Conectar
by Gift Treighcy Banda-Mtaula, Ibrahim Simiyu, Sangwani Nkhana Salimu, Stephen A. Spencer, Nateiya M. Yongolo, Marlen Chawani, Hendry Sawe, Jamie Rylance, Ben Morton, Adamson S. Muula, Eve Worall, Felix Limbani, Miriam Taegtmeyer, Rhona Mijumbi, on behalf of the Multilink consortium
Multimorbidity, the presence of multiple chronic health conditions, is a leading cause of death globally. In Malawi, chronic noncommunicable and communicable diseases such as HIV frequently co-exist, putting pressure on an under-resourced system. However, the health system is primarily structured around disease-specific [vertical] programs, which hinders person-centred care approaches to multimorbidity. Our study focuses on multimorbidity care and explores the perceptions of healthcare workers on the patient pathways and service organisation throughout the patient’s interaction with the health facilities. This cross-sectional qualitative study took an interpretivist approach. We conducted 13 days of clinical observations at Queen Elizabeth Central Hospital and Chiradzulu District Hospital. We also conducted 13 days of clinical observations and semi-structured in-depth interviews with different cadres of purposively sampled healthcare workers (n = 22) at Queen Elizabeth Central Hospital and Chiradzulu District Hospital. Through thematic analysis, we identified an understanding of the organisation of care and healthcare workers’ perspectives on the delivery of services. Findings showed both hospitals provided services for inpatients and outpatients with multimorbidity, including screening, management, prevention of secondary conditions and rehabilitation. Patient diagnosis and management for multimorbidity were often delayed due to frequent stockouts of medication and consumables necessary for diagnostic testing for NCDs at the hospital level. Some healthcare workers were not equipped with the knowledge, skills, or guidelines to manage multimorbidity. As HIV care is currently better resourced than other chronic conditions, healthcare facilities may strengthen the supply chain, healthcare workers’ training sessions and monitoring and evaluation tools to ensure NCDs are well managed, learning from HIV programmes.by Ibrahim Naif Alenezi, Fathia Ahmed Mersal, Amal Ahmed Elbilgahy
BackgroundGenerative artificial intelligence (AI) tools such as ChatGPT are increasingly used in academic research, yet evidence on postgraduate students’ perceptions remains limited in non-Western and health-professional contexts. Understanding how students perceive AI’s benefits, risks, and ethical implications is essential for informing institutional research policies.
MethodsThis cross-sectional case study surveyed 267 master’s students enrolled in nursing and health profession programs at Northern Border University in Arar, Saudi Arabia. Data were collected between October 1 and November 15, 2025, using a validated 54-item questionnaire that assessed perceived benefits, perceived risks, privacy concerns, mistrust in AI, performance anxiety, social bias, regulatory matters, liability issues, and intention to adopt AI tools. Multiple linear regression with heteroscedasticity-robust (HC3) standard errors was used to identify predictors of AI adoption intention.
ResultsMost participants (85.0%) reported prior use of AI tools, predominantly ChatGPT. Perceived benefits were the strongest predictor of intention to adopt AI for research purposes (β = 0.588, p 2 = 0.560).
ConclusionsAmong nursing and health profession master’s students at a regional Saudi university, findings indicate pragmatic optimism toward AI integration in academic research, driven primarily by perceived benefits alongside heightened ethical and privacy awareness. Privacy concerns appear to reflect critical literacy rather than barriers to adoption.
Outcomes for degenerative cervical myelopathy (DCM) patients are limited by delayed and missed diagnoses, driven in part by poor professional awareness. Despite DCM being the most common cause of adult spinal cord injury, it remains under-recognised and undertaught in clinical education. Lessons from other common pathology like stroke and acute myocardial infarction highlight the potential of education to improve early diagnosis. This study will develop a professional education strategy to improve early DCM diagnosis. It will define key audiences and identify an effective delivery method, laying the groundwork for a sustained, targeted intervention.
