bluuebunny/crossref_metadata_2025_split huggingface dataset:
WHO criteria for diabetes in pregnancy: a retrospective cohort
Authors: Zaccara Tatiana A. , Paganoti Cristiane F. , Mikami Fernanda C. F. , Francisco Rossana P. V. , Costa Rafaela A. 
Published: May 2022

Abstract
Background
Recognizing that hyperglycemia in pregnancy can impact both individually a patient’s health and collectively the healthcare system and that different levels of hyperglycemia incur different consequences, we aimed to evaluate the differences and similarities between patients who met the diagnostic criteria for gestational diabetes mellitus (GDM) or diabetes in pregnancy (DIP) according to the World Health Organization diagnostic criteria based on the 75 g oral glucose tolerance test (OGTT).

Methods
This retrospective study included a cohort of 1064 women followed-up at the Gestational Diabetes Unit of Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (Sao Paulo, Brazil). Patients were classified into GDM and DIP groups, according to their OGTT results. Their electronic charts were reviewed to obtain clinical and laboratory data for all participants.

Results
Women in the DIP group had a higher pre-pregnancy body mass index (30.5 vs 28.1 kg/m2, odds ratio [OR] 1.07, 95% confidence interval [CI] 1.02–1.11), more frequently experienced GDM in a previous pregnancy (25% vs. 11%, OR 2.71, 95% CI 1.17–6.27), and were more likely to have chronic hypertension (43.1% vs. 23.5%, OR 2.46, 95% CI 1.47–4.11), a current twin pregnancy (10.8% vs. 2.9%, OR 4.04, 95% CI 1.70–9.61), or require insulin (46.1% vs. 14.3%, OR 5.14, 95% CI 3.06–8.65) than those in the GDM group. Patients in the DIP group also had a higher frequency of large-for-gestational-age infants (12.3% vs. 5.1%, OR 2.78, 95% CI 1.23–6.27) and abnormal postpartum OGTT (45.9% vs. 12.6%, OR 5.91, 95% CI 2.93–11.90) than those in the GDM group. Nevertheless, in more than half of the DIP patients, glucose levels returned to normal after birth.

Conclusions
Diabetes in pregnancy is associated with an increased risk of adverse perinatal outcomes but does not equate to a diagnosis of diabetes post-pregnancy. It is necessary to identify and monitor these women more closely during and after pregnancy. Keeping patients with hyperglycemia in pregnancy engaged in healthcare is essential for accurate diagnosis and prevention of complications related to abnormal glucose metabolism.
The effects of childhood trauma on personality in unaffected first-degree relatives of patients with major depressive disorder
Authors: Wen Yu-jie , Bo Qi-jing , Hou Wen-peng , Mao Zhen , Li Feng , He Fan , Dong Fang , Ma Xin , Tang Yi-lang , Li Xian-bin , Wang Chuan-yue 
Published: May 2022

Abstrac
Objectives
This study aimed to preliminarily and exploratorily examine the associations between childhood trauma (CT), its subtypes, and personality traits among unaffected first-degree relatives (FDR, children, or siblings) of patients with major depressive disorder (MDD).

Methods
The study sample included three subgroups: MDD patients (N = 85), Patients’ FDRs (N = 35), and healthy control individuals (HC, N = 89). The Childhood Trauma Questionnaire (CTQ) was used to assess childhood trauma and the Eysenck Personality Questionnaire was used to assess personality traits.

Results
Significant differences were found in a few personality traits (p < 0.05 for extraversion, neuroticism, and psychoticism) among MDD patients, FDR, and HC, and there were no significant differences between HC and FDR. In the FDR group, compared with those without CT, participants with CT scored significantly higher for neuroticism (N) (F = 3.246, p = 0.046). CT was significantly associated with N, psychoticism (P) and Lie (L), and the strongest association was between CT total score and N. Significantly positive correlations were found between N and sexual abuse (SA) (r = 0.344, p = 0.043), emotional neglect (EN) (r = 0.394, p = 0.019), physical neglect (PN) (r = 0.393, p = 0.019), and CTQ total score (r = 0.452, p = 0.006); between P and CTQ total score (r = 0.336, p = 0.049); and significant negative correlations were found between L and EN (r = -0.446, p = 0.007), CTQ total score (r = -0.375, p = 0.027).

