bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development and reliability of questionnaires for the assessment of diet and physical activity behaviors in a multi-country sample in Europe the Feel4Diabetes Study
Authors:   Feel4Diabetes-study group, Anastasiou Costas A. , Fappa Evaggelia , Zachari Konstantina , Mavrogianni Christina , Van Stappen Vicky , Kivelä Jemina , Virtanen Eeva , González-Gil Esther M. , Flores-Barrantes Paloma , Nánási Anna , Semánová Csilla , Dimova Roumyana , Usheva Natalya , Iotova Violeta , Cardon Greet , Manios Yannis , Makrilakis Konstantinos 
Published: March 2020

Abstract
Background
Assessment of diet and physical activity and their determinants still remains a demanding task, especially when the objective is to evaluate the efficacy of lifestyle interventions. In the context of the Feel4Diabetes study (a European community based intervention study in families with school aged children and at high risk of developing diabetes), we aimed to develop questionnaires for the assessment of food-frequency and eating behaviors, and physical activity and sedentary behaviors in both parents and school-aged children and a questionnaire for overall family’s energy balance-related behaviors.

Methods
Questionnaires were developed to be used in 6 countries under standardized harmonization procedures and included questions regarding not only food intake and physical activity, but also questions of their determinants. A reliability study was conducted in 191 pairs of parents and their children (N = 191). Parents completed the questionnaires on two occasions, within a 1–2 week interval. Reliability was tested by the intra-class correlation coefficients (ICC) of test-retest.

Results
Most of the questions in all questionnaires had excellent reliability, assessed as an ICC of > 0.810. Mean ICCs for food-frequency and eating behaviors questionnaires were 0.838 and 0.787, and for physical activity and sedentary behaviors questionnaires were 0.734 and 0.793, in adults and children respectively. Mean ICC for overall family’s energy balance-related behaviors and their determinants was 0.659.

Conclusion
The developed questionnaires showed acceptable reliability and may be valuable tools in the assessment of children’s and parents’ behaviors related to diet, physical activity, sedentary behavior and overall energy balance in school- and community-based interventions.
Methodological procedures followed in a school-and community-based intervention to prevent type 2 diabetes in vulnerable families across Europe: the Feel4Diabetes-study
Authors:   on behalf of the Feel4Diabetes-study, Liatis Stavros 
Published: March 2020

AbstractFeel4Diabetes (standing for: Families across Europe following a hEalthy Lifestyle for Diabetes prevention, http://feel4diabetes-study.eu/) is a school and community based intervention program, aiming to prevent type 2 diabetes (T2D) among families from vulnerable population groups, in six European countries, by promoting healthy lifestyle. In the current issue of BMC Endocrine Disorders, three reviews and three papers providing a detailed description of the methodology used to obtain measurements related to the trial conduction, as well as two papers using original data collected in the Feel4Diabetes-study are presented.
Factors associated with nurses’ performance of oral assessments and dental referrals for hospital inpatients
Authors: Haresaku Satoru , Uchida Souhei , Aoki Hisae , Akinaga Kazuyuki , Yoshida Rie , Kubota Keiko , Naito Toru 
Published: March 2020

Abstract
Background
Nurses’ oral assessment and dental referral performance for inpatients are important to provide appropriate oral care services in hospitals. The purpose of this study was to investigate the knowledge, attitudes, and performance of oral assessments and dental referrals for their inpatients among nurses and to identify factors associated with that performance to promote oral health care in hospitals.

Methods
All nurses (n = 919) who worked at five hospitals in Japan were recruited as responders. A questionnaire regarding their performance of oral assessments and dental referrals was distributed to the subjects in each hospital. The data were collected from August 2018 to September 2018.

Results
A total of 757 (82.4%) nurses (82 males and 675 females) responded to the questionnaire. With respect to each of the 8 oral assessment categories, 16.2–41.2% of the nurses performed oral assessments for more than 50% of their inpatients, and 20.3–29.9% had encouraged more than one inpatient to see a dentist within the previous 3 months. Significant differences were found by ward and hospital in their performance of oral assessments for inpatients. Additionally, their oral assessment performance, knowledge of the usage of oral assessment tools, wards, and hospitals were significantly associated with their dental referral performance.

