Conectar
To investigate whether micronized acellular dermal matrix (mADM) can be used to treat diabetes-related and traumatic foot wounds with bone defects after bone or joint resection. We retrospectively reviewed 52 patients who underwent bone or joint resection, followed by mADM-assisted reconstruction of diabetes-related or traumatic foot wounds between 2021 and 2024. mADM was applied using sheet-type, paste-type or combined formulations in one- or multi-stage procedures. Wound healing, contour preservation and radiological alignment were assessed. Among the 52 patients (43 with diabetes and 9 with trauma), complete epithelialization was achieved in 48 (mean follow-up: 14.8 months; mean time to wound closure: 5.6 weeks). Four cases showed recurrence or delayed healing and five developed mild early local infection; all were controlled with additional wound care or antibiotics, with no progressive osteomyelitis or graft loss. In 40 radiologically evaluable cases, the toe length and alignment were generally preserved (mean toe length ratio: 91.6% and no angular deformity > 10°). mADM-assisted reconstruction may be useful for treating diabetes-related and traumatic foot wounds with bone defects after bone or joint resection. Its role appears to lie in dead-space management, contour preservation and durable wound coverage, rather than bone replacement.
To identify and differentiate workload patterns across shifts and to provide evidence for optimizing nursing workforce allocation in emergency departments:
A cross-sectional study.
Real time data were collected from an emergency department in a general hospital in Seoul, South Korea, between October 30, 2023 to October 24, 2024. Smartphones, beacons, and smartwatches were used to capture nursing time, physical activity, work-related characteristics, and location transitions across 238 shifts. A multiclass eXtreme Gradient Boosting model was developed and evaluated to classify working shifts (day, evening, night). Shapely Additive exPlanations were applied to identify key contributing features, and shift-specific differences were examined using analysis of variance with post hoc tests.
The model demonstrated strong performance in distinguishing shifts. Key features included the number of admissions, discharges, assigned patients, and both direct and indirect nursing time, all of which varied across shifts. In contrast, location transition patterns were relatively consistent.
Shift-specific nursing workloads in emergency departments can be effectively identified using multidimensional, real-world nursing activity data.
Findings support the development of staffing strategies that account for variation in workload across shifts, with potential to improve efficiency and maintain quality of care.
This study addresses the lack of objective evidence for shift-specific workload differences in emergency nursing. It demonstrates that multidimensional activity data can distinguish workload patterns across shifts. The findings may inform staffing decisions for emergency department nurses and support improvements in workforce management and patient care.
This study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology guidelines.
No patients or members of the public were involved in the design, conduct, analysis, or reporting of this study.
‘Spin’ refers to reporting practices that distort the interpretation of results and mislead readers’ impression of the research findings so that the results are viewed in a more favourable light. This systematic review aims to assess the impact of spin on the impressions and/or interpretation of research findings among healthcare professionals and decision makers involved in health-related decision-making and to evaluate interventions/strategies designed to reduce the influence of spin.
This systematic review will be conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. MEDLINE (via Ovid), EMBASE, the Cochrane Library (CENTRAL) and the Education Resources Information Center (ERIC) will be searched from their inceptions to 27 January 2026. Randomised controlled trials evaluating the impact of spin on participants’ impressions and/or interpretation of research findings, as well as trials assessing the effect of interventions/strategies on the recognition and interpretation of spin, will be considered. Study selection, data extraction and risk of bias (RoB) assessment with the Cochrane RoB2 tool will be performed independently by multiple reviewers. Where sufficient data are available, meta-analyses will be conducted.
As this study is based on a review of publicly available literature, ethical approval is not required. The findings will be disseminated through publication in peer-reviewed journals, presentations at international conferences and press releases.
INPLASY202620006.
Mycoplasma pneumoniae (MP) is a major cause of community-acquired pneumonia in children. In East Asia, the prevalence of macrolide-resistant MP (MRMP) has surged, leading to treatment failures and prolonged illness. While doxycycline is an effective alternative, its use in young children has historically been limited due to concerns about tooth discolouration. This study aims to evaluate the efficacy and safety of doxycycline compared with azithromycin as a first-line treatment for children with pneumonia suspected of MRMP infection.
