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Ayer — Octubre 2nd 2025Tus fuentes RSS

“<i>Skills for Resilience in Farming</i>”; an evidence-based, theory driven educational intervention to increase mental health literacy and help-seeking intentions among Irish farmers

by Siobhán O’Connor, Sandra M. Malone, Joseph Firnhaber, Sinéad O’Keeffe, John McNamara, Anna Donnla O’Hagan

While mental health literacy is an important component to successful help-seeking, rural populations often face gaps in both knowledge and service provision. Informed by the Theory of Planned Behaviour and Self-Efficacy Theory, we designed the ‘Skills for Resilience’ as a brief, once-off, community-based educational intervention to increase Irish farmers’ mental health literacy and help-seeking intentions. We adopted a quasi-experimental between (group: intervention and control) and within-group design (time: baseline [T1], immediately post-intervention [T2], and ≥ 1 month post-intervention [T3]). A total of 72 participants (intervention n = 37; control n = 35) were recruited from knowledge-sharing discussion groups. Although recruitment was also open to women, all discussion groups consisted of men. A trained facilitator delivered a discussion lasting between 30 and 90 minutes. Five intervention participants also participated in a qualitative interview after T3. Our results identified intervention participants’ mental health literacy increased significantly at T2 and T3 compared to T1, but did not increase between T2 and T3. Mental health literacy was also significantly greater in the intervention group compared to the control group at T2 and T3. Help-seeking intentions and self-efficacy in seeking mental healthcare also increased significantly at T2 compared to T1, but did not increase between T1 and T3 or T2 and T3. There were no significant changes in outcome measures for the control group at any time point. Through reflexive thematic analysis we identified that the intervention also addressed stigma against mental health (Theme 1) and provided important resources for participants and their community’s present and future coping (Theme 2). At T3, 100% of participants enjoyed the discussion and would recommend the intervention to other farmers. This intervention provides a successful example of integrating the Theory of Planned Behaviour and Self-Efficacy Theory to improve mental health literacy in farmers using a brief, educational intervention.
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Use of Artificial Intelligence‐Driven Wound Care Management to Enhance Access to Care Rural and Northern Communities

ABSTRACT

Wound care remains a high-priority area for improvement in the Canadian health care system. Older adults aged 65 and older are disproportionately affected by chronic and non-healing wounds and often experience multiple co-morbid conditions, challenges which can be further complicated by living in rural and northern areas. A workshop-based multi-methods study was conducted to describe rural and northern perspectives on opportunities and feasibility to implement innovative wound care technologies. Each workshop included pre- and post- workshop surveys, a live demonstration of Swift Skin and Wound, a Q&A session, and facilitated discussion exploring the technology's feasibility, usability, and accessibility in northern and rural care contexts. Participants who volunteered for the study included care staff and healthcare executives (N = 11), described their perspectives on implementing AI-driven digital wound care management solutions with a focus on integration into health care settings. Three themes were identified including: confidence and optimism in improving wound care management, recognition of the superiority of AI-driven digital wound care solutions over current practices, and the importance of adaptable change processes for successful adoption. While generalizability may be limited, findings suggest that adopting AI-driven wound care tools could improve wound assessment accuracy and streamline care for aging populations in rural and northern areas.

Changes in prescription patterns of antidiabetic medication in patients newly diagnosed with type 2 diabetes in Spain: an observational study

Por: Cea-Soriano · L. · Moreno · A. · Calonge · M. · Rivas · A. · Pulido-Manzanero · J. · Colchero · M. C. · Artola · S. · Serrano · R. · Franch-Nadal · J. · Regidor · E. · the PRECOZIN Study Group · Adan · Almanzar · Alonso · Alonso · Alonso · Alvarez · Alvarez · Amoros · Araujo · Arbide
Objective

To estimate the frequency of antidiabetic prescriptions in type 2 diabetes mellitus (T2DM) in Spain and describe changes in prescription patterns between 2018–2022 and 2023-2024.

Design

Observational study.

Participants

Patients from primary care centres newly diagnosed with T2DM in 2018–2022 and 2023–2024.