Conclusions
The performance of oral assessment and dental referral was not developed sufficiently in the hospitals. Thus, oral health professionals should support oral assessment education for nurses, including usage of assessment tools, to promote dental referral by nurses. These results may contribute to promotion of dental referral performance by nurses and provision of oral health care by oral health professionals for hospital inpatients.
Is it morally permissible for general practitioners to disclose their opinion on a woman’s decision on abortion?
Authors: Aung Lynnlette , Knight Selena 
Published: March 2020

Abstract
Background
This paper considers ethical dilemmas arising where a patient asks their General Practitioner for advice and their personal opinion regarding whether or not to have an abortion. Patients often seek their General Practitioner’s advice regarding treatments and procedures, which may occasionally lead to the General Practitioner facing a difficult dilemma of whether to share their personal opinion with their patient. As General Practitioners are more accessible as the first point of contact for patients and often have a closer relationship with them, they may be particularly exposed to such situations. Additionally, the significance of abortion as a sensitive topic and the fact the General Practitioner may have their own personal viewpoint on its morality may make it particularly difficult for them to know how to respond to such a request.

Main text
This paper explores the difficulties arising in such a situation and considers whether it could ever be ethically justifiable for General Practitioners to express their opinions on such a matter. We consider the duties of a doctor, and highlight the need for clearer guidance for healthcare professionals on managing tensions in their professional boundaries between their personal moral views and their professional responsibilities. A range of ethical viewpoints are considered to explore how a doctor might ap, in particular the principle of autonomy, virtue ethics, and consequentialism.

Conclusions
This article recognises that a General Practitioner in a situation such as this faces many ethical challenges. We propose that offering their opinion to the patient where specifically requested may be morally justifiable. A virtue ethics approach in particular requires that the General Practitioner applies practical wisdom to make this decision, and where they do disclose their opinion ensure this is done so in such a manner that it does not harm the patient and promotes flourishing. We encourage GPs and other healthcare professionals to consider their own moral perspectives on sensitive issues such as abortion, and reflect on how their moral viewpoints have the potential to influence their practice. In doing so, we hope clinicians can be better should they be faced with a situation such as this.
Evaluating implementation effectiveness and sustainability of a maternity waiting homes intervention to improve access to safe delivery in rural Zambia: a mixed-methods protocol
Authors: Henry Elizabeth G. , Ngoma Thandiwe , Kaiser Jeanette L. , Fong Rachel M. , Vian Taryn , Hamer Davidson H. , Rockers Peter C. , Biemba Godfrey , Scott Nancy A. 
Published: March 2020

Abstract
Background
In low-income countries such as Zambia, where maternal mortality rates are persistently high, maternity waiting homes (MWHs) represent one potential strategy to improve access to safe delivery, especially for women living in remote areas. The Maternity Homes Access in Zambia project (MAHMAZ) is evaluating the impact of a MWH model on women’s access to safe delivery in rural Zambia. There is a growing need to understand not only the effectiveness of interventions but also the effectiveness of their implementation in order to appropriately interpret outcomes. There is little evidence to guide effective implementation of MWH for both immediate uptake and to promote sustainability in this context. This protocol describes a study that aims to investigate the effectiveness of the implementation of MAHMAZ by not only documenting fidelity but also identifying factors that influence implementation success and affect longer-term sustainability.

Methods
This study will use mixed methods to evaluate the implementation effectiveness and sustainability of the MAHMAZ intervention. In our study, “implementation effectiveness” means to expand beyond measuring fidelity to the MWH model and includes assessing both the adoption and uptake of the model and identifying those factors that facilitate or inhibit uptake. Sustainability is defined as the routine implementation of an intervention after external support has ended. Quantitative methods include extracting data from existing records at the MWHs and health facilities to analyze patterns of utilization, and conducting a routine health facility assessment to determine facility-level factors that may influence MWH implementation and woman-level outcomes. We will also conduct an experience survey with MWH users and apply a checklist to assess fidelity to the MWH model. Qualitative methods include in-depth interviews and focus group discussions with MWH users, community members and other stakeholders. Qualitative data will be analyzed using an integrated framework drawing constructs from the Consolidated Framework for Implementation Research and the Conceptual Framework for Sustainability.

Discussion
The findings from this evaluation will be shared with policymakers formulating policy affecting the implementation of MWH and may be used as evidence for programmatic decisions by the government and supporting agencies in deciding to take this model to scale.

Trial registration
NCT02620436, Registered 3 December 2015, Prospectively registered (clinicaltrials.gov; for the overarching quasi-experimental impact study).
A cross-sectional study of job burnout, psychological attachment, and the career calling of Chinese doctors
Authors: Zhang Shu’e , Wang Jinghui , Xie Fengzhe , Yin Dong , Shi Yu , Zhang Min , Yin Hongyan , Li Fujun , Yang Libin , Cao Depin , Sun Tao 
Published: March 2020

