Conectar
Ensuring gender equity in leadership is crucial for fair representation and diversity in academic medicine. This study aims to investigate the representation of women in leadership positions in Turkish academic medicine, including medical schools, specialty boards, conferences and medical journals.
A cross-sectional study was conducted between August and December 2023. The study analysed data from members of medical faculties, specialty boards, medical conferences and medical journals across Turkey. The source of information was publicly accessible websites.
The study included data from 17 939 members of 113 medical faculties, 112 specialty boards, 73 medical conferences and 246 medical journals in Turkey.
This study has no interventions.
Women made up 40.4% of all medical-school faculty but only 22.5% of deans (95% CI 15.5 to 31.6; p
Turkey’s academic medicine pipeline contains substantial numbers of women, yet marked gaps persist in senior positions. Bridging these gaps will require targeted policies that look beyond overall workforce proportions to the specific decision-making roles where shortfalls remain.
Opioid use disorder (OUD) is a chronic and severe psychiatric condition defined by a level of opioid use which significantly impairs interpersonal and social functioning. In the biopsychosocial model of addiction, research has shown that psychiatric, sociological and neurobiological factors individually affect OUD severity. However, how these factors interact in the determination of OUD severity remains poorly understood.
The Epigenetic Bonds of Opioid Use Profiles are a multidisciplinary project whose primary objective is to characterise psychiatric and social factors of OUD in a large cohort of patients. The secondary objectives are, first, to correlate psychosocial severity with blood-derived epigenetic biomarkers to provide a deeper understanding of determinants of OUD and, second, to examine over a 2 year follow-up the correlation between the evolution of OUD and psychosocial severity with epigenetic biomarkers at inclusion. An additional objective is to analyse the impact of drug consumption rooms on access to care for most severely affected patients with OUD. In total, 300 opioid users will be recruited at supervised injection sites in Strasbourg and Paris and at addiction care centres in Strasbourg and Lyon to explore four psychiatric (substance use disorders beyond opioids, depression, anxiety, post-traumatic stress disorder) and five social (social support and status, traumatic experiences, housing, imprisonment, access to care) factors. Opioid users will be followed for 24 months and reassessed for psychosocial factors at 3, 6, 12, 18 and 24 months. Opioid consumption will be measured in all subjects using questionnaires, complemented by toxicological screenings (mass spectrometry). Finally, DNA methylation and gene expression will be characterised in capillary blood using next-generation sequencing. Mixed models will be used to model the primary and secondary outcomes.
This ongoing study was approved by the French Ethics Committee ‘Sud Méditerranée III’ of University Hospital of Nîmes (approval 2023–2024, protocol IDRCB number 2022-A02477-36) and authorised by the French Data Protection Authority (authorisation decision DR-2023–277 in December 2023). Results will be presented in international and national conferences and published in peer-reviewed international journals.
by Martin Chebet, Kathy Burgoine, Joseph Rujumba, Noela Regina Akwi Okalany, Peter Olupot-Olupot, Thorkild Tylleskär, Andrew D. Weeks, Agnes Napyo, David Mukunya, Ingunn Marie S. Engebretsen
BackgroundIn sub-Saharan Africa, stillbirth rates remain high. To design effective interventions to reduce stillbirths, accurate determination of their aetiology is important. Conventional autopsy for accurate confirmation of cause is not acceptable or feasible in several societies in sub-Saharan Africa; minimal invasive tissue sampling (MITS), is a recently developed, less invasive alternative. In this study, we explored the acceptability of MITS in the community and among healthcare workers in Uganda to guide the future implementation.
MethodsA qualitative study was done among community members and healthcare workers in Mbale in Eastern Uganda. We undertook in-depth interviews and focus group discussions in English or local languages. Interviews were audio-recorded, transcribed as necessary prior to formal content analysis. The themes were organised using NVivo software and presented according to Sekhon’s theoretical framework.
ResultsOverall, participants preferred the idea of MITS to conventional autopsy because of the perception that it was fast, maintained the facial appearance and kept the body intact. It was thought that the procedure would improve the detection of the cause of stillbirths, which in turn would help to prevent future stillbirths. It would also resolve conflicts in the community between community members or the women and the healthcare workers about the cause of a stillbirth. It was suggested that some community members may not approve of MITS because of their religious beliefs; the fear that the body parts may be extracted and stolen for witchcraft or organ donation; and a lack of trust in the healthcare system. To implement the procedure, it was suggested that extensive community sensitization should be done, space limitations in healthcare facilities overcome, healthcare workers should be trained and limited human resource should be addressed.
