bluuebunny/crossref_metadata_2025_split huggingface dataset:
Community nurse-paramedics’ sphere of practice in primary care; an ethnographic study
Authors: Rasku Tuija , Kaunonen Marja , Thyer Elizabeth , Paavilainen Eija , Joronen Katja 
Published: July 2021

Abstract
Background
Primary care, the principal function of the health care system, requires effort from all local primary health care teams. Community Paramedicine (CP) has managed to reduce the use of Emergency Medical Services (EMS) for non-emergency calls, but for the paramedic to move from traditional emergency calls to non-emergency care will mean new demands. There is a paucity of research exploring nurse-paramedics’ experiences and perceptions of their novel roles as community paramedics in Finland. This study aims to explore the community nurse-paramedics’ (CNP) experiences in their new sphere of practice.

Methods
A descriptive ethnographic study was conducted, to collect data through participant observation (317 h total) and semi-structured interviews (N = 22) in three hospital districts (HD) where the CNPs have worked for at least 1 year. Both data sets were combined, organised, and analysed using inductive content analysis.

Results
Five main categories were developed by applying inductive content analysis: the new way of thinking, the broad group of patients, the way to provide care, the diversity of multidisciplinary collaboration, and tailored support from the organisation. The CNP was identified as needing an appropriate attitude towards care and a broader way of thinking compared to the traditional practice of taking care of the patient and the family members. The diversity of multidisciplinary collaboration teams can be a sensitive but worthwhile topic for offering new possibilities. Tailored support from the organisation includes tools for future CP models.

Conclusions
Our results indicate the CNPs’ deep involvement in patients’ and families’ care needs and challenges with their skills and competencies. Their professional attitudes and eagerness to develop and maintain multidisciplinary collaboration can offer preventive and long-term caring solutions from which citizens, allied health, safety, and social care providers benefit locally and globally.
Health service underutilization and its associated factors for chronic diseases patients in poverty-stricken areas in China: a multilevel analysis
Authors: Hu Haiyan , Jian Weiyan , Fu Hongqiao , Zhang Hao , Pan Jay , Yip Winnie 
Published: July 2021

Abstract
Background
Underutilization of health services among chronic non-communicable disease sufferers, especially for hypertension (HBP) and diabetes mellitus (DM), was considered as a significant contributing factor to substantial cases in terms of both avoidable morbidity and mortality. However, evidence on health services underutilization and its associated factors in poverty-stricken areas remain scarce based on previous literature. This study aims to describe health services underutilization for people diagnosed with chronic diseases in impoverished regions and to identify its associated factors, which are expected to provide practical implications for the implementations of interventions tailored to the specific needs of disadvantaged residents in rural China to achieve effective utilization of health services in a timely manner.

Methods
Data were collected from a cross-sectional survey conducted through face-to-face interviews among 2413 patients from six counties in rural central China in 2019. The Anderson behavioral model was adopted to explore the associated factors. A two-level logistic model was employed to investigate the association strengths reflected by adjusted odds ratios (AOR) and 95% confidence intervals in forest plots.

Results
On average, 17.58% of the respondents with HBP and 14.87% with DM had experienced health services underutilization during 1 month before the survey. Multilevel logistic regression indicated that predisposing factors (age), enabling factors (income and a regular source of care), and need factors (self-reported health score) were the common predictors of health service underutilization both for hypertensive and diabetic patients in impoverished areas, among which obtaining a regular source of care was found to be relatively determinant as a protective factor for health services underutilization after controlling for other covariates.

