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by Meshack Achore, Martine Hackett, Tatiana Ramirez
IntroductionCommunity health workers (CHWs) play a critical role in advancing health equity by bridging underserved communities with health and social services. However, expanding responsibilities, emotional labor, and fragmented service systems contribute to burnout. While prior research has examined CHW burnout in urban, rural, and crisis contexts, little is known about how burnout is experienced and mitigated in suburban settings characterized by geographic dispersion and administrative fragmentation. This study explored how CHWs in suburban Long Island, New York, experience emotional labor overload and the strategies they use, individually and organizationally, to prevent burnout.
MethodsWe conducted a qualitative descriptive study using purposive and snowball sampling and recruited 10 CHWs from Nassau and Suffolk counties in New York. Data were collected through ten semi-structured interviews and five participant observations. Participants were primarily women aged 35–44 years, most of whom (86%) worked in Nassau County and reported 2–5 years of experience. Transcripts were analyzed thematically using Braun and Clarke’s six-step framework in ATLAS.ti.
ResultsTwo overarching themes emerged: (1) Creating a healthy work-life balance, in which CHWs managed burnout by setting boundaries and practicing self-care; and (2) Building support structures in the workplace, where organizational supports such as supervision, peer collaboration, and ongoing training promoted resilience. Participants emphasized the importance of self-care rituals, spiritual grounding, and collegial networks as protective factors against emotional exhaustion.
ConclusionsBurnout among suburban CHWs is shaped by the interaction of individual coping practices and organizational conditions within fragmented service systems. Strengthening supervision, peer support infrastructure, and professional development opportunities may enhance workforce resilience and sustainability. Investments in organizational support structures are critical to sustaining CHWs’ capacity to promote health equity.
To examine the relationship between moral courage, personality traits and organisational climate among nurses.
A cross-sectional, descriptive-analytical study.
A total of 264 nurses from three hospitals in Semnan, Iran, participated in the study. Stratified random sampling was used, and data were collected in summer and autumn 2024 through the Moral Courage Scale, Organisational Climate Scale and Personality Traits Inventory. Data analysis was conducted using SPSS 26.
Moral courage was positively associated with a supportive organisational climate. A weak inverse relationship was noted with agreeableness, while other personality traits showed no notable influence. Moral courage was more prevalent among married nurses, supervisors and those with permanent contracts.
A positive organisational climate enhances nurses' moral courage, emphasising the need to foster supportive work environments. While agreeableness may slightly inhibit moral courage, other personality traits did not show a significant effect.
Understanding the contributors to moral courage can assist healthcare institutions in developing training and policies that empower nurses to act ethically and confidently in challenging situations, ultimately improving care quality.
Problem addressed: The study explores the relationship between moral courage, personality traits, and organisational climate among nurses in clinical settings. Main findings: Organisational climate significantly impacts moral courage, while most personality traits do not play a major role. Where and on whom will the research have an impact? These findings can inform hospital leaders, educators, and policymakers in shaping ethics-centred strategies to support nurses in clinical settings.
This study adheres to EQUATOR guidelines for cross-sectional studies.
This study did not include patient or public involvement in its design, conduct or reporting.
To measure and compare the temporal variations in sub-bandage pressure compression systems in the Andalusian Health System (SAS). Additional objectives included assessing the relationship between pressure and healing, analysing the influence of the healthcare professional applying the bandage, and determining bandage stiffness. This prospective observational and multicentre study included 140 patients with active VLUs in Andalusia. Sub-bandage pressures were measured at three anatomical points in the leg for 96 h, under different positions and activities. The bandage application technique was standardised through specific training provided to advanced practice nurses. The initial pressures were higher than those recommended by guidelines, but showed a notable reduction within the first 24 h, stabilising within therapeutic ranges for the remainder of the 96-h study period. Most systems showed low dynamic and static stiffness. No significant pressure differences were found attributable to the nurses or the location of the injury. The observed pressure dynamics, initially high, with a subsequent drop and final stabilisation, suggest a high material settlement or application to compensate for the expected loss. The sustained pressure stability confirms the effectiveness of the systems over 96 h.
To evaluate the effectiveness of a web-based secondary prevention programme for postpartum depression, delivered with or without telephone support, compared with usual care.