ConclusionThe implementation of MITS in Mbale, Eastern Uganda, is likely to be acceptable given sufficient training and sensitisation.
by Tessy Luger, Felix Uhlemann, Florestan Wagenblast, Thomas Läubli, Barbara Munz, Manfred Schmolz, Monika A. Rieger, Benjamin Steinhilber
BackgroundWork-related musculoskeletal disorders (WMSDs) are prevalent in occupations characterised by high repetition and high force demands. Both factors not only evoke inflammatory and degenerative processes in affected musculoskeletal tissue, but also systemic responses identified by biomarkers in blood serum. Clarifying methodological aspects of biomarkers may provide insights into their predictive role in the pathway of developing WMSDs. This study will primarily assess reliability of systemic inflammatory biomarkers (CRP, TNF-α, IL-6, IL-1β) and immune cell reactivity by repeated measures in workers with constant workloads over time.
MethodsThis observational cross-sectional study will include two groups of workers: exposed group including workers exposed to higher upper-extremity physical workloads, especially affecting the elbow/forearm/hand-area; unexposed group, including office workers exposed to lower upper-extremity physical workloads. Recruited persons are screened against eligibility criteria followed by a medical anamnesis and blood analysis. Enrolled participants undergo nine repeated measurements once every two weeks, taking blood among others. Blood analyses will determine values of systemic inflammatory biomarkers and reactivity of immune cells. The absolute test-retest reliability of biomarkers and immune cell reactivity over time is assessed by the intra-class correlation coefficient applying two-way mixed-effects models. The relative test-retest reliability is assessed by the standard error of measurement.
DiscussionKnowledge of and models currently describing the pathological role of systemic inflammatory biomarkers are based on highly-controlled laboratory rat experiments. This study has the strength of assessing a human population under real-life conditions. The major challenge is in participant recruitment given the intensive and complex study design. The results of this study could provide fundamentals for initiating a cohort study and be used for developing work-related stress-recovery concepts for occupations with different physical demands to identify workers who may be at risk for developing WMSDs. German Clinical Trials Register (DRKS00031872, 25 May 2023).
by Chengya Feng, Xiaohe Lu, Zimian Fan, Xinxing Wang
BackgroundHuman papillomavirus (HPV) is the most prevalent sexually transmitted infection. Copper is essential for immune function, but its association with HPV infection remains unclear. This study aims to investigate the relationship between dietary copper intake and HPV infection.
MethodsThis cross-sectional study analyzed 8,071 participants from the National Health and Nutrition Examination Survey (2003–2016). Copper intake was assessed using two 24-hour recalls, and HPV status was confirmed by DNA testing. Weighted multivariable logistic regression and restricted cubic splines (RCS) were used.
ResultsAfter adjusting for multiple confounders, dietary copper intake was significantly inversely associated with vaginal HPV infection (odds ratio [OR], 0.79; 95% confidence interval [CI], 0.67–0.92). Compared with women in the lowest quartile of dietary copper intake, those in the highest quartile had a lower adjusted OR for vaginal HPV infection (OR, 0.60; 95% CI, 0.48–0.73). RCS analysis revealed an L-shaped association with a threshold at 1.2 mg/day of copper intake. Subgroup analyses showed that marital status moderated the association between copper intake and HPV infection (P for interaction Conclusion
An L-shaped association was observed between copper intake and HPV infection, suggesting that maintaining an optimal level of copper intake may be associated with reduced risk of HPV infection and related diseases.