Conclusions
Our results suggested that the implementation of a series of comprehensive strategies should be addressed throughout policy-making procedures to improve the provision of regular source of care as a significant determinant for reducing health services underutilization, thus ultimately achieving equal utilization of health services in impoverished regions, especially among chronic disease patients. Our findings are expected to provide practical implications for other developing countries confronted with similar challenges resulting from underdeveloped healthcare systems and aging population structures.
Molecular detection of Theileria species, Anaplasma species, Candidatus Mycoplasma haemobos, Trypanosoma evansi and first evidence of Theileria sinensis-associated bovine anaemia in crossbred Kedah-Kelantan x Brahman cattle
Authors: Agina Onyinyechukwu Ada , Shaari Mohd Rosly , Isa Nur Mahiza Md , Ajat Mokrish , Zamri-Saad Mohd , Mazlan Mazlina , Muhamad Azim Salahuddin , Kassim Afrah Alhana , Ha Lee Chai , Rusli Fairuz Hazwani , Masaud Darulmuqaamah , Hamzah Hazilawati 
Published: July 2021

AbstractBackgroundSerious disease outbreaks in cattle are usually associated with blood pathogens. This study aims to detect blood pathogens namelyTheileriaspecies,Anaplasmaspecies,Candidatus Mycoplasma haemobosandTrypanosoma evansi, and determine their phylogenetic relationships and haemato-biochemical abnormalities in naturally infected cattle.MethodsMolecular analysis was achieved by PCR amplification and sequencing of PCR amplicons of 18SrRNA gene of Theileria species, 16SrRNA genes ofAnaplasmaandMycoplasmaspecies, MPSP genes ofT. orientalisandT. sinensis, MSP4 gene ofA. marginale, 16SrRNA gene ofCandidatus Mycoplasma haemobos, and RoTat1.2 VSG gene ofTrypanosoma evansi, in sixty-one (61) clinically ill Kedah-Kelantan x Brahman cattle in Pahang, Malaysia.ResultsA total of 44 (72.13%) cattle were infected with more than one blood pathogen.Theileriaspecies was the blood pathogen with the highest molecular detection rate (72.13, 95% CI 59.83–81.81%). Nucleotide blast analyses of all sequences demonstrated high degree of molecular similarity (98–100%) in comparison with their respective reference sequences. Analysis of 18SrRNA gene sequences ofTheileriaspecies and 16SrRNA gene sequences ofAnaplasmaspecies revealedTheileria sinensisandAnaplasma platysrespectively as additional species detected in these cattle. MPSP-PCR analysis was conducted for further confirmation ofT. sinensis.The blood picture of eight infected cattle groups revealed poikilocytosis, anisocytosis, rouleaux formation and degenerative left shift. High mean erythrocyte fragility values were common in infected cattle groups. Anaemia of the macrocytic normochromic type and spherocytes were observed in theT. evansi and Anaplasma platys + Theileria sinensisdouble species co-infected cattle group. Normocytic normochromic anaemia was observed in theT. sinensisinfected cattle group. Significant (p < 0.05) increases in serum liver and kidney parameters, total protein, globulin, total and unconjugated bilirubin and decreased albumin values were observed in theT. evansiinfected cattle when compared to clinically healthy cattle.ConclusionWe present the first evidence ofTheileria sinensis-associated bovine anaemia (TSABA) in Malaysian cattle. Because of the high occurrence of bovine theileriosis and detection ofA. platys, there is an urgent need for appropriate preventive and control measures against these blood pathogens.
Socioeconomic status and lifestyle factors modifies the association between snack foods intake and incidence of metabolic syndrome
Authors: Mirmiran Parvin , Aghayan Maryam , Bakhshi Bahar , Hosseinpour-Niazi Somayeh , Azizi Fereidoun 
Published: July 2021