Primary and secondary outcomes

In each period, the prescription frequency of an antidiabetic medication at the diagnosis of T2DM was calculated and subsequently subdivided into monotherapy and combination therapy. The prescription frequency of the most common antidiabetic drugs was also calculated. Calculations were made for the entire group of subjects and stratified by sex and age (under 60 years and 60 years or older). Comparison of the frequencies between the two periods was performed using the chi-square test.

Results

In 2018–2022 and 2023–2024, 78.4% and 88.9% of patients, respectively, were prescribed an antidiabetic medication. The prescription frequencies for monotherapy and combination therapy were 66.1% and 33.9% in the first period and 57.4% and 42.6% in the second. The prescription frequencies for metformin as monotherapy and combination therapy were 57.4% and 27.8% in the first period and 46.6% and 39.8% in the second. Prescribing metformin with sodium-glucose cotransporter-2 inhibitors (SGLT2i) and/or glucagon-like peptide receptor 1 agonists (GLP1a) was the most frequent combination therapy: 12.8% in 2018–2022 and 29.5% in 2023–2024. With a few exceptions, the prescribing pattern was similar by sex and age. The difference between the prescribing distributions in the two periods is significant.

Conclusion

Antidiabetic medication prescribing at the diagnosis of T2DM was high. Most prescriptions contained metformin. Monotherapy decreased in 2023–2024 compared with 2018–2022, while combination therapy increased due to increased prescriptions of metformin with SGLT2i and/or GLP1a.

Measurement properties of instruments used to measure health-related quality of life in pediatric and adults patients with inherited epidermolysis bullosa: A systematic review and meta-analysis protocol

by Mario Gómez-Martínez, Greta Arias-Merino, Juan Benito-Lozano, Ana Villaverde-Hueso, Renata Linertová, Verónica Alonso-Ferreira

Inherited Epidermolysis Bullosa (EB) is a group of rare, genetic skin diseases characterized by extreme fragility of the skin and mucous membranes, leading to blistering and wounds in response to minimal trauma or friction. These clinical manifestations significantly reduce health-related quality of life (HRQoL). The objective of this protocol article is to provide information about the methods planned to be used to assess the measurement properties of HRQoL instruments specifically developed for EB patients of all age groups through a systematic review and meta-analysis. The protocol followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses Protocols (PRISMA-P) guideline. The literature search will be conducted in PubMed, Web of Science (WOS) and EMBASE, including terminology that aligns with the four key elements of the COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) research question (construct, target population, measurement properties and type of PROM), as well as the terminology proposed by COSMIN for measurement properties. Studies that include information on measurement properties (specifically, validity and/or reliability) with a sample of patients with inherited EB will be selected. Both title and abstract screening and full text review, will be conducted by two independent reviewers using the Rayyan tool. In addition, the risk of bias will be assessed using the COSMIN-Risk of Bias checklist. The data from each study and each measurement property will be summarized in accordance with the COSMIN guidelines. The evidence gathered will strive to adjudicate data on measurements properties of HRQoL instruments used in EB patients, and the limitations of the future systematic review will be discussed. Ultimately, results of the future systematic review will help develop more personalized guidelines for the assessment of HRQoL in EB patients of all age groups. The protocol is registered in OSF with registration number vrm87: https://osf.io/vrm87/

Hard‐To‐Reach and Hidden Groups in Health‐Related Research—A Scoping Review

ABSTRACT

Aims

The aim of this scoping review was to identify hard-to-reach and hidden groups in health-related research and to understand the recruitment methods used with these groups.

Design

The presented scoping review has an exploratory perspectiveand was conducted in accordance with Arksey and O'Malley's framework and the PRISMA-ScR guidelines.

Data Sources

A comprehensive search of CINAHL and MEDLINE databases was performed for studies published up to November 2022. The searches were updated in December 2024.

Review Methods

Relevant papers were identified via specific search terms and inclusion and exclusion criteria. Two authors independently assessed eligible literature and extracted relevant data, which was analysed and synthesised to answer the research questions. The analysis method used was descriptive analysis with quantification.