by Francesco Colussi, Jacopo Favaro, Claudio Ancona, Edoardo Passarotto, Maria Federica Pelizza, Eleonora Lorenzon, Simone Ruzzante, Stefano Masiero, Giorgio Perilongo, Giovanni Sparacino, Irene Toldo, Stefano Sartori, Maria Rubega
Brain maturation from birth to adolescence involves profound transformations in neural dynamics, which can be studied in a minimally invasive manner using quantitative EEG. Most of the results published in the literature are based on spectral analysis approaches, which are extremely effective in detecting and assessing EEG rhythms. However, some aspects of EEG dynamics can only be investigated using nonlinear approaches, the use of which is still relatively unexplored in the pediatric population. The aim of the present paper is to assess the EEG differentiation of wakefulness from deep sleep (quiet sleep in neonates, stage N3 in older children) and its maturation across a wide developmental window (0–17 years) using the fractal dimension. Specifically, Higuchi fractal dimension (HFD) algorithm is used to analyse both wakefulness and sleep EEG recordings collected from 63 infants (aged 0-1 year) and 160 children (aged 2-17 years). To ensure methodological consistency, a data-driven criterion for the selection of HFD user parameters is implemented to enhance reproducibility. Our results show that HFD during wakefulness increases during the first year of life, followed by a stabilization or slight decrease in later years. In contrast, HFD during sleep exhibits a more stable profile, with only a mild increase over development. These findings are consistent with known neurodevelopmental processes—including synaptogenesis, pruning, and white matter maturation—and support the interpretation of HFD as a sensitive marker of large-scale integrative brain dynamics. These physiological trajectories of HFD both in wakefulness and sleep could be used as reference for future clinical applications in pediatric neurology and developmental monitoring.by Jakob Morén, Barbro Persson, Anna Sörman, Åke Lundkvist, Hanin Shihab, Marie Studahl, Malin Veje, Göran Günther, Gabriel Westman
BackgroundTick-borne encephalitis is a viral infection of the central nervous system that may cause severe illness and long-term sequelae, to which underlying mechanisms are not completely understood. Autoantibodies against the N-methyl-D-aspartate receptor (anti-NMDAR) may be triggered by immunologic events, occur sporadically, and can cause autoimmune encephalitis. Following herpes simplex encephalitis and Japanese encephalitis, anti-NMDAR autoantibodies may develop and have been associated with relapse or impaired cognitive recovery. Tick-borne encephalitis has been shown to trigger anti-NMDAR encephalitis in sporadic cases, but the frequency of autoimmunization is unknown.
ObjectivesThe objective of this study was to assess the frequency of intrathecal anti-NMDAR antibody development following tick-borne encephalitis and to explore whether such antibodies could be relevant to cognitive complaints.
MethodsAdult patients with tick-borne encephalitis were included retrospectively from one cohort and prospectively from another. A stored post-acute cerebrospinal fluid sample was required for anti-NMDAR analysis. Two commercial kits (Euroimmun AG, Lübeck, Germany) were used to detect anti-NMDAR IgG antibodies in cerebrospinal fluid.
ResultsA total of 71 cerebrospinal fluid samples from 53 patients were analyzed for anti-NMDAR antibodies. Samples were obtained at a median of 91 days (range 21–471) after onset of central nervous system symptoms. Anti-NMDAR antibodies were detected in two samples from a single tick-borne encephalitis patient, corresponding to 1.9% of patients (95% CI: 0.05–10.1%).
ConclusionsThe development of intrathecal anti-NMDAR autoantibodies following tick-borne encephalitis is a rare event, and further studies are needed to clarify their potential relevance to cognitive outcomes in a minority of cases. Testing for anti-NMDAR antibodies in cerebrospinal fluid may be considered in patients who experience clinical deterioration following an initial recovery.
by Mostafa Bondok, Moses Kasadhakawo, John Onyango, Oscar Turya, Khumbo Kalua
PurposeTo determine the prevalence and causes of blindness and vision impairment (VI) among adults aged ≥50 years in Western Uganda.
MethodsA population-based cross-sectional survey was conducted in Western Uganda (July-August 2023) using RAAB7. Adults aged ≥50 years who had resided in the study districts for at least six months in the past year were eligible. Participants were identified through door-to-door household visits using a two-stage cluster sampling approach. Primary outcomes include prevalence of blindness and VI and its causes. Secondary outcomes include cataract surgical coverage (CSC), effective CSC (eCSC), refractive error coverage (REC), and effective REC (eREC).