This is a multicentre, randomised, open-label, parallel-group superiority trial conducted at 14 tertiary hospitals in South Korea. A total of 208 children (aged 3–17 years) with pneumonia and confirmed or suspected MP infection will be randomised 1:1 to receive either doxycycline (4 mg/kg/day in two divided doses for 7–14 days) or azithromycin (10 mg/kg on day 1, then 5 mg/kg on days 2–5) (). Randomisation will be stratified by age (3–7 years vs 8–17 years). A standardised ‘rescue therapy’ protocol ensures patient safety by allowing control group patients to switch to doxycycline if no clinical improvement is observed within 48–72 hours. The primary outcome is the defervescence rate within 72 hours after randomisation. Secondary outcomes include treatment failure rate, length of hospital stay, symptom duration and adverse events. Safety assessment will specifically include tooth discolouration evaluation at Day 28, focused on children aged
This study has been approved by the Institutional Review Boards (IRB) of all participating centres. Written informed consent will be obtained from parents or legal guardians, and assent will be obtained from children aged 7 years and older. Results will be disseminated through peer-reviewed publications and conference presentations.
by Seo-Yun Choi, Yuri Jang
Perceived neighborhood danger poses significant risks to mental health in later life, yet the underlying psychological mechanisms remain unclear. Given that environmental stressors can compromise sleep health, we conceptualize insomnia symptoms as a potential mediator in the association between perceived neighborhood danger and depressive symptoms. Data from 2,240 adults aged 65 or older from Wave 3 of the National Social Life, Health, and Aging Project (NSHAP) were analyzed. Multivariate analyses showed significant associations of both perceived neighborhood danger and insomnia symptoms with depressive symptoms after controlling for sociodemographic and health covariates. Bootstrap mediation analysis provided supportive evidence for the indirect effect of perceived neighborhood danger on depressive symptoms through insomnia symptoms (B = .04, SE = .01, bias-corrected 95% CI = [.02, .07]), accounting for 25.8% of the total effect. Insomnia symptoms were identified as an important pathway through which perceived neighborhood danger undermines mental health in older adults.Hepatocellular carcinoma (HCC) recurs in most patients after curative treatment. Late recurrence (>2 years after curative treatment) typically indicates de novo tumours in the residual liver. Although contrast-enhanced computed tomography (CECT) and MRI are widely used for post-treatment follow-up, they each have limitations including radiation exposure, high cost and limited access. The abbreviated MRI using gadoxetic acid versus multiphasic CECT for detection of late recurrent HCC after curative treatment (AMRICT) trial aims to compare gadoxetic acid-enhanced abbreviated MRI using hepatobiliary phase imaging (HBP-AMRI) and multiphasic CECT for detecting late recurrent HCC after curative treatment.
This prospective multicentre intra-individual comparison trial will enrol 455 participants who have undergone surgical resection or local ablation for HCC and remained recurrence-free for over 2 years. Each participant will undergo two imaging sessions at 6±2 month intervals, using both HBP-AMRI and multiphasic CECT. The primary endpoint is the detection rate of all-stage HCC. The secondary endpoints include the false referral rate of all-stage HCC and detection and false referral rates of Barcelona Clinic Liver Cancer stage 0–A HCC and of stage 0 HCC. Structured imaging protocols and quality assessments will be implemented for both modalities.
This study was approved by the Institutional Review Boards of the three participating institutions (approval number: 2023–1630 (Asan Medical Center), H-2407-146-1556 (Seoul National University Hospital) and B-2410-929-401 (Seoul National University Bundang Hospital)) and registered at ClinicalTrials.gov (NCT06537193). Findings will be disseminated through peer-reviewed journals, scientific meetings, public forums and guideline updates.
ClinicalTrials.gov: NCT06537193. Participant enrolment began on 12 December 2024, and is ongoing.
To investigate the impact of parenting stress in both fathers and mothers on the quality of life (QoL) of children with down syndrome (DS) and the mediating effect of family adaptation.
This cross-sectional study was conducted between April 2023 and August 2023.
A total of 106 father–mother dyads of children with DS aged 2–12 years in South Korea were included. The parents independently completed questionnaires assessing parenting stress, family adaptation, and their children's QoL. The Actor–Partner Interdependence Mediation Model was used for the dyadic analysis.
The direct effect of parenting stress on children's QoL was not significant; however, the indirect effect of family adaptation was significant. Fathers' parenting stress indirectly influenced their children's QoL through their own and their mothers' family adaptations. Conversely, mothers' parenting stress indirectly influenced their children's QoL through their own family adaptation, although the mediating effect of fathers was not statistically significant.
