Conectar
by Yu-Chun Diao, Meei-Fang Lou
IntroductionEffective communication between healthcare providers and families is critical in ICUs, yet existing assessment scales predominantly focus on unidirectional, face-to-face interactions. The COVID-19 pandemic accelerated adoption of digital communication modalities that have persisted in contemporary practice. This study developed and validated the Healthcare Provider and Family Bidirectional Digital Communication Scale (HF-BDCS) to address these gaps.
Materials and MethodsThe HF-BDCS was developed through literature review and qualitative interviews with 15 stakeholders (healthcare providers and family members). Content validity was assessed by 5 experts. Psychometric evaluation with 300 participants (100 physicians, 100 nurses, 100 family members) included exploratory factor analysis and internal consistency assessment using Cronbach’s alpha.
ResultsExpert review yielded 14 items with excellent content validity (S-CVI/Ave: relevance=1.00, importance=1.00, clarity=0.98). Exploratory factor analysis produced a 13-item scale with three factors explaining 64.53% of variance: Digital Communication Efficiency and Quality (6 items, 25.87%), Digital Communication Perceptions (5 items, 25.12%), and Digital Communication Regulations (2 items, 13.54%). Internal consistency was good (Cronbach’s alpha=0.80-0.86) across all factors and participant subgroups.
DiscussionThe HF-BDCS is the first validated bidirectional instrument for assessing digital communication in ICUs, demonstrating strong psychometric properties. By capturing both healthcare provider and family perspectives, the scale enables identification of perception discrepancies and supports improvements in digital communication practices, ultimately enhancing patient- and family-centered care in contemporary ICUs.
by Jin-Hwa Kim, Ji-Soo Jeong, Jeong-Won Kim, Eun-Hye Chung, Su-Ha Lee, Je-Won Ko, Youn-Hwan Hwang, Tae-Won Kim
Moutan Cortex (MC), the dried root bark of Paeonia suffruticosa, is used in traditional Chinese and Korean medicine to treat enteritis for its anti-inflammatory properties. This study compared the pharmacokinetic (PK) profiles of paeonol and paeoniflorin in normal and dinitrobenzene sulfonic acid (DNBS)-induced colitis rats, and to determine how repeated low-dose MC [MC(L), 0.5 g/kg] or high-dose MC [MC(H), 2.5 g/kg] alters PK and disease severity. Using ultra-performance liquid chromatography–tandem mass spectrometry, we found that DNBS modestly increased paeonol AUClast (NC: 247.8 ± 63.7 vs DNBS: 337.0 ± 120.8 hr*ng/mL) and decreased paeoniflorin (NC: 474.1 ± 11.7 vs DNBS: 463.7 ± 106.8 hr*ng/mL) compared to controls (ns). After repeated dosing, the maximum plasma concentration (Cmax) of paeonol was higher in the MC(H) than that in the MC(L) group (MC(L): 63.81 ± 29.74 vs MC(H): 4221.5 ± 1579.2 ng/mL, p max in the MC(H) group was also higher than MC(L) group (MC(L): 60.5 ± 15.3 vs MC(H): 164.7 ± 74.7 ng/mL, pby Yi-Hua Wu, Chia-Ing Li, Chiu-Shong Liu, Chih-Hsueh Lin, Shing-Yu Yang, Cheng-Chieh Lin, Tsai-Chung Li
Glycemic variability (GV) is an emerging biomarker of glycemic control and may be a predictor for lung function impairment in persons with type 2 diabetes mellitus (T2DM). However, the associations between GV and lung function variables and lung function impairment have not been fully evaluated. The objective of this study was to assess the associations of glycemic variability (GV) with lung function impairment in persons with T2DM. A follow-up study was conducted on the data of 3,108 subjects collected from 2001 to 2020 using the diabetes care management program database in Taiwan. GV in fasting plasma glucose (FPG) was calculated using standard deviation (SD), average real variability (ARV), coefficient of variation (CV), variability independent of the mean (VIM), and slope of 1-year repeated measurements. A ratio of forced expiratory volume in 1 s (FEV1) to forced vital capacity (FVC) less than 0.70 was used to define lung function impairment. Multivariable linear and logistic regression models were applied to explore the relationships of GV with lung function variables and lung function impairment. A total of 359 (11.6%) subjects were defined as having lung function impairment. After multivariable adjustment, FPG‐SD, FPG-CV, FPG-AVR, FPG-VIM and were found to be negatively linked with FEV1, % predicted FEV1, and FVC but not FEV1/FVC. Relative to those for the first tertile, the odds ratios (ORs) of lung function impairment for the second and third tertiles were 1.37 (95% confidence interval [CI]: 1.01, 1.87) and 1.51 (1.10, 2.08) for FPG-CV, respectively; 1.59 (1.16, 2.17) and 1.73 (1.24, 2.40) for FPG‐SD, respectively; and 1.57 (1.15, 2.13) and 1.69 (1.22, 2.33) for FPG-AVR, respectively. GV, measured by CV, SD, VIM, and VIM, is linked with lung function impairment and all lung function variables, except for FEV1/FVC ratio. GV may serve as a useful biomarker for assessing lung function impairment in persons with T2DM.To synthesise the current evidence about practices, preferences and challenges related to returning aggregate research results to participants, with implications for public health, health equity and policy development.
Scoping review conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews framework.
Four electronic databases—PubMed (National Library of Medicine), Excerpta Medica Database (Elsevier), Cumulative Index to Nursing and Allied Health Literature (Elton B. Stephens CO(mpany)) and Cochrane Library (Wiley)—were from inception to February 2025.
English-language, peer-reviewed articles reporting practices or preferences for returning aggregate clinical research results to participants. Studies reporting only individual/incidental findings, opinion pieces and non-original research were excluded.
Two reviewers independently screened studies and extracted data. Study quality was assessed using a modified Oxford Centre for Evidence-Based Medicine scale. Thematic synthesis identified patterns in dissemination methods, participant preferences and implementation barriers.
Of 272 articles screened, 12 published between 2002 and 2019 were included. They employed cross-sectional, qualitative and mixed-methods design across North America, Europe, Africa and Australia. Half focused on cancer; others addressed malaria, autism, hypothyroidism, HIV prevention and preterm labour. Most (8/12) included patients; others also included researchers, caregivers or mixed stakeholders. Participants were predominantly middle-aged or older, female and well-educated. Only two studies assessed literacy, both using unvalidated self-reports. Eight studies explored preferences without returning results; four implemented disseminations via mailed reports, printed summaries, in-person discussions or digital platforms. Participants favoured mailed letters and face-to-face meetings over online methods. Six themes emerged: receiving results as respect; preference for personalised, timely formats; importance of cultural tailoring; emotional and ethical considerations; institutional barriers; and community engagement as a facilitator.
Returning aggregate research results to participants is ethically supported and strongly desired yet rarely practised. Bridging this gap requires clearer policy guidance, institutional support and equity-focused dissemination strategies. Health systems and researchers should adopt scalable, participant-centred approaches to fulfil ethical obligations and strengthen public trust in science.
