To summarise the evidence on long-term and infrequent harms following selected spinal and paraspinal injections and denervation procedures for chronic non-cancer spine pain.

Systematic review and meta-analysis.

MEDLINE, EMBASE and Cumulative Index to Nursing and Allied Health Literature from inception to October 2023.

Non-randomised studies reporting on harms of selected interventional procedures administered to adults living with chronic axial or radicular non-cancer spine pain with ≥4 weeks of follow-up.

A parallel guideline panel provided input on the scope, design and interpretation of this systematic review, including selection of adverse events for consideration. Systematic literature screening, data abstraction and risk of bias appraisal were conducted independently and in duplicate by pairs of reviewers. We used random-effects models for all meta-analyses and the Grading of Recommendations Assessment, Development and Evaluation approach to evaluate the certainty of evidence.

We included 60 longitudinal studies (56 non-comparative, 4 comparative) that enrolled 4966 patients with chronic non-cancer spine-related pain. 31 studies investigated radiofrequency ablation or denervation, 22 epidural injections and 11 joint injections or nerve blocks. Low certainty evidence suggests that joint targeted steroid injection and epidural steroid injection for chronic spine pain may result in temporary altered level of consciousness (incidence: 2.1%; 95% CI 1.1% to 4.0%), joint radiofrequency nerve ablation, joint targeted steroid injection and epidural injection of local anaesthetic and steroids may result in deep infection (incidence: 0.7%; 95% CI 0.3% to 2.0%), epidural steroid injection, joint radiofrequency nerve ablation and joint targeted injection of local anaesthetic and steroids may result in dural puncture (incidence: 1.4%; 95% CI 0.5% to 4.3%), and dorsal root ganglion radiofrequency and joint radiofrequency nerve ablation with or without joint-targeted injection of steroids may result in prolonged pain or stiffness (incidence: 8.6%; 95% CI 6.3% to 11.6%). Several interventional procedures may result in metabolic complications and prolonged sensory deficits, but the supporting evidence was only very low certainty. Most complications resolved spontaneously or with conservative management.

Low certainty evidence suggests that several common interventional procedures for chronic spine pain show risk of deep infection, dural puncture, temporary altered level of consciousness and prolonged pain or stiffness. Other harms are uncertain due to very low certainty evidence, and catastrophic outcomes were not reported in the small studies that contributed to our analyses.

To identify early cardiovascular changes in normotensive obstetricians, a high-stress group, using non-invasive haemodynamic monitoring, and to examine the association between burnout and haemodynamic parameters.

Cross-sectional study.

A single tertiary hospital in China.

A total of 120 healthy Han Chinese adults (aged 25–45 years, both sexes) were enrolled using stratified random sampling by age and categorised into three groups: obstetricians, clinical support staff and administrative personnel. Of these, 105 (87.5%) completed the study and entered the final analysis (obstetricians n=40; clinical support staff n=33; administrative personnel n=32); 15 were excluded due to incomplete questionnaire data. Key exclusion criteria were chronic medical conditions, medication use, acute illness, a clinical shift within 24 hours before measurement, pregnancy or lactation, body mass index extremes (≤18.5 or ≥ 28 kg/m²) and major life events within the past 6 months. Burnout was assessed using the Maslach Burnout Inventory-Human Services Survey; workload, lifestyle and family history were collected via questionnaire.

Advanced haemodynamics were assessed via Ultrasonic Cardiac Output Monitor. The primary outcome was cardiac power output (CPO). Secondary outcomes included other non-invasive haemodynamic parameters, such as cardiac index (CI), systemic vascular resistance index, Smith–Madigan inotropy index and corrected flow time.

Severe burnout was associated with reduced CPO and CI (–0.152 W and –0.403 L/min/m², respectively; both p2, respectively; both p

In high-stress populations, advanced haemodynamic patterns may serve as an early-warning biomarker for burnout, guiding personalised exercise advice. Longitudinal studies are needed to confirm their predictive value.

To systematically review qualitative studies on the self-management experiences and needs of patients with chronic obstructive pulmonary disease (COPD) and to provide evidence for developing needs-based self-management intervention strategies.

A systematic review and meta-aggregation of qualitative studies conducted in accordance with the Enhancing Transparency in Reporting the Synthesis of Qualitative Research statement.