Conclusion
In unaffected FDRs, there were significant associations between childhood trauma and a few personality traits, including neuroticism, psychoticism, and lie, and emotional neglect was significantly associated with neuroticism.
An observational comparison of FACT and ACT in the Netherlands and the US
Authors: Westen Koen , Boyle Patrick , Kroon Hans 
Published: May 2022

Abstract
Background
Assertive Community Treatment (ACT) is a well-defined service delivery model for the care and treatment of the most severely mentally ill in the community with American origins. The Dutch have adapted the model in order to accommodate a broader range of needs and allow more flexible implementation. Functional Assertive Community Treatment (FACT) provides the intensity of care needed to help participants sustain life in the community as well as continuity of care over time for many vulnerable client populations.
Palliative care in home health care services and hospitals – the role of the resource nurse, a qualitative study
Authors: Johansen Håkon , Grøndahl Vigdis Abrahamsen , Helgesen Ann Karin 
Published: May 2022

AbstractBackgroundThe role of the resource nurse aims at bridging the gap between the specialist nurses and the nurses who work in non-specialist wards. The role is established internationally and used in a wide area of clinical settings. The resource nurse is promoting evidence-based practice.Patients with life limiting conditions including cancer and other chronic diseases will likely need palliative care during the trajectory of illness. Due to the complexity of palliative care, both interprofessional help and cooperation between levels of healthcare are considered necessary.AimThe aim of this study was to explore the perceptions and experiences related to the role of the resource nurse in palliative care in the setting of home health care services and hospitals in Norway, from the perspectives of the resource nurses and the ward nurses.DesignThe study has an explorative design with a qualitative approach.MethodsEight individual interviews were conducted. Audiotaped interview material was transcribed verbatim and the data were analysed using systematic text condensation. The encoded data material provided the basis for writing analytical texts that in turn resulted in meaningful descriptions of the different categories.ResultsFour resource nurses and four ward nurses participated in individual interviews.Analysis of the data yielded three categories: 1. Expectations of better competence in the ward. 2. Expectations of better cooperation between professions and different levels of healthcare services. 3. Improvements and hindrances.ConclusionThe resource nurse role is underutilized due to heavy workload and inefficient organization of care. Improvements such as sufficient time resources, support from the ward nurse and cooperation with staff nurses, the resource nurses’ role could contribute to increased competence and cooperation interprofessionally and between levels of healthcare.
Effect of end-of-life nursing education on the knowledge and performance of nurses in the intensive care unit: a quasi-experimental study
Authors: Ghaemizade Shushtari Sima Sadat , Molavynejad Shahram , Adineh Mohammad , Savaie Mohsen , Sharhani Asaad 
Published: May 2022

Abstract
Background
End-of-life care education is required for nurses to acquire the clinical competence necessary for the improvement of the quality of end-of-life nursing care. The aim of this study was to determine the effect of nursing care education based on End-of-Life Nursing Education Consortium (ELNEC) on the knowledge and performance of nurses working in the intensive care unit (ICU).

Methods
This quasi-experimental study was conducted with a pretest–posttest design. From among nurses working in the ICU of Golestan and Imam Khomeini hospitals in Ahvaz, Iran, 80 nurses were selected based on the inclusion criteria. They were randomly assigned to the intervention and control groups (40 people in each group) using a table of random numbers. Data were collected using a demographic characteristics form, the ELNEC Knowledge Assessment Test (ELNEC-KAT), and the Program in Palliative Care Education and Practice Questionnaire (German Revised Version; PCEP-GR).

Results
A significant difference was observed between the intervention and control groups in terms of the average knowledge score in all 9 modules including nursing care, pain management and control, disease symptom management, ethical/legal issues, culture, communication with the patient and his/her family, loss and grief, death, and quality of life (QOL) (P < 0.001). Moreover, the average performance score of nurses in the fields of preparation for providing palliative care, self-assessment of ability to communicate with dying patients and their relatives, self-assessment of knowledge and skills in palliative care increased significantly in the intervention group compared to the control group (P < 0.001).

