bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of interpregnancy interval on the risk of gestational diabetes mellitus during a second pregnancy
Authors: Deng Yuqing , Xu Chang , Yang Ao , Wang Ying , Peng Yanting , Zhou Ying , Luo Xiangzhi , Wu Yalin , Zhong Shilin 
Published: June 2024

Abstract
Background
Interpregnancy interval (IPI) is associated with the risk of GDM in a second pregnancy. However, an optimal IPI is still need to be determined based on the characteristics of the population. This study aimed to analyze the effect of interpregnancy interval (IPI) on the risk of gestational diabetes mellitus (GDM) in the Chinese population.

Methods
We conducted a retrospective cohort study on female participants who had consecutive deliveries at Peking University Shenzhen Hospital from 2013 to 2021. The IPI was categorized into 7 groups and included into the multivariate logistic regression model with other confound factors. Analysis was also stratified based on age of first pregnancy, BMI, and history of GDM. Adjusted OR values (aOR) and 95% confidence intervals (CI) calculated. The regression coefficient of IPI months on GDM prediction risk was analyzed using a linear regression model.

Results
A total of 2,392 participants were enrolled. The IPI of the GDM group was significantly greater than that of the non-GDM group (P < 0.05). Compared with the 18–24 months IPI category, participants with longer IPIs (24–36 months, 36–48 months, 48–60 months, and ≥ 60 months) had a higher risk of GDM (aOR:1.585, 2.381, 2.488, and 2.565; 95% CI: 1.021–2.462, 1.489–3.809, 1.441–4.298, and 1.294–5.087, respectively). For participants aged < 30 years or ≥ 30 years or without GDM history, all longer IPIs (≥ 36 months) were all significantly associated with the GDM risk in the second pregnancy (P < 0.05), while any shorter IPIs (< 18 months) was not significantly associated with GDM risk (P > 0.05). For participants with GDM history, IPI 12–18 months, 24–36 months, 36–48 months, and ≥ 60 months were all significantly associated with the GDM risk (aOR: 2.619, 3.747, 4.356, and 5.373; 95% CI: 1.074–6.386, 1.652–8.499, 1.724–11.005, and 1.078–26.793, respectively), and the slope value of linear regression (0.5161) was significantly higher compared to participants without a history of GDM (0.1891) (F = 284.168, P < 0.001).

Conclusions
Long IPI increases the risk of GDM in a second pregnancy, but this risk is independent of maternal age. The risk of developing GDM in a second pregnancy for women with GDM history is more significantly affected by IPI.
Associations of vegetable and fruit intake, physical activity, and school bullying with depressive symptoms in secondary school students: the mediating role of internet addiction
Authors: Ji Lujun , Ren Zhisheng , Chen Jian , Zhao Hui , Zhang Xiaofei , Xue Bai , Zhang Dongfeng 
Published: June 2024

Abstract
Background
Few studies have simultaneously focused on the associations of vegetable and fruit intake, physical activity, school bullying, and Internet addiction (IA) with depressive symptoms. This study aimed to explore the direct and indirect effects of the above factors on depressive symptoms in adolescents by constructing a structural equation model (SEM).

Methods
This study was conducted in Qingdao from September to November 2021. A total of 6195 secondary school students aged 10–19 years were included in the analysis. Information on all variables was assessed using a self-administered questionnaire. An SEM was constructed with depressive symptoms as the endogenous latent variable, IA as the mediating variable, and vegetable and fruit intake, physical activity, and school bullying as the exogenous latent variables. The standardized path coefficients (β) were the direct effects between the latent variables, and the indirect effects were obtained by the product of direct effects between relevant latent variables.

Results
The median value with the interquartile range of depressive symptom scores was 7 (3,12). Vegetable and fruit intake (β=-0.100, P<0.001) and physical activity (β=-0.140, P<0.001) were directly negatively related to depressive symptoms. While school bullying (β=0.138, P<0.001) and IA (β=0.452, P<0.001) were directly positively related to depressive symptoms. IA had the greatest impact on depressive symptoms. Vegetable and fruit intake, physical activity, and school bullying could not only directly affect depressive symptoms, but also indirectly affect depressive symptoms through the mediating effect of IA, the indirect effects and 95% confidence intervals (CIs) were -0.028 (-0.051, -0.007), -0.114 (-0.148, -0.089) and 0.095 (0.060, 0.157), respectively. The results of the multi-group analysis showed that the SEM we constructed still fit in boy and girl groups.