Higher family adaptation in both fathers and mothers was associated with an improved QoL in children with DS. The pathways through which parents influenced their children's QoL differed but were interdependent. Therefore, dyadic interventions aimed at improving family adaptation in both fathers and mothers may help improve the QoL of children with DS.
This is the first study to examine parental influence on children's QoL based on dyadic interactions among fathers, mothers, and children with DS. This study highlights the importance of assessing and promoting fathers' and mothers' levels of family adaptation to improve the QoL of children with DS. Nurses should consider effective dyadic interventions for families that include both parents to maximise improvements in the QoL of children with DS.
No patient or public contributions.
This study adhered to the STROBE guidelines for cross-sectional studies.
Healthcare quality improvement increasingly relies on patient experience data, yet traditional survey modes face declining response rates and rising costs. Mobile web surveys have emerged as a promising alternative for improving response rates. The primary aim of this study was to investigate the effectiveness of mobile web surveys in improving response rates in South Korea’s Patient Experience Assessment. We also aimed to assess the impact of a mixed-mode approach integrating mobile web and follow-up telephone surveys across different demographic groups.
A randomised experimental design was employed to compare response rates as well as contact and cooperation rates among survey modes. A total of 4800 patients from four general hospitals were randomly allocated to telephone, mobile web or mixed-mode survey, with 1600 patients per mode. Each mode allowed five contact attempts through calls or mobile survey links. The mixed-mode survey included follow-up calls for mobile non-respondents.
The survey was conducted between October and November 2022 among patients discharged from four general hospitals in South Korea.
A total of 4800 patients aged 19 years or older who were hospitalised for more than 1 day and discharged within 2–56 days from four general hospitals were included in this study. Exclusion criteria included patients in day clinics, palliative care, paediatrics and neuropsychiatry, as well as those without personal information consent forms during hospital admission.
The primary outcome measure was the response rate for each survey mode. Secondary outcome measures included the contact rate and the cooperation rate.
The mobile web survey yielded an overall higher response rate (32.5%) than the telephone survey (22.4%), with the mixed-mode survey achieving the highest response rate (39.3%). Decomposing response rates revealed that while contact rates were comparable for both telephone and mobile web surveys, the cooperation rate was considerably higher for the mobile web survey (73.2%) compared with the telephone survey (52.2%). Substantial gender-age subgroup differences were found.
Adopting mobile web surveys for patient experience assessments, which aligns with the public’s preference for information and communication technologies, could significantly improve response rates in patient experience surveys.
KCT0011374 (post-results).
This study aimed to address two objectives: (1) To analyse the meal support behaviours of direct care workers in long-term care facilities in South Korea and (2) to explore associations between mealtime support behaviours and caregiver characteristics.
Secondary analysis of behavioural coding of cross-sectional video recordings.
Positive and negative staff behaviours at mealtimes were coded using the Mealtime Engagement Scale and Cue Utilization and Engagement in Dementia tool, respectively. Statistical analyses, including t-tests and analysis of variance, were used to examine differences in mealtime support behaviours based on caregiver characteristics.
The average mealtime duration of residents was 19.03 ± 5.30 min. Positive meal support behaviours accounted for 91.1% of the observed interactions, whereas negative interactions accounted for 8.9%. The most frequent positive behaviour observed was ‘providing one-on-one assistance’, whereas the most frequent negative behaviour was ‘leaving the resident alone’. Positive meal support behaviours were observed at significant higher frequencies among caregivers working during day shifts than those working during rotating shifts. Additionally, positive behaviours were associated with a higher carer-resident ratio.
Positive mealtime support behaviours were frequently observed but were concentrated in a few specific actions. Negative behaviours, such as leaving the resident alone, were still observed in a considerable portion of mealtime interactions. Training programmes focusing on diverse positive mealtime support behaviours should be developed to improve the quality of dementia care in long-term care facilities.
The findings emphasise the need for targeted training programmes to improve mealtime support and overall care quality in long-term care facilities. This approach signals a transformative shift in caregiver training, fostering more personalised and effective care for older adults with dementia.
This study quantified positive and negative mealtime support behaviours. These findings contribute to understanding caregiver behaviours during mealtimes in dementia care, offering evidence-based insights for developing targeted training programmes and improving quality of care in long-term care facilities.
We adhered to the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines.
No patient or public contribution.