Results

Overall, 1024 studies were screened. The included studies were published between 2001 and 2022. A total of 41 studies were included in the review. In this data, groups were defined mostly as hard-to-reach and hidden. The groups were divided into eight categories: LGBTQ+ community, intoxicant users, sex workers and their clients, marginalised groups, mental health care seekers and users, impaired persons, people living outside their original home country and victims of abuse or neglect. Recruitment methods were varied, with snowball sampling, respondent-based sampling and websites being the most used.

Conclusion

This review provides insight into the current knowledge on hard-to-reach and hidden study groups. In studies targeting hard-to-reach and hidden groups, the use of concepts is variable and inconsistent.

Impact

In clinical nursing practice, it is important to identify hidden and hard-to-reach groups, as the goal of equality is to improve the health and well-being of all individuals, including marginalised groups.

Reporting Method

Reporting was guided by Preferred Reporting Items for Systematic Reviews and Meta-Analysis ex-tension for Scoping Reviews (PRISMA-ScR).

Patient or Public Contribution

No patient or public contribution.

Association of nociceptive, neurocognitive, psychological and genetic profile on conditioned pain modulation in women with migraine: protocol for a case-control study

Introduction

Migraine is a primary headache showing a multifactorial component that includes altered pain processing, psychological/emotional problems, neurocognitive and executive function deficits, all with a possible genetic association. The aim of the current study will be to evaluate the association between sensitisation, psychological/emotional, neurocognitive and genetic profile on conditioned pain modulation (CPM) in women with migraine from a multidisciplinary perspective.

Methods and analysis

A cross-sectional observational case–control study including 90 women with chronic migraine, 90 women with episodic migraine and 90 women without migraine (as controls) will be conducted. Clinical variables (disability, pain), processing (sensitisation-associated, neuropathic-like symptoms), psychological/emotional (anxiety, depression, sleep quality, catastrophising), neurocognitive (attention), executive functions (memory, mental inhibition, speed processing) and genetics (Val158Met polymorphism rs4680 gene) will be assessed in all subjects by healthcare professionals. Subsequently, CPM will be evaluated with the cold-pressor test paradigm by assessing changes obtained in mechanical and thermal stimuli. The association of each group of variables on CPM will be analysed with multivariate analyses (OMNIBUS analysis of variance). A network model will also be created to identify those variables showing the greatest key measure of centrality with the rest of the severity indicators (strength, intermediation and closeness) to establish the potentially therapeutic targets in patients with migraine from a multidisciplinary point of view.

Ethics and dissemination

The protocol of the current study has been approved by the Ethics Committee of all involved institutions (Hospital Universitario Fundación Alcorcón 24–117, Universidad Rey Juan Carlos 010220240912024). All procedures will be conducted following the Declaration of Helsinki. Participants will be informed of the aims and procedures of the study and will receive the informed written consent which should be signed before their inclusion. Study results will be disseminated through peer-reviewed publications and presentations at scientific meetings.

A Tutorial on Conducting and Interpreting a Bayesian Independent T‐Test Using Open‐Source Software

ABSTRACT

Aim

To demonstrate a worked-out example of a Bayesian independent t-test using open-source software, simulated data, a hypothetical nurse education intervention and a randomised controlled study design. This tutorial explains relevant Bayesian concepts and highlights literature that provides statistically principled justifications for replacing or complementing the frequentist independent t-test with its Bayesian counterpart.

Design

Bayesian t-test analysis tutorial.

Methods

A pedagogical framework was applied.

Data Source

Simulated data generated in Microsoft Excel was uploaded to the Open Science Framework, accessible at: osf.io/4t9gn.

Results

The Bayesian independent t-test in JASP provides: (1) a Bayes factor quantifying the relative evidence for determining which of two competing theories, that is, the null (H0) or the alternative (H1) hypotheses, better supports the experimental data and (2) the posterior probability distribution, with its median point estimate plus a 95% credible interval, quantifying the magnitude and uncertainty of the effect size estimate.

Conclusions

This article provides a practical method for nursing and midwifery researchers to conduct Bayesian analysis, offering statistical, practical and ethical advantages, including the application of sequential analysis and optimal stopping rules enhancing research efficiency.