AbstractBackgroundIntake of snack foods has been previously associated with an elevated risk of chronic disease; however, studies on snack foods and metabolic syndrome (MetS) while considering the modifying effect of socioeconomic status (SES) and lifestyle factors on this association are lacking. We aimed to investigate the association between snack foods intake and the MetS risk, and the mediatory effects of SES and lifestyle factors on the forenamed association among adults who participated in the Tehran Lipid and Glucose Study (2006–2018).MethodsThis is a prospective study of 1915 participants (male, 40.5%), aged 19–74 year who were free of MetS at baseline. Dietary intakes were gathered using a validated, semi-quantitative food frequency questionnaire at baseline (2006–2008), and with 3-year intervals afterwards. Alternative approach was used for snack foods from all available questionnaires during follow-up. Snack foods were divided into 4 categories, including total snacks, biscuits and cakes, candies and chocolate, and salty snacks. Total snack foods intake and its subgroup (serving/week) were modeled as tertiles. MetS was diagnosed according to the Joint Interim Statement criteria. Physical activity level (PAL) categorized as low/medium and high levels. Information regarding smoking (Smoker/Non-smoker), education (higher/lower education), and occupation (employed/non-employed) was gathered using questionnaire. The Cox regression was used, regarding interaction between snack foods, SES, and PAL on the MetS risk.ResultsA total of 591 incident MetS cases were diagnosed during 8.9 years of follow-up. The median total snack foods intake was 5.2 serving/week (IQR: 3.0–9.1). Total snack foods intake was positively associated with the MetS risk after adjusting for potential confounders (adjusted for age and gender, energy intake, total fiber intake, smoking status, PAL, education levels, family history of diabetes, family history of CVD events, and BMI). After adjustment for confounders, among snacks’ subgroups, candies and chocolate intake was positively associated with MetS risk. Moreover, among lower-educated and non-employed participants, candies and chocolate intake was positively associated with the MetS risk, by 38 and 43% respectively. Stratification based on PAL resulted a positive association between intake of total snack foods and candies and chocolates and risk of MetS among participants with low PAL.ConclusionSnack foods, especially candies and chocolate, increased the risk of MetS, among individuals with a low PAL.
Association between serum low-density lipoprotein cholesterol and metabolic syndrome in a working population
Authors: Wang Saibin 
Published: July 2021

Abstract
Background
The studies, investigating the association of low-density lipoprotein cholesterol (LDL-C) with metabolic syndrome (MetS) are limited with controversial conclusions. Therefore, this study aimed at revealing the specific relationship between the serum LDL-C levels and MetS prevalence in a large working population.

Methods
Secondary data analysis of a cross-sectional study, conducted between 2012 and 2016 in Spain on participants aged within the range of 20–70 years, involved 60,799 workers. Logistic regression analysis was applied to evaluate the association between the levels of serum LDL-C and MetS prevalence.

Results
Among the 60,799 workers, the prevalence of MetS was 9.0%. The odds ratios (95% confidence intervals) of MetS prevalence were 1.27 (1.16–1.39) and 1.53 (1.41–1.65) for the individuals with the LDL-C levels in lower (< 103.8 mg/dL) and upper (> 135.8 mg/dL) tertiles as compared to those with the LDL-C levels in middle tertile (103.8–135.8 mg/dL) in the studied population. Similarly, a U-shaped relationship was also observed in male cohort. The serum LDL-C levels associated with the lowest risk of current MetS were 113.6 mg/dL and 117.6 mg/dL in the overall studied population and male cohort, respectively. The female workers with the levels of LDL-C higher than 135.0 mg/dL had an increased prevalence of MetS (P < 0.05).

Conclusions
The low and high levels of serum LDL-C were associated with an increased prevalence of MetS in the working population and in male workers. Only the high (> 135.0 mg/dL) levels of LDL-C increased MetS prevalence in female workers.
Injectable stress relaxation gelatin-based hydrogels with positive surface charge for adsorption of aggrecan and facile cartilage tissue regeneration
Authors: Wang Kai-Yang , Jin Xiang-Yun , Ma Yu-Hui , Cai Wei-Jie , Xiao Wei-Yuan , Li Zhi-Wei , Qi Xin , Ding Jian 
Published: July 2021

Abstract
Background
Cartilage injury and pathological degeneration are reported in millions of patients globally. Cartilages such as articular hyaline cartilage are characterized by poor self-regeneration ability due to lack of vascular tissue. Current treatment methods adopt foreign cartilage analogue implants or microfracture surgery to accelerate tissue repair and regeneration. These methods are invasive and are associated with the formation of fibrocartilage, which warrants further exploration of new cartilage repair materials. The present study aims to develop an injectable modified gelatin hydrogel.