ResultsA total of 3,125 participants were examined (54.1% female). The adjusted prevalence of blindness (presenting visual acuity (PVA) Conclusion
Blindness and vision impairment remain major public health issues in Western Uganda, primarily due to untreated cataract and uncorrected refractive error. Poor post-operative outcomes highlight the urgent need to improve surgical quality. These findings may guide targeted interventions and policy to strengthen eye care services.
by Yu Zhang, Chen Chen, Tianhang Zhu, Wei Luo, Ranran Zhou, Wanlong Tan
Glucocorticoids play a pivotal role in tumorigenesis and cancer progression. However, the prognostic significance of glucocorticoid signaling-related genes remains poorly understood, particularly in kidney renal clear cell carcinoma (KIRC). Collected samples indicated KIRC patients exhibited elevated serum glucocorticoid levels compared to healthy donors (P P P PEndometriosis is a chronic gynaecological condition affecting 2%–10% of women worldwide, often leading to severe pain, organ dysfunction and infertility. Despite its prevalence, diagnosis is frequently delayed, and treatment options remain limited. Mobile health (mHealth) applications have gained popularity as tools for symptom tracking, yet concerns about their accessibility, evidence-based content and inclusivity persist. Ensuring that these digital tools are culturally relevant, user-friendly and available to diverse populations is crucial for improving patient care and engagement. This study aims to systematically review mobile applications designed for tracking endometriosis symptoms, with a focus on content quality, inclusivity and functionality. The objective is to identify gaps in existing apps and provide recommendations for developing more inclusive digital health solutions.
This study follows a systematic review methodology proposed by Gasteiger et al. The research process consists of seven steps, including defining research questions, identifying relevant applications, determining eligibility criteria, selecting and analysing apps and synthesising results. The apps will be sourced from the Apple App Store and Google Play Store via predefined search strategies. The evaluation criteria include content accuracy, usability, inclusivity, privacy protection and adherence to evidence-based medical guidelines. Data extraction focuses on app characteristics, including language availability, user accessibility, evidence-based symptom tracking and adherence to health equity principles. The Mobile App Rating Scale will be used to assess usability, functionality, aesthetics and information quality. The findings will be systematically compared to identify strengths, limitations and areas for improvement in existing applications.
This systematic review of applications offers an overview of available apps that can be downloaded in Switzerland. Furthermore, it will present a detailed analysis of those that are specifically geared towards symptom tracking and will evaluate the level of evidence-based content, inclusivity, data protection and quality. A key strength of this review is its multidisciplinary approach, which involves engaging experts in healthcare, digital technology, inclusivity and individuals with lived experiences with endometriosis.
Approval from an ethics committee is not required. Data and material will be available on request from the authors.
To evaluate whether liposomal bupivacaine provides superior postoperative analgesia compared with ropivacaine following haemorrhoidectomy, reduces the need for rescue analgesics in patients with mixed haemorrhoids and maintains a comparable safety profile.
Prospective, randomised controlled multicentre trial.
Three grade 3A general hospitals in Guangxi, China, conducted between September 2023 and July 2024.
Eligible patients were aged 18–75 years undergoing elective external dissection and internal ligation for mixed haemorrhoids (grade III and IV mixed haemorrhoids). Key exclusion criteria were severe systemic diseases, history of substance abuse or known allergies to local anaesthetics. A total of 264 patients (male, n=162; mean age, 43.1±12.2 years) were enrolled and completed the study, with 132 randomised to each group.
Patients received either ropivacaine (100 mg in 20 mL) or liposomal bupivacaine (226 mg in 20 mL) through local infiltration at the end of surgery.
The primary outcomes were the resting numerical rating scale (NRS) pain scores (0–10) at postoperative 1, 5, 7, 9, 11, 24, 36, 48 and 72 hours. The secondary outcomes included the following: (1) exercise NRS pain scores at the same time points; (2) time to first ambulation, ambulation NRS pain scores on postoperative days 1, 2 and 3 and the proportion of patients having ambulation NRS pain scores ≥4; (3) defecation NRS pain scores and the proportion of of patients having score ≥4; (4) the time to the first administration of rescue analgesics and proportion of patients requiring rescue analgesics; (5) proportion of pain-free patients (NRS pain scores ≤1) 0–24, 24–72 and 0–72 hour after surgery; (6) incision assessments on postoperative days 1, 3 and 7 and postoperative adverse events (AEs); and (7) patients’ and researchers’ satisfaction with pain management.