The study aims to define who needs to know about DCM, what they need to know and how they can learn it. This will be carried out in three phases: phase 1—who and what: to establish the target population and to define core competencies for the educational intervention; phase 2—how: to create and review the educational intervention; phase 3—evaluation: to test whether the framework is an improvement to existing strategies.
Ethical approval is in place from the University of Cambridge (HBREC.2024.24). Results from the study will be disseminated through scientific publication, conference presentation, blog posts and podcasts.
CRD42023461838
To validate the Workplace COVID-19 Knowledge and Stigma Scale (WoCKSS) using item response theory (IRT), exploratory factor analysis (EFA) and confirmatory factor analysis (CFA).
Cross-sectional psychometric validation.
Manufacturing companies registered in Malaysia.
A total of 137 factory workers participated in the exploratory phase and 300 in the confirmatory phase. Inclusion criteria were Malaysian nationality and ability to read Malay.
The knowledge domain was examined using the two-parameter logistic IRT model in two stages: an exploratory IRT analysis in phase 1 to screen items and a confirmatory IRT analysis in phase 2 to evaluate the final item set. The stigma domain was analysed using EFA followed by CFA. Reliability was assessed using Cronbach’s alpha and McDonald’s omega (). The development process and content and face validity results were previously published.
14 knowledge items were retained after exploratory IRT and formed the final knowledge scale evaluated in confirmatory IRT. For these final items, discrimination parameters ranged from 0.77 to 3.17 and difficulty values from –4.47 to 0.23, with unidimensionality supported (p=0.644). EFA supported a three-factor stigma structure (stereotype, fear, prejudice), and CFA confirmed excellent model fit (2=8.91, df=11, p=0.630; root mean square error of approximation=0.00; Comparative Fit Index=1.00; Tucker-Lewis Index=1.00; standardised root mean square residual=0.021). Composite reliability by McDonald’s omega ranged from 0.691 to 0.893.
WoCKSS is a reliable and valid instrument for assessing workplace COVID-19 knowledge and stigma in industrial sectors in Malaysia.
This study explores and understands community members' resilience in outpatient clinics, considering various dimensions and types of resilience.
A cross-sectional study.
This study was conducted in Saudi outpatient clinics from September to December 2023 and included 384 individuals chosen through systematic random sampling. Various tools were used, such as Social Cohesion and Trust Scale, Community Resilience Assessment Tool, Community Assessment of Psychic Experiences, Environmental Resilience Assessment, Economic Resilience Index, Connor-Davidson Resilience Scale, Brief Resilience Scale, Resilience Scale for Adults and Healthcare Resilience Index.
Participants displayed a robust overall resilience level, as indicated by Total Connor–Davidson Resilience Scale score of 63.0 ± 9.0. Additionally, they demonstrated commendable levels of resilience in Total Brief Resilience Scale (56.04 ± 8.6), Resilience Scale for Adults (82.5 ± 7.2) and Healthcare Resilience Index (45.8 ± 5.5). These findings offer significant insights into psychological and emotional well-being of the study population, highlighting their adaptive capacities and coping mechanisms across various life domains.
This study provides valuable insights into the multidimensional nature of resilience in outpatient settings. The cross-sectional design sets the groundwork for future longitudinal investigations, highlighting the need for a holistic approach to understanding and promoting resilience.
This study holds immediate implications for participants and their communities. It underscores the adaptive capacities and coping mechanisms prevalent in the outpatient population by revealing commendable resilience levels. This insight enhances individuals' psychological and emotional well-being, contributing positively to the overall resilience and communal strength. Additionally, this study sheds light on how resilience among community members in Saudi Arabia relates to international advanced nursing communities, providing insight into their work.