by Jianhua Liao, Jun Cheng, Baoqing Liu, Yuzhi Shao, Chunyan Meng
The growing prevalence of methicillin-resistant Staphylococcus aureus (MRSA) infections, coupled with the increasing resistance to existing antibiotics, underscores the critical need for novel therapeutic approaches to combat this pathogen. In this study, the role of yqhG, a conserved gene encoding a periplasmic protein, in MRSA virulence and stress adaptation was investigated. yqhG deletion in MRSA significantly attenuated virulence in a murine infection model, leading to reduced bacterial burden in infected organs and improved host survival. In vitro, the yqhG mutant exhibited impaired membrane integrity, reduced motility, and increased sensitivity to oxidative stress, but did not affect biofilm formation. These defects were fully restored upon genetic complementation. These findings highlight the critical role of yqhG in maintaining MRSA’s ability to withstand host-imposed stresses, suggesting that yqhG is a key determinant of MRSA pathogenesis. The study provides new insights into the stress-defense mechanisms employed by MRSA and underscores yqhG as a potential target for therapeutic strategies aimed at combating MRSA infections.by Ya-Chun Feng, Bo-Cheng Kuo, Wen-Yau Hsu
Previous studies have demonstrated that emotional facial expressions influence attention and perception in individuals with social anxiety. However, the relative influence of positive versus negative expressions on distinct subprocesses of attention and perception remains unclear. This event-related potential (ERP) study investigates the temporal dynamics of electrophysiological responses to emotional faces in high (HSA; N = 56) or low (LSA; N = 47) social anxiety individuals using a dot-probe task. Four face pairs (angry-neutral, happy-neutral, angry-happy, and neutral-neutral) were presented to probe the influence of positive and negative expressions. While behavioural results showed no significant group differences in attention bias, ERP results showed a reduced N170 amplitude for the HSA vs. LSA group in angry-neutral, happy-neutral, and angry-happy face pairs. Furthermore, enhanced N2pc effects to emotional expressions were found only in the HSA group when angry-neutral and happy-neutral face pairs were presented. No N2pc effect emerged when both positive and negative expressions were presented simultaneously. Finally, no significant P1 effect was found. Together, both positive and negative expressions influenced attentional deployment and face-specific processing in relation to social anxiety. Socially anxious individuals perceived less emotional facial information, yet their attention was biased by both negative and positive expressions.To synthesise the current research on long-term care workers' perceptions (i.e., attitudes, concerns, and expected functions) of robot-assisted care and their perceived effects of different types of robot-assisted care for older adults in long-term care facilities.
Scoping review.
A search was conducted in July 2024 using five databases. Articles published between 2010 and 2024 on the perceptions and/or perceived effects of robot-assisted care for older adults among frontline long-term care workers in long-term care facilities were identified. Additionally, the reference lists of the included articles were manually searched.
A five-step framework that guided the development of research questions, screening of studies, and synthesis and presentation of data was adopted. Two authors independently screened and analysed the identified articles. Conflicts were resolved through joint-discussions.
Forty-one articles were included in the review. Data were narratively synthesised into three categories: expected function of care robots, perceived effects of robot-assisted care, and attitudes and concerns regarding robot-assisted care. Subcategories were identified and presented in tabular form.
This review shows the physical, psychological, social, and practical benefits and limitations of different types of robot-assisted care. It also contributes to understanding long-term care workers' attitudes, concerns, and expectations regarding the function of robot-assisted care.
Having a priori discussion with long-term care workers about their expectations regarding using robot-assisted care is needed. Improvements in the design and in the digital literacy of the workers are also necessary.
This review provides an overview of the perceptions and perceived effects of different types of robot-assisted care among care workers in long-term care facilities. The findings provide practical implications and highlight areas in need of further studies.
Scoping Review (PRISMA-ScR) checklist.
No Patient or Public Contribution.
To explore the influence of broader cultural and social factors on clinicians' care delivery to patients from culturally and linguistically diverse backgrounds in the emergency department.
A qualitative exploratory study.
A social ecological perspective drawn from a Social Ecological Model was used to guide the study. Clinicians from two public hospital emergency departments in Southeast Queensland, Australia were recruited with purposive and snowballing sampling strategies. Semi-structured interviews were undertaken between October 2022 and September 2023. Data were analysed using a content analysis approach.
Seventeen clinicians participated in the interviews: nine nurses and eight doctors. Nine participants were born in a country outside of Australia. Three main themes were generated from the interview data: (i) cultural and religious diversity and challenges in care delivery; (ii) social interactions and communication in clinical care; and (iii) perception about care delivery, services and supports.
