Conectar
by Sosina Workineh Tilahun, Adiam Nega, Lealem Wagaw, Adamu Addissie
BackgroundShared decision-making is crucial for alignment of treatment options with patient values and preferences. However, currently in Ethiopia, shared decision-making in clinical care of cancer, in which cervical cancer is not exceptional, is not well understood.
AimThis study aimed to assess the perceived level of shared decision-making and its predictors in cervical cancer care at Tikur Anbessa Specialized Hospital in Addis Ababa, Ethiopia.
MethodsWe employed a convergent parallel mixed-methods study design from February 18 to May 23, 2025, at Tikur Anbessa Specialized Hospital. The study used interviewer-administered questionnaires for 203 cervical cancer patients and in-depth interviews for 15 cervical cancer patients and 10 clinical oncologists. Using SPSS v26, multiple linear regression analysis was used to determine significant predictors of the perceived level of shared decision-making, with statistical significance set at P Results
The overall mean score for the perceived level of shared decision-making was 24.94 (± 9.12), with a range of 7–44, and the standardized mean score was 2.77 (± 1.01). The perceived level of shared decision-making had positive linear associations with increased trust in oncologists (0.32, 95% CI (0.21, 0.44); p Conclusions
The study emphasized the complex interplay of factors influencing the practice of shared decision-making in clinical care of cervical cancer. Therefore, understanding these dynamics may help to enhance the practice of shared decision-making in clinical cervical cancer care.
by José Manuel García-Moreno, Tyler Adams, Amber Beynon, Janine Vlaar Olthuis, Stephan U. Dombrowski, Richelle Witherspoon, Niels Wedderkopp, Jeffrey J. Hébert
BackgroundRehabilitation and behavior change interventions are commonly used after lumbar surgery to improve recovery, but their effects on physical capacity and physical activity remain unclear. This study aimed to investigate the effectiveness of rehabilitation and behavior change interventions on physical capacity and physical activity behavior in patients following lumbar surgery for degenerative disease.
MethodsEMBASE, MEDLINE, PsycINFO, and CENTRAL were searched from inception to September 2025 and reference lists were hand-searched. Randomized controlled trials assessing rehabilitation or behavior change interventions on physical capacity or physical activity behavior in adults with lumbar degenerative disc disease who underwent lumbar surgery were included. Review author pairs independently extracted data and assessed included studies. Risk of bias was assessed with the Cochrane tool, and study quality with the Grading of Recommendations Assessment, Development and Evaluation classification. Results were pooled using random-effects models and reported as standardized mean differences (SMD) with 95% confidence intervals (CI).
ResultsExercise was more effective than minimal or usual care in improving trunk extension endurance in the immediate term (SMD, 1.54; 95% CI, 0.93–2.16). Supervised exercise outperformed self-directed exercise in improving trunk extension endurance in the immediate term (SMD, 1.28; 95% CI, 0.75–1.81). Psychologically informed rehabilitation was more effective than minimal or usual care in increasing physical activity levels in the intermediate term (SMD, 0.26; 95% CI, 0.02–0.49), but not in the immediate term (SMD, 0.17; 95% CI, −0.14 to 0.49). Physical activity advice did not increase physical activity levels compared to minimal or usual care in the immediate term (SMD, 0.21; 95% CI, −0.13 to 0.55). Prehabilitation was more effective than minimal or usual care in increasing physical activity levels in the intermediate term (SMD, 0.28; 95% CI, 0.03–0.53). Certainty of evidence ranged from low to moderate.
ConclusionsFor adults with lumbar degenerative disease who underwent lumbar surgery, exercise, especially supervised programs, improved trunk extension endurance in the immediate term. Psychologically informed rehabilitation and prehabilitation increased physical activity levels in the intermediate term, while physical activity advice showed no benefit. Findings are limited by low certainty of evidence and high risk of bias.