Patients who have received outpatient services in the past 6 months were purposively chosen to ensure a diverse representation across age, gender and socio-economic backgrounds in this study.
by Yeshwas Abite Workneh, Desye Melese Sisay, Abebaw Fekadu, Abraham Tesfaye Bika, Alemu Tekewe Mogus, Tesfaye Sisay Tessema
Hepatitis B virus (HBV) contributes substantially to liver cancer, related mortality, and liver transplantation worldwide. The small hepatitis B surface antigen (HBsAg), particularly its major hydrophilic region (MHR) and the “a” determinant, is the primary target of serological diagnostics. However, escape mutant amino acid variants (EMAVs) within this region may reduce diagnostic specificity and sensitivity. In this study, publicly available HBsAg sequences were analyzed to determine the prevalence of EMAVs circulating in Ethiopia. We computationally designed three region-specific recombinant antigens (MeRPYS1, MeRPYS2, and MeRPYS3) by incorporating both wild-type and prevalent EMAV sequences. Linear and conformational B-cell epitopes, as well as T helper cell epitopes, were predicted for each antigen. Homology analyses were also performed to assess similarity to host proteins. Secondary and tertiary structures of the antigens were predicted to generate theoretical molecular models. Molecular docking analyses were performed to explore putative interaction patterns between each designed antigen and an anti-HBsAg-specific antibody. The predicted antigen–antibody complexes were further examined using molecular dynamics (MD) simulations to assess their theoretical stability and behavior over time. The resulting simulations provide predictive computational insights into possible antigenic features and interaction tendencies of the designed constructs. These findings are intended to generate testable hypotheses and should be interpreted cautiously, as the study is limited to in silico analyses and requires experimental validation.by Zoya Waqas, Aisha Irum, Muhammad Ibrahim, Maheen Sughra, Sanaa Khan, Ayesha Khan, Adnan Ahmad Khan
IntroductionUnintended pregnancies remain a major public health concern globally and in Pakistan, where family planning (FP) uptake continues to be hindered by entrenched social and behavioral barriers. This study applies the Theory of Planned Behavior (TPB) to examine how attitudes, subjective norms, and perceived behavioral control (PBC) shape women’s contraceptive intentions in Pakistan.
MethodsWe analyzed data from 13,335 non-pregnant women aged 15–49 using the Pakistan Demographic and Health Survey (PDHS) 2017–18. Partial Least Squares Structural Equation Modeling (PLS-SEM) was used to test TPB pathways. Model reliability, validity, and fit were assessed using Composite Reliability, Average Variance Extracted, discriminant validity indices, and bootstrapped estimates to ensure analytical rigor.
ResultsOver half of respondents lacked formal education, and most (84%) were unemployed. Only 23% had FP knowledge, and 96% were unaware of contraceptive side effects. Subjective norms negatively influenced contraceptive intentions (β = −0.056, p Conclusion
The study demonstrates the applicability of TPB for understanding contraceptive intentions in a collectivist, patriarchal context. Subjective norms and PBC emerge as critical determinants, underscoring the need for interventions that engage families, strengthen women’s autonomy, and improve access to FP services. The findings offer a theoretically grounded and policy-relevant framework for designing behaviorally informed family planning programs in Pakistan.
by Seid Mohammed Abdu, Hussen Abdu, Endris Seid Muhaba, Ebrahim Msaye Assefa, Gosa Mankelkl
BackgroundThe sciatic nerve (SN), the longest and largest nerve in the body, arises from the L4-S3 nerve roots and exits as a single trunk below the piriformis muscle through the greater sciatic foramen. However, variations in its anatomy are common, believed to originate from embryological development. These variations show significant racial and geographical differences, which have often been overlooked in previous review studies. Therefore, this meta-analysis aims to address this gap by systematically reviewing global data to evaluate the impact of race on sciatic nerve variations.
MethodsA systematic review and meta-analysis were conducted to assess the pooled prevalence of SN variations among racial subgroups. A comprehensive literature search was performed using PubMed, Google Scholar, Hinari, and additional sources, including major anatomical journals and cross-referenced articles. Subgroup analyses by region and country were also conducted using a random-effects model. Heterogeneity was assessed with the Cochrane Q test and the I² statistic.