PubMed, Cochrane Library, Web of Science, Scopus, CINAHL, Embase, CNKI, Wanfang Database, VIP Database and CBM were searched from database inception to March 2025 for qualitative studies on COPD self-management experiences and needs.

Qualitative studies involving adults (≥18 years) with a confirmed diagnosis of COPD that reported patients’ real feelings, experiences and needs during the self-management process in any setting (hospital, community or home). Studies were excluded if the full text could not be obtained or data were incomplete, if they were duplicate publications or if they were not published in Chinese or English.

Two reviewers independently screened titles, abstracts and full texts, extracted data using a standardised form and assessed methodological quality using the 2016 Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Qualitative Research. Findings (participants’ quotations and authors’ interpretive statements) were synthesised using a JBI meta-aggregation approach to develop categories and overarching synthesised findings.

15 qualitative studies were included, comprising 251 patients with COPD. A total of 52 findings were identified, grouped into 13 categories and synthesised into 4 overarching findings: (1) physical symptom burden strongly shapes psychological well-being during COPD self-management; (2) patients face multiple and interrelated barriers to effective self-management; (3) some patients develop active coping strategies and self-management resources; and (4) patients express multidimensional and continuing support needs.

Patients with COPD experience substantial physical and psychological distress and face multiple challenges in the self-management process. Healthcare professionals should prioritise patients’ lived experiences, establish comprehensive and coordinated support systems and develop diversified, needs-based intervention strategies to address patients’ multidimensional needs, thereby enhancing self-management capacity and improving quality of life.

CRD42024607051.

Hearing loss (HL) imposes a substantial burden on families and society and is the largest modifiable risk factor for dementia. As a practical and non-invasive approach to managing HL, hearing aid use has been associated with a reduced risk of incident dementia and global cognitive decline. However, high-level evidence on the cognitive benefits of hearing aids among those at high dementia risk is scarce and adherence to hearing aid use remains challenging. Our study aims to explore whether a family-supported hearing aid use behaviour intervention, guided by the integrated framework of self-determination theory, technology acceptance model and family social support theory, can improve cognitive function in Chinese older adults with both HL and mild cognitive impairment (MCI).

This study is a two-arm, single-blinded, randomised controlled trial. A total of 150 participants with HL and MCI will be randomly assigned in a 1:1 ratio to either an intervention group (hearing aid use and family intervention) or a control group (hearing aid use and regular health education). All interventions will last for 4 months. Hearing aid use will be delivered by professional audiologists, while family caregivers will deliver the behavioural intervention at home after receiving standardised training from researchers and guidance through structured manuals. Furthermore, family caregivers will be guided through a WeChat group to address unresolved issues related to hearing aid maintenance and intervention skills. The primary outcome is cognitive function measured by the Montreal Cognitive Assessment–Hearing Impairment at baseline and follow-up. Secondary outcomes include adherence score to hearing aid use measured by daily duration and weekly frequency, hearing aid use skills, motivation, activities of daily life, quality of life, depressive symptoms, subjective cognitive decline, social support, self-efficacy, healthcare utilisation, autonomy support and caregiver burden.

The study was approved by the Institutional Review Board of Peking University. Research findings will be published in peer-reviewed journals and at national and international conferences.

ChiCTR2400091791.

Accessing samples from mediastinal and hilar lymph nodes is considerably more difficult, rendering the diagnosis of tuberculous mediastinal and hilar lymphadenopathy particularly challenging. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive interventional technique used for sampling mediastinal and hilar lymph nodes. Nanopore sequencing technology (NST) permits the rapid identification of Mycobacterium tuberculosis genes directly from clinical samples. NST has significantly improved the diagnostic accuracy for both pulmonary and extrapulmonary tuberculosis; its accuracy in diagnosing tuberculous mediastinal and hilar lymphadenopathy using EBUS-TBNA specimens has not yet been systematically evaluated.