We first conducted a randomised controlled superiority trial to test whether the web-based Parents and Babies programme (Toi, Moi, Bébé; TMB) delivered with motivational telephone support (ie, coaching) was superior to the fully automated programme (ie, self-help). TMB incorporated classic and third-wave cognitive–behavioural therapy components and psychoeducation. Then, we tested whether TMB (both treatment modalities combined) was superior to usual care. The usual care comparison group was drawn from the CONCEPTION prospective pan-Canadian perinatal cohort (N=592).
A remote study based at Sainte-Justine Hospital Centre, Quebec, Canada.
Web-based intervention programme participants were women aged ≥14 years at 12–25 weeks’ gestation, with subclinical to moderate clinical Edinburgh Postnatal Depression Scale (EPDS) scores: 9–16. Exclusion criteria were psychosis and self-reported substance abuse. The usual care comparison group was pregnant women ≥18 years old. All participants were living in Canada at study inception.
The primary outcome was EPDS scores at 3 months post partum, accounting for baseline EPDS scores and depression events defined as EPDS ≥13 at 3 months post partum. The secondary outcomes were EPDS scores at 6 months post partum, depression events (EPDS≥13) at 6 months post partum, anxiety symptoms (Generalised Anxiety Disorder 7-item Scale, GAD-7) at 3 and 6 months post partum, accounting for baseline scores for the continuous outcomes; as well as the number of completed intervention modules and well-being scores (WHO 5-Item Well-being Index) at 3 months post partum.
We randomised 510 participants to TMB self-help (n=255) or TMB with coaching (n=255); 211 and 214 participants, respectively, were included in the complete-case intention-to-treat analyses. At baseline, 91% lived with a partner, 71% were university graduates and 42% self-reported GAD-7≥10. Randomisation was successful. First, TMB with coaching was not superior to TMB self-help: at 3 months post partum, EPDS scores were TMB self-help (mean 8.0±4.3) vs TMB with coaching (mean 8.6±4.5); effect size was 0.01 (95% CI 0.00 to 0.03; p=0.16). Second, TMB (regardless of intervention arm) was superior to usual care: in adjusted regression models, EPDS scores were 6.2 units lower (per SD, 95% CI –8.2 to –4.3) in TMB (both treatment modalities combined) than in usual care; and proportions of depression events were 4.7 units lower (per SD on the logit scale, 95% CI –6.6 to –2.7) in TMB (combined) than in usual care. No other group differences were observed.
Our findings suggest that, in women with subclinical to moderate clinical antenatal depressive symptoms, receiving a web-based cognitive–behavioural therapy-based programme in addition to usual care can reduce depression postnatally.
The COVID-19 pandemic threatened global HIV Test and Treat Efforts. We assessed whether it affected (1) the number of antiretroviral therapy (ART) initiations and (2) the proportion of timely ART initiations in people living with HIV (PLWH) globally.
Quasi-experimental, regression discontinuity design using routinely collected data from HIV clinics.
360 HIV care clinics across primary and secondary levels of care, participating in the International epidemiology Databases to Evaluate AIDS consortium, in 31 countries in Asia, Africa and the Americas.
177 391 PLWH (≥18 years old) who initiated ART 2 years before and 1 year after the onset of the COVID-19 pandemic in their country.
The primary outcome was the number of ART initiations per week; the secondary outcome was the proportion of timely ART initiations (ie, ART initiated within 7 days of enrolment). We assessed changes in these outcomes in the 52 weeks after compared to the 104 weeks before the pandemic onset, defined using each country’s peak Oxford Stringency Index score between January and June 2020.
Among 177 391 newly enrolled PLWH, 129 743 initiated during the pre-pandemic and 47 648 post-pandemic onset. 72.5% of ART initiations were timely pre-pandemic whereas 82.3% were during the pandemic. Absolute number of ART initiations remained stable during the pandemic period in 25 of 31 countries but decreased significantly in six countries: India (–5.0 p, 95% CI –9.2 to –0.7), Rwanda (–10.0 p, –18.6 to –1.4), Malawi (–33.4 p, –54.1 to –12.3), South Africa (–130.8 p, –188.6 to –73.1), Zimbabwe (–12.9 p, –20.0 to –5.8) and Togo (–19.6 p, –39.1 to –0.1). The proportion of timely initiations was stable in all countries except in Kenya (+4.2 pp, 95% CI +0.3 to +8.1) and in Mozambique (+2.7 pp, +0.5 to +4.9), where it increased significantly.