AbstractBackgroundThe main objectives of this study were as follows: (1) evaluate the prevalence of burnout syndrome among doctors, (2) establish associations with demographic factors in China, and (3) examine the mediating role of psychological attachment in the relationship between job burnout and career calling.MethodsThis cross-sectional survey was conducted by administering an online questionnaire in May 2016. The survey was performed across Thirty provinces. In total, A total of 3016 Chinese doctors were selected as participants, of which 2617 completed valid questionnaires (effective response rate: 86.77%).ResultsThe overall prevalence of burnout symptoms among Chinese doctors was 85.79%. Little variance was reported for burnout symptoms according to age (Waldχ2 = 6.843,P < 0.05,OR < 1), professional title (Waldχ2 = 13.110,P < 0.05,OR > 1), and daily working hours (Waldχ2 = 7.226,P < 0.05,OR > 1). However, the burnout of Chinese doctors was found to be associated with psychological attachment (B = − 0.6433,P < 0.0001) and career calling (B = 0.3653,P < 0.0001); furthermore, psychological attachment (B = 0.2350,P < 0.001) mediated the relationship between job burnout and career calling.ConclusionBurnout symptoms among Chinese doctors were prevalent and associated with age, professional title, and long working hours. Chinese doctors aged 20–30 experienced a much higher level of burnout symptoms. The longer hours doctors worked, the more likely they were at risk of burnout symptoms, especially among attending physicians. Doctors who endured high-level burnout tended to exhibit decreasing psychological attachment, which threatened their sense of career calling. Finally, this paper proposed related explanations for the function mechanisms based on both theoretical and practical perspectives.
Cost-effectiveness of pain management services for chronic low back pain: a systematic review of published studies
Authors: AlMazrou Saja H. , Elliott Rachel A. , Knaggs Roger D. , AlAujan Shiekha S. 
Published: March 2020

AbstractBackgroundChronic low back pain (CLBP) is a highly prevalent condition that has substantial impact on patients, the healthcare system and society. Pain management services (PMS), which aim to address the complex nature of back pain, are recommended in clinical practice guidelines to manage CLBP. Although the effectiveness of such services has been widely investigated in relation to CLBP, the quality of evidence underpinning the use of these services remains moderate. Therefore the aim is to summarize and critically appraise the current evidence for the cost effectiveness of pain management services for managing chronic back pain.MethodsElectronic searches were conducted in MEDLINE, EMBASE and PsycINFO from their inception to February 2019. Full economic evaluations undertaken from any perspective conducted alongside randomized clinical trials (RCTs) or based on decision analysis models were included. Cochrane Back Review Group (CBRG) risk assessment and the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist were used to assess the methodological quality of eligible studies.ResultsFive studies fulfilled eligibility criteria. The interventions varied significantly between studies in terms of the number and types of treatment modalities, intensity and the duration of the program. Interventions were compared with either standard care, which varied according to the country and the setting; or to surgical interventions. Three studies showed that pain management services are cost effective, while two studies showed that these services are not cost effective.In this review, three out of five studies had a high risk of bias based on the design of the randomised controlled trials (RCTs). In addition, there were limitations in the statistical and sensitivity analyses in the economic evaluations. Therefore, the results from these studies need to be interpreted with caution.ConclusionPain management services may be cost effective for the management of low back pain. However, this systematic review highlights the variability of evidence supporting pain management services for patients with back pain. This is due to the quality of the published studies and the variability of the setting, interventions, comparators and outcomes.
Elder abuse and neglect: an overlooked patient safety issue. A focus group study of nursing home leaders’ perceptions of elder abuse and neglect
Authors: Myhre Janne , Saga Susan , Malmedal Wenche , Ostaszkiewicz Joan , Nakrem Sigrid 
Published: March 2020

Abstract
Background
The definition and understanding of elder abuse and neglect in nursing homes can vary in different jurisdictions as well as among health care staff, researchers, family members and residents themselves. Different understandings of what constitutes abuse and its severity make it difficult to compare findings in the literature on elder abuse in nursing homes and complicate identification, reporting, and managing the problem. Knowledge about nursing home leaders’ perceptions of elder abuse and neglect is of particular interest since their understanding of the phenomenon will affect what they signal to staff as important to report and how they investigate adverse events to ensure residents’ safety. The aim of the study was to explore nursing home leaders’ perceptions of elder abuse and neglect.

Methods
A qualitative exploratory study with six focus group interviews with 28 nursing home leaders in the role of care managers was conducted. Nursing home leaders’ perceptions of different types of abuse within different situations were explored. The constant comparative method was used to analyse the data.

Results
The results of this study indicate that elder abuse and neglect are an overlooked patient safety issue. Three analytical categories emerged from the analyses: 1) Abuse from co-residents: ‘A normal part of nursing home life’; resident-to-resident aggression appeared to be so commonplace that care leaders perceived it as normal and had no strategy for handling it; 2) Abuse from relatives: ‘A private affair’; relatives with abusive behaviour visiting nursing homes residents was described as difficult and something that should be kept between the resident and the relatives; 3) Abuse from direct-care staff: ‘An unthinkable event’; staff-to-resident abuse was considered to be difficult to talk about and viewed as not being in accordance with the leaders’ trust in their employees.