Method
The hydrogel effectively adsorbed proteoglycans secreted by chondrocytes adjacent to the cartilage tissue in situ, and rapidly formed suitable chondrocyte survival microenvironment modified by ε-poly-L-lysine (EPL). Besides, dynamic covalent bonds were introduced between glucose and phenylboronic acids (PBA). These bonds formed reversible covalent interactions between the cis−diol groups on polyols and the ionic boronate state of PBA. PBA-modified hydrogel induced significant stress relaxation, which improved chondrocyte viability and cartilage differentiation of stem cells. Further, we explored the ability of these hydrogels to promote chondrocyte viability and cartilage differentiation of stem cells through chemical and mechanical modifications.

Results
In vivo and in vitro results demonstrated that the hydrogels exhibited efficient biocompatibility. EPL and PBA modified GelMA hydrogel (Gel-EPL/B) showed stronger activity on chondrocytes compared to the GelMA control group. The Gel-EPL/B group induced the secretion of more extracellular matrix and improved the chondrogenic differentiation potential of stem cells. Finally, thus hydrogel promoted the tissue repair of cartilage defects.

Conclusion
Modified hydrogel is effective in cartilage tissue repair.
Cultural adaptation and psychometric evaluation of the Kinyarwanda version of the problem areas in diabetes (PAID) questionnaire
Authors: Lygidakis Charilaos , Uwizihiwe Jean Paul , Bia Michela , Kallestrup Per , Dukundane Damas , Asiimwe-Kateera Brenda , Niyonsenga Simon Pierre , Vögele Claus 
Published: July 2021

Abstract
Background
High prevalence rates in diabetes-related distress have been observed in several studies; however, in the region of Sub-Saharan Africa evidence is lacking as is, for example, the case for Rwanda, where diabetes prevalence is expected to increase over the next decade. The aim of this study is to report on the translation and cultural adaption of the problem areas in diabetes (PAID) questionnaire into Kinyarwanda and its psychometric properties.

Methods
The questionnaire was translated following a standard procedure. Interviews were conducted with 29 participants before producing a final version. For the psychometric evaluation, a sample of 266 patients with diabetes mellitus, aged 21–64 years old were examined. Participants either came from a separate cluster-randomised controlled trial or were recruited ad-hoc for this study. The evaluation included testing internal consistency, known groups validity, and construct validity. A series of confirmatory factor analysis were conducted investigating seven previously established factorial structures. An exploratory factor analysis (EFA) was also carried out to examine the structure further.

Results
The full scale showed good internal reliability (Cronbach’s α = 0.88). A four-factor solution previously tested in Spain with subdimensions of emotional, treatment, food-related and social-support problems demonstrated adequate approximate fit (RMSEA = 0.056; CFI = 0.951; TLI = 0.943). The EFA revealed a four-factor structure; however, two of these factors were not as homogeneous and easily interpretable as those of the Spanish model.

Conclusions
The psychometric properties of the Kinyarwanda version of PAID are acceptable. The questionnaire can be helpful in research and clinical practice in Rwanda, however certain cross-cultural differences should be taken into account.
Cost transferability problems in economic evaluation as a framework for an European health care and social costs database
Authors: García-Mochón Leticia , Rovira Forns Joan , Espin Jaime 
Published: July 2021

AbstractThis article presents part of the work within Work Package 3 (WP3) of Impact HTA (Improved methods and actionable tools for enhancing HTA), a H2020 EU-funded research project, intended to enhance and promote collaboration in HTA across EU MS. Amongst other objectives, and in close collaboration with WP4, WP3 addressed setting up a multi-country unit-cost database: the European health care and social costs database (EU HCSCD). The purpose of the database is to facilitate the transference of healthcare economic evaluation analyses across countries, jurisdictions and settings. WP3 concentrates on healthcare costs; WP4 on social costs. This paper discusses the state of the art on this topic, building an appropriate conceptual and theoretical framework for Database development. We conducted a broad, but not systematic, literature and gray-literature review (LR), identifying existing practices and problems, and their implications, described in the Results section. We discuss practical implications and draw important conclusions behind the construction, and future evolution, of this database.
C1q/TNF-related protein 4 restores leptin sensitivity by downregulating NF-κB signaling and microglial activation
Authors: Ye Liu , Jia Gongwei , Li Yuejie , Wang Ying , Chen Hong , Yu Lehua , Wu Dandong 
Published: July 2021