Implications for the Profession and/or Patient Care

This article increases awareness of the feasibility and benefits of Bayesian analysis in nursing and midwifery research, emphasising its ease of implementation through open-source software. Clear step-by-step guidance is provided to support its wider adoption and strengthen methodological rigour in nursing and midwifery research.

Impact

Nursing and midwifery research has traditionally relied upon frequentist statistical techniques, based on p values and confidence intervals. Bayesian methods can: (a) improve nursing and midwifery decision-making with probabilistic evidence and (b) reduce publication bias by avoiding binary interpretation of research results.

Reporting Method

The methodology aligns with van Doorn et al. (2021) guidelines for conducting and reporting a Bayesian analysis.

Patient or Public Contribution

No patient or public contribution.

Parental grief following infant death in the NICU: a longitudinal mixed-methods exploration of parental experiences and influencing factors

Por: Alonso-Prieto · E. · Chung · R. · Allison · K. · Nightbird · M. · Kieran · E. · Albersheim · S.
Objectives

To characterise neonatal intensive care unit (NICU) parents’ grieving process across time and to identify their perspectives on the healthcare providers’ actions that acted as facilitators or barriers to the grieving process in the short (3–9 months) and longer term (18–24 months).

Design

Longitudinal mixed-methods study combining standardised grief and care satisfaction scales with qualitative data collected through semistructured interviews. The qualitative component was guided by an interpretive description approach, which is well-suited for generating clinically relevant insights into complex human experiences such as parental grief. Triangulating quantitative and qualitative data enhanced insight into how parental grief and perceptions of care evolved between 3–9 months and 18–24 months post loss.

Setting

Tertiary-level NICU hospital in British Columbia, Canada.

Participants

13 parents participated in the study, including 10 mothers and three fathers. Among them were two couples who participated as individuals. Their median age was 35 years (IQR: 32–38).

Primary and secondary outcome measures

Quantitative data obtained through the application of the Perinatal Grief Scale (PGS) and care satisfaction scale and qualitative data collected through semistructured interviews. Data were collected at two points (3–9 months and 18–24 months post loss) to track parents’ grief over time.

Results

The PGS scores indicated active grieving without complicated grief, while the Care Satisfaction Scale reflected high overall satisfaction with care. Thematic analysis identified two primary grieving stages: the initial traumatic event during NICU hospitalisation and the complex adjustment to life post loss. Key factors influencing parents’ coping mechanisms included respecting the infant’s dignity, enhancing communication and decision-making, preserving the bond between parents and the NICU team, nurturing enduring connections with the infant and aiding in finding meaning from the experience.

Conclusion

The study outlined the stages parents experience during and after infant loss, offering practical steps for NICU professionals to aid families in their healing process.

Interventions to lower cardiovascular disease risk factors among Asian Indian immigrants: a scoping review protocol

Por: Mobarki · A. M. · DAlonzo · K. T. · Joseph · M. E. · Wadhawan · A. · Mathur · S. · Holly · C.
Introduction

To identify effective interventions to lower cardiovascular disease (CVD) risk factors among Asian Indian (AI) immigrants.

As the second largest immigrant group in the USA, AI immigrants experience CVD prevalence rates as high as 13% among males and 4.4% among females; these rates are significantly higher than other Asian subgroups and the general US population. Despite extensive knowledge of CVD risk factors, there have been few cardioprotective interventions in this population.

Methods and analysis

Interventional studies of first-generation AI immigrants aged 18–70 years, conducted between 2000 and 2025, will be identified, including randomised controlled trials, factorial and cross-over designs, and cluster randomised trials. We will include AIs with and without a specific family history of CVD, or personal history of type 2 diabetes mellitus, hyperlipidaemia or obesity. Exclusion criteria include AIs born in the USA or visiting.

The Arksey and O’Malley methodology framework and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews will be used for analysis. A preliminary review of interventions to lower the CVD risk in AIs will guide the research questions (stage 1). Relevant articles published between 2000 and 2025 will be retrieved using electronic databases and search terms (stage 2). Two independent reviewers will select studies based on eligibility criteria (stage 3). Reviewers will determine eligibility status, screen full texts and retrieve relevant publications. Reviewers will extract data, capturing study design, sample characteristics, types of interventions, outcomes and key findings (stage 4). A summary of results will be presented (stage 5). The review will identify the most effective interventions, potential areas for future research and practical recommendations to improve CVD outcomes among AI immigrants.