Adhering to Preferred Reporting Items for a Systematic Review and Meta-Analysis Protocols (PRISMA-P) and PRISMA-Diagnostic Test Accuracy Studies (DTA) guidelines, this protocol (PROSPERO: CRD420251274529) will synthesise evidence from five international databases (PubMed, Embase, SCOPUS, Web of Science and Cochrane Library) and two Chinese databases (China National Knowledge Infrastructure and Wanfang Database). The literature search is planned to be conducted between 1 December 2026 and 31 December 2026 (start and end dates of the search). The publication dates of the included literature ranged from the inception of the relevant databases to 31 December 2026. Data extraction from the included studies is anticipated to be completed by 31 May 2027, and the final reporting of findings is expected by 31 December 2027. Study selection followed the PICT framework: participants (P): patients with suspected tuberculous mediastinal and hilar lymphadenopathy; index test (I): the index test was defined as NST; comparator (C): the reference standard for tuberculous lymphadenopathy; target condition (T): the target condition was confirmed tuberculous mediastinal and hilar lymphadenopathy. Two independent investigators will perform a three-step screening process, extract data and assess methodological quality using Quality Assessment of Diagnostic Accuracy Studies. Bivariate random-effects models implemented in STATA V.15.0 will be used to pool sensitivity, specificity and hierarchical summary receiver operating characteristic curves when four or more studies are available; for fewer studies, Meta-DiSc V.1.4 will be employed. If substantial heterogeneity is detected (I² statistic >50%), meta-regression and subgroup analysis will be performed across prespecified covariates.

This study is based on publicly available data and therefore does not require ethics committee approval. Upon completion, the findings will be submitted for publication in a peer-reviewed medical journal. The review is conducted in accordance with established guidelines for systematic review and meta-analysis.

CRD420251274529.

To investigate how patients with sarcoma present prior to diagnosis—through a general practitioner (GP) or another healthcare professional (HCP)—and describe presenting symptoms.

International observational cohort study.

Data were obtained from the longitudinal ‘QUality of life and Experiences of Sarcoma Trajectories’ (QUEST) cohort study, conducted across the Netherlands, the United Kingdom (UK), Australia and New Zealand.

Among 572 patients, 487 (85.1%) started their diagnostic trajectory at the GP (subcohort 1) and 85 (14.9%) with another HCP (subcohort 2)—mainly medical specialists treating unrelated conditions (36/85; 42.4%). Soft tissue sarcoma patients most often reported swelling, whereas bone sarcoma patients reported unexplained pain. Notably, 31/85 (36.5%) of subcohort 2 were asymptomatic. Reasons for delaying GP visits included assuming symptoms were minor and expecting them to resolve. Patients sought care when, among others, symptoms persisted and worsened.

Most patients first consulted a GP, underlining the role of primary care in sarcoma diagnosis internationally. Due to rarity and nonspecific symptoms, faster diagnosis remains challenging, requiring improvements in both primary and specialist care.

NCT03441906; Results.

To investigate the risk factors for primary non-central malposition of peripherally inserted central catheter (PICC) tip in neonates admitted to the neonatal surgical department, compare the malposition rates across different insertion sites in disease types, and explore whether different diseases affect PICC tip malposition.

A retrospective case–control study conducted in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement.

A 3A women’s and children’s hospital in South China (Guangdong Province).

A total of 558 neonates aged ≤28 days who underwent PICC insertion between January 2019 and November 2024 were enrolled. Neonates with congenital circulatory system malformations, incomplete clinical data and death or treatment withdrawal before tip positioning were excluded.

The primary outcome was the incidence of primary non-central PICC tip malposition confirmed by X-ray or ultrasound within 24 h after insertion. Secondary outcomes included comparison of primary non-central PICC tip malposition rates across different insertion sites and comparison of primary PICC tip malposition rates by insertion sites across different disease groups.

558 neonates were included in this study, including 460 cases with PICC tip in place and 98 with PICC tip malposition. In binary logistic regression analysis, the PICC insertion site was considered an independent risk factor (OR 2.908, 95% CI 1.748, 4.840, p

Medical staff can choose appropriate upper or lower limb veins for PICC insertion without worrying about the impact of abdominal diseases or thoracic diseases on non-central PICC tip malposition. PICC insertion via the head and neck veins should be performed with caution in neonates, as these sites carry a high risk of primary non-central tip malposition compared with other insertion sites.