A deeper understanding of the factors that contributed to sustaining ART initiations, particularly in settings with stringent public health and social measures, is needed. These insights should inform preparedness strategies, resource allocation and policy development to ensure continuity of HIV services during future health emergencies, in line with World Health Organisation recommendations.
Global ageing populations require accessible, non-invasive tools for early detection and monitoring of neurological chronic and neurodegenerative diseases. Current diagnostic methods face limitations including invasiveness, high costs and infrequent clinical assessments. The human voice has emerged as a promising digital biomarker, with vocal characteristics reflecting physiological and cognitive changes associated with conditions like dementia and Parkinson’s disease. While artificial intelligence (AI) and machine learning have enabled sophisticated vocal analysis, the literature remains fragmented without comprehensive synthesis. This scoping review protocol delineates a systematic approach to collate and synthesise existing research on the application of AI-driven audio biomarkers for the detection and management of neurological diseases (eg, cognitive decline, Parkinson’s disease, Alzheimer’s, dementia and depression) in older adults aged 65 years and above.
This scoping review will be conducted in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines and the methodological framework proposed by Arksey and O’Malley, incorporating recent methodological advancements. The eligibility criteria for study selection will be formulated using the PCC (Population, Concept, Context) framework. A comprehensive literature search will be performed across several electronic databases, including PubMed/MEDLINE, Scopus, Web of Science, IEEE Xplore, Embase, Compendex, CINAHL, Scientific Information Database (SID), Magiran, IranMedex and Barakat Knowledge Network System (BKNS). The search will encompass peer-reviewed articles published in Persian and English from 1 January 2012 to 31 March 2026. Two independent reviewers will screen titles, abstracts and full texts and extract data according to the predefined PCC-based eligibility criteria. Discrepancies will be resolved through discussion or, if necessary, by consultation with a third reviewer. The results will be synthesised and presented narratively, accompanied by summary tables, charts and figures to address each research question.
The Research Ethics Committee of Tabriz University of Medical Sciences approved the protocol for this scoping review (approval number: IR.TBZMED.VCR.REC.1404.223). They concluded that since the review involves only analysis of existing literature without direct patient involvement or clinical procedures, it meets the relevant ethical standards. Results from the review will be shared through peer-reviewed journals and conference presentations to provide valuable insights for researchers, clinicians and policymakers on the use of audio-based biomarkers in older adults.
Not registered.
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.
Human papillomavirus (HPV) is one of the most common sexually transmitted diseases and affects the quality of life (QoL) of individuals, necessitating interventions beyond physical treatments. The aim of this study is to determine the effectiveness of individual supportive counselling on the QoL in women with high-risk HPV.
This randomised clinical trial will include 80 women with HPV who will be selected from 2025 to 2026 in Babol, Iran. Following selection based on inclusion criteria, samples will be randomly allocated to intervention and control groups. Then, they will complete demographic–social questionnaires, QoL in HPV patients and general health questionnaires. Individuals in the intervention group will receive 4 weekly online supportive counselling sessions in addition to routine care. The control group will receive routine care. Both groups will complete the questionnaires again at 6 weeks and 4 months postbaseline. Data will be analysed using SPSS V.26 software and statistical tests including ², t-test and repeated measures analysis of variance, and regression models if necessary. A significance level of 5% will be used for the tests.
This study was approved by the Ethics Committee of Babol University of Medical Sciences (IR.MUBABOL.HRI.REC.1404.082). The trial will adhere to the ethical principles of the Declaration of Helsinki. Findings will be disseminated through publication in peer-reviewed journals and presentation at scientific conferences.