Conclusions
The results indicated that vegetable and fruit intake, physical activity, school bullying, and IA had a significant direct impact on depressive symptoms, among which IA had the greatest impact. In addition, both vegetable and fruit intake, school bullying, and physical activity indirectly affected depressive symptoms through the mediating effect of IA. The impact of IA on depressive symptoms should be given extra attention by schools and parents. This study provides a scientific and effective basis for the prevention and control of adolescent depressive symptoms.
Body image, eating distress and emotional-behavioral difficulties among adolescents in Mbarara, Southwestern Uganda
Authors: Abaatyo Joan , Twakiire Godwin , Favina Alain , Munaru Gideon , Rukundo Godfrey Zari 
Published: June 2024

Abstract
Background
Adolescents frequently have emotional and behavioral difficulties as they struggle with the challenges of transition from childhood to adulthood. Many struggle with issues of body image and eating distress as they deal with the difficult and frequently perplexing changes that occur with puberty. Yet there is surprisingly little research on the emotional and behavioral challenges, as well as body image and eating distress among this sizable population in Uganda. This study sought to assess attitudes and behaviors related to body image and eating distress, as well as emotional and behavioral difficulties among adolescents in Mbarara, Southwestern Uganda.

Methods
This was a cross-sectional study among 788 adolescents aged 13 to 19 years in secondary schools in Mbarara city and Mbarara district in south-western Uganda. The study employed the Body Image and Eating Distress scale to assess attitudes and behaviors about dieting and body shape and the extended version of the Strengths and Difficulties Questionnaire (SDQ) to assess for perceived emotional and behavioral difficulties. Logistic regression was used to identify the association between body image and eating distress and perceived difficulties.

Results
The prevalence of high body image and eating distress was 10.8% while that of perceived emotional and behavioral difficulties was 45.8%. Some of the adolescents (16.1%) were dissatisfied with their body shape, 24.6% exercised a lot to avoid gaining weight, 15.0% were terrified to gain even a little weight, and 12.1% could not control their eating. More males reported eating large amounts of food at one time (p =  < 0.001). Having emotional and behavioral difficulties (aOR: 1.89; 95% CI: 1.18 – 3.02; p = 0.019) and coming from a two-parent household (aOR: 1.79; 95% CI: 1.10 – 2.92; p = 0.019) increased the odds of high body image and eating distress.

Conclusion
High levels of body image and eating distress are linked to behavioral and emotional problems and adolescent’s family structure. Clinicians who treat adolescents should use a holistic care strategy and be aware of the high prevalence and close association between emotional and behavioral difficulties, concerns about weight, and dieting. It is important to encourage parental involvement and support in providing information about mental health issues among adolescents.
Adherence to Legionella control regulations and guidelines in Norwegian nursing homes: a cross-sectional survey
Authors: Bekkelund Anders , Angeloff Line Ødegård , Amato Ettore , Hyllestad Susanne 
Published: June 2024

Abstract
Background
Infection by Legionella bacteria is a risk to elderly individuals in health care facilities and should be managed by preventing bacterial proliferation in internal water systems. Norwegian legislation calls for a mandatory Legionella-specific risk assessment with the subsequent introduction of an adapted water management programme. The present study investigates adherence to legislation and guidelines on Legionella control and prevention in Norwegian nursing homes.

Methods
A cross-sectional survey was distributed to Norwegian municipalities to investigate the status of Legionella specific risk assessments of internal water distribution systems and the introduction of water management programmes in nursing homes.