Findings from this study offer insight into clinicians' experiences and perspectives regarding the influence of cultural and religious diversity as well as cross-cultural communication and prejudice in care delivery. Social interactions and communication in clinical care were found to facilitate care delivery process and navigate challenges. Cultural competency training and multicultural services and resources can help support clinicians in providing culturally appropriate care in the emergency department.
The findings of this study may help inform the development of practical guidelines and strategies to support clinicians in care delivery. Appropriate training regarding cultural competency is essential to promote culturally appropriate care. Developing a tailored multicultural service and targeted resources in the emergency department is recommended in clinical practice.
The consolidated criteria for reporting qualitative research checklist was used.
A health consumer representative was involved to provide advice on the study conceptualization and data interpretation.
by Sunghoon Jeon, Keunho Kim, Cheolwon Choe, Juil Choi, Gun Lee, Chung-Do Lee, Hyeon-Jeong Moon, Jun-Gyu Park, Jin-kyung Kim, Namsoon Lee, Dongwoo Chang
Quick-soluble gelatin microparticles (QS-GMP) are emerging embolic agents under investigation for temporary vascular occlusion, offering reduced ischemic risk compared to permanent materials. The aim of this preclinical study was to evaluate the safety and efficacy of QS-GMP for transarterial embolization in a rabbit model of urinary bladder embolization. Twelve male New Zealand White rabbits underwent bilateral umbilical artery embolization using QS-GMP. Animals were assigned to four time-points (immediately, 3, 7, and 14 days post-embolization), with comprehensive assessments including clinical observations, hematologic and serum biochemical analysis, angiography, and histopathology. The procedure was technically feasible in all animals without intraoperative complications. Temporary hematuria and a transient decrease in body weight were observed post-procedure, both of which resolved spontaneously. Complete occlusion of the cranial vesical artery and absence of bladder wall perfusion were achieved immediately after embolization, followed by full recanalization at 3 days. Angiographic imaging at 7 and 14 days revealed transient hypervascularization of the bladder wall. Histopathological analysis showed marked edema, epithelial necrosis, and inflammatory infiltration at 3 and 7 days, with full urothelial regeneration observed at 14 days. No signs of ureteral or renal injury, or adverse systemic responses were detected. These findings suggest that QS-GMP may serve as a feasible option for temporary arterial occlusion in future veterinary lower urinary tract applications, although further long-term evaluation is warranted.To explore the abnormal experiences of time and space among transitional-age youth with major depressive disorder.
A descriptive phenomenological qualitative study.
The study was conducted at a psychiatric hospital in China. Purposive sampling was used to recruit transitional-age youth with major depressive disorder. Data were collected through semi-structured interviews and analysed using Colaizzi's method.
Seventeen participants were interviewed. The abnormal experiences of time and space among transitional-age youth with major depressive disorder were synthesised into five overarching themes: (1) Disturbance of Time Order; (2) Slackening of the Flow of Time; (3) Vital Inhibition; (4) Desynchronisation of Social Rhythms; and (5) Disturbance of Lived Space.
This study highlights that pervasive abnormalities in temporal and spatial experiences characterise transitional-age youth with major depressive disorder. These disturbances shape their sense of self, personal development, relationships and engagement with the world, underscoring the need for interventions that address these temporal and spatial disturbances within the context of developmental transition.
This study addresses a knowledge gap regarding the subjective experience of time and space among transitional-age youth with major depressive disorder. This study highlights that transitional-age youth with major depressive disorder experience desynchronisation across temporal, spatial, bodily and social domains. Moreover, the desynchronisation of social rhythms appears to be a unique and developmentally salient challenge for transitional-age youth with major depressive disorder. These insights expand phenomenological understandings of major depressive disorder and highlight the developmental vulnerabilities of major depressive disorder as it navigates this critical life phase.
Five participants were involved in reviewing and providing feedback on the interview content and results. Their contributions included enhancing the authenticity and credibility of the findings.