IRCT20180218038783N11, 14 September 2025.
by Md. Masud Reza, Hasibul Hasan Shanto, Samira Dishti Irfan, A. K. M. Masud Rana, Mohammad Niaz Morshed Khan, Golam Sarwar, Mohammad Sha Al Imran, Mahbubur Rahman, Md. Safiullah Sarker, Muntasir Alam, Md. Abu Hena Chowdhury, Mustafizur Rahman, Sharful Islam Khan
BackgroundUnintended pregnancy among female sex workers (FSW) is a pressing reproductive health concern attributable to risky sexual behaviors, healthcare inequities and poor negotiation powers with male sex partners. However, evidence is scarce on the prevalence and determinants of unintended pregnancies among FSW, which is crucial for enhancing reproductive healthcare. This analysis aims to measure the prevalence of lifetime unintended pregnancies and their associated factors.
MethodsA cross-sectional study was conducted on 327 FSW in Jashore (a border belt district of Bangladesh) from September 2022 to March 2023. Participants were recruited through take-all sampling. Data were collected on the lifetime history of unintended pregnancies and other relevant variables through face-to-face interviews. Chi-square statistic was used to compare the characteristics of FSW reporting unintended pregnancies. To assess the net association of factors associated with unintended pregnancy, multiple logistic regression was applied.
ResultThe lifetime prevalence of unintended pregnancies was reported at 75.8% (95%CI: 71.0–80.1). Among those who reported unintended pregnancies, 37.1% (95%CI: 30.8–43.8) had no education, 39.9% (95%CI: 32.8–47.5) were 25–34 years old, 49.6% (95%CI: 39.3–59.9) were currently married and 62.9% (95%CI: 49.7–74.4) earned ≤10,000 BDT per month compared to those who did not report lifetime unintended pregnancies. The likelihood of unintended pregnancies was significantly higher among those who reported having sex with non-transactional male sex partners (AOR: 2.4, 95%CI: 1.1–5.3, p = 0.036) than those who never had sex with any non-transactional male sex partner. The likelihood was also higher among those who reported rape in their lifetime (AOR: 2.0, 95%CI: 1.0–3.8, p = 0.037) and who self-reported mental health problems (AOR: 2.1, 95%CI: 1.0–4.2, p = 0.045) within the past year, compared to their counterparts.
ConclusionThis study highlights the considerable prevalence and associated determinants of unintended pregnancies among FSW in Jashore. These determinants need to be considered to strengthen reproductive healthcare interventions and policies for FSW. Reproductive health of FSW cannot be improved unless these factors are addressed in the ongoing interventions.
by Smail Acila, Nora Allioui, Samir Derouiche
Heavy metal contamination poses a significant threat to agricultural productivity. This study investigated the physiological and biochemical responses of Cucurbita pepo seeds to cadmium (Cd) and copper (Cu) stress (100–200 µM) during germination. Although germination rates remained high (86.67–93.33%), seed vigor indices declined significantly under metal stress. Cadmium exhibited stronger growth inhibition, reducing total seedling length by 63.02% at 200 µM, whereas copper primarily affected biomass accumulation, reducing the seedling weight-based vigor index (SVIW) by 40.4%. Biochemical analyses revealed metal-specific impacts on reserve mobilization. Cadmium exposure (200 µM) decreased soluble sugars in cotyledons by 16%, while maintaining protein content at 106% of control levels, indicating inhibition of protein degradation and impaired reserve utilization. In contrast, copper at 100 µM increased cotyledonary sugars by 63%, reflecting its dual role as both a micronutrient and stressor. Principal component analysis confirmed the greater toxicity of Cd, which explained 79.7% of the variance in metabolic disruption. These findings demonstrate that cadmium consistently impairs seedling establishment by disrupting nutrient mobilization pathways, while copper exhibits concentration-dependent effects, being stimulatory at low concentrations but inhibitory at higher levels. This study provides crucial insights into heavy metal phytotoxicity mechanisms and underscores the importance of monitoring metal pollution in agricultural systems to enhance crop resilience.by Tahere Seyedhoseinpoor, Ramin Jafari, Zohreh Shafizadegan, Maryam Abbaszadeh-Amirdehi
PurposeThe objective of this study was to systematically review the effectiveness of thoracic-focused interventions, including breathing exercises and thoracic manual techniques (mobilization, high-velocity low-amplitude manipulation, and release techniques), on pain and disability in patients with low back pain (LBP).