Cardiac resynchronisation therapy (CRT) is a cornerstone device-based treatment for patients with heart failure with ventricular dyssynchrony. However, approximately 30–40% of recipients fail to achieve clinical response. Despite extensive research, validated prediction tools grounded in high-level evidence and readily applicable in clinical practice remain lacking. This study protocol describes the development and real-world validation of a simplified clinical scoring model for CRT response derived from systematic review and meta-analysis.

This study will develop a CRT response prediction model via meta-analysis and preliminarily validates it in a single-centre retrospective cohort. Initially, systematic searches of multiple databases up to 31 January 2026 and meta-analysis will synthesise effect estimates for candidate predictors, creating an evidence-based foundation that conceptually functions as a ‘training dataset’. Predictor selection and prioritisation will be guided by study frequency, effect magnitude and clinical accessibility, with factor weights derived directly from pooled random-effects meta-analytic estimates. Log relative risks will be converted to integer scores to establish a series of nested prediction models. Model performance will then be comprehensively assessed in an independent ‘validation dataset’ comprising a single-centre cohort from Xinjiang Medical University, evaluating discrimination (area under the receiver operating characteristic curve), calibration (calibration plots and Hosmer-Lemeshow test) and clinical utility (decision curve analysis). The final scoring system will be identified through comparative model evaluation guided by parsimony principles.

This meta-analysis exclusively uses published, de-identified data and therefore does not require ethical approval. The validation cohort employs retrospectively anonymised patient data in strict adherence to the ethical principles of the Declaration of Helsinki. The study protocol has been approved by the Institutional Review Board of the First Affiliated Hospital of Xinjiang Medical University (Approval No.: K202403-48-2503A-Y1). As this constitutes a retrospective analysis of existing data, individual informed consent will be waived. Comprehensive measures to protect participant privacy and ensure data integrity will be implemented throughout all research procedures. The findings will be presented at academic gatherings or published in scholarly, peer-reviewed journals.

CRD42024572313

This study aims to explore the history of prior abortions and the factors influencing them among young women seeking abortion services in Foshan, Guangdong, China.

This is a retrospective, cross-sectional study of young women seeking abortion care.

Gynaecological outpatient clinics at the Department of Gynaecology, Foshan Women and Children Hospital Affiliated to Guangdong Medical University, Foshan, Guangdong, China, between 2013 and 2023.

A total of 7361 young women aged 12–25 years seeking abortion services.

Data on abortion history, sociodemographic factors, contraceptive use and postabortion contraceptive choices were collected and analysed, with special emphasis on the incidence of repeat abortions and the factors associated with them.

Of the 7361 participants, 34.2% reported at least one previous abortion, underscoring a notable public health concern. The mean age of the participants was 22.30 years (SD=2.13). Women with a history of abortion were significantly older than those without (22.57 vs 22.08 years, p

This study underscores the need for targeted interventions to address the multifaceted factors leading to repeat abortions among young women in China. The results offer valuable insights for improving reproductive health outcomes in this vulnerable population and highlight the importance of expanding access to contraceptive education and services in China.

The prolonged survival of lung cancer patients is accompanied by an increasing incidence of leptomeningeal metastases (LM). Patients with LM have a poor prognosis, significantly impacting their quality of life and overall survival. Recent studies have shown that while intrathecal pemetrexed (IP) can improve symptoms and confer a survival benefit in non-small cell lung cancer (NSCLC) patients with LM, drug resistance remains a significant challenge. As for systemic therapy, intravenous bevacizumab combined with chemotherapy has demonstrated clinical benefits in NSCLC patients. However, clinical data on intrathecal bevacizumab remain scarce. Therefore, this study aims to preliminarily explore the efficacy and safety of intrathecal pemetrexed and bevacizumab in the treatment of NSCLC patients with LM.

This is a single-centre, single-arm, prospective, investigator-initiated phase Ia clinical trial sponsored by Shanghai Chest Hospital, involving patients with advanced NSCLC and LM. Participants will be enrolled and allocated into two predefined cohorts. Cohort A: six participants will receive IP monotherapy for safety exploration. Cohort B: participants will receive intrathecal pemetrexed and bevacizumab. Pemetrexed will be administered at a fixed dose, while the dosage exploration for bevacizumab will employ a combination of a 3+3 design and an accelerated titration design (ATD). The primary endpoint is the safety and the secondary endpoint is the overall survival (OS).