The study followed the Consolidated Criteria for Reporting Qualitative Research guidelines.
by Chun-Fang Ma, Xiang-Xiang Li, Shan Liu, Xiao-Fei Wu
BackgroundHypertension (HTN) progression is linked to insulin resistance (IR), yet the association between Metabolic Score for Insulin Resistance (METS-IR) and HTN remains underexplored.
MethodsThis study included 4,051 individuals without a history of HTN from the China Health and Retirement Longitudinal Study (CHARLS). Participants were stratified into four groups according to their baseline METS-IR values. It was the development of incident HTN that was the primary outcome. We used Cox regression to assess this association, conducted subgroup and sensitivity analyses, and evaluated METS-IR’s incremental predictive value over conventional risk factors (age, sex, systolic blood pressure) using C-statistic, net reclassification improvement (NRI), integrated discrimination improvement (IDI), and decision curve analysis (DCA).
ResultsOver the 9-year follow-up, 1,572 participants (38.81%) experienced their first incident of HTN. Participants were categorized into quartiles (Q1-Q4) based on their METS-IR levels. After full adjustment for confounders, the hazard ratio (HR) with a 95% confidence interval (CI) for incident HTN demonstrated a progressive increase across ascending METS-IR quartiles, with Q1 as reference: Q2, 0.99 (0.85–1.15); Q3, 1.17 (1.01–1.36); Q4, 1.31 (1.13–1.52). The restricted cubic spline (RCS) model revealed a linear dose-response relationship between METS-IR and the incidence of HTN (P for overall trend P for nonlinear = 0.310). Adding METS-IR to a base model (age/sex/systolic blood pressure) improved HTN prediction (C-statistic Δ= + 0.004; NRI = 16.58%, IDI = 0.75%; all P Conclusion
Elevated METS-IR independently predicts HTN risk in Chinese adults, suggesting METS-IR as a potential indicator.
The aim of this study was to explore the trajectory of home-based cardiac rehabilitation exercise adherence in patients with coronary heart disease over 12 months and to identify heterogeneous trajectories and their predictors.
A prospective cohort study with 428 coronary heart disease patients was conducted in this study.
The Latent Class Growth Model was adopted to describe exercise adherence trajectories, and heterogeneous adherence trajectory was determined based on the Cox proportional hazards regression model. Predictors were identified using a multivariable logistic regression model. The study was conducted from January 2023 to April 2024.
This study explored five adherence trajectories, including persistent adherence, gradual decline, U-shaped adherence, delayed initiation and consistent non-adherence. Two of these trajectories (gradual decline and consistent non-adherence) were merged and labelled as a heterogeneous adherence trajectory based on association with cardiovascular readmissions. Regression analysis revealed seven independent predictors for the heterogeneous trajectory, covering education level, ejection fraction, C-reactive protein level, frailty, depression, exercise motivation and work conditions.
The identification of distinct adherence trajectories and their predictors highlights the dynamic nature of cardiac rehabilitation engagement. Heterogeneous trajectories (gradual decline and non-adherence) were strongly linked to increased readmission risks, emphasising the need for targeted interventions in high-risk subgroups.
These findings provide a framework for nurses to stratify patients' adherence risks early and personalise rehabilitation strategies. Addressing modifiable predictors (e.g., depression management, frailty mitigation and motivation enhancement) could improve long-term adherence, reduce healthcare burdens from readmissions and optimise resource allocation in cardiac rehabilitation programmes.
The reporting procedure of this study followed the STROBE guidelines.
No patient or public contribution.
To examine the relationships among perceived organisational support, perceived job security, self-efficacy and job engagement among newly recruited nurses and the mediating role of perceived job security and self-efficacy in the relationship between perceived organisational support and job engagement.
Cross-sectional study.
This study employed a multicentre cross-sectional survey design and used the Perceived Job Security Scale, General Self-Efficacy Scale, Perceived Organisational Support Scale and Job Engagement Scale to survey 536 newly recruited nurses (from September 2023 to April 2024). Structural equation modelling was used to test the effects of perceived organisational support, perceived job security and self-efficacy on job engagement.
