of their learning conversations, enabling reflection during the interview. Taking an inductive approach, interview recordings were transcribed verbatim and analysed with NVivo software.

Results
GP trainees perceived learning conversations as useful for learning and discussing EBM. Multiple EBM learning activities were identified, such as discussing evidence together, relating evidence to cases in daily practice and discussing the supervisor’s experience and the specific local context in the light of what the evidence recommends. However, for learning to occur, trainees need and expect specific behaviour, both from their supervisors and themselves. Supervisors should supply well-substantiated answers that are applicable in practice and give the trainee confirmation. In turn, the trainee needs to prepare well in order to ask focused, in-depth questions. A safe space allowing equal and open discussion between trainee and supervisor is perceived as an essential context for optimal EBM learning.

Conclusions
Our findings show that trainees find learning conversations useful for EBM learning in general practice. To bring EBM learning to its full potential, attention should be paid to optimising the behavioural and contextual factors found relevant to enhancing EBM learning.
Influence of nurse and midwife managerial leadership styles on job satisfaction, intention to stay, and services provision in selected hospitals of Rwanda
Authors: Ngabonzima Anaclet , Asingizwe Domina , Kouveliotis Kyriakos 
Published: May 2020

Abstract
Background
Nurses and midwives are a critical part of the healthcare team and make up the largest section of health professionals. Leadership styles are believed to be an important determinant of job satisfaction and retention making effective leadership within nursing and midwifery crucial to health systems success. In Rwanda, there are gaps in knowledge of managerial leadership styles of nurses and midwives and the influence of these styles on job satisfaction and retention for nurses and midwives who report to them, as well as their influence on the provision of health services. This study describes the managerial leadership styles adopted by nurses/midwives and examines the relationship between managerial leadership styles and job satisfaction, intention to stay, and service provision.

Methods
The Path-Goal Leadership questionnaire was adopted and used to collect data on leadership styles while other questionnaires with high validity and reliability were used to collect data on job satisfaction, intention to stay and service provision. The study involved 162 full-time nurses and midwives practicing in 5 selected hospitals with a minimum of 6 months of experience working with their current direct managers. Regression analysis was used to draw conclusions on relationships between variables.

Results
Nurses and midwives managers were more inclined to the directive leadership style followed by a supportive leadership style, and the participative leadership style. The nurse and midwife’s managerial leadership styles together significantly explained 38, 10 and 23% of the variance in job satisfaction, intention to stay and service provision, respectively.

Conclusion
The findings of this study indicate that managerial leadership styles play a substantial role in enhancing job satisfaction, intention to stay and service provision.

The implication for nursing and midwifery management
There is a need to develop a comprehensive formal professional continuous development course on leadership styles and ensure that all nurses and midwives managers benefit from this course prior to or immediately after being appointed as a manager. Having such a course may even prepare future leaders for their role early in their career. Effective leadership in nursing and midwifery should be enhanced at all levels to improve the job satisfaction of nurses and midwives, address the issue of retention in their respective health facilities and strengthen service provision.
Smoking is associated with a higher risk of unplanned medical visits among adult patients with diabetes, using retrospective electronic medical record data from 2014 to 2016
Authors: Selya Arielle , Johnson Eric L. , Weber Tess L. , Russo Jaymi , Stansbury Cheryl , Anshutz Drake , Griese Emily , Hsu Benson 
Published: May 2020

Abstract
Background
Smoking exacerbates the complications of diabetes, but little is known about whether patients with diabetes who smoke have more unplanned medical visits than those who do not smoke. This study examines the association between smoking status and unplanned medical visits among patients with diabetes.

Methods
Data were drawn from electronic medical records (EMR’s) from a large healthcare provider in the Northern Plains region of the US, from adult (≥18 years old) patients with type 1 or type 2 diabetes who received care at least once during 2014–16 (N = 62,149). The association between smoking status (current, former, or never smoker) and having ≥1 unplanned visit (comprised of emergency department visits, hospitalizations, hospital observations, and urgent care) was examined after adjusting for age, race/ethnicity, and body mass index (BMI). The top ten most common diagnoses for unplanned visits were examined by smoking status.

Results
Both current and former smoking were associated with an approximately 1.2-fold increase in the odds of having at least one unplanned medical visit in the 3-year period (OR = 1.22, 95% CI = 1.16–129; OR = 1.23, 95% CI = 1.19–1.28, respectively), relative to never-smokers. Most common diagnoses for all patients were pain-related. However, diagnoses related to musculoskeletal system and connective tissue disorders were more common among smokers. Smoking is associated with a higher rate of unplanned medical visits among patients with diabetes in this regional healthcare system.