To explore the lived experiences of Chinese older adult cancer patients in Hong Kong navigating the challenges of long COVID.
A descriptive phenomenological study.
Semi-structured interviews were conducted with 27 purposively sampled older Chinese cancer survivors in Hong Kong between January 2023 and January 2024. Data were analysed using Colaizzi's thematic analysis method.
Four key themes emerged: (1) the invisible scars of COVID-19: unrecognised and diverse symptoms; (2) the double-edged sword of protection: shielding from COVID-19 while battling cancer and long COVID; (3) forging strength in the crucible: adapting and thriving with cancer and long COVID and (4) nurturing resilience: the integral role of nursing in supporting cancer patients with long COVID during a pandemic.
Older Chinese cancer patients with long COVID experience a dual burden of unrecognised physical symptoms and profound psychological distress from isolation. Despite this, they demonstrate remarkable resilience, a process that can be actively supported through specialised nursing care.
This study offers original contributions to the limited literature on the intersection of cancer, long COVID, and ageing. It provides in-depth insights into the lived experiences of this vulnerable population, highlighting the diversity of long COVID symptoms, the psychological impact of pandemic-related precautions, and the crucial role of nursing in fostering resilience.
This study highlights the urgent need for nurses to recognise the unique challenges of this population. It provides a foundation for developing nurse-led, resilience-focused interventions that integrate tailored education, emotional support, and resource navigation into oncology care. These findings can inform practice and policy to better support the well-being of a vulnerable and growing patient demographic.
The study adhered to the consolidated criteria for reporting qualitative research (COREQ) checklist.
No patient or public contribution.
Alcohol consumption above recommended limits has been associated with increased cardiovascular disease (CVD) risk in observational studies. In particular, little is known about the association between high-risk drinking and cardiovascular health (CVH), as assessed by the American Heart Association’s Life’s Essential 8 (LE8) health metrics, in the context of community-based population datasets. Therefore, this study aimed to determine the relationship between high-risk drinking and CVH status using data from the 2016–2021 Korea National Health and Nutrition Examination Survey (KNHANES).
Cross-sectional secondary analysis study.
The 2016–2021 KNHANES.
This analysis included 18 500 adults aged 19 years or older.
High-risk drinking was defined as consuming seven or more drinks (or five cans of beer) in one sitting for men, and five or more drinks (or three cans of beer) for women, at least once a month. The frequency of high-risk drinking was categorised as follows: ‘rarely or never’, ‘less than once per month’, ‘at least once per month’, ‘once a week’ or ‘nearly daily’. We calculated an LE8 score for each of eight composite metrics, with each metric ranging from 0 to 100. LE8 total scores were categorised as 0–49, 50–79 and 80–100, representing low, moderate and high CVH, respectively. We used weighted log-linear regression models to analyse the relationship between high-risk drinking and CVH.
Nearly daily or weekly high-risk drinking was reported by 37.3% of men and 14.7% of women. The mean CVH score of groups with more frequent high-risk drinking decreased linearly in both sexes. Using the ‘nearly daily’ drinking group as the reference group, the exponential coefficients (exp(B)) showed that the total CVH score increased progressively as the frequency of high-risk drinking decreased in both men and women. Compared with the ‘nearly daily’ group, the total CVH score was 5% higher in the ‘once a week’ group (exp(B)=1.05, p
This study found that high-risk drinking was negatively associated with ideal CVH in Korean adults, and this association showed sex differences. Interventions targeting high-risk drinking may be more effective than focusing on overall alcohol consumption.
This study aimed to analyse patient-initiated compliment letters from a single institution, identify the key elements that patients value and offer actionable insights to enhance patient-centred care.
A retrospective, single-institution study using the Healthcare Complaints Analysis Tool (HCAT), text network analysis and latent Dirichlet allocation (LDA) topic modelling on patient compliment letters to pinpoint key valued care elements.
A newly established general hospital in Gwangmyeong, South Korea, opened on 22 March 2022.
A total of 1213 compliment letters were collected through the hospital’s feedback system, which accepted both online and on-site submissions between 25 March 2022 and 28 June 2024. Letters lacking substantive descriptive content and those containing purely administrative requests were excluded.
The HCAT was adapted to categorise positive statements into clinical, management and relationship domains, along with six stages of care. Inter-rater reliability was evaluated using Gwet’s AC1 statistic. A text network analysis, applying a term frequency–inverse document frequency approach, was conducted to identify prominent keywords. Subsequently, LDA was performed to extract thematic topics.