Resting NRS pain scores were significantly lower in the liposomal bupivacaine group at all time points (median, 0–2.0 vs 2.0–4.0 for ropivacaine, p
Perianal infiltration of liposomal bupivacaine significantly alleviates postoperative resting and exercise pain in patients undergoing surgery for mixed haemorrhoids, enhances comfort during ambulation and defecation, reduces the need for additional analgesics and demonstrates a safety profile comparable to that of ropivacaine.
chictr.org.cn # ChiCTR2300075276.
Glenohumeral subluxation (GHS) is a common rehabilitation challenge in the hemiplegic upper limb following stroke, potentially leading to shoulder pain, secondary brachial plexus injury and various other complications. While electrical stimulation therapies, such as electromyography biofeedback, electroacupuncture and neuromuscular electrical stimulation, have shown promise in managing GHS, some controversy remains. Although clinical trials and meta-analyses have confirmed the efficacy of these therapies, healthcare professionals have yet to reach a consensus on which specific therapy is most effective for reducing shoulder subluxation (SS), alleviating pain and improving quality of life. This study will perform a network meta-analysis to compare the relative efficacy of different electrical stimulation therapies for treating GHS in patients following acute stroke.
We will systematically search the following databases: PubMed, MEDLINE, Embase, Cochrane Library, Web of Science, Chinese biomedical literature database (SinoMed), Wanfang databases (Wanfang), VIP Journal Integration Platform (VIP) and China National Knowledge Infrastructure (CNKI). Our search will cover the period from the inception of each database until 14 April 2025, and will be restricted to studies published in Chinese or English. The primary outcomes of interest will be the degree of improvement in SS, improvements in quality of life and reductions in pain. We will conduct pairwise meta-analyses using RevMan V.5.3 (The Cochrane Collaboration, Copenhagen, Denmark), and network meta-analyses using ADDIS V.1.16.6 (Drugis, Groningen, The Netherlands) and Stata V.16.0 (StataCorp, College Station, Texas, USA) to compare the relative efficacy of different electrical stimulation therapies. Screening, data extraction, risk of bias assessment and evaluation of the certainty of evidence will all be performed independently by two reviewers to ensure accuracy and reliability. The risk of bias within individual studies will be assessed using the Cochrane Risk of Bias 2 (ROB 2) tool, and the certainty of evidence will be evaluated using the Grading of Recommendations Assessment, and Evaluation (GRADE) and Confidence in Network Meta-Analysis (CINeMA) frameworks to ensure transparency and methodological rigour.
Ethical approval is not required for this study. The findings will be submitted to a peer-reviewed journal or conference.
CRD42024541228.
Hypertrophic scars (HTSs) result from excessive collagen accumulation and impaired wound remodelling, leading to considerable aesthetic and functional concerns. Despite the availability of various treatment strategies, their clinical success remains limited, emphasising the need for alternative approaches. Human amniotic fluid (hAF), naturally enriched with cytokines and growth factors, has emerged as a promising biological material for tissue regeneration. This study investigated the therapeutic potential of two forms of hAF—pooled-frozen and pooled-frozen gamma-irradiated—in a rat model of hypertrophic scarring. Fifteen adult male Sprague–Dawley rats were randomly assigned to receive subcutaneous injections of either saline, pooled-frozen hAF, or pooled-frozen gamma-irradiated hAF at the wound margins on days 1, 3 and 5 following the induction of hypertrophic scars via talc powder application. After 21 days, wound healing was evaluated through histological and immunohistochemical analyses. Both treatment groups demonstrated significantly improved wound healing compared to the control group. Granulation tissue formation was enhanced in the treated groups, particularly in animals receiving gamma-irradiated fluid, which also showed superior collagen remodelling characterised by aligned and mature collagen bundles. Both treatment groups demonstrated an increase in M2 macrophage density, as evidenced by elevated Arg+/CD68+ cell ratios; however, this effect was more pronounced in the gamma-irradiated group, indicating a stronger shift towards a regenerative immune profile. Enhanced reepithelialisation, increased hair follicle density and reduced scar thickness were also observed. These findings suggest that gamma-irradiated hAF provides a more effective and minimally invasive therapeutic option for modulating scar formation and improving wound healing outcomes, supporting its potential translation into clinical applications for the management of hypertrophic scars.