Conclusions
Results from this study reveal higher rates of unplanned visits among smokers and former smokers, as well as increased frequencies of unplanned medical visits among current smokers.
Expression of HIF-1α and VEGF in feline mammary gland carcinomas: association with pathological characteristics and clinical outcomes
Authors: Chen Bo , Lin Susanne Je-Han , Li Wen-Ta , Chang Hui-Wen , Pang Victor Fei , Chu Pei-Yi , Lee Chin-Cheng , Nakayama Hiroyuki , Wu Ching-Ho , Jeng Chian-Ren 
Published: May 2020

AbstractBackgroundThe microenvironment within solid malignant tumors, including feline mammary gland carcinomas (FMGCs), is commonly hypoxic, possibly due to the lack of functional blood vessels in rapidly proliferating neoplastic tissue. Malignant cells can undergo genetic and adaptive changes that prevent them from dying due to oxygen deprivation through expressions of hypoxia-inducible factor 1 alpha (HIF-1α) and vascular endothelial growth factor (VEGF). Therefore, HIF-1α and VEGF are ideal biomarkers for cancer therapy and prognostic evaluation. The aims of this study were to evaluate the expression of HIF-1α and VEGF in feline mammary carcinomas and analyze their correlations with clinical and pathological factors, such as clinical stage, histologic grading, regional metastasis, and overall survival rate.ResultsParaffin-embedded tissue samples collected from 72 cats with FMGCs were retrospectively studied. Histologic pattern and histologic grading (Elston and Ellis grading system) of these FMGCs were determined. Our data indicated that grade II tubulopapillary carcinomas (43/72, 59.7%) prevailed in this study, and most FMCGs showed apparent necrosis, squamous metaplasia, and intratumoral stromal response. According to the results of immunohistochemical (IHC) stainings performed in tissue microarrays (TMAs), HIF-1α and VEGF overexpressions were respectively noted in 69.4% (50/72) and 77.8% (56/72) of FMGC cases. Chi-square test showed no correlation of HIF-1α overexpression with clinical and pathological factors. VEGF overexpression was significantly correlated with histologic pattern (p = 0.021), stromal response (p = 0.048), squamous metaplasia (p = 0.001), and lymphovascular invasion (p = 0.007). However, neither HIF-1α nor VEGF overexpression was correlated with histologic grading and metastasis. Of 38 cats with 1-year follow-up, IHC stainings of HIF-1α and VEGF were performed on whole tissue sections. The results showed that overexpression of HIF-1α was significantly correlated with the overall survival rate (p < 0.05) (log-rank test), whereas there was no significant correlation between VEGF overexpression and overall survival rate.ConclusionsThis study suggests that the overexpression of HIF-1α may indicate poor prognosis/overall survival rate in cats with FMGCs. Developing compounds that inhibit HIF-1α may be a potential approach to FMGC treatment.
Characterization of Clostridium novyi isolated from a sow in a sudden death case in Korea
Authors: Jeong Chang-Gi , Seo Byoung-Joo , Nazki Salik , Jung Byung Kwon , Khatun Amina , Yang Myeon-Sik , Kim Seung-Chai , Noh Sang-Hyun , Shin Jae-Ho , Kim Bumseok , Kim Won-Il 
Published: May 2020

AbstractBackgroundMultifocal spherical nonstaining cavities and gram-positive, rod-shaped, and endospore-forming bacteria were found in the liver of a sow that died suddenly.Clostridium novyitype B was identified and isolated from the sudden death case, and the isolate was characterized by molecular analyses and bioassays in the current study.ResultsC. novyiwas isolated from the liver of a sow that died suddenly and was confirmed asC. novyitype B by differential PCR. TheC. novyiisolate fermented glucose and maltose and demonstrated lecithinase activity, and the cell-free culture supernatant of theC. novyiisolate exhibited cytotoxicity toward Vero cells, demonstrating that the isolate produces toxins. In addition, whole-genome sequencing of theC. novyiisolate was performed, and the complete sequences of the chromosome (2.29 Mbp) and two plasmids (134 and 68 kbp) were identified for the first time. Based on genome annotation, 7 genes were identified as glycosyltransferases, which are known as alpha toxins; 23 genes were found to be related to sporulation; 12 genes were found to be related to germination; and 20 genes were found to be related to chemotaxis.ConclusionC. novyitype B was isolated from a sow in a sudden death case and confirmed by biochemical and molecular characterization. Various virulence-associated genes were identified for the first time based on whole-genome sequencing.