Conclusions
End-of-life nursing education is recommended as an effective method for promoting knowledge, attitude, performance, and clinical competence among all nurses involved in end-of-life care.
The first COVID-19 new graduate nurses generation: findings from an Italian cross-sectional study
Authors: Palese Alvisa , Brugnolli Anna , Achil Illarj , Mattiussi Elisa , Fabris Stefano , Kajander-Unkuri Satu , Dimonte Valerio , Grassetti Luca , Danielis Matteo 
Published: May 2022

Abstract
Background
Nursing education has been disrupted by the onset of the COronaVIrus Disease 19 (COVID-19) pandemic, potentially impacting learning experiences and perceived competencies at the time of graduation. However, the learning experiences of students since the onset of COVID-19, their perceived competences achieved and the employment status one month after graduation, have not been traced to date.

Methods
A cross sectional online survey measured the individual profile, the learning experience in the last academic year and the perceived competences of the first COVID-19 new nursing graduates in two Italian universities. Details relating to employment status and place of employment (Covid-19 versus non-COVID-19 units) one month after graduation were also collected and the data compared with those reported by a similar cohort of new graduates pre-pandemic in 2018–2019. All those who graduated in November 2020 and attended their third year after the onset of the COVID-19 pandemic were eligible. The online survey included individual, nursing programme and first working experience variables alongside the Nurse Competence Scale (NCS). Descriptive and inferential statistical analyses were performed.

Results
A total of 323 new graduates participated. In their last academic year, they experienced a single, long clinical placement in non-COVID-19 units. One month after graduation, 54.5% (n = 176) were working in COVID-19 units, 22.9% (n = 74) in non-COVID-19 units and 22.6 (n = 73) were unemployed. There was no statistical difference among groups regarding individual variables and the competences perceived. Fewer new graduates working in COVID-19 units experienced a transition programme compared to those working in non-COVID-19 units (p = 0.053). At the NCS, the first COVID-19 new graduate generation perceived significantly lower competences than the pre-COVID-19 generation in the ‘Helping role’ factor and a significant higher in ‘Ensuring quality’ and ‘Therapeutic interventions’ factors.

Conclusions
The majority of the first COVID-19 new graduate generation had been employed in COVID-19 units without clinical experience and transition programmes, imposing an ethical debate regarding (a) the role of education in graduating nurses in challenging times with limited clinical placements; and (b) that of nurse managers and directors in ensuring safe transitions for new graduates. Despite the profound clinical placement revision, the first COVID-19 new graduate generation reported competences similar to those of the pre-COVID-19 generation, suggesting that the pandemic may have helped them to optimise the clinical learning process.
Use of outpatient and inpatient health care services by occupation—a register study of employees in Oulu, Finland
Authors: Rinne Hanna , Laaksonen Mikko , Blomgren Jenni 
Published: May 2022

Abstract
Background
The aim of this study was to examine how the use of outpatient and inpatient health services differs by occupational groups, and whether the differences are explained by sociodemographic factors and health status.

Methods
We used register-based data on 25–64-year-old employees living in the city of Oulu, Finland, in 2018 (N = 61,848). Use of outpatient health care services (public, private and occupational health care) among men and women was analysed with negative binomial regression models, and use of inpatient health care with logistic regression models, using two occupational classifications: occupational group (1-digit level) and more detailed occupation (2-digit level). Adjusted covariates were age, education, income, marital status, special reimbursement entitlements for medicines, and sickness absence.

Results
Examined at the level of larger occupational groups, the use of outpatient and inpatient health care was less common than average among managers, professionals and skilled agricultural, forestry and fishery workers; in women also among craft and related trades workers. Controlling for covariates explained only part of the differences, more among women than among men. Analysed at the level of more detailed occupations, the adjusted use of outpatient and inpatient care was more common among health associate professionals and stationary plant and machine operators, both among men and women. Furthermore, the use of outpatient care was common among male personal care workers, protective service workers and metal, machinery and related trades workers as well as among labourers in mining, construction, manufacturing and transport, and female customer services clerks and sales workers.

Conclusion
The use of health care services differs by occupation, and the differences are not fully explained by sociodemographic factors and health status. High occupational risks, attitudes and knowledge may explain the more frequent use of health services. Furthermore, explanations may be sought from lack of access to occupational health care or healthier working conditions and behavior.
A deep learning approach identifies new ECG features in congenital long QT syndrome
Authors: Aufiero Simona , Bleijendaal Hidde , Robyns Tomas , Vandenberk Bert , Krijger Christian , Bezzina Connie , Zwinderman Aeilko H. , Wilde Arthur A. M. , Pinto Yigal M. 
Published: May 2022

Abstract
Background
Congenital long QT syndrome (LQTS) is a rare heart disease caused by various underlying mutations. Most general cardiologists do not routinely see patients with congenital LQTS and may not always recognize the accompanying ECG features. In addition, a proportion of disease carriers do not display obvious abnormalities on their ECG. Combined, this can cause underdiagnosing of this potentially life-threatening disease.