This study protocol (Version 1.1, dated 8 October 2024) was approved by the Ethics Commission of Shanghai Chest Hospital (IS24103) on 23 October 2024. Trial results will be published in a peer-reviewed journal.

NCT06663306, ClinicalTrials.gov.

To evaluate the effect of lobeglitazone on renal disease progression in patients with type 2 diabetes mellitus using longitudinal real-world data.

Retrospective cohort study.

Hospital-based Common Data Model database.

A total of 14 712 adults with type 2 diabetes mellitus who visited the Diabetes Center of Ewha Womans University Mokdong Hospital between 2013 and 2019 were identified. A 1:2 propensity score matching was performed to compare patients treated with lobeglitazone plus metformin with those receiving metformin monotherapy, sulfonylurea plus metformin, or a dipeptidyl peptidase-4 (DPP4) inhibitor plus metformin.

Treatment with lobeglitazone plus metformin compared with metformin monotherapy, sulfonylurea plus metformin or DPP4 inhibitor plus metformin.

Renal progression, defined as initiation of renal replacement therapy, a sustained ≥30% decline in estimated glomerular filtration rate (eGFR) from baseline, or doubling of serum creatinine with a concurrent eGFR ≤45 mL/min/1.73 m².

The HR of renal progression was 0.84 (95% CI 0.58 to 1.21) in the lobeglitazone plus metformin compared with metformin monotherapy, 1.00 (95% CI 0.79 to 1.27) compared with sulfonylurea plus metformin group, 1.10 (95% CI 0.84 to 1.44) compared with DPP4 inhibitor plus metformin group after adjusting for multiple variables. Subgroup analyses demonstrated significant interactions by sex in the comparison with metformin monotherapy (P for interaction=0.0179) and by glycaemic control in the comparisons with sulfonylurea plus metformin (P for interaction=0.0161) and DPP4 inhibitor plus metformin (P for interaction=0.0006), suggesting potential heterogeneity in treatment effects.

Lobeglitazone showed renal outcomes comparable to those of other antidiabetic medications, with a possible heterogeneity in treatment effects according to sex and glycaemic control.

To assess the levels of knowledge, attitudes and practices (KAP) toward skin cancer prevention among Malaysian adults and to examine differences in KAP across socio-demographic groups.

Cross-sectional online survey.

Community-based study conducted in Malaysia using social media recruitment.

A total of 386 adults aged ≥18 years residing in Malaysia. Most participants were young adults (86.3%), female (55.4%) and of Chinese ethnicity (65.5%). Healthcare professionals were excluded.

Primary outcomes were levels of knowledge, attitude and preventive practices toward skin cancer, measured using the validated KAP-SC-Q (Knowledge, Attitude and Practice of Skin Cancer Questionnaire) and categorised as poor, moderate or good. Secondary outcomes included differences in KAP across socio-demographic and clinical characteristics, analysed using independent t-tests and ² tests.

Over half of participants demonstrated poor knowledge of skin cancer (56.0%) and the vast majority showed inadequate preventive practices (84.2%), while attitudes toward skin cancer were predominantly positive (62.4%). Significant differences in mean KAP scores and categorical levels were observed across several socio-demographic variables. Participants with tertiary education had higher knowledge (14.32 vs 12.61) and attitude scores (20.01 vs 15.95; p

Malaysian adults exhibited limited knowledge and very poor preventive practices toward skin cancer despite generally positive attitudes. These findings highlight substantial gaps between awareness and behaviour and support the need for targeted public health interventions to correct misconceptions, improve risk perception especially in high-risk groups and promote effective ultraviolet protection behaviours.

International guidelines on breast cancer (BC) screening have differing recommendations leading to uncertainty on best practices for primary care providers. The purpose of this study was to create a Canadian best practices document on BC health and screening for primary healthcare providers through multidisciplinary consensus using Nominal Group Technique and Delphi method.

A 9-member multidisciplinary expert group and a patient advocate participated in the consensus methods and voting. Experts included those involved in BC management and two primary care physicians. Twenty-nine experts across BC disciplines participated in external review.