by Gift Treighcy Banda-Mtaula, Ibrahim Simiyu, Sangwani Nkhana Salimu, Stephen A. Spencer, Nateiya M. Yongolo, Marlen Chawani, Hendry Sawe, Jamie Rylance, Ben Morton, Adamson S. Muula, Eve Worall, Felix Limbani, Miriam Taegtmeyer, Rhona Mijumbi, on behalf of the Multilink consortium
Multimorbidity, the presence of multiple chronic health conditions, is a leading cause of death globally. In Malawi, chronic noncommunicable and communicable diseases such as HIV frequently co-exist, putting pressure on an under-resourced system. However, the health system is primarily structured around disease-specific [vertical] programs, which hinders person-centred care approaches to multimorbidity. Our study focuses on multimorbidity care and explores the perceptions of healthcare workers on the patient pathways and service organisation throughout the patient’s interaction with the health facilities. This cross-sectional qualitative study took an interpretivist approach. We conducted 13 days of clinical observations at Queen Elizabeth Central Hospital and Chiradzulu District Hospital. We also conducted 13 days of clinical observations and semi-structured in-depth interviews with different cadres of purposively sampled healthcare workers (n = 22) at Queen Elizabeth Central Hospital and Chiradzulu District Hospital. Through thematic analysis, we identified an understanding of the organisation of care and healthcare workers’ perspectives on the delivery of services. Findings showed both hospitals provided services for inpatients and outpatients with multimorbidity, including screening, management, prevention of secondary conditions and rehabilitation. Patient diagnosis and management for multimorbidity were often delayed due to frequent stockouts of medication and consumables necessary for diagnostic testing for NCDs at the hospital level. Some healthcare workers were not equipped with the knowledge, skills, or guidelines to manage multimorbidity. As HIV care is currently better resourced than other chronic conditions, healthcare facilities may strengthen the supply chain, healthcare workers’ training sessions and monitoring and evaluation tools to ensure NCDs are well managed, learning from HIV programmes.by Sian E. Wanstall, Brandon W. J. Brown, Meagan E. Crowther, Claire Dunbar, Robert J. Adams, Anjum Naweed, Amy C. Reynolds
BackgroundParamedics face unique occupational hazards, including high operational demands, trauma exposure, and shift work, all of which impact mental well-being. Suboptimal sleep is also common in this workforce and closely linked to adverse mental health outcomes. This scoping review synthesizes evidence to date on interventions to support paramedic mental well-being including sleep-based interventions.
Materials and methodsThis review was pre-registered on the Open Science Framework (https://doi.org/10.17605/OSF.IO/7VSD9). Systematic database searches were conducted in October 2024 for original research published after 2004. Data were narratively synthesised, and findings reported following established guidelines.
ResultsNineteen sources were included, involving 1,067 participants across seven countries. Seventeen interventions were examined, predominantly via randomized controlled trials (58%), utilizing a total of 43 different measurement scales to evaluate mental health and sleep outcomes. Interventions included psychological (37%), sleep, fatigue and/or shift work (32%), and complementary and alternative medicine (32%) approaches which primarily focussed on the individual-level (94%). Studies were limited by sample sizes, design and quality, limited long term follow-up, and low baseline symptoms.
ConclusionsThis review highlights a critical gap in robust, evidence-based, system-level interventions to address poor sleep and mental well-being in paramedics. Future research should prioritise co-designed, context-sensitive approaches, ideally integrated within organisational structures to ensure relevance and accessibility.
by Adam V. Wisnewski, Jian Liu
A panel of hybridomas specific for different isomers of toluene diisocyanate (TDI), a cross‑linking chemical used in polyurethane production, has been previously described. These hybridomas were originally developed by researchers at the USA’s National Institute for Occupational Safety and Health (NIOSH). We sought to determine the DNA sequence encoding these TDI-specific monoclonal antibodies, enabling identification of germline gene rearrangement resulting in chemical specificity as well as production of the mAbs recombinantly. B cell receptor sequencing (BCR-seq) of hybridoma RNA readily identified productive heavy and light chain antibody sequences. The productive light chains of all 7 hybridomas showed strong identity with different genomic variable (V) and joining (J) region sequences with few changes from germline configuration. However, the productive heavy chains contained more substantial changes in their genomic V and J-region sequences consistent with antigen-driven affinity maturation, as well as N- and P- nucleotide additions comprising their complementarity-determining region 3 (CDR3). The hybridoma-defined TDI-specific mAbs were subsequently produced recombinantly in a human embryonic kidney cell line expression system, purified, and tested for their binding capacity against albumin derivatized with TDI, related diisocyanates, and control antigen. The recombinant versions of the TDI-specific mAbs demonstrated binding capacity for different isomers (2,4 and 2,6) of TDI consistent with that previously reported for the hybridoma secreted clones; one specific for 2,4-TDI, one specific for 2,6-TDI, three that bind both 2,4- and 2,6-TDI, and two that show cross-reactivity with 4,4′‑methylene diphenyl diisocyanate (MDI). None of the recombinant mAbs bound to aliphatic hexamethylene diisocyanate (HDI), its oligomer, or control antigen. Additional recombinant versions of the TDI mAbs, with identical V-regions, but different C-regions, demonstrated the dependence of antigen specificity on the V-region, but also highlighted the potential for C-region sequence to affect their detection in ELISA assays. The DNA sequences defined herein may be useful to other investigators wishing to generate recombinant TDI-specific mAbs as detection reagents for research or as standards for clinical serology tests.by Vikram Arora, Alex Thabane, Jude Hynes, Adam Sutoski, Mohit Bhandari
IntroductionStroke is a leading cause of long-term disability and mortality worldwide. Survivors can experience a range of physical and emotional challenges, often leading to depression, anxiety, and a poorer quality of life. Creative arts therapies (CATs), an umbrella term encompassing music, art, dance/movement, drama, and creative writing therapies, have increasingly been explored in stroke survivor populations as interventions to improve psychological outcomes. Qualitative analysis suggests these therapies can be helpful, but the exact efficacy of CATs in stroke rehabilitation, as well as the optimal intervention types and treatment protocols, has yet to be established. This systematic review and meta-analysis plans to evaluate the effect of CATs on depression, anxiety, and quality of life among adults recovering from stroke.