Methods
This study presents 1D convolutional neural network models trained to identify genotype positive LQTS patients from electrocardiogram as input. The deep learning (DL) models were trained with a large 10-s 12-lead ECGs dataset provided by Amsterdam UMC and externally validated with a dataset provided by University Hospital Leuven. The Amsterdam dataset included ECGs from 10000 controls, 172 LQTS1, 214 LQTS2, and 72 LQTS3 patients. The Leuven dataset included ECGs from 2200 controls, 32 LQTS1, and 80 LQTS2 patients. The performance of the DL models was compared with conventional QTc measurement and with that of an international expert in congenital LQTS (A.A.M.W). Lastly, an explainable artificial intelligence (AI) technique was used to better understand the prediction models.

Results
Overall, the best performing DL models, across 5-fold cross-validation, achieved on average a sensitivity of 84 ± 2%, 90 ± 2% and 87 ± 6%, specificity of 96 ± 2%, 95 ± 1%, and 92 ± 4%, and AUC of 0.90 ± 0.01, 0.92 ± 0.02, and 0.89 ± 0.03, for LQTS 1, 2, and 3 respectively. The DL models were also shown to perform better than conventional QTc measurements in detecting LQTS patients. Furthermore, the performances held up when the DL models were validated on a novel external cohort and outperformed the expert cardiologist in terms of specificity, while in terms of sensitivity, the DL models and the expert cardiologist in LQTS performed the same. Finally, the explainable AI technique identified the onset of the QRS complex as the most informative region to classify LQTS from non-LQTS patients, a feature previously not associated with this disease.

Conclusions
This study suggests that DL models can potentially be used to aid cardiologists in diagnosing LQTS. Furthermore, explainable DL models can be used to possibly identify new features for LQTS on the ECG, thus increasing our understanding of this syndrome.
Predictive value of circulating NMR metabolic biomarkers for type 2 diabetes risk in the UK Biobank study
Authors: Bragg Fiona , Trichia Eirini , Aguilar-Ramirez Diego , Bešević Jelena , Lewington Sarah , Emberson Jonathan 
Published: May 2022

AbstractBackgroundEffective targeted prevention of type 2 diabetes (T2D) depends on accurate prediction of disease risk. We assessed the role of metabolomic profiling in improving T2D risk prediction beyond conventional risk factors.MethodsNuclear magnetic resonance (NMR) metabolomic profiling was undertaken on baseline plasma samples in 65,684 UK Biobank participants without diabetes and not taking lipid-lowering medication. Among a subset of 50,519 participants with data available on all relevant co-variates (sociodemographic characteristics, parental history of diabetes, lifestyle—including dietary—factors, anthropometric measures and fasting time), Cox regression yielded adjusted hazard ratios for the associations of 143 individual metabolic biomarkers (including lipids, lipoproteins, fatty acids, amino acids, ketone bodies and other low molecular weight metabolic biomarkers) and 11 metabolic biomarker principal components (PCs) (accounting for 90% of the total variance in individual biomarkers) with incident T2D. These 11 PCs were added to established models for T2D risk prediction among the full study population, and measures of risk discrimination (c-statistic) and reclassification (continuous net reclassification improvement [NRI], integrated discrimination index [IDI]) were assessed.ResultsDuring median 11.9 (IQR 11.1–12.6) years’ follow-up, after accounting for multiple testing, 90 metabolic biomarkers showed independent associations with T2D risk among 50,519 participants (1211 incident T2D cases) and 76 showed associations after additional adjustment for HbA1c (false discovery rate controlledp< 0.01). Overall, 8 metabolic biomarker PCs were independently associated with T2D. Among the full study population of 65,684 participants, of whom 1719 developed T2D, addition of PCs to an established risk prediction model, including age, sex, parental history of diabetes, body mass index and HbA1c, improved T2D risk prediction as assessed by the c-statistic (increased from 0.802 [95% CI 0.791–0.812] to 0.830 [0.822–0.841]), continuous NRI (0.44 [0.38–0.49]) and relative (15.0% [10.5–20.4%]) and absolute (1.5 [1.0–1.9]) IDI. More modest improvements were observed when metabolic biomarker PCs were added to a more comprehensive established T2D risk prediction model additionally including waist circumference, blood pressure and plasma lipid concentrations (c-statistic, 0.829 [0.819–0.838] to 0.837 [0.831–0.848]; continuous NRI, 0.22 [0.17–0.28]; relative IDI, 6.3% [4.1–9.8%]; absolute IDI, 0.7 [0.4–1.1]).ConclusionsWhen added to conventional risk factors, circulating NMR-based metabolic biomarkers modestly enhanced T2D risk prediction.
Autonomic nervous system dysregulation in response to postural change in patients with pectus excavatum in Taiwan: a pilot study
Authors: Hsu Yu-Ting , Cheng Yeung-Leung , Chang Yi-Wei , Lan Chou-Chin , Wu Yao-Kuang , Yang Mei-Chen 
Published: May 2022