MethodsPubMed, Scopus, Web of Sciences, ProQuest, Ovid, Physiotherapy Evidence Database (PEDro), Cochrane Central Register of Controlled Clinical Trials (CENTRAL), and Google Scholar were searched without language restrictions. Clinical trials with control groups on pain and disability in low back pain patients focusing on the efficacy of breathing exercises or thoracic technique were included. In total, 31 studies contributed to the meta-analysis for pain and 24 for disability.
ResultsPooled analyses using Morris’ dppc demonstrated a statistically significant, small effect for pain reduction (dppc = −0.35, 95% CI = −0.46 to −0.23) and a large effect for disability improvement (dppc = −0.71, 95% CI = −0.86 to −0.57) when compared with control groups. Thoracic manual techniques showed larger effects on both pain and disability compare to breathing exercises. However, substantial statistical heterogeneity (I² > 85%) persisted in most analyses.
ConclusionBreathing and thoracic manual techniques may be effective in reducing disability and, to a lesser extent, pain in patients with LBP, but the overall certainty of evidence is low. However, the quality of the evidence is low. Variability in treatment protocols, study quality, blinding, and outcome measures likely contributed to inconsistencies. Further high-quality trials with standardized protocols are needed to confirm these findings and inform clinical practice.
Solidarity in global health is often invoked as an ethical imperative to guide responses to global health challenges. Its meanings and practices across diverse contexts, however, remain under-explored. Deepening an understanding of how solidarity is conceptualised, enacted and perceived by a diverse array of actors within the global health ecosystem is crucial to advancing meaningful and measurable application of this commitment in global health.
This qualitative study uses interpretive research methodology to explore perspectives on solidarity among key global health stakeholders: community-level leaders in civil society organisations working on global health issues; research institute directors in the Global South; and individuals with experience of funding decision-making with major global health funding and agenda setting organisations (‘global health influencers’). Data will be gathered through semi-structured interviews and analysed using inductive and deductive reflexive thematic analysis, to identify patterns and differences in how these global health stakeholders recognise and define solidarity or its absence in their day-to-day work, while remaining attentive to conceptual tensions, participant interpretations of solidarity that may be unfamiliar to our team, and our role as researchers in shaping what we register and emphasise as significant in our reporting of findings.
Ethics approval was obtained from the Western University Health Sciences Research Ethics Board (HSREB) in Ontario, Canada # 2024-123965-87873 and the Ethics Committee for the Humanities, University of Ghana # ECH 163/23–24 and University of Oxford, Oxford Tropical Research Ethics Committee (OxTREC) waiver dated 10 April 2024. Study results will be submitted for peer-reviewed publication. Results will also be summarised in an open access report and presented at various stakeholder meetings and in online webinars.
The final protocol was registered with Open Science Framework on 28 October 2023. View only link: https://osf.io/gryp5/?view_only=8baff435a35847f09a342408d38ee35b.
by Paula Tatiana Angarita-Melo, Karen Panche-Castellanos, Víctor Zein Rizo-Tello, Ana Yibby Forero-Torres, Alexandra Porras-Ramírez
AimTo determine the independent association and quantify the magnitude of influence of clinical and social determinants on the ten-year cardiovascular disease risk (estimated using the Framingham scale) in individuals diagnosed with arterial hypertension or type 2 diabetes mellitus in Maicao, La Guajira.
MethodsA cross-sectional analytical study was conducted among 273 adults enrolled in noncommunicable disease programs. Anthropometric, biochemical, and sociodemographic data were collected using standardized instruments. Multivariable logistic regression was used to identify and quantify factors associated with high cardiovascular disease risk (defined as 10% or greater Framingham score).
ResultsThe prevalence of high ten-year cardiovascular disease risk was 16.9%, being significantly higher in women (23.5%) compared to men (3.3%). The multivariable analysis quantified the influence of the determinants. Key clinical factors associated with the highest magnitude of risk were Type 2 Diabetes Mellitus (Adjusted Odds Ratio: 21.87) and High Blood Pressure (Adjusted Odds Ratio: 16.04). The independent effect of a social determinant, receiving a monthly salary, was also strongly associated with high risk (Adjusted Odds Ratio: 4.62). Conversely, being male and having normal High Density Lipoprotein cholesterol levels were identified as protective factors.