Two study objectives included (1) building consensus on key ‘best practice’ behaviours related to BC-related health and screening and (2) building consensus on specific definitions related to BC screening.

The final consensus document consists of 65 statements grouped in five categories with companion resources to support uptake of all best practices. Categories include identification and work-up for diagnostic imaging, risk factors and identifying individuals eligible for high-risk screening, shared decision-making, decisions and referrals for BC screening and screening outcomes. Special areas of focus were shared decision-making, age to initiate screening, and BC screening in special populations.

We created a comprehensive consensus document distilling the latest evidence to provide practical Canadian consensus-based advice on specific ‘best practice behaviours’ related to BC health and screening to serve as a resource for providers.

This study aimed to investigate the self-management experiences of individuals living with systemic lupus erythematosus (SLE) through the lens of the Capability, Opportunity, and Motivation-Behaviour model to inform the design of personalised self-management interventions.

A phenomenological method, common in qualitative research, was used. Data were collected using semistructured in-depth interviews. Data collection and analysis were conducted concurrently, guided by the principle of reaching data saturation. The data were evaluated using thematic analysis.

The study was conducted in a quiet, private setting, either a classroom or consultation room, free from external disturbances.

Between March and September 2023, 15 individuals diagnosed with SLE who met the inclusion criteria participated in the in-depth interviews.

A total of 15 patients were interviewed, and 3 themes and 9 subthemes regarding self-management experiences were extracted: (1) Capability level: Deficiency in disease knowledge and insufficient self-management skills; (2) Motivation level: Lack of self-management awareness, perceived benefits and risks, uncertainty about disease progression and appearance-related anxiety; (3) Opportunity level: Family understanding and support, social support and environmental facilitation.

SLE patients’ self-management behaviours are influenced by both personal experiences and external environments. Healthcare professionals should enhance health education, deliver individualised guidance, strengthen patients’ self-management awareness and psychological positivity, optimise medical resource allocation, and bolster social support to improve patients’self-management capabilities.

The aim of this study was to explore the application of enhanced recovery after surgery (ERAS) in patients undergoing gynaecological surgery. This investigation included an analysis of the postoperative recovery curve and the factors that influenced the number of postoperative recovery days. This study also aimed to further investigate the impact of various factors on health economics.

A retrospective cohort study was conducted in the Fourth Ward of the General Gynaecology Centre of the Peking Union Medical College Hospital. A total of 1000 patients who had undergone elective benign gynaecological surgery between July 2021 and December 2022 were included. Demographic, perioperative and other relevant data were collected, and a visual analogue scale (VAS) survey was conducted using the European Five-Dimensional Health Scale (EQ-5D). The factors that influenced the number of postoperative recovery days were analysed using a multivariate linear regression analysis. Additionally, patients who had undergone laparoscopic myomectomy, laparoscopic ovarian cystectomy, laparoscopic total hysterectomy, abdominal myomectomy and abdominal total hysterectomy were grouped based on whether their ERAS implementation rate was ≥70%. Our goal was to evaluate the health economic value of the diagnosis-related group (DRG) payments from multiple perspectives and provide actionable recommendations for health insurance bureaus, hospitals and patients from a multi-dimensional perspective.

ERAS completion rates for measures such as avoiding preoperative sedation and early postoperative ambulation exceeded 95%, whereas rates for chewing gum and intraoperative temperature monitoring were

An analysis of the relationship between hospital costs and different ERAS measures, insurance types and disease types showed that seven measures could reduce hospital costs without negatively affecting the patient recovery speed, and five measures could slightly increase hospital costs. In addition, hospitalisation cost differences based on various insurance types and disease categories were statistically significant (p

The postoperative recovery speed was accelerated, the recovery time was shortened and the patient’s quality of life was enhanced during gynaecological surgery due to the implementation of ERAS practices. Increasing the ERAS completion rate can significantly reduce patient average hospitalisation costs. Additionally, variations in medical insurance, disease categories and specific ERAS measures influenced these costs. Therefore, hospitals that are unable to fully implement all ERAS measures must prioritise those that promote recovery. In addition, hospitals should adopt flexible strategies to minimise costs, thereby achieving mutual benefits for patients and hospitals. These findings establish a foundation for the implementation of a simplified ERAS version. It has been observed through the perspective of DRG implementation in China that payment standards exceed the average hospitalisation costs associated with specific surgical procedures. This result suggests that DRG implementation can benefit both patients and hospitals. These study results will serve as a valuable reference for decision-making by health insurance bureaus, hospitals and patients.