Dietary intervention is fundamental for the management of type 2 diabetes (T2D), playing a crucial role in stabilising blood glucose levels and improving quality of life. As the major contributor to daily energy intake, the quality of carbohydrates can directly influence the glycaemic stability. Therefore, we aim to explore whether adjusting and optimising the composition of dietary carbohydrates, specifically starch, can provide multiple metabolic benefits for patients with T2D.
This multicentre randomised crossover clinical trial will include 150 participants with T2D. Participants will be assigned to either a conventional diet (CD) following the guidelines for T2D or an optimised carbohydrate diet (OCD) focused on increasing resistant starch intake to 40 g/day and decreasing rapidly digestible starch intake for 12 weeks. This will be followed by a 6-week wash-out period, after which participants will crossover to the alternate diet with equal energy and consistent energy proportion of the three macronutrients for another 12 weeks. The primary outcome is the difference in the change of postprandial glycaemia (changes in the average incremental area under the blood glucose curve (iAUC)) induced by OCD and CD interventions. Secondary outcomes include changes in other glucose and lipid metabolism-related parameters and cognitive function, as well as psychological, behavioural and physiological factors. Exploratory outcomes include changes in the iAUCs for each of the three meals, appetite-related hormone levels, degree of hepatic steatosis, serum cytokines, immune functions and multiomics parameters.
The protocol has received approval from the Ethics Committee of Shanghai Sixth People’s Hospital (Approval No. 2025–018; Protocol V.4.1, 20250112) and has been registered with the ClinicalTrials.gov Registry. The findings will be disseminated through peer-reviewed journal publications, conference presentations and media releases.
The suicide risk among discharged psychiatric patients is substantially higher than that among patients with physical diseases and the general population. In China, few cohort studies have investigated suicidal acts in patients discharged from psychiatric facilities, and the factors that convey the risk of post-discharge suicidal acts in this specific population remain unclear. Therefore, we are conducting a prospective multicentre cohort study to investigate the association between suicide attempt history and disease severity in patients with common psychiatric disorders with post-discharge suicidal acts.
This study will recruit 3000 inpatients with one of three common psychiatric disorders, namely schizophrenia, bipolar disorder and major depressive disorder, from three hospitals in North China: Beijing Huilongguan Hospital, Tianjin Anding Hospital and the First Hospital of Shanxi Medical University. Participants will include 1500 inpatients with schizophrenia, 900 inpatients with major depressive disorder and 600 inpatients with bipolar disorder. The baseline assessment includes determining whether each recruited patient meets the diagnostic criteria for schizophrenia, major depressive disorder or bipolar disorder using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth edition (DSM-IV) and obtaining details on prior histories of suicide attempts and the severity of the diagnosed disorders using several questionnaires. A 2-year follow-up will be conducted after the recruited patients have been completely assessed. Follow-ups are scheduled at 3, 6, 12 and 24 months after discharge. The primary outcomes are suicidal acts, including suicide attempts and death, that occurred during the follow-up period. A survival analysis will be performed to test for the supposed associations.
This study was approved by the institutional review boards of Beijing Huilongguan Hospital (2022-67-Science), Tianjin Anding Hospital (2022-47) and First Hospital of Shanxi Medical University (2022-K155). All participants will be required to provide written informed consent before the baseline assessment. The recruitment methods will be explained to potential participants, and their confidentiality will be protected throughout the study. The findings of this study will be disseminated to peer-reviewed scientific journals and conference presentations.
ChiCTR2200064610.
Engaging patients in surgical safety is challenging and has not been thoroughly investigated. Although surgical checklists and other safety protocols have been introduced across various surgical fields, preventable adverse events still occur, highlighting the need for additional research. A Patient’s Safety Checklist (PASC) has been developed and validated for use by surgical patients. Its effect on patient safety and patient outcomes is currently being investigated in a Stepped Wedge Cluster Randomised Controlled Trial (NCT03105713). In connection with this trial, we have examined elective patients’ experiences with using the PASC.