ConclusionThis study quantifies that, in addition to the strong influence of traditional clinical factors (T2DM and HBP), social determinants such as income-related work status exert a significant and independent effect on cardiovascular risk in this vulnerable population. The findings underscore the critical need for integrated public health strategies in Maicao, La Guajira, that not only target metabolic control but also effectively address structural social and gender inequalities to achieve a meaningful reduction in the cardiovascular disease burden.
This study aims to explore the impact of financial toxicity (FT) faced by cancer patients in Bahawalpur, Pakistan, identify their coping strategies and provide patient-driven recommendations to mitigate the FT.
A qualitative study design was used, and thematic analysis was employed to analyse the data.
Patients were selected from two tertiary care hospitals located in Bahawalpur, Pakistan.
Thirty patients were selected using a purposive and convenience sampling method. Data were collected between April and June 2024. Patients who provided consent, were 18 years or older and were receiving cancer treatment were included in the study.
Most participants were between 40 and 60 years old, and 66.6% were male. The study highlights severe FT, characterised by financial instability, psychological distress and family lifestyle disruptions. Patients employed various strategies, such as adjusting healthcare decisions, mobilising financial resources and seeking financial aid to cover treatment costs. Novel insights revealed the inadequacy of existing government health card programmes, which focus on direct medical expenses but fail to cover indirect costs, further exacerbating FT. Patients reported significant challenges in accessing government aid programmes due to administrative barriers. Participants highlighted the need for additional support mechanisms to address these gaps effectively, including enhanced accessibility, broadening financial assistance and integrated financial counselling.
This study is the first to explore FT in Pakistan’s healthcare system. It reveals gaps in support mechanisms and highlights the need for comprehensive policy interventions. Addressing these challenges holistically can improve patient outcomes and quality of life.
Kerato-lenticule extraction (KLEx) is a refractive surgery technique that, in contrast with femtosecond laser-assisted in situ keratomileusis (FS-LASIK), does not require the creation of a flap to correct refractive defects. The potential advantages of this technique are related to the absence of a flap and its complications. On the other hand, FS-LASIK is the most widely practised refractive surgery worldwide, as it offers excellent visual outcomes and is currently the gold standard of refractive surgery. The objective of this study is to compare the effectiveness and safety of KLEx versus FS-LASIK as a treatment option in patients with myopia or myopic astigmatism.
This double-masked, parallel-group, single-centre randomised clinical trial will enrol 80 eyes from adults with myopia or compound myopic astigmatism within the ranges sphere –0.50 to –12.00 D and cylinder –0.50 to –6.00 D, recruited at the Instituto de Oftalmología Conde de Valenciana, Mexico City, Mexico. Participants will be allocated to KLEx or FS-LASIK and assessed at baseline and 1 day, 1 week, 1, 3, 6 and 12 months postoperatively. The primary outcome is uncorrected visual acuity at all postoperative visits. Secondary outcomes include postoperative spherical equivalent, best-corrected visual acuity (BCVA), loss of ≥2 BCVA lines, the proportion of eyes within ±0.50 D of the refractive target, corneal aberrations over a 5 mm pupil, epithelial changes and adverse events. Participants and outcome assessors will be masked to the assigned surgical technique.
Participant confidentiality will be maintained with the publication of results. This study was approved by the research and ethics committee of the Instituto de Oftalmología Fundación de Asistencia Privada Conde Valenciana (CI-017-2024). The study results will be disseminated in scientific articles published in peer-reviewed journals and presented through research posters at national and international conferences.
ClinicalTrials.gov registry (NCT06477081).
This paper discusses data errors and offers guidance on data cleaning techniques, with a particular focus on handling missing values and outliers in quantitative datasets.
Methodological discussion.
This paper provides an overview of various techniques for identifying and addressing data anomalies, which can arise from incomplete, noisy, and inconsistent data. These anomalies can significantly affect data quality, leading to biased model parameter estimates and evidence-based decisions. Data cleaning, particularly the appropriate handling of missing values and outliers, is essential to improving data quality before analysis. Data cleaning includes screening for anomalies, diagnosing errors, and applying appropriate corrective measures.
Proper handling of missing values and the identification and correction of outliers are crucial aspects of data cleaning in ensuring data quality and the reliability of statistical analyses. Effective data cleaning enhances the validity and accuracy of research findings for evidence-based decision making that leads to optimal patient outcomes.