In the study model, perceived organisational support, perceived job security and self-efficacy all directly affect job engagement among newly recruited nurses. Additionally, perceived organisational support can be used to predict job engagement through self-efficacy and perceived job security.
Perceived organisational support, job security and self-efficacy are positive predictors of job engagement among newly recruited nurses. Furthermore, perceived job security and self-efficacy mediate the relationship between perceived organisational support and job engagement.
Newly recruited nurses, as key agents in clinical nursing practice, play a crucial role in reducing nursing errors and improving work efficiency. The results of this study show that perceived organisational support, perceived job security and self-efficacy positively predict job engagement among newly recruited nurses. Clinical nursing managers and educators should assist newly recruited nurses in enhancing their perceived organisational support to foster job engagement by bolstering their perceived job security and self-efficacy.
This study adhered to the STROBE guidelines.
No patient or public contribution.
by Hanui Lee, Gyeong Han Jeong, Geun-Joong Kim, Seung Sik Lee, Byung Yeoup Chung, Hyoung-Woo Bai
Exosomes are cell-derived vesicles that play a crucial role in intracellular communication and are promising biomarkers for therapeutic applications. Despite their significant potential, the application of exosomes as biological therapeutics is limited by their low yield and inconsistent production quality. Ionizing radiation is known to enhance exosome release; however, this effect has been primarily studied in cancer cells. Given the critical role of macrophages in immune regulation and their potential for exosome-based therapies, we investigated the impact of gamma radiation on the secretion of macrophage-derived exosomes. This study demonstrated that gamma radiation significantly enhanced exosome release by both naïve and polarized macrophages. This effect was associated with the overexpression of Myh10 and Myo5b, the motor proteins that play crucial roles in exosome biogenesis and secretion. Furthermore, RNA sequencing and western blot analyses identified the EGFR/IGFR-MYC signaling axis as a key upstream pathway regulating the expression of Myh10 and Myo5b, thereby accelerating exosome secretion. These findings provide a deeper understanding of the molecular mechanisms underlying radiation-induced exosome secretion from macrophages and offer a novel strategy for optimizing exosome production to advance exosome-based therapeutic applications.Nurse-led telephone-based follow-up interventions play a role in patient follow-up, but at present, no meta-analysis has been found to assess the effectiveness of nurse-led, telephone follow-up interventions for patients with acute coronary syndrome.
This systematic review and meta-analysis aimed to evaluate the effectiveness of nurse-led telephone-based follow-up interventions on health outcomes in people with acute coronary syndromes.
Systematic review and meta-analysis of randomized controlled trials.
A comprehensive search of six databases: PubMed, Web of Science, Embase, Cochrane Library, CINAHL and Scopus was conducted from the inception of the databases to 30 September 2023. The Cochrane Risk of Bias Tool was used to assess the methodological quality of the included randomized controlled studies. Review Manager 5.4 and Stata 16.0 were used to conduct statistical analysis.
A total of 12 studies were included. Nurse-led telephone-based follow-up interventions may reduce systolic and diastolic blood pressure (MD = −2.55, 95% CI [−4.16, −0.94]) (MD = −2.15, 95% CI [−3.18, −1.12]) and low-density lipoprotein (MD = −9.06, 95% CI [−14.33, −3.79]) in patients with acute coronary syndrome. However, its effectiveness in controlling high-density lipoprotein (MD = 1.65, 95% CI [−4.30, 7.61]) and reducing total cholesterol (MD = −2.72, 95% CI [−7.57, 2.13]) was uncertain. In addition, the results showed that the nurse-led follow-up intervention did not play a role in improving anxiety (SMD = −0.20, 95% CI [−0.44, 0.04]) and depression (SMD = −0.07, 95% CI [−0.21, 0.06]) in patients with acute coronary syndrome, but it probably improved drug adherence (RR = 1.30, 95% CI [1.05, 1.60]) and smoking cessation (RR = 1.31, 95% CI [1.08, 1.60]).