Most compliments concerned the ‘relationship’ domain (62%), particularly during the care in the ward stage (56%). Keyword analysis indicated that the most frequently mentioned terms were ‘gratitude’, ‘kindness’, ‘nurse’, ‘doctor’ and ‘heart/mind’, underscoring patients’ high valuation of positive interactions, professional competence and compassionate communication with medical staff. Topic modelling identified three primary topics, namely, ‘appreciation of nursing care’ (39%), ‘professionalism in surgery and treatment’ (35%) and ‘effective communication during consultations’ (26%).
Positive relationships with medical staff, particularly kindness, professionalism and effective communication, influence patient satisfaction. Patient compliment letters serve as important indicators of exceptional care and can inform quality improvement initiatives. Healthcare institutions should leverage these insights to enhance patient-centred services by strengthening patient–provider relationships and promoting a culture of excellence.
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.
This study aimed to investigate the association between smoking behaviours during early pregnancy and the risk and severity of gestational diabetes mellitus (GDM), with a particular focus on smoking status, smoking intensity and secondhand smoke exposure.
Secondary analysis of prospectively collected cohort data.
Multi-centre study conducted in South Korea (Korean Pregnancy Outcome Study) between March 2013 and January 2017.
From 4537 pregnant women initially enrolled, 3457 singleton pregnancies were included after excluding cases with transfer, loss to follow-up, twin pregnancies, miscarriages and pre-existing diabetes mellitus. All participants were women of Korean ethnicity.
Primary outcome was GDM and its subtypes (A1GDM: diet-controlled; A2GDM: insulin-requiring). Secondary outcomes were associations with active smoking (before pregnancy and during early pregnancy), smoking intensity dose–response relationships (pack-years) and secondhand smoke exposure among never-smokers.
Among 3457 participants, 231 women (6.7%) were diagnosed with GDM (198 A1GDM, 33 A2GDM). Active smoking before pregnancy (adjusted OR (aOR) 3.98, 95% CI 1.58 to 9.30) and during early pregnancy (aOR 9.90, 95% CI 2.97 to 29.45) were significantly associated with A2GDM, while no significant association was observed with A1GDM. A clear dose-response relationship was observed, with smoking intensity >4 pack-years markedly increasing A2GDM risk (aOR 20.68, 95% CI 6.75 to 59.39). Detailed pack-year analysis showed 4–6 pack-years (aOR 20.57, 95% CI 5.80 to 65.46) and >6 pack-years (aOR 25.98, 95% CI 3.21 to 146.45). Among never-smokers, secondhand smoke exposure showed a borderline association with overall GDM risk (aOR 1.33, 95% CI 0.98 to 1.81).
Maternal active smoking before and during early pregnancy, as well as higher smoking intensity, was associated with an increased risk of pharmacologically treated GDM (A2GDM). Although secondhand smoke exposure did not reach statistical significance, the trend suggested a potential association with GDM risk among never-smokers. These findings provide important evidence for public health strategies for prenatal care, as smoking cessation and environmental smoke avoidance during prenatal and early antenatal care in women reduce the risk of gestational diabetes.
Patients undergoing abdominal surgeries have a chance to experience surgical-related anxiety. But the most effective non-pharmacological interventions in managing this anxiety have not yet been identified.
To examine the effectiveness of different types of non-pharmacological interventions, and identify the effective components on pre- and postoperative anxiety management among patients undergoing abdominal surgeries.
A systematic search of randomized control trials (RCTs) examined the effects of non-pharmacological interventions on preoperative and/or postoperative anxiety (Primary outcomes) among patients undergoing abdominal surgery was conducted across MEDLINE, Ovid Nursing, AMED, PsycINFO, CINAHL, EMBASE, Cochrane Library, HyRead, and WANFANG DATA from 1987 to March 1, 2024. Secondary outcomes including postoperative pain, postoperative analgesics consumption, resumption of postoperative bowel movements, and length of hospital stay were also examined. Cochrane Risk of Bias Tool (version 2.0) was used for quality assessment. Meta-analysis was performed to synthesize the findings. Narrative summaries were provided for the studies that could not be included in the meta-analysis.