The quality of study results depends on how a dataset and its complexities are processed or handled before the analysis. Nursing researchers must use a framework to identify and address important data anomalies and produce reliable results.
This paper describes data cleaning, often overlooked during the data mining process, as a crucial step before conducting data analysis. By addressing missing values and outliers, identifying and fixing data anomalies, and enhancing data quality prior to analysis, data cleaning techniques can produce precise research findings for evidence-based decision making.
In this methodological paper, no new data were generated.
No patient or public contribution.
The objective of this study was to generate evidence for strengthening the local food system to contribute to improved dietary diversity among children in Ethiopia.
A community-based cross-sectional survey.
The study was conducted in the Amhara, Oromia and Somali regions of Ethiopia.
A total of 1475 children aged 6–23 months were included. Children requiring special care or not permanently residing in the study areas were excluded.
The primary outcome measure was the adequate Minimum Dietary Diversity, defined as the consumption of at least five of the eight defined food groups in the previous 24 hours.
Only 25.6% of children met the adequate minimum dietary diversity requirement. Children from households with backyard gardening (Adjusted odds ratio (AOR)=1.43, 95% CI 1.08 to 1.88), access to communication devices (AOR=1.99, 95% CI 1.51 to 2.64), attendance at cooking demonstrations (AOR=1.99, 95% CI 1.44 to 2.74), use of labour-saving and time-saving technologies (AOR=1.55, 95% CI 1.15 to 2.09) and irrigation use for crop production (AOR=1.78, 95% CI 1.26 to 2.52) had higher odds of meeting adequate minimum dietary diversity. Residence was strongly associated with dietary outcomes: children in Amhara had more than seven times the odds of achieving adequate minimum dietary diversity of children compared with Somali (AOR=7.56, 95% CI 4.92 to 11.62), while those in Oromia had nearly twice the odds (AOR=1.74, 95% CI 1.17 to 2.60).
Dietary diversity among children was low in the study areas. Strengthening local food systems through promotion of backyard gardening, cooking demonstrations, irrigation use, communication access and appropriate technologies could improve children’s dietary diversity. Regional disparities highlight the need for context-specific strategies, particularly to address the low dietary diversity in children.
by Nailya Ibragimova, Arailym Aitynova, Seitzhan Turganbay, Marina Lyu, Alexandr Ilin, Tamari Gapurkhaeva, Galina Ponomareva, Karina Vassilyeva, Diana Issayeva, Amirkan Azembayev, Serzhan Mombekov, Aralbek Rsaliyev, Nurgul Sikhayeva, Yergali Abduraimov, Saki Raheem
Iodine-based antiseptics are essential in wound care but are often limited by cytotoxicity, instability, and rapid iodine release. Novostron is a novel polymer–iodine complex incorporating dextrin, polyvinyl alcohol, and metal ions, designed to enable controlled iodine release. Structural integrity and composition were confirmed by ¹H and 13C NMR spectroscopy and physicochemical analysis, indicating a molecular weight of ~9500 g/mol, a pH of 4.23, and an iodine content of 8.13%. Pharmacokinetic analysis in rabbits demonstrated that following a single dermal application, systemic iodine absorption was minimal, with peak blood iodine concentrations remaining within physiological limits and rapid elimination within 24 hours. Evaluation of thyroid function revealed no significant changes in serum T₃, T₄, or TSH levels compared with those of the controls, confirming that topical application of Novostron does not disrupt thyroid homeostasis. In compliance with OECD guidelines in rabbits, guinea pigs, and rats, Novostron showed no signs of dermal irritation, skin sensitization, or systemic toxicity (LD₅₀ > 2000 mg/kg). In a rat cotton pellet granuloma model, Novostron significantly reduced the inflammatory mass (23.65% inhibition), supporting its anti-inflammatory potential. In a murine burn model, Novostron accelerated wound contraction (25.95% at day 10), increased epidermal thickness, and enhanced collagen deposition (~44%), outperforming controls and matching or exceeding betadine. These findings suggest that Novostron promotes tissue repair by modulating inflammation. Overall, Novostron demonstrated a favourable preclinical safety and efficacy profile, and its polymer–iodine composition, which enables controlled release and localized activity highlights its potential as a promising topical therapeutic. However, the study was limited to animal models and short-term observation; further long-term and clinical investigations are needed