The findings of this review suggest that nurse-led telephone-based follow-up interventions had a potentially positive effect on controlling blood pressure and low-density lipoprotein levels, as well as improving medication adherence and smoking cessation among patients with acute coronary syndrome, compared to usual care. However, the intervention did not appear to significantly impact high-density lipoprotein, total cholesterol, anxiety, and depression, indicating that further research in these areas will be necessary in the future.
PROSPERO (International Prospective Register of Systematic Reviews): CRD42023465894
by Jiangwei Hu, Chunyun Tan
BackgroundAs internet use rises among older adults, the internet has become a vital tool for maintaining social ties and enhancing life satisfaction. Prior research suggests that online engagement may be linked to subjective well-being (SWB) by offering emotional support and opportunities for participation. However, the psychological pathways underlying this association—such as psychological anxiety, social loneliness, and goal deficiency (reduced sense of purpose)—remain underexplored. To address this gap, this study examines how these psychological factors are associated with internet use and older adults’ SWB in a cross-sectional context.
MethodsDrawing on cross-sectional data from the 2021 Chinese General Social Survey (CGSS), this study analyzed a sample of 825 Chinese adults aged 60 years and above. A structural equation modeling (SEM) approach was used to examine the associations among internet use, three psychological variables (psychological anxiety, social loneliness, and goal deficiency), and SWB. Control variables included age, gender, education level, and place of residence.
ResultsThe direct association between internet use and SWB was non-significant. However, internet use was associated with lower psychological anxiety, lower social loneliness, and lower goal deficiency, and the overall indirect association with SWB was positive. Among the mediators, psychological anxiety accounted for the largest share of the indirect association, goal deficiency contributed modestly, and the loneliness pathway was not statistically significant. The total association between internet use and SWB remained positive when indirect paths were considered.
ConclusionThe evidence indicates that, among older adults, digital engagement is associated with SWB chiefly via mental-health pathways—particularly through its associations with lower anxiety and reduced goal deficiency—rather than through a direct association. These findings suggest that policy and practice may complement access and digital-literacy initiatives with supports that reduce anxiety and strengthen purpose and competence (e.g., step-by-step onboarding, simplified interfaces, peer mentoring) as well as goal-oriented uses such as health self-management and community participation. Since the loneliness-mediated route was not supported, programs should emphasize emotionally meaningful online connections and relationship quality rather than merely increasing contact volume.
To investigate the clinical outcomes and predictors associated with the severity of new-onset pressure injuries in hospitalised patients with multiple comorbidities.
Retrospective cohort study.
We retrospectively collected data on hospitalized patients. The severity of pressure injury was defined as per the National Pressure Injury Advisory Panel. Outcome measures included short-term mortality and discharge to extended care facilities.
A total of 2150 hospitalised patients were screened, and 186 (8.7%) developed new-onset pressure injuries, including 84 classified as stage I and 102 as stage II. The Braden scale score and time from admission to pressure injury onset were significantly associated with new-onset stage II pressure injuries. Patients with stage II pressure injuries had a significantly higher risk of being discharged to extended care facilities compared to those with stage I pressure injuries (24% vs. 12%, p = 0.041). The short-term mortality rate was high in the total cohort (34%) but was not significantly different between the two groups. The worse Braden scale, lower body mass index, history of stroke and presence of stage II pressure injuries were significant predictors of discharge to extended care facilities.
New-onset Stage II pressure injuries significantly increased the risk of discharge to extended care facilities. Furthermore, this study expands the potential clinical utility of the Braden Scale by demonstrating its association not only with the risk of pressure injury development but also with the initial severity of injuries once they occur. These findings support its role in early risk stratification and targeted nursing interventions.
This study highlights the importance of early identification and prevention of pressure injuries and the potential role of the Braden scale in minimizing injury severity, reducing healthcare utilization, and improving quality of life.
STROBE guidelines.
None.