AbstractBackgroundPectus excavatum (PE) negatively impacts psychological function, but its effect on autonomic nervous system (ANS) function has not been investigated. We evaluated ANS function following postural changes in patients with PE.MethodsThe participants were 14 healthy men (control group) and 20 men with PE (study group). Psychological function was assessed using the visual analog scale for pain, Brief Symptom Rating Scale-5, and Beck Depression Inventory-II. Sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI). ANS regulation in response to postural change was measured in the supine position and immediately after sitting. All measurements were compared between the control and study groups at baseline and between the study groups before and after Nuss surgery.ResultsAt baseline, upon postural change, symptomatic activity increased in the control group (50.3–67.4%, p = 0.035) but not in the study group (55.0–54.9%, p = 0.654); parasympathetic activity decreased in the control group (49.7–32.6%, p = 0.035) but not in the study group (45.1–45.1%, p = 0.654); and overall ANS regulation increased in the control group (1.02–2.08, p = 0.030) but not in the study group (1.22–1.22, p = 0.322). In response to postural change after Nuss surgery in the study group, sympathetic activity increased (48.7–70.2%, p = 0.005), parasympathetic activity decreased (51.3–29.8%, p = 0.005), and overall ANS regulation increased (0.95–2.36, p = 0.012).ConclusionANS function in response to postural change is dysregulated in patients with PE, which improved after Nuss surgery.Trial registrationClinicalTrials.gov, ID: NCT03346876, November 15, 2017, retrospectively registered,https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S0007KGI&selectaction=Edit&uid=U0003JZU&ts=2&cx=cstxeg
Ginsenoside compound K inhibits the proliferation, migration and invasion of Eca109 cell via VEGF-A/Pi3k/Akt pathway
Authors: Huang Jianhou , Pan Dinglong , Liu Feng , Hong Yiting , Huang Gang , Huang Xiaowei , Wang Xinwen , Lin Zhiqiang 
Published: May 2022

Abstract
Objective
Esophageal cancer, one of the most common cancers in the upper digestive tract and is one of the leading cancer-related mortality worldwide. Accumulating studies found that Ginsenoside compound K (CK) has significantly anti-tumor effects, especially in the suppression of proliferation, migration, as well as invasion in various human cancers. While the effects of Ginsenoside CK in esophageal cancer have not been well studied. In our present study, we aim to explore the functions and mechanisms of Ginsenoside CK in the progression of esophageal cancer cells (Eca109).

Methods
Cell Counting Kit-8 (CCK-8), wound healing, transwell and flow cytometry assays were applied to analyze the effects of Ginsenoside CK in the progression of Eca109 cell, western blot assay was used to investigate the potential downstream signaling pathway after Ginsenoside CK treatment.

Results
Our study found that Ginsenoside CK can suppress cell proliferation, migration and invasion of Eca109 cell. Furthermore, the flow cytometry showed that Ginsenoside CK increased of apoptosis rates in Eca109 cell. The western blot results indicated that Ginsenoside CK decreased the expression of VEGF-A, P-Pi3k and P-Akt proteins. Moreover, the knockdown of VEGF-A gene could suppress cell proliferation, migration, invasion and induce apoptosis in Eca109 cell, and the expression of P-Pi3k and P-Akt proteins were significantly downregulated.

Conclusions
Our study suggests that Ginsenoside CK inhibits the proliferation, migration, invasion, and induced apoptosis of Eca109 cell by blocking VEGF-A/Pi3k/Akt signaling pathway.