Ethics and dissemination

Included studies will meet ethical standards in research. Findings will be disseminated through manuscripts, presentations at relevant conferences and community outreach programmes to promote effective interventions.

Changes in cardiovascular disease risk, lung function and other clinical health outcomes when people who smoke use e-cigarettes to reduce cigarette smoking: an exploratory analysis from a randomised placebo-controlled trial

Por: Dahal · S. · Yingst · J. · Wang · X. · Cobb · C. O. · Carrillo · M. · Hrabovsky · S. · Bascom · R. · Lopez · A. A. · Kang · L. · Maloney · S. · Halquist · M. · Foulds · J. · Veldheer · S.
Objectives

To examine changes in cardiovascular disease (CVD) risk factors, lung function and clinical laboratory markers among people who smoke who used e-cigarettes to reduce their cigarette smoking.

Design

Four-arm, parallel-group, double-blind, randomised placebo-controlled trial.

Setting

Two sites—Virginia Commonwealth University (Richmond, Virginia, USA) and Penn State University, College of Medicine (Hershey, Pennsylvania, USA).

Participants

Adults (n=520) aged 21–65 years who smoked at least 10 cigarettes per day, had an expired-air carbon monoxide reading of >9 parts per million at baseline and were interested in reducing their cigarette consumption.

Interventions

E-cigarettes with 0, 8 or 36 mg/mL nicotine liquid concentration or a cigarette substitute.

Primary outcome measures

CVD risk factors (blood lipids, C-reactive protein, blood pressure, heart rate, waist-to-hip ratio, body mass index and INTERHEART risk score), lung function (spirometry indices, and pulmonary symptoms and functional state using the Clinical Chronic Obstructive Pulmonary Disorder Questionnaire), and other clinical laboratory markers (complete blood count and complete metabolic panel).

Results

At 6 months, the use of nicotine e-cigarettes caused no significant between-group differences for most measures. However, participants randomised to the 36 mg/mL e-cigarette condition had significantly higher levels of high-density lipoprotein (HDL) (p=0.003 unadjusted, p=0.002 adjusted) and lower levels of low-density lipoprotein (LDL) (p=0.044 adjusted) and cholesterol/HDL ratio (p=0.034 unadjusted, p=0.026 adjusted) compared with the cigarette substitute condition. Also, those in the 36 mg/mL e-cigarette condition had higher HDL levels than those in the 0 mg/mL condition (p=0.016 unadjusted, p=0.019 adjusted).

Conclusions

Participants randomised to the highest nicotine e-cigarette condition showed modest improvements in some measures of blood lipids (eg, increased HDL, and reduced LDL and cholesterol/HDL ratio) as compared with a non-aerosol cigarette substitute among individuals attempting to reduce their cigarette smoking. Future studies of e-cigarettes for smoking cessation would benefit from including these measures to further explore the results found in this study.

Trial registration number

NCT02342795.

What is the impact of a shift to remote consultations? A qualitative interview study in primary and secondary healthcare

Por: Chaloner · C. · Stevenson · F. A. · Rehill · N. · Halvorsrud · K. · Raine · R. · Barratt · H.
Objective

The COVID-19 pandemic prompted a significant increase in the use of remote consultations—by telephone or video—in both primary and secondary healthcare. The reported advantages of remote consulting for both patients and clinicians include greater efficiency, flexibility and convenience. However, disadvantages, such as the uncertainty created by a loss of face-to-face contact, have also been highlighted. The aim of this study was to explore, explain and interpret patients’ and clinicians’ perceptions and experiences of remote consultations and assist decision-making about their future use.

Design

A qualitative study based on semistructured online interviews.

Setting

Primary mental healthcare or secondary care cardiology services, London, UK, February–March 2022.

Participants

Primary care mental health patients (n=5), primary care clinicians (general practitioners) (n=15), secondary care cardiology patients (n=9) and secondary care cardiology clinicians (n=5).

Results

The results demonstrate that a range of factors have influenced the experiences of both clinicians and patients and indicate shifts in the norms of professional practice and clinician–patient relationships.