This review included 35 RCTs. The interventions of included studies were categorized as prehabilitation, sensory stimulation, preoperative counseling, information provision, and psychological interventions. Meta-analysis revealed that preoperative counseling was beneficial in managing preoperative anxiety (SMD = −1.36; 95% CI = −1.96, −0.76), postoperative anxiety (SMD = −1.30; 95% CI = −1.62, −0.98), and postoperative pain (SMD = −0.84; 95% CI = −1.21, −0.47). Meanwhile, psychological interventions adopting relaxation exercises had potential effects in reducing postoperative opioid consumption and shortening time to postoperative bowel movement.
Adopting preoperative counseling is suggested for the management of pre- and postoperative anxiety and postoperative pain among patients undergoing elective abdominal surgeries. A one-off lasting for 20–45 min preoperative counseling including individualized information about the coming surgery and perioperative process, and a discussion addressing patients' concerns is recommended. Future research is needed to explore the effects of relaxation exercise on important patients' outcomes such as postoperative analgesics consumption and time to resume bowel movement among patients undergoing abdominal surgery.
PROSPERO registration number: CRD42023359484
(1) To determine the mediating effects of children's transition readiness, which reflects self-management skill acquisition, and family resilience on the relationship between parenting stress and the quality of life (QOL) of parents and children with spina bifida (SB). (2) To conduct an exploratory analysis of the differences in the mediating pathways based on the presence of SB-related clinical characteristics.
A cross-sectional study.
Data were collected from a single centre in South Korea between October 2022 and July 2024. Participants included children aged 7–13 years diagnosed with myelomeningocele, lipomyelomeningocele or tethered cord syndrome, along with their parents. Statistical analysis was conducted using SPSS and the MEDYAD macro for actor–partner interdependence mediation model analysis.
Family resilience significantly mediated the relationship between parenting stress and both child and parent QOL. However, transition readiness was not a significant mediator in the overall sample. Among children with SB-related clinical characteristics, transition readiness significantly mediated the association between parenting stress and child QOL. In contrast, family resilience mediated the relationship between parenting stress and parent QOL. No significant mediators were found in children without SB-related clinical characteristics.
This study highlights the mediating role of family resilience and transition readiness in improving the QOL of children with SB, particularly those with clinical characteristics. The findings suggest that interventions should be tailored to address both family resilience and transition readiness, especially for children with SB-related clinical challenges.
These findings are valuable for nurses supporting children with SB, as the results highlight the importance of transition education tailored to SB-related clinical characteristics. In particular, nurse-led transition education may play a key role in enhancing transition readiness and improving the QOL of children with SB who have clinical characteristics.
None.
STROBE Checklist for cross-sectional studies.
To evaluate how recurrent COVID-19 infections influence the clinical course of patients with chronic obstructive pulmonary disease (COPD), focusing on moderate-to-severe symptom flare-ups, all-cause mortality and long covid.
Nationwide retrospective cohort study.
Korean Health Insurance Review and Assessment database covering the entire Korean population between January 2020 and December 2023.
A total of 313 760 patients aged ≥40 years who met an established operational definition of COPD based on diagnostic codes and inhaled therapy prescriptions. Patients were stratified by the number of COVID-19 events: none, one, two or three or more.
The primary outcomes were moderate-to-severe COPD exacerbations and all-cause mortality. The secondary outcome was long covid, defined by WHO criteria using International Classification of Diseases (ICD)-10 codes persisting ≥2 months within 3 months after infection.
Among 313 760 patients, 154 095 (49.1 %) experienced at least one COVID-19 event. COVID-19 infection was associated with increased risk of exacerbations (adjusted HR (aHR) 1.64, 95% CI 1.62 to 1.66) and mortality (aHR 2.25, 95 % CI 2.19 to 2.31). Risk rose progressively with repeated infections, reaching an aHR of 2.41 for exacerbations and 2.93 for mortality after three or more events. Long covid was more frequent in patients with multiple infections, but most cases occurred after the first event, with diminishing occurrence after subsequent infections.
Recurrent COVID-19 infections in patients with COPD were linked to progressively higher risk of exacerbations and mortality, whereas the burden of long covid was greatest after the first infection. Preventing the initial infection and reducing reinfection risk remain critical components of COPD care in the post-COVID-19 era.