Results
A total of 55.1% (n = 228) of the participating nursing homes had performed Legionella-specific risk assessments, of which 55.3% (n = 126) stated that they had updated the risk assessment within the last year. 96.5% introduced a water management programme following a risk assessment, whereas 59.6% of the ones without a risk assessment did the same. Nursing homes with risk assessments were more likely to monitor Legionella levels than those without (61.2% vs 38.8%), to remove dead legs (44.7% vs 16.5%), and to select biocidal preventive treatment over hot water flushing (35.5% vs 4.6%).

Conclusions
This study presents novel insight into Legionella control in Norway, suggesting that adherence to mandatory risk assessment in nursing homes is moderate-low. Once performed, the risk assessment seems to be advantageous as an introduction to future Legionella prevention in terms of the scope and contents of the water management programme.
Factors influencing unintended pregnancy and abortion among unmarried young people in Nigeria: a scoping review
Authors: Ayamolowo Love Bukola , Ayamolowo Sunday Joseph , Adelakun Dorcas Oluwatola , Adesoji Bukola Abimbola 
Published: June 2024

Abstract
Background
Unintended pregnancies and abortions among unmarried adolescents in Nigeria are outcomes of the interplay of multifaceted factors. Abortion, a global public health and social issue, impacts both developed and developing countries. This scoping review explored the literature and mapped the risk factors for unintended pregnancies and abortions among unmarried female adolescents in Nigeria.

Methods
A scoping literature search was conducted across databases, including PubMed, Science Direct, Web of Science, EBSCOhost, JSTOR, African Index Medicus, and Scopus. Inclusion criteria encompassed peer-reviewed articles and reports in English, focusing on unmarried female adolescents. The range of interest included the past incidents of having sex, unintended pregnancies, contraceptive use, and abortions among this demographic. Studies categorized as grey literature were excluded to ensure the reliability and validity of the synthesized information.

Results
A total of 560 articles, 553 identified through databases and 7 through hand search, were subjected to a comprehensive full-text review, resulting in the inclusion of 22 studies that met the criteria for the final review. The scoping review shed light on the past incidents of having sex, unintended pregnancies, contraceptive use, and abortions among unmarried adolescents in Nigeria. The range of incidence for having sex varied from 57.2% to 82.7%, with the prevalence of unintended pregnancies ranging from 23.4% to 92.7%. Contraceptive use was notably low, with 21.5% reporting low usage, contributing to the high incidence of abortions, ranging from 20.2% to 51.0%. Factors influencing unintended pregnancies included a lack of awareness of modern contraceptives and limited access to sexual and reproductive health information. For induced abortions, factors such as the impact on educational career, childbearing outside wedlock and fear of expulsion from school were identified.

Conclusion
This scoping review, through a systematic examination of existing literature, contributes to a more robust understanding of the factors influencing unintended pregnancies and abortions among unmarried adolescents in Nigeria. The findings inform future research directions and guide the development of targeted interventions to improve reproductive health outcomes for this vulnerable population.
An in-depth analysis of young adults with osteonecrosis secondary to developmental dysplasia of the hip who underwent total hip arthroplasty
Authors: Nayar Sandeep Krishan , Marks Avi , Hashemi-Nejad Aresh , Roposch Andreas 
Published: June 2024

Abstract
Background
Patients with osteonecrosis of the femoral head secondary to DDH frequently require total hip arthroplasty (THA), but it is not well understood which factors necessitate this requirement. We determined the incidence of THA in patients who have osteonecrosis secondary to DDH and factors associated with need for THA.

Methods
We included patients who received closed or open reductions between 1995 and 2005 with subsequent development of osteonecrosis. We determined osteonecrosis according to Bucholz and Ogden; osteoarthritis severity (Kellgren-Lawrence), subluxation (Shenton’s line); neck-shaft angle; and acetabular dysplasia (centre-edge and Sharp angles). We also recorded the number of operations of the hip in childhood and reviewed case notes of patients who received THA to describe clinical findings prior to THA. We assessed the association between radiographic variables and the need for THA using univariate logistic regression.

Results
Of 140 patients (169 hips), 22 patients received 24 THA (14%) at a mean age of 21.3 ± 3.7 years. Associated with the need for THA were grade III osteonecrosis (OR 4.25; 95% CI 1.70-10.77; p = 0.0019), grade IV osteoarthritis (21.8; 7.55–68.11; p < 0.0001) and subluxation (8.22; 2.91–29.53; p = 0.0003). All patients who required THA reported at least 2 of: severe pain including at night, stiffness, and reduced mobility. Acetabular dysplasia and number of previous operations were not associated with the need for THA.