Conclusions

Patients and clinicians demonstrated pragmatic acceptance of remote consultations and, looking forward, a preference for a balanced ‘hybrid model’ of remote and face-to-face appointments. The study also highlights a need to consolidate and build on the informal learning and adaptation to remote consulting that has already taken place.

A Clinical Decision Support Tool for the Management of Diabetes‐Related Foot Ulcers (DRFUs) Using a Topical Haemoglobin Spray

ABSTRACT

Diabetes related foot ulcers (DFUs) are complex and costly to manage, with the prevalence of non-healing wounds steadily increasing across the globe. Non-healing wounds can occur when clinicians fail to undertake an appropriate assessment, fail to recognise the importance of systemic or local complications, or provide the optimal treatment. The aetiological causes behind non-healing wounds are multifactorial; however, the purpose of this article is to focus on the role of oxygen in non-healing wounds and to introduce readers to advances in the delivery of topical oxygen therapy (TOT) via a haemoglobin spray. Importantly, this article incorporates a clinical decision support tool (CDST) to help clinicians identify the most appropriate individuals for whom topical haemoglobin may be most beneficial and the most appropriate time for introducing the intervention to improve wound healing outcomes.

Impact of burnout on turnover, medical errors, medical leave and a cross-sectional study of contributing factors among Chilean physicians

Por: Villalon Lopez · F. · Mundt · A. P. · Hirmas · A. · Rivera · R. M. · Guiloff · R.
Background

During the COVID-19 pandemic, many physicians experienced burnout, underscoring the need to identify factors associated with this condition to develop effective prevention and treatment strategies.

Objective

To examine the relationship between physician burnout and individual factors, medical errors, medical leave and the work environment.

Design

A cross-sectional online survey conducted from November 2020 to December 2020.

Participants

Physicians registered with the Medical College of Chile.

Setting

Registered physicians working in Chile across primary, secondary and tertiary levels of healthcare.

Primary outcomes

Burnout was assessed using the Maslach Burnout Inventory for Human Services.

Secondary outcomes

Self-reported medical errors, medical leave and turnover.

Independent variables

Sociodemographic characteristics, personality factors, psychological well-being, mindfulness factors, self-compassion and work environment factors. Descriptive statistics, linear and logistic regressions and regression analyses with cross-validation using least absolute shrinkage and selection operator (LASSO) tests were applied.

Results

Of the 23 481 registered physicians, 795 (3.4%) completed the survey. The sample included 64.1% women, with a mean age of 37.7 years (SD=11.3). The prevalence of burnout syndrome was 20.4% based on strict criteria and 68.9% based on lax criteria. Burnout scores predicted days of medical leave (ß=0.086, p

Conclusion

Younger physicians may be prioritised for individual-level interventions, while addressing time pressure at the organisational level could help prevent burnout. However, longitudinal studies are needed to clarify the directionality of relationships with psychological factors.

Trial registration number

NCT05013489; Results.

Scoping Review of Gamification in Rehabilitation Care of Adults With Chronic Illnesses

imageBackground Gamification uses game-based mechanics, aesthetics, and game thinking to engage people, motivate action, promote learning, and solve problems. However, gaps remain in understanding and implementing gamification in rehabilitation care, necessitating further exploration and clarification of the best evidence for application of gamification. Objective To conduct a scoping review of the use of gamification in rehabilitation care for adults with chronic illnesses, summarizing the scope, forms, elements, guiding theories, effectiveness, and ease of use of gamification. Methods Eight databases in English or Chinese were searched from January 1, 2011 to May 20, 2024 following the standard scoping review framework. Results A total of 24 papers were included. Gamification was applied in the rehabilitation of endocrine, skeletal, circulatory, neurological, and cerebrovascular diseases, primarily using virtual reality and three-dimensional forms. Eight gamification elements were most commonly utilized. Positive outcomes included enhanced rehabilitation knowledge, improved attitudes, better physical function, and increased self-care ability. Most patients found gamified rehabilitation care engaging and easy to use. Discussion The application of gamification in adult chronic disease rehabilitation care shows great promise. However, the lack of theory-driven or longitudinal data in some studies highlights the need for more randomized controlled and longitudinal research to explore the effectiveness of gamified intervention.