ResultsType A, considered the normal pattern, had the highest pooled prevalence at 86%. The remaining 14% represented variations of the sciatic nerve (SN). Among these, Type B was the most common at 7%, followed by Type C and G each observed in 2% of limbs, while less frequent variations included Type Type D (1%), Type E (0%), and Type F (0% (0–1)). Racial analysis showed that SN variations occurred in 15% of Asians, 12% of Whites, and 13% of Blacks. Regarding continents, the highest prevalence was in Asia with 15%, the second highest prevalence was observed in Europe with 14%, followed by Africa with 13%, and the lowest in America with 11%. No significant differences were found among the races and continents. However, East Asia showed the highest significant prevalence, with China at 35% and Japan at 32%.
ConclusionThis review revealed only modest and statistically non-significant differences in the prevalence of sciatic nerve variations across broad racial and continental groups. In contrast, substantial variation was observed at the regional level, with particularly high prevalence rates in East Asian countries, specifically China and Japan. These findings suggest that regional factors contribute more to the observed variations than racial factors.
Stroke is one of the top causes of disability in Malaysia, yet caregivers have limited access to structured, culturally tailored education to support poststroke care.
To develop and validate the CaknaStrok Education Package (CEP), a blended learning intervention comprising a printed guidebook and a trilingual mobile health application for informal stroke caregivers in Malaysia.
Methodological study involving the development and validation of a caregiver education programme guided by the Analyse, Design, Develop, Implement, Evaluate (ADDIE) instructional design framework.
Development and validation were conducted in Malaysia between January 2022 and December 2023. Both experts and caregivers were recruited from two tertiary hospitals on the East Coast of Malaysia, with caregivers identified from inpatient wards and outpatient clinics at these hospitals.
Content validation involved 10 multidisciplinary experts. Face validation involved 14 informal stroke caregivers who met eligibility criteria, and all completed the study.
CEP was developed based on prior needs assessment and expert input. Content validation was undertaken using the Content Validity Index (CVI) and face validation using the Face Validity Index (FVI), both assessed on a four-point Likert scale. Qualitative feedback was also obtained from the participants.
CEP consists of six modules delivered via a printed guidebook and a trilingual app with videos, assessment tools and local resources. Experts rated the content highly valid (Scale-level (S)-CVI/the average method (Ave): 0.97–0.99 across domains). Caregivers reported strong acceptability (S-FVI/Ave: 0.95–0.99). Qualitative feedback from experts and caregivers informed refinements to content clarity, usability and presentation, including improved navigation, consistent language use and enhanced visual design. Suggestions requiring substantial structural changes were documented for future iterations.
The CEP shows strong content and face validity as a blended caregiver education tool. By combining printed and digital formats, CEP addresses cultural and access challenges and provides a scalable model for stroke caregiver education in Malaysia. Further pilot or feasibility studies are warranted to evaluate usability, engagement and implementation in real-world settings prior to effectiveness evaluation.
Older adults face growing risks of depression and anxiety, yet stigma, comorbidities, cost, and limited access impede receipt of conventional care. Digital mental health interventions (DMHIs), including immersive virtual reality (VR), exergaming, and mobile apps, may reduce these barriers.
To evaluate the efficacy of DMHIs in reducing depressive and anxiety symptoms among adults aged ≥ 50 years.
We conducted a PRISMA adherent systematic review and meta-analysis of randomized controlled trials. Interventions included immersive VR, exergaming/physical digital platforms, mobile applications, and digital cognitive training. Standardized mean differences (SMDs) were pooled with random effects models; heterogeneity was assessed with I 2.
Nineteen RCTs (n = 718; mean ages 50.9–84.7 years) met inclusion criteria. Across studies, DMHIs significantly reduced depressive symptoms (SMD = −0.656, 95% CI = −0.932 to −0.380; p < 0.001) and anxiety symptoms (SMD = −0.559, 95% CI = −0.740 to −0.380; p < 0.0001). Immersive and physically engaging modalities (e.g., VR, exergaming) outperformed app-based approaches. Heterogeneity ranged from moderate to high (I 2 ≈ 69.6%–97%).