Conclusions
We identified a 14% incidence of THA by age 34 years in patients with osteonecrosis secondary to DDH. Grade III osteonecrosis (global involvement femoral head and neck) was strongly associated with THA, emphasising the importance to avoid osteonecrosis when treating DDH.
Role of secreted frizzled-related protein 4 in prediabetes and type 2 diabetes: a cross sectional study
Authors: Sánchez-Pozos Katy , Granados-Silvestre MA , Nieto-Velázquez NG , Mejía-Blanquel María Alicia , Galicia-Martínez Natsyelli , Mandujano-Cerón Jessica , Jaimes-Santoyo Joel , Ortiz-López María Guadalupe 
Published: June 2024

Abstract
Background
Type 2 diabetes (T2D) has become an epidemic. Delays in diagnosis and as a consequent late treatment has resulted in high prevalence of complications and mortality. Secreted frizzled-related protein 4 (SFRP4), has been recently identified as a potential early biomarker of T2D related to obesity, due to its association with low grade inflammation in adipose tissue and impaired glucose metabolism. We aimed to evaluate the role of SFRP4 in prediabetes and T2D in a Mexican population.

Methods
This was a cross-sectional study that included 80 subjects with T2D, 50 subjects with prediabetes and 50 healthy individuals. Fasting SFRP4 and insulin concentrations were measured by ELISA. Human serum IL-10, IL-6, IL-1β and IL-8 levels were quantified by flow cytometry. Genotyping was performed by TaqMan® probes.

Results
Prediabetes and T2D patients had significantly higher SFRP4 levels than controls (P < 0.05). In turn, prediabetes subjects had higher SFRP4 concentrations than control subjects (P < 0.05). Additionally, the prediabetes and T2D groups had higher concentrations of proinflammatory molecules such as IL-6, IL-1β and IL-8, and lower concentrations of IL-10, an anti-inflammatory cytokine, than controls (P < 0.001). The serum SFRP4 concentrations were positively correlated with parameters that are elevated in prediabetes and T2D states, such as, HbA1c and homeostasis model assessment insulin resistance (HOMA-IR), (r = 0.168 and 0.248, respectively, P < 0.05). Also, serum SFRP4 concentrations were positively correlated with concentrations of pro-inflammatory molecules (CRP, IL-6, IL-1β and IL-8) and negatively correlated with the anti-inflammatory molecule IL-10, even after adjusting for body mass index and age (P < 0.001). The genetic variant rs4720265 was correlated with low HDL concentrations in T2D (P < 0.05).

Conclusions
SFRP4 correlates positively with the stage of prediabetes, suggesting that it may be an early biomarker to predict the risk of developing diabetes in people with high serum concentrations of SFRP4, although further longitudinal studies are required.
How do stressful life events affect medical students’ academic adjustment? Parallel mediating mechanisms of anxiety and depression
Authors: Guo Hui-Bing , Qiu Chen 
Published: June 2024

Abstract
Background
Medical students frequently face challenges in academic adjustment, necessitating effective support and intervention. This study aimed to investigate the impact of stressful life events on medical students’ academic adjustment, focusing on the mediating roles of depression and anxiety. It also differentiated the impacts between at-risk students (those with academic failures) and their peers respectively.

Methods
This case-control study involved 320 at-risk medical students and 800 other students from a university in western China. Participants anonymously completed the scales of stressful life events, depression, anxiety, and academic adjustment. T-tests, ANOVA, Pearson correlation, and structural equation modeling were employed for statistical analysis.

Results
Depression and anxiety were significantly more prevalent in at-risk students (46.8% and 46.1%, respectively) than in controls (34.0% and 40.3%, respectively). Notably, at-risk students had poorer academic adjustment (t = 5.43, p < 0.001). The structural equation modeling had good fit indices and the results indicated that depression and anxiety fully mediated the effects of stressful life events on academic adjustment. For at-risk students, stressful life events significantly decreased academic adjustment through increased depression and anxiety (p < 0.001). Conversely, anxiety had a positive effect on academic adjustment in other students.