Statins are a cornerstone of cardiovascular disease prevention yet remain underused among eligible patients. Clinical decision support systems embedded in electronic health records (EHRs) are commonly used to encourage guideline-concordant prescribing. Interruptive reminders (eg, pop-ups) may be effective but interfere with clinical workflows and contribute to alert fatigue. Non-interruptive alerts are less intrusive, but their effectiveness remains unclear. The Interruptive versus Non-Interruptive Reminders for Statin tHerApy in Primary Care (INIRSHA-PC) trial is designed to evaluate the comparative effectiveness of interruptive and non-interruptive reminders on statin-prescribing rates.
INIRSHA-PC is a single-centre, pragmatic, three-arm, parallel-group randomised controlled trial embedded in the EHR at Vanderbilt University Medical Center. The trial will enrol adults aged 18–74 seen in primary care who are eligible for, but not currently prescribed, statin therapy. The planned sample size is 3000 patients (1000 per arm). Enrolled patients will be randomised 1:1:1 to (1) interruptive reminder, (2) non-interruptive reminder or (3) no reminder (usual care). The primary outcome is statin prescription within 24 hours of enrolment. Secondary outcomes are statin prescribing within 12 months and low-density lipoprotein cholesterol levels measured between 30 days and 12 months after enrolment. Enrolment began on 14 August 2024. The study is expected to be completed on 19 November 2025.
The trial has been approved by the Vanderbilt University Medical Center Institutional Review Board with waiver of patient informed consent (IRB number: 240419). Results will be disseminated through peer-reviewed publication and presentation at scientific conferences.
To investigate factors affecting the quality of life of parents of children with spina bifida and examine how family resilience mediates between parental depression and quality of life.
Cross–sectional study.
Secondary data analysis was performed using first-year data from a five-year spina bifida cohort project (2022–2026) in South Korea. The study included 162 parents of children aged 4–12 years with spina bifida. Data were collected using the Korean version of the Family Resiliency Scale, the Center for Epidemiologic Studies Depression Scale, and the WHO Quality of Life Scale.
Factors were found to have a statistically significant influence on the quality of life of parents of children with spina bifida: the child's need for enemas, parental stress, parental depression, and family resilience. Baron & Kenny's mediation analysis and bootstrap analysis in SPSS further confirmed that family resilience plays a mediating role between parental depression and quality of life. The indirect effect of parental depression on quality of life through family resilience was statistically significant, with a 95% confidence interval of [−0.2615, −0.0516].
The quality of life of parents with children with spina bifida is significantly influenced by both their child's daily symptom management and their psychological health. Family resilience plays a positive mediating role between parental depression and quality of life.
These findings support a two-track approach to family resilience building programs and the development of core intervention strategies to enhance the quality of life in spina bifida families.
This study adhered to Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.
There was no direct patient involvement in the study design, data collection, or analysis.
This study aimed to identify the predictors of burnout, anxiety and depression among healthcare professionals during the COVID-19 pandemic.
A secondary quantitative analysis of data from the Mental Health Research Canada (MHRC).
Healthcare professionals across Canada during the COVID-19 pandemic.
1439 Canadian healthcare professionals.
Data from MHRC, collected between April 2020 and January 2024, including sociodemographic factors and measures of burnout, anxiety and depression.
In total, 1439 participants were included in the analysis. Women (OR: 2.25; 95% CI 1.46 to 3.48), younger workers (OR: 2.29; 95% CI 1.29 to 4.06) and mental health professionals (OR: 2.59; 95% CI 1.11 to 6.01) were more likely to experience burnout. Meanwhile, men (OR: 2.05; 95% CI 1.40 to 3.00), younger workers (OR: 8.58; 95% CI 4.12 to 17.86) and physicians (OR: 2.01; 95% CI 1.16 to 3.46) had an increased likelihood of being diagnosed with anxiety. Similar findings were obtained for depression, where men (OR: 1.74; 95% CI 1.18 to 2.56), young workers (OR: 5.22; 95% CI 2.68 to 10.18), physicians (OR: 2.11; 95% CI 1.22 to 3.64), visible minorities (OR: 2.29; 95% CI 1.55 to 3.38) and those with a physical impairment (OR: 4.79; 95% CI 2.55 to 8.97) were more likely to receive a diagnosis since the COVID-19 pandemic.
These findings underscore the need for targeted clinical interventions among healthcare professionals during and beyond public health emergencies. Specifically, healthcare institutions should implement accessible mental health programmes, regular psychological assessments and workload management strategies for those who face increased vulnerabilities to mental health struggles.
FreshRSS 