An exploratory qualitative study was conducted based on individual in-depth telephone interviews with 31 elective surgical patients. The interviews were carried out across three Norwegian hospitals including seven surgical specialties. The patients interviewed were part of the trial’s intervention arm and had used PASC. The interviews were transcribed verbatim, and reflective thematic analysis was applied.
Three themes were identified in the data: patient awareness, patient actions and utility value. Patients perceived PASC to increase awareness around surgical information, preparations, what to speak up about and which information to seek and repeat. This awareness led to a series of actions, such as ensuring medication control, optimising their own health, contacting healthcare professionals, asking questions, and for some no actions were needed. Patients perceived PASC to have high utility value for their surgical preparation.
The PASC enhanced patients’ involvement in surgical care and safety by ensuring they received systematic, accurate, clear, and understandable information and instructions throughout the surgical pathway. It is one of the few existing interventions that specifically focuses on assisting patients in preparing for surgery and managing their recovery. Further research is needed on the implementation of PASC and its adaptation to other clinical settings.
Squamous cell carcinoma and multiple actinic keratoses caused by solar ultraviolet radiation (UVR) are among the most frequently recognised occupational diseases in Germany. Employees who regularly work outdoors, for example, in the construction industry, agriculture, forestry and gardening, are at a higher risk of developing occupational skin cancer. However, sun-safety behaviour in outdoor workers is currently insufficient. Therefore, this study aims to investigate the effectiveness of an intervention to increase sunscreen use among outdoor workers.
In this non-randomised, controlled intervention study, 234 outdoor workers from different companies in industries with outdoor working activities based in Germany will be included. The study population, aged 18 years and above, has to be intensively exposed to solar UVR of regularly 1 hour or more per day. The intervention group will receive a sunscreen package as well as health education. The control group follows the practice in their companies (‘treatment-as-usual’). At the beginning of the study, after 3 months and at the end of the study (after 6 months), both groups filled in different questionnaires. In addition, stratum corneum (SC) samples will be collected at the beginning and after 3 months. The primary outcome—increase in the frequency of sunscreen use during work and in leisure time—will be assessed from data on self-reported sunscreen use. The secondary outcomes include sun protection behaviour, knowledge about sun protection and skin cancer, and acceptance of the provided sunscreens. Further secondary outcomes include internal UV dose and UV-related immune response, determined by the levels of SC biomarkers. Data will be analysed using both descriptive and inferential methods.
The study protocol followed the principles of the Declaration of Helsinki (2013) and was approved by the Ethics Committee of Osnabrück University, Germany (reference Ethik-37/2024). Study results will be disseminated through peer-reviewed publications and conference presentations.
DRKS00035178.
To develop and compare algorithms for identifying gestational diabetes mellitus (GDM) across European electronic healthcare databases and evaluate their impact on the estimated prevalence.
Multi-national cohort study using routinely collected electronic healthcare data
National and regional databases in five European countries (Norway, Finland, Italy, Spain and France), in primary and/or secondary care.
Pregnancy cohorts resulting in stillbirths or live births between 2009 and 2020, comprising 602 897 pregnancies in Norway, 507 904 in Finland, 374 009 in Italy, 193 495 in Spain and 116 762 in France.
The primary outcome was the prevalence of GDM identified using six algorithms: (1) Only diagnosis; (2) Diagnosis or prescription; (3) Two diagnoses or prescriptions (2DxRx); (4) Diagnosis including unspecified diabetes in pregnancy or prescription (DxRx broad); (5) Diagnosis excluding pre-existing diabetes in pregnancy or prescription; (6) Registration of GDM in a birth registry (BR).
The strictest algorithm (2DxRx) resulted in the lowest GDM prevalence, while the broadest (DxRx broad) resulted in the highest, except in France where it was BR. In the Nordic countries, GDM prevalence varied only slightly by algorithm; greater variations were observed in other countries. The prevalence ranged from 3.5% (95% CI: 3.5% to 3.5%) to 4.6% (95% CI: 4.5% to 4.7%) in Norway; 12.1% (95% CI: 12.0% to 12.2%) to 15.8% (95% CI: 15.7% to 15.9%) in Finland, where prevalence was much higher than elsewhere. The prevalence ranged from 1.3% (95% CI: 1.3% to 1.3%) to 5.4% (95% CI: 5.3% to 5.5%) in Italy; 1.6% (95% CI: 1.5% to 1.7%) to 6.2% (95% CI: 6.1% to 6.3%) in Spain; and 1.7% (95% CI: 1.6% to 1.8%) to 5.8% (95% CI: 5.7% to 5.9%) in France.