Conclusion
Targeted interventions focusing on depression and anxiety could reduce the negative impact of stressful life events on medical students’ academic adjustment. However, educators have to distinguish the differences between at-risk students and others.
Transitional care for older persons with need of geriatric rehabilitation nursing interventions
Authors: Ferreira Rogério , Pedrosa Ana Rita , Reis Neuza , Sousa Luís , Nicolau Célia , Ferreira Bruno , Rocha Belmiro , Baixinho Cristina Lavareda 
Published: June 2024

Abstract
Background
The literature review notes that people in need of care from Rehabilitation Programs do not always see their continuity ensured.

Objective
This study aim to analyze the perspective of Specialists Nurse in Rehabilitation Nursing in relation to the organization and specialized intervention of transitional care for older people in need of rehabilitation programs.

Methods
This is a qualitative study within the interpretivist paradigm. A focus group with 8 nurses and 13 interviews with Portuguese nurses were carried out between April 2022 and February 2023. Content analysis was carried out.

Results
The triangulation of the data made it possible to identify 3 categories: Coordination of a transitional care program; Empowering the person to self-manage the transitional care process and Empowering the Informal Caregiver.

Conclusions
It is imperative to promote the coordination of transitional care, increase the functional capacity of the person and empower the informal caregiver.
Structure–activity relationships of the intramolecular disulphide bonds in LEAP2, an antimicrobial peptide from Acrossocheilus fasciatus
Authors: Yu Ci-Gang , Ma Li , Zhang Di-Ni , Ma Yue , Wang Chang-Yong , Chen Jie 
Published: June 2024

Abstract
Background
The liver-expressed antimicrobial peptide 2 (LEAP2) plays a pivotal role in the host’s immune response against pathogenic microorganisms. Numerous such antimicrobial peptides have recently been shown to mitigate infection risk in fish, and studying those harboured by the economically important fish Acrossocheilus fasciatus is imperative for enhancing its immune responses against pathogenic microorganisms. In this study, we cloned and sequenced LEAP2 cDNA from A. fasciatus to examine its expression in immune tissues and investigate the structure–activity relationships of its intramolecular disulphide bonds.

Results
The predicted amino acid sequence of A. fasciatus LEAP2 was found to include a signal peptide, pro-domain, and mature peptide. Sequence analysis indicated that A. fasciatus LEAP2 is a member of the fish LEAP2A cluster and is closely related to Cyprinus carpio LEAP2A. A. fasciatus LEAP2 transcripts were expressed in various tissues, with the head kidney exhibiting the highest mRNA levels. Upon exposure to Aeromonas hydrophila infection, LEAP2 expression was significantly upregulated in the liver, head kidney, and spleen. A mature peptide of A. fasciatus LEAP2, consisting of two disulphide bonds (Af-LEAP2-cys), and a linear form of the LEAP2 mature peptide (Af-LEAP2) were chemically synthesised. The circular dichroism spectroscopy result shows differences between the secondary structures of Af-LEAP2 and Af-LEAP2-cys, with a lower proportion of alpha helix and a higher proportion of random coil in Af-LEAP2. Af-LEAP2 exhibited potent antimicrobial activity against most tested bacteria, including Acinetobacter guillouiae, Pseudomonas aeruginosa, Staphylococcus saprophyticus, and Staphylococcus warneri. In contrast, Af-LEAP2-cys demonstrated weak or no antibacterial activity against the tested bacteria. Af-LEAP2 had a disruptive effect on bacterial cell membrane integrity, whereas Af-LEAP2-cys did not exhibit this effect. Additionally, neither Af-LEAP2 nor Af-LEAP2-cys displayed any observable ability to hydrolyse the genomic DNA of P. aeruginosa.

Conclusions
Our study provides clear evidence that linear LEAP2 exhibits better antibacterial activity than oxidised LEAP2, thereby confirming, for the first time, this phenomenon in fish.