MethodsThis protocol has been prospectively registered with PROSPERO (CRD420251237926). Eligible studies will include primary quantitative research involving creative arts interventions. Searches will be conducted in Medline, Embase, and PsycInfo from inception to December 2025. Two reviewers will independently screen records, extract data, and assess study quality and the certainty of the evidence using the RoB 2, ROBINS-I, and GRADE tools. Restricted maximum likelihood random-effects meta-analyses of Cohen’s d effect sizes and risk ratios will be performed to calculate pooled effect sizes for each outcome. Subgroup analyses will explore moderators such as the effect of study design, intervention type, session frequency, and patient setting.
Dissemination of resultsResults will be disseminated through a peer-reviewed publication, conference presentations, and clinical networks to inform evidence-based guidelines on the use of CATs in multidisciplinary stroke care.
by Veronica Vabishchevich, Ryan T. Smith, Adam J. Bittel
BackgroundAerobic exercise promotes mitochondrial morphological, enzymatic, and bioenergetic adaptions to improve muscle health and function. Although moderate intensity continuous training (MICT) is frequently recommended for sedentary and multiple clinical populations, there is little consensus regarding the effects of chronic MICT on these adaptations. The aim of this systematic review and meta-analysis is to evaluate the evidence for the effects of MICT on molecular transducers of mitochondrial biogenesis and cardiorespiratory fitness in adults.
MethodsA comprehensive search was conducted in PubMed and CINAHL. Eligible studies assessed MICT lasting ≥2 weeks in adults, published since 2010, and collected vastus lateralis skeletal muscle biopsies pre and post chronic endurance exercise exposure. Data were extracted for mitochondrial transcription factor A (TFAM), citrate synthase (CS), peroxisome proliferator-activated receptor-gamma coactivator 1-alpha (PGC-1α), mitofusin 2 (MFN2), dynamin-related protein 1 (DRP1), VO₂max, and mitochondrial density (MitoVD). Meta-analyses using inverse-variance random effects models were conducted for outcomes reported in at least three studies.
ResultsA total of fourteen studies (n = 184) met inclusion criteria, with an overall low to moderate risk of bias and very low to low certainty of evidence. MICT significantly increased MitoVD (p p p = 0.05) and MFN2 showed a modest increase (p = 0.01) following MICT. No changes were observed for TFAM, DRP1, or PGC-1α.
ConclusionMICT significantly improves MFN2 expression, CS activity, MitoVD, and VO2 max in adults. However, the overall quality of evidence is low. Heterogeneity in molecular responses suggests potential moderating effects of training duration, modality (e.g., cycling vs. treadmill), and sex – warranting further research.
RegistrationPROSPERO ID:CRD42024611640.