Current evidence is unclear due to methodological limitations. We bridge critical knowledge gaps by quantifying the longitudinal changes in movement behaviours and their correlates from early childhood through adolescence.

Longitudinal observational cohort study.

General healthy child and adolescent sample in Singapore.

Growing Up in Singapore Towards healthy Outcomes study participants.

We used wrist-worn accelerometry and proxy-reported data to examine movement behaviours (sleep, inactivity, light physical activity (PA; LPA) and moderate-to-vigorous PA (MVPA) and screen-viewing) at ages 5.5, 8, 10 and 12 years and the sociodemographic and maternal lifestyle-related correlates using linear regression models with generalised estimating equations.

Among 837 children, sleep, LPA and MVPA declined by 3% (from 9.1 to 8.8 hours/day), 24% (from 5.8 to 4.4 hours/day) and 44% (from 71.3 to 40.1 min/day), respectively, while inactivity and screen viewing increased by 26% (from 8.0 to 10.1 hours/day) and 155% (from 1.8 to 4.6 hours/day), respectively, from ages 5.5 to 12 years. The greatest annual increase in inactivity (0.6 hour/annum) and screen-viewing (0.8 hour/annum) and decrease in LPA (0.3 hour/annum) and MVPA (10.4 min/annum) occurred from ages 8 to 10 years. Girls of Malay ethnicity and lower socioeconomic status, and whose mothers had less favourable movement behaviours, had significantly less sleep, higher inactivity and screen-viewing and/or lower PA. Maternal PA levels and/or sitting time were associated with children’s sleep, inactivity and MVPA up to age 8 years, while maternal sitting and screen-viewing behaviours were associated with children’s screen-viewing at all ages.

Using contemporaneous datasets relevant to the present day, we confirmed that children become less physically active and have longer screen-viewing as they transition into adolescence and highlighted characteristics to be prioritised in future interventions.

To examine end-of-life knowledge, attitudes and behaviours associated with hospice care preference in community-dwelling older adults from Shanghai, China.

This was a cross-sectional study recruiting community-dwelling older adults from Shanghai. Bivariate analysis and multivariate logistic regression models were conducted to identify associated factors.

Seven community health service centres in Shanghai, China.

A total of 404 community-dwelling older adults.

Participants were asked to provide their hospice care preference (‘If you were to become critically ill with limited life expectancy, would you choose hospice care?’) and related reasons. To evaluate knowledge, attitudes and planning behaviours related to end-of-life issues, a structured questionnaire was developed through a multistep process. Demographic and clinical characteristics were also collected.

Nearly two-thirds of participants (65.8%) reported awareness of hospice care. Most of the participants (81.2%) reported they would choose hospice care at the end-of-life stage. Bivariate analyses showed that marital status, living status, education background and disposable personal income were significantly associated with hospice care preference. After controlling for confounding variables, the logistic regression analysis suggested the significant effects of knowledge level of hospice care (β=0.318, 95% CI (1.156 to 1.636), p

The Chinese older adults’ knowledge, attitudes and behaviours towards end-of-life issues in metropolitan areas has been changing. Their preference towards hospice care provides a good foundation for the utilisation of hospice care in the future. Community-based educational interventions should target demographic characteristics such as being unmarried, living alone and having lower levels of education and income among older adults to enhance their knowledge and family communication about hospice care.

In-hospital cardiac arrest (IHCA) is associated with high mortality and serious neurological sequelae. Although medical alert systems have evolved, the ability of these systems to influence changes in IHCA incidence and aetiology remains limited.

Retrospective observational cohort study.

A single tertiary hospital in South Korea, covering tertiary care levels.

A total of 1994 adult patients (≥18 years) who experienced 2121 episodes of IHCA between January 2011 and December 2019. Patients with out-of-hospital cardiac arrest, those aged ≤18 years and those with do-not-resuscitate orders were excluded. The mean age of patients was 63.0 years (SD, 14.6); 64.1% were male.