Conclusions
Findings in the present study show that care managers lack awareness of elder abuse and neglect, and that elder abuse is an overlooked patient safety issue. The consequence is that nursing home residents are at risk of being harmed and distressed. Care managers lack knowledge and strategies to identify and adequately manage abuse and neglect in nursing homes.
Immune-related prognosis biomarkers associated with osteosarcoma microenvironment
Authors: Hong Weifeng , Yuan Hong , Gu Yujun , Liu Mouyuan , Ji Yayun , Huang Zifang , Yang Junlin , Ma Liheng 
Published: March 2020

AbstractBackgroundOsteosarcoma is a highly aggressive bone tumor that most commonly affects children and adolescents. Treatment and outcomes for osteosarcoma have remained unchanged over the past 30 years. The relationship between osteosarcoma and the immune microenvironment may represent a key to its undoing.MethodsWe calculated the immune and stromal scores of osteosarcoma cases from the Target database using the ESTIMATE algorithm. Then we used the CIBERSORT algorithm to explore the tumor microenvironment and analyze immune infiltration of osteosarcoma. Differentially expressed genes (DEGs) were identified based on immune scores and stromal scores. Search Tool for the Retrieval of Interacting Genes Database (STRING) was utilized to assess protein–protein interaction (PPI) information, and Molecular Complex Detection (MCODE) plugin was used to screen hub modules of PPI network in Cytoscape. The prognostic value of the gene signature was validated in an independent GSE39058 cohort. Gene set enrichment analysis (GSEA) was performed to study the hub genes in signaling pathways.ResultsFrom 83 samples of osteosarcoma obtained from the Target dataset, 137 DEGs were identified, including 134 upregulated genes and three downregulated genes. Functional enrichment analysis and PPI networks demonstrated that these genes were mainly involved in neutrophil degranulation and neutrophil activation involved in immune response, and participated in neuroactive ligand–receptor interaction and staphylococcus aureus infection.ConclusionsOur study established an immune-related gene signature to predict outcomes of osteosarcoma, which may be important targets for individual treatment.
Genes associated with inflammation may serve as biomarkers for the diagnosis of coronary artery disease and ischaemic stroke
Authors: Zheng Peng-Fei , Liao Fu-Jun , Yin Rui-Xing , Chen Lu-Zhu , Li Hui , Nie Rong-Jun , Wang Yong , Liao Pei-Juan 
Published: March 2020

Abstract
Background
The current research aimed to expound the genes and pathways that are involved in coronary artery disease (CAD) and ischaemic stroke (IS) and the related mechanisms.

Methods
Two array CAD datasets of (GSE66360 and GSE97320) and an array IS dataset (GSE22255) were downloaded. Differentially expressed genes (DEGs) were identified using the limma package. The online tool Database for Annotation, Visualization and Integrated Discovery (DAVID) (version 6.8; david.abcc.ncifcrf.gov) was used to annotate the Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway and Gene Ontology (GO) enrichment analyses of the DEGs. A protein-protein interaction (PPI) network was constructed by Cytoscape software, and then Molecular Complex Detection (MCODE) analysis was used to screen for hub genes. The hub genes were also confirmed by RT-qPCR and unconditional logistic regression analysis in our CAD and IS patients.

Results
A total of 20 common DEGs (all upregulated) were identified between the CAD/IS and control groups. Eleven molecular functions, 3 cellular components, and 49 biological processes were confirmed by GO enrichment analysis, and the 20 common upregulated DEGs were enriched in 21 KEGG pathways. A PPI network including 24 nodes and 68 edges was constructed with the STRING online tool. After MCODE analysis, the top 5 high degree genes, including Jun proto-oncogene (JUN, degree = 9), C-X-C motif chemokine ligand 8 (CXCL8, degree = 9), tumour necrosis factor (TNF, degree = 9), suppressor of cytokine signalling 3 (SOCS3, degree = 8) and TNF alpha induced protein 3 (TNFAIP3, degree = 8) were noted. RT-qPCR results demonstrated that the expression levels of CXCL8 were increased in IS patients than in normal participants and the expression levels of SOCS3, TNF and TNFAIP were higher in CAD/IS patients than in normal participants. Meanwhile, unconditional logistic regression analysis revealed that the incidence of CAD or IS was positively correlated with the CXCL8, SOCS3, TNF and TNFAIP3.

Conclusions
The CXCL8, TNF, SOCS3 and TNFAIP3 associated with inflammation may serve as biomarkers for the diagnosis of CAD or IS. The possible mechanisms may involve the Toll-like receptor, TNF, NF-kappa B, cytokine-cytokine receptor interactions and the NOD-like receptor signalling pathways.