by Cyndirela Chadambuka, Prossy Kiddu Namyalo, Rhea Raghunauth, Navya Arora, Fiona Kouyoumdjian, Beverley M. Essue
The risk of gender-based violence (GBV) against migrant women is largely exacerbated by precarious employment opportunities available to them as they go through the resettlement process. Despite the risk that the connection of precarious employment and GBV pose to migrant women’s health and wellbeing, critical gaps exist in literature. Our scoping review sought to identify and synthesize evidence on the interconnectedness of GBV and precarious employment among migrant women. Six electronic databases were searched for empirical literature and two reviewers independently conducted title/abstract and full text screening of studies that met the inclusion criteria. Data synthesis was guided by the intersectionality theory and the Feminist Political Economy framework. 50 articles met the criteria for inclusion in this review. Our findings reveal that precarious employment plays both a catalytic and consequential role in GBV. Findings highlighted how post-migration shifts in gender roles, schedule unpredictability leading to work-life imbalance, and debt bondage trap migrant women in cycles of exploitation and abuse. Few studies highlighted how human trafficking is intertwined with precarious labor markets, where the exploitation and abuse of migrant women mirror the characteristics of human trafficking. This review underscores the urgent need for integrated policy responses that are not only focused on individual supports but also address the structural drivers or labor precarity and protect migrant women from GBV and human trafficking. By applying an intersectional lens, policies and intervention programs can tackle systemic oppression across economic, and social systems essential in reducing exploitation and abuse to advance migrant women’s wellbeing.by Oumarou I. Wone Adama, Iman Frédéric Youa, Alexandra Bitty-Anderson, Arnold Junior Sadio, Rogatien Comlan Atoun, Yao Rodion Konu, Hezouwe Tchade, Martin Kouame Tchankoni, Kokou Herbert Gounon, Kparakate Bouboune Kota-Mamah, Abissouwessim Egbare Tchade, Godonou Amivi Mawussi, Fiali Ayawa Lack, Fifonsi Adjidossi Gbeasor-Komlavi, Anoumou Claver Dagnra, Didier Koumavi Ekouevi
IntroductionIn Togo, the syndromic approach is used for the diagnosis and management of sexually transmitted infections (STIs). The aim of this study was to evaluate the syndromic approach for diagnosis of STIs among female sex workers (FSW) in Lomé, Togo.
MethodsA cross-sectional study was carried out from September to October 2023 among FSW in Lomé (Togo). FSW aged 18 years and above were included. A gynecological examination was performed for syndromic diagnosis, and the Xpert® CT/NG were used to screen vaginal swabs for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG). The performance (predictive values) of the syndromic approach to STI diagnosis was evaluated using the Xpert® CT/NG test as the gold standard.
ResultsA total of 357 FSW were recruited. The median age of FSW was 32 years (IQR: [26–40 years]) and 8.2% had attained a higher level of education. The prevalence of syndromic STI among FSW was 33.3%. Vaginal swabs were positive for CT (8.4%) and NG (8.7%), with a prevalence of bacterial STIs (CT and/or NG) of 14.3%. The syndromic approach to STI diagnosis demonstrated a positive predictive value of 24.3%.
ConclusionThe prevalence of STIs is relatively high among FSW in Lomé. According to this study, the diagnosis of STIs using the syndromic approach has limited relevance. National STI screening and management policies urgently need to be rethought, incorporating recent technological advances.
by Tyler Marshall, Karin Olson, Adam Abba-Aji, Xin-Min Li, Richard Lewanczuk, Sunita Vohra
BackgroundShared decision-making (SDM) is a process in which healthcare providers (HCPs) and patients make health-related decisions collaboratively, guided by the best available evidence. Previous research suggests that emerging adults (aged 18–29) with mental health concerns might prefer SDM over traditional approaches; however, it remains unclear whether prevalent symptoms of anxiety, depression, or health-related quality of life (HRQL) are associated with the level of SDM that occurs during a clinical encounter.
ObjectiveThis study explored whether prevalent symptoms of anxiety, depression or HRQL among emerging adults were associated with the perceived level of SDM involvement during a single clinic visit at a primary care or community addiction and mental health (AMH) setting.
MethodsA cross-sectional survey was conducted using a subset of data (emerging adults and their HCPs) obtained from an overarching study on SDM in adults (18–64 years) in Alberta, Canada. Sociodemographic data were collected and reported descriptively. SDM was the primary outcome variable and was measured dyadically (i.e., the mean score between HCPs and patients) using the Alberta Shared Decision-Making Instrument (ASK-MI). Symptoms of patient anxiety/depression and HRQL were measured using the Hospital Anxiety and Depression Scale (HADS) and the EQ-5D-5L. Pearson R correlation matrices were conducted to explore relationships between SDM, anxiety/depression, HRQL, and demographic variables.
ResultsForty-two emerging adult patients and 31 HCP dyads were recruited from six community AMH settings and eight primary care settings. The mean SDM dyad rating was 8.69 (SD, ± 2.01), indicating an “excellent” level of SDM. Symptoms of anxiety, depression, and HRQL were not significantly correlated with SDM dyad ratings during the clinic visit. Post hoc analyses showed that patient age was inversely related to SDM dyad ratings; R = −0.34, p = 0.03.
DiscussionIn this study, emerging adults reported high levels of perceived engagement in SDM, regardless of their HRQL or symptoms of anxiety and depression. However, several limitations, such as the risk of performance bias, should be considered when interpreting these findings. To strengthen the evidence base, future research should aim to address these limitations.
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