In this multinational study, GDM prevalence ranged from 1.3% to 15.8% depending on the algorithm and database. Nordic countries showed smaller differences in prevalence between algorithms, while the other countries showed larger variations, likely due to differences in coding practices, healthcare systems and database coverage.
Spiritual care has been shown to assist patients in managing anxiety, fear of death and existential concerns commonly encountered during the preoperative period. Nevertheless, surgical clinics often fail to prioritise this dimension of care. Accordingly, it is essential to gain a thorough understanding of how surgical nurses perceive and implement spiritual care. This study aims to describe the views of nurses working in surgical units regarding the provision of spiritual care in the preoperative phase, the challenges they encounter and the factors that influence this process.
A qualitative descriptive study using an inductive thematic analysis approach.
The study was conducted in the general surgery units of a tertiary-level hospital providing healthcare services to a diverse patient population, with the aim of enhancing nurses’ views related to spiritual care.
18 nurses with a minimum of 6 months of experience in surgical units were selected using purposive sampling. Head nurses and those on leave during the data collection period were excluded from participation.
Semi-structured interviews were conducted via video conferencing or telephone between September and October 2023, each lasting between 45 and 60 min. Audio-recorded interviews were transcribed verbatim and analysed using Braun and Clarke’s six-step thematic analysis method. Data collection ceased at the point of thematic saturation.
Three key themes emerged: (1) perceptions of spirituality—nurses viewed spirituality as abstract and subjective, yet recognised religious rituals as visible signs of patients’ emotional and spiritual needs. (2) Spiritual care in nursing—though seen as vital to holistic care, spiritual support was limited by privacy concerns and unclear professional boundaries. (3) Dynamics of spiritual care—delivery was shaped by institutional barriers, nurses’ personal traits and patients’ non-verbal communication of distress.
This study revealed the views of general surgical nurses regarding spiritual care. The findings indicate that while nurses acknowledge the importance of spiritual care, they encounter obstacles in its implementation. Consequently, the results suggest that nurses need to be culturally sensitive and receive institutional support—particularly in collectivist and high-context cultures such as Turkey—in order to better understand and meet spiritual needs. Future studies should explore spiritual care models adapted to different cultural contexts.
This study aimed to examine how older adults form beliefs about their memory and how these beliefs are influenced by their level of concern about dementia. Inaccurate beliefs and excessive worrying, indicative of erroneous metacognition, are associated with negative health outcomes. This research can help identify mitigation for these harmful effects.
Qualitative focus groups; thematic analysis.
Focus group discussion with healthy older adults hosted at a university in central London.
35 healthy older individuals (women=29) without any psychiatric or neurological diagnoses, over the age of 65 years (mean 75.31, SD: 6.15). 13 participants were identified as having a high level of worry about dementia and 22 as having low worry. Groups were matched for cognitive performance on the Telephone Mini Addenbrooke’s cognitive assessment (Tele-MACE).
Participants were assigned to a focus group depending on their level of worry about dementia. During focus groups, a vignette prompted discussion around lifespan changes in memory and how this affected concerns around memory. This allowed investigation of the differences in beliefs about memory.
Thematic analysis revealed two key themes. First, older adults appear to base their definition of ‘normality’ of their own memory on comparisons. These comparisons were between themselves and others and between themselves now and their own past self. Despite similar strategies to define ‘normality’, those with high dementia worry had stricter definitions of what they determined as normal. The second theme described narratives around the ‘self’ and the ‘other’. There was a difference between those with high versus low worry; those with high worry had a strong focus on the ‘self’, while those with low dementia worry focused on ‘others’.
Comparison is a common metacognitive strategy used in forming beliefs about memory. Targeting the use of comparison is potentially valuable in interventions aiming to alleviate older adults’ memory concerns. Addressing self-focused thinking, for example, with cognitive behavioural therapy, could improve harmful levels of high worry.
FreshRSS 