Abstract
Objective
C1qTNF-related protein 4 (CTRP4) acts in the hypothalamus to modulate food intake in diet-induced obese mice and has been shown to exert an anti-inflammatory effect on macrophages. Since high-fat diet-induced microglial activation and hypothalamic inflammation impair leptin signaling and increase food intake, we aimed to explore the potential connection between the anorexigenic effect of CTRP4 and the suppression of hypothalamic inflammation in mice with DIO.

Methods
Using an adenovirus-mediated hypothalamic CTRP4 overexpression model, we investigated the impact of CTRP4 on food intake and the hypothalamic leptin signaling pathway in diet-induced obese mice. Furthermore, central and plasma proinflammatory cytokines, including TNF-α and IL-6, were measured by Western blotting and ELISA. Changes in the hypothalamic NF-κB signaling cascade and microglial activation were also examined in vivo. In addition, NF-κB signaling and proinflammatory factors were investigated in BV-2 cells after CTRP4 intervention.

Results
We found that food intake was decreased, while leptin signaling was significantly improved in mice with DIO after CTRP4 overexpression. Central and peripheral TNF-α and IL-6 levels were reduced by central Ad-CTRP4 administration. Hypothalamic NF-κB signaling and microglial activation were also significantly suppressed in vivo. In addition, NF-κB signaling was inhibited in BV-2 cells following CTRP4 intervention, which was consistent with the decreased production of TNF-α and IL-6.

Conclusions
Our data indicate that CTRP4 reverses leptin resistance by inhibiting NF-κB-dependent microglial activation and hypothalamic inflammation.
Interleukin-10 deficiency exacerbates inflammation-induced tau pathology
Authors: Weston Lea L. , Jiang Shanya , Chisholm Devon , Jantzie Lauren L. , Bhaskar Kiran 
Published: July 2021

Abstract
Background
The presence of hyperphosphorylated microtubule-associated protein tau is strongly correlated with cognitive decline and neuroinflammation in Alzheimer’s disease and related tauopathies. However, the role of inflammation and anti-inflammatory interventions in tauopathies is unclear. Our goal was to determine if removing anti-inflammatory interleukin-10 (IL-10) during an acute inflammatory challenge has any effect on neuronal tau pathology.

Methods
We induce systemic inflammation in Il10-deficient (Il10−/−) versus Il10+/+ (Non-Tg) control mice using a single intraperitoneal (i.p.) injection of lipopolysaccharide (LPS) to examine microglial activation and abnormal hyperphosphorylation of endogenous mouse tau protein. Tau phosphorylation was quantified by Western blotting and immunohistochemistry. Microglial morphology was quantified by skeleton analysis. Cytokine expression was determined by multiplex electro chemiluminescent immunoassay (MECI) from Meso Scale Discovery (MSD).

Results
Our findings show that genetic deletion of Il10 promotes enhanced neuroinflammation and tau phosphorylation. First, LPS-induced tau hyperphosphorylation was significantly increased in Il10−/− mice compared to controls. Second, LPS-treated Il10−/− mice showed signs of neurodegeneration. Third, LPS-treated Il10−/− mice showed robust IL-6 upregulation and direct treatment of primary neurons with IL-6 resulted in tau hyperphosphorylation on Ser396/Ser404 site.

Conclusions
These data support that loss of IL-10 activates microglia, enhances IL-6, and leads to hyperphosphorylation of tau on AD-relevant epitopes in response to acute systemic inflammation.