Not applicable.

The incidence and temporal trends of IHCA were stratified by aetiology (cardiac vs non-cardiac). Additional analyses examined changes in arrhythmic versus non-arrhythmic causes over time using Poisson regression.

Cardiac arrhythmia was the most common cause of IHCA (314 of 2121, 14.8%; incidence: 0.42/1000 admissions), including ventricular tachycardia (n=86), ventricular fibrillation (n=87) and Torsades de Pointes (n=79). Respiratory failure was the second most common cause (266 of 2121, 12.5%; incidence: 0.36/1000 admissions). The incidence of IHCA due to respiratory failure in 2011 was 0.63/1000 admissions, which decreased to 0.20/1000 admissions by 2019 (β=0.883, 95% CI 0.842 to 0.926, p for trend 0.007; Poisson p

IHCA causes have shown significant temporal shifts. Arrhythmia has become the leading cause of IHCA, with incidences remaining stable, whereas a marked decrease has been observed in respiratory-related IHCA. Therefore, enhanced in-hospital cardiac monitoring systems are required for early detection.

Interstitial lung diseases (ILD) associated with an underlying connective tissue disease (CTD), also known as a systemic autoimmune rheumatic disease or SARD, are chronic conditions with a tendency to progress. CTD-ILDs are increasingly diagnosed and pose an important global health challenge. This systematic review aims to provide an overarching evaluation of their epidemiology and disease burden in Asia. In this review, the term CTD-ILD will be used to denote all major forms of ILD arising in the context of a SARD.

This systematic review will adhere to the standards of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, including a flow diagram to depict the process by four independent reviewers that will assess titles and abstracts against the following predetermined criteria. A systematic review of the literature search published from 2000 to 2024 will be conducted using five electronic databases including PubMed/MEDLINE, Scopus, EMBASE, Cochrane Library and Web of Science. Publications that meet the inclusion criteria of this review will be subjected to a full-text review to extract relevant data. Collated data will be analysed and organised into categories based on the expected outcome and objectives. The quality of published evidence, including heterogeneity across studies, will be checked against PRISMA checklists and assessed by Newcastle-Ottawa Scale.

Ethics approval is not applicable for this study since no original data will be collected. The findings of this review will be disseminated through a peer-reviewed publication in a scientific journal and conference communications, with the aim of contributing insights to the field by identifying research gaps and informing clinical practice.

The protocol of this systematic review is registered with the National Medical & Research Register (ID-24–03600-GUB) and International Prospective Register of Systematic Reviews PROSPERO (CRD420251037095).

This study aims to examine the longitudinal relationship between fear of disease recurrence and depressive symptoms in elderly patients who have experienced postoperative adjacent vertebral refractures, as well as in their spouses, using the actor-partner interdependence model (APIM) to assess both individual and mutual psychological influences.

A prospective longitudinal study in China.

A total of 230 osteoporotic vertebral compression fractures (OVCF) and their spouses were selected by convenience sampling method.

Simplified fear disease Progression Scale and 9-item Patient Health Questionnaire were used at admission (T1), before discharge (T2) and 1 month after discharge (T3), respectively. Equivalence test and cross-lagged analysis of APIM were used for statistical examination.

A total of 224 valid questionnaires were collected in this study, yielding an effective recovery rate of 97.31%. Across the measurement stages, both patients and their spouses exhibited a decreasing trend in scores for fear of disease recurrence and depressive symptoms. The subjective effect analysis revealed that, in elderly patients with postoperative adjacent vertebral refracture, fear of disease recurrence significantly and positively predicted depressive symptoms at the subsequent stage (T1->T2: β=0.18, T2->T3: β=0.17, pT2: β=0.16, T2->T3: β=0.17, pT2: β=0.21, T2->T3: β=0.20, pT2: β=0.20, pT3: β=0.18, pT2: β=0.21, T2->T3: β=0.20, pT2: β=0.17, T2->T3: β=0.16, all p

It is recommended that medical staff prioritise the assessment and management of fear of disease recurrence and depressive symptoms in elderly patients with OVCF and their spouses, and strategically leverage the mutual influence between them to minimise depressive symptom levels as much as possible.