To assess the association of normal systolic blood pressure maintenance (SBPmaintain) with coronary artery calcification (CAC) progression in non-diabetic and diabetic subjects at low to intermediate cardiovascular risk.
Retrospective cohort study with a mean follow-up of 3.3 years.
Data from the Korea Initiatives on Coronary Artery Calcification registry were analysed.
10 754 asymptomatic Korean adults (51.5±8.6 years; 84.5% male; 14.2% diabetes) were enrolled. Participants were divided into two groups: normal SBPmaintain (maintain (≥120 mmHg) at the time of follow-up CAC scan.
CAC progression was defined as a difference of ≥2.5 between the square roots () of the baseline and follow-up coronary artery calcium score (CACS) (transformed CACS). Annualised transformed CACS was defined as transformed CACS divided by the interscan period.
Compared with non-diabetics, the incidence of CAC progression was higher in diabetics (28.4% vs 47.3%, pmaintain was inversely associated with an annualised transformed CACS (β: –0.18, 95% CI: –0.25 to –0.12, pmaintain showed a lower risk of CAC progression than ≥elevated SBPmaintain in non-diabetics; however, this association was not observed in patients with diabetes.
Maintaining normal systolic blood pressure was associated with a significantly attenuated CAC progression, especially in clinical conditions without established diabetes.
To investigate whether systemic lupus erythematosus (SLE) increases the risk of cataract development and to evaluate the impact of corticosteroid use and dosage on this risk.
Nationwide retrospective cohort study.
Using Taiwan’s National Health Insurance (NHI) database, which covers over 99.9% of the population.
The SLE cohort included 30 501 newly diagnosed adults from 2011 to 2020. For each patient with SLE, four individuals without SLE were selected from the NHI database using frequency matching by age (in 5 year intervals), gender and index year of diagnosis, resulting in a comparison cohort of 122 004 individuals.
The primary outcome was incident cataract. Secondary outcomes included risk stratification by age, sex, comorbidities and corticosteroid dose.
SLE patients had a higher incidence of cataracts than non-SLE individuals (adjusted HR (aHR) = 1.73, 95% CI 1.66 to 1.81). Stratified analyses showed elevated risks in women (aHR=1.74, 95% CI 1.66 to 1.83), men (aHR=1.68, 95% CI 1.52 to 1.86), and across age groups 20–49 years (aHR=2.32, 95% CI 2.11 to 2.56), 50–64 years (aHR=1.60, 95% CI 1.51 to 1.69), and ≥65 years (aHR=1.50, 95% CI 1.36 to 1.66). Analysis of corticosteroid exposure revealed that cumulative dose showed a trend towards increased risk at high exposure (adjusted OR (aOR) = 1.14, 95% CI 0.99 to 1.31), while average daily dose demonstrated a dose–response effect: 1–5 mg/day (aOR=1.31, 95% CI 1.13 to 1.52) and ≥5 mg/day (OR=2.48, 95% CI 2.16 to 2.86).
Adults with SLE have an increased risk of developing cataracts compared with matched controls, and higher average daily corticosteroid doses are associated with this risk. These findings highlight the need for careful monitoring of ocular complications in SLE patients.
To explore the association between the degree of coronary artery calcium (CAC) and the progression of calcific aortic valve disease (CAVD).
A single-centre retrospective cohort study using a hospital-based database.
A total of 2898 patients who underwent coronary CT angiography and serial echocardiograms at ≥6 months apart were included. Initial echocardiography was performed within 6 months from the time of CCTA.
CAC was divided into four groups: 0, 1–99, 100–399 and ≥400 (Agatston units, AU). The progression of CAVD was defined in two ways: progression 1 as at least one grade of progression, progression 2 as at least moderate aortic stenosis (AS) at follow-up.
At the initial CAVD grade, patients with at least mild AS tended to increase with increasing CAC (p
CAC was significantly associated with the progression of CAVD. Particularly, CAC≥400 was linked to progression toward significant AS.
FreshRSS 