Offer DMHIs: especially VR or exergaming when access to in-person therapy is limited or as an adjunct to usual care. Provide brief onboarding and, when feasible, caregiver support to boost adherence and confidence with technology. Select or configure age-friendly interfaces (e.g., large fonts, simple navigation) to address common usability barriers. Integrate DMHIs into stepped-care or rehabilitation pathways and monitor outcomes with validated tools (e.g., GDS, STAI). Address equity by supplying devices/connectivity solutions and consider cost-effectiveness and long-term engagement in implementation plans.
Trial Registration: PROSPERO ID: CRD420250655153
This study aimed to assess the association between lipid accumulation product (LAP) index, a novel index combining waist circumference (WC) and triglyceride levels, and anthropometric indices, metabolic factors and hepatic function markers in obese subjects with non-alcoholic fatty liver disease (NAFLD).
Cross-sectional study.
Specialised and subspecialised outpatient clinics of Tabriz University of Medical Sciences.
Overall, 232 adult patients with obesity and ultrasound-proven NAFLD were included in the present study.
Anthropometric measurements (body weight, height and waist and hip circumferences) were measured, and serum levels of glucose, lipid profile, ferritin and liver enzymes were assessed subsequent to an overnight fasting.
Mild and Moderate NAFLD were found in 43.5% and 48.2% of the participants, respectively. LAP index markedly increased with higher grades of steatosis, showing values of 63.72±22.26, 84.57±44.96 and 112.14±56.97 for healthy, grade I and grade II groups, respectively (p
In conclusion, the LAP index was not only associated with anthropometric indices, metabolic parameters and hepatic function markers, but also increased in line with higher grades of liver steatosis in NAFLD.
Non-communicable diseases (NCDs) are rapidly escalating in developing countries and social factors such as the dynamics of the family play an important part in the lifestyle choices that lead to the onset and maintenance of chronic illness. There remains a gap in Malaysia as the majority of the studies were focused on the normal population rather than directly towards persons having NCDs. This study aimed to examine emerging risk factors such as family functionality and its association with NCD.
A cross-sectional survey was conducted using a multistage random sampling method.
Urban residential areas in Selangor, Malaysia.
A total of 2542 adults residing in urban areas of Selangor were recruited.
Family functionality was measured using the APGAR (Adaptation, Participation, Gain or Growth, Affection and Resources) scale and multiple logistic regression was performed to measure the association between emerging risk factors and NCD.
The prevalence of diabetes mellitus and hypertension was 10.8% and 6.1%, respectively. Widowed/separated status (adjusted OR (AOR) 41.53, 95% CI 19.06 to 90.48, p value=0.001) was reported to be a predictor of diabetes. As for hypertension, familial functionality (AOR 4.2, 95% CI 1.11 to 14.50, p value
There is a growing concern that family functionality is an emerging risk factor for NCDs. Future family-centred health promotion programmes should be incorporated to improve self-management behaviours and health outcomes.
by Yu Wang, Filzani Illia Ibrahim, Junlin Chang, Siti Norzaini Zainal Abidin
The issue of stress among urban residents is becoming increasingly serious, affecting both physical and mental health in cities in China. Pocket parks serve as essential green spaces for people’s well-being in high-density urban environments. However, limited empirical research has examined how plant landscape components support stress recovery among urban residents, particularly in the context of pocket parks in China. This study investigated the effects of plant species richness and plant landscape types on stress recovery, with a focus on the mediating role of perceived aesthetic quality. A pre-test and post-test design were conducted in six selected pocket parks with different landscape characteristics using questionnaire surveys. A total of 605 urban residents were recruited using a random sampling method at different sites. The results indicated that medium plant species richness (t = −10.502, p pby Fahad Saleem, Fazal ur Rehman Khilji, Sajjad Haider, Qaiser Iqbal, Baharudin Ibrahim, Fatiha Hana Shabaruddin, Mohammad Bashaar