Exposure to air pollutants contributes to increased rate of neovascular age-related macular degeneration in Israel

by Alon Sela, Rinat Levinshtein, Shiri Shulman

Age-related macular degeneration (AMD) is a multi-factorial degenerative disease of the retina and the leading cause for vision loss in the developed world. Air pollution is considered the greatest environmental threat to public health globally. Accumulating evidence indicates that air pollution may be a modifiable risk factor for chronic eye diseases of the lens and retina, including AMD. We examined the concentration of seven air pollution particles and their influence on the prevalence of neovascular AMD in Israel. Records of patients with AMD between 2016 and 2019 were crossed with their residential areas and correlated with pollution data. AMD rates were correlated with 5 types of gas: nitrogen dioxide (NO2), nitrogen oxide (NO), carbon monoxide (CO), ozone (O3), sulphur dioxide (SO2), and particulate matter - PM2.5 and PM10. A total of 93 localities across Israel were included in the analysis. AMD rates were higher in localities with greater air pollution. NO2, NOx, and PM2.5 were positively correlated with AMD rates, while O3 was negatively correlated with AMD rates. However, analysis of the effect of all air pollutant particles combined, showed a complex and highly non-linear effect on AMD rate, with the strongest non-linearity observed for carbon monoxide. NO2, NOx, and PM2.5 contribute to higher rate of AMD in Israel while O3 seems to have a protective role (probably due to ultraviolet filtering) on AMD rates. The interaction between air pollutants and AMD seems to be complex and non-linear and should be further studied.

Protocol of the pilot study to test and evaluate the iCARE tool: a machine learning-based e-platform tool to make health prognoses and support decision-making for the care of older persons with complex chronic conditions

Por: Hiltunen · A.-M. · Haavisto · I. · Nuutinen · M. · Lahelma · M. · Salminen · A. · de Almeida Mello · J. · Liperoti · R. · Howard · E. P. · Fialova · D. · Szczerbinska · K. · Alon · M. · Baranska · I. · Exmann · C. · Declercq · A. · Boorsma · W. · Onder · G. · van Hout · H. P. J. · Leskel
Introduction

The provision of optimal care for older adults with complex chronic conditions (CCCs) poses significant challenges due to the interplay of multiple medical, pharmacological, functional and psychosocial factors. To address these challenges, the I-CARE4OLD project, funded by the EU-Horizon 2020 programme, developed an advanced clinical decision support tool—the iCARE tool—leveraging large longitudinal data from millions of home care and nursing home recipients across eight countries. The tool uses machine learning techniques applied to data from interRAI assessments, enriched with registry data, to predict health trajectories and evaluate pharmacological and non-pharmacological interventions. This study aims to pilot the iCARE tool and assess its feasibility, usability and impact on clinical decision-making among healthcare professionals.

Methods and analysis

A minimum of 20 participants from each of the seven countries (Italy, Belgium, the Netherlands, Poland, Finland, Czechia and the USA) participated in the study. Participants were general practitioners, geriatricians and other medical specialists, nurses, physiotherapists and other healthcare providers involved in the care of older adults with CCC. The study design involved pre-surveys and post-surveys, tool testing with hypothetical patient cases and evaluations of predictions and treatment recommendations. Two pilot modalities—decision loop and non-decision loop—were implemented to assess the effect of the iCARE tool on clinical decisions. Descriptive statistics and bivariate and multivariate analysis will be conducted. All notes and text field data will be translated into English, and a thematic analysis will be performed. The pilot testing started in September 2024, and data collection ended in January 2025. At the time this protocol was submitted for publication, data collection was complete but data analysis had not yet begun.

Ethics and dissemination

Ethical approvals were granted in each participating country before the start of the pilot. All participants gave informed consent to participate in the study. The results of the study will be published in peer-reviewed journals and disseminated during national and international scientific and professional conferences and meetings. Stakeholders will also be informed via the project website and social media, and through targeted methods such as webinars, factsheets and (feedback) workshops. The I-CARE4OLD consortium will strive to publish as much as possible open access, including analytical scripts. Databases will not become publicly available, but the data sets used and/or analysed as part of the project can be made available on reasonable request and with the permission of the I-CARE4OLD consortium.