to confirm its translational potential in human wound healing.Introducción: La Inseguridad Alimentaria (IA), vinculada a la pobreza, favorece el consumo de alimentos poco nutritivos y aumenta el riesgo de enfermedades crónicas. Su comprensión es clave en enfermería comunitaria y escolar para fomentar hábitos saludables desde edades tempranas. Objetivo: Analizar la relación entre el Nivel Socioeconómico (NSE) e IA en Estudiantes de Una Universidad Pública del Norte de Sinaloa, México. Metodología: Estudio cuantitativo, descriptivo, correlacional y transversal en estudiantes de 18 a 25 años inscritos en un programa de Licenciatura. Los participantes fueron seleccionados a partir de un muestreo aleatorio simple. La muestra fue de 311 estudiantes. Se aplicó una cédula de datos sociodemográficos, el cuestionario AMAI y la Escala Latinoamericana y Caribeña de Inseguridad Alimentaria. Resultados: En los hogares sin presencia de menores, la IA severa presenta mayor prevalencia en NSE medio (29,6%) y alto (32,5%). Se observó una correlación positiva y significativa entre el NSE y la IA, tanto en hogares sin integrantes menores de edad (rs = 0,263, p < 0,01), como en aquellos con menores (rs = 0,231, p < 0,01). Conclusiones: En esta población de estudiantes universitarios, se observó que a medida que aumenta el NSE, también lo hace la IA, lo que sugiere que esta no es exclusiva de los sectores socioeconómicos bajos, sino que también afecta de forma considerable a los niveles medio y alto. La persistencia de esta problemática en todos los niveles sugiere que factores estructurales, más allá del ingreso, como el acceso a alimentos nutritivos, educación alimentaria y estabilidad laboral, podrían influir significativamente.
ABSTRACT
Introduction: Food insecurity (FI), linked to poverty, promotes the consumption of unhealthy foods and increases the risk of chronic diseases. Understanding it is key in community and school nursing to foster healthy habits from an early age. Objective: To analyze the relationship between socioeconomic status (SES) and FI in students at a public university in Northern Sinaloa, Mexico. Methodology: A quantitative, descriptive, correlational, and cross-sectional study was conducted with students aged 18 to 25 years enrolled in an undergraduate program. Participants were selected using simple random sampling. The sample consisted of 311 students. A sociodemographic data form, the AMAI questionnaire, and the Latin American and Caribbean Food Insecurity Scale were administered. Results: In households without children, severe FI was more prevalent in middle (29.6%) and high (32.5%) SES groups. A positive and significant correlation was observed between socioeconomic status (SES) and food insecurity (FI), both in households without minor members (rs = 0.263, p < 0.01) and in those with minors (rs = 0.231, p < 0.01). Conclusions: In this population of university students, it was observed that as SES increases, so does FI, suggesting that it is not exclusive to low socioeconomic sectors, but also significantly affects middle and high levels. The persistence of this problem at all levels suggests that structural factors, beyond income, such as access to nutritious food, nutrition education, and job stability, could have a significant influence.
by Mohamadreza Hatefi, Seyedeh Feriyal Mahdavi, Amirreza Abbasi, Farideh Babakhani
BackgroundUpper extremity (UE) dominance is often defined by self-reported hand preference; however, this may not accurately reflect true functional or strength-based dominance. This study examined the relationship between writing hand, throwing hand, and maximal grip strength to assess how these measures align.
MethodsThirty-four healthy, recreationally active college-aged individuals reported their preferred writing and throwing hands and completed standardized grip strength testing. Associations among the variables were analyzed using Phi coefficients and chi-square tests.
ResultsA moderate, significant relationship was found between writing and throwing hand preference (φ = 0.456; p = 0.008), indicating general consistency across these subjective measures. However, no significant association emerged between grip strength dominance and either writing (φ = 0.027; p = 0.876) or throwing hand (φ = 0.096; p = 0.574).
ConclusionThese results suggest that grip strength dominance may not correlate with commonly used indicators of hand preference, highlighting the need for task-specific definitions of dominance in clinical and athletic contexts. Consequently, employing such task-specific definitions allows for more accurate assessments and enhances the translational relevance of research findings in practical settings.
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