Terrorism-related disasters (TRDs) continue to exert profound and recurring pressures on healthcare systems, particularly in vulnerable regions like Pakistan. Although pharmacists are increasingly recognized as an essential component of disaster management, there is a clear gap in the literature regarding their preparedness, experience, and specific roles in responding to TRDs particularly in low and middle-income countries. This study aimed to explore the preparedness, experiences, and response strategies of pharmacists managing TRDs at the Trauma Centre of Sandeman Provincial Hospital, Quetta, Pakistan. A qualitative design was adopted, guided by the Consolidated Criteria for Reporting Qualitative Research. Semi-structured, face-to-face interviews were conducted with pharmacists (n = 10) providing services at the Trauma Centre. Data were audio-recorded, transcribed verbatim, validated by participants, and analyzed using thematic content analysis. Analysis revealed five overarching themes: (1) pharmacists’ experiences with terrorism-related incidents and existing response mechanisms; (2) professional and personal responses to emergencies, reflecting both commitment and psychological burden; (3) preparedness challenges, including lack of disaster management training, limited awareness of policies and protocols, and inadequate understanding of triage and coordination; (4) barriers such as security risks, pharmacy curriculum deficiencies, insufficient experiential learning, and minimal involvement in planning and management activities; and (5) recommendations for strengthening capacity, including revising curricula, implementing structured training programs, conducting regular disaster drills, and expanding pharmacists’ roles in preparedness and response. Findings revealed a pronounced lack of formal training in disaster management, limited awareness of protocols and triage systems, and minimal involvement of pharmacists in planning and coordination activities. Despite strong professional commitment and frontline engagement, pharmacists’ contribution remain constrained by educational, structural, and policy-level shortcomings. The study highlights the urgent need for integrating disaster management into pharmacy curricula, implementing structured training programs and regular disaster drills, and expanding pharmacists’ roles within institutional and national disaster preparedness frameworks.by Ibrahim Abdalla Alfaki, Michal Grivna, Mohamed El Sadig
Despite significant progress in road safety in developed countries, it remains a persistent and critical challenge in the developing world. This study investigates the long- and short-term relationships between socio-economic conditions and road safety performance in affluent developing countries, using the United Arab Emirates (UAE) as a case study. Employing an autoregressive distributed lag (ARDL) cointegration error-corrected model with data from 1980 to 2024 (sourced from the UAE Federal Government, the World Bank, and UN World Population Prospects), the analysis examines the link between the road crash severity index (fatalities to total injuries) and core socio-economic variables—GDP per capita, unemployment rate, and population density—while controlling for traffic law enforcement via fines. The findings confirm a long-term equilibrium, with an error correction term indicating road safety adjusts to socio-economic shocks at a rapid annual rate of 60%. Granger-causality tests further establish that these socio-economic factors significantly influence road safety outcomes, a concern underscored by an identified upward trend in crash severity. We conclude that socio-economic conditions are a fundamental determinant of road safety, highlighting the necessity for policy interventions that move beyond traditional engineering solutions. Consequently, road safety must be reframed not solely as a transportation concern but as an integral objective of public health and socioeconomic policy, which requires a collaborative, multi-sectoral approach to forge a resilient, safe system.To determine the prevalence of internet addiction and examine its association with psychological factors specifically depression, anxiety and loneliness among Malaysian public university students.
Cross-sectional study.
All public universities in Malaysia, 20 universities.
The study included 7278 students from 20 public universities in Malaysia.
Statistical analyses were performed usingSTATA V.17 software. Descriptive statistics summarised participants’ demographic characteristics, prevalence of internet addiction and psychological distress (depression, anxiety and loneliness). Pearson’s correlation was used to assess bivariate relationships between internet addiction and psychological variables, while multiple logistic regression identified independent factors associated with internet addiction after adjusting for significant confounders.
The study found that 38.6% of the students showed signs of internet addiction, along with a high level of psychological distress; 24.8% had depressive symptoms, 32.4% experienced anxiety and 35.5% reported loneliness. Moderate positive correlations were observed between internet addiction and depression, anxiety and loneliness (p
The findings indicate significant associations between internet addiction and psychological factors such as depression, anxiety and loneliness. A comprehensive, multifaceted approach is essential to address psychological distress among university students and reduce the risk of internet addiction.
FreshRSS 