The Personal and Collective Resources of Nurses and the Relationship to Job Commitment and Work Engagement

ABSTRACT

Background

Identifying personal, social and emotional resources relevant to nurses' wellbeing and job engagement is important for addressing workforce shortages and nurse burnout, and turnover.

Aim

This study examined the relationships between New Zealand (NZ) nurses' personal resources (resilience, adaptability, self-efficacy, collective efficacy) and their occupational commitment and job engagement.

Sample

Participants were 270 New Zealand nurses.

Methods

Quantitative research design involving a confirmatory factor analysis was used to provide measurement support and to obtain latent correlations among factors. The final analysis was performed using structural equation modelling. The Job Demands-Resources (JD-R) model was adopted as the conceptual framework for this study.

Results

The personal resources for New Zealand nurses of self-efficacy, adaptability and resilience were generally positively associated with their occupational commitment and job engagement. In addition, New Zealand nurses' collective efficacy was seen as important for managing the demands of the job.

Conclusion

Taken together, findings offer an understanding about the salient personal and collective resources in relation to New Zealand nurses wellbeing and job engagement.

Implications for the Profession

Future research could explore how integrating cultural perspectives can improve job satisfaction and retention among nurses who identify as coming from collectivist cultures. The personal resources used in this study also need to be examined from a Māori perspective to ensure their relevance to the health and wellbeing of Māori nurses.

Impact

This study highlights the crucial role of collective support in enhancing job engagement among nurses. It underscores the importance of incorporating a cultural lens in workplace research, showing how collective efficacy can help individual nurses adapt to workplace challenges and reduce their intention to leave amid global nurse shortages.

Reporting Method

STROBE.

No patient/public contribution.

Monitoring the Sustainability of a Breastfeeding Guideline During the COVID‐19 Pandemic: A Mixed‐Methods Study

ABSTRACT

Aim

To analyse the impact of the COVID-19 pandemic on the sustainability of a breastfeeding (BF) clinical practice guideline (CPG) for women without COVID-19, throughout the 5 waves of the pandemic.

Desing

A mixed-methods design was utilised.

Methods

For the quantitative approach, an interrupted time series design was utilised, as well as the analysis of CPG sustainability reports as a qualitative approach. The study setting was in a health area in the Spanish health system from April 2019, until October 2021. The sample was composed of 2239 mother–infant dyads.

Results

The exclusive-BF rate at hospital discharge obtained values between 90% and 94.8%, without statistically significant changes. A significant increase in the risk of not starting BF in the first feeding was observed (adjusted odds ratio = 9.36; 95% CI: 1.04–84.13), between the pre-pandemic period and the first wave. Skin-to-skin contact (SSC) decreased in the first wave to 82.20%, and the oscillations observed throughout the pandemic were not statistically significant. In general, the qualitative indicators were maintained. A decrease was observed in the spaces used for postpartum care due to the re-assigning to the intensive care unit. Also, the acquisition of materials and equipment decreased.

Conclusions

The measures implemented for the sustainability of the BF CPG during the 5 waves of the pandemic were positive. The programmes of implementation of BF guidelines were shown to resist the COVID-19 pandemic.

Impact

Our findings contribute to the understanding and evolution of the main indicators of the sustainability of a BF CPG on COVID-19 context, providing details on the magnitude of the effect and the process of change.

Reporting Method

The Preferred Reporting Items for observational studies (STROBE) checklist was followed.

Patient or Public Contribution

No Patient or Public Contribution.

Desafíos en la formación de la Enfermera Gestora de Recursos Materiales

La formación de la enfermera gestora de recursos materiales (EGRM) se enfrenta a una carencia de especialización reconocida y de programas académicos oficiales que fundamenten su rol crucial en la optimización de recursos y consiguiente mejora de la calidad asistencial. Como se anticipó en el 16º congreso de ANECORM, en esta editorial se reflexiona sobre la actual situación de su formación y de su cuerpo de conocimientos, así como sobre estrategias para su impulso.

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