Conectar
To assess the time to first optimal glycaemic control and its predictors among adult patients with type 1 and type 2 diabetes at the University of Gondar Comprehensive Specialized Hospital in Ethiopia.
A retrospective cohort study.
University of Gondar Comprehensive Specialized Hospital, northwest, Ethiopia.
We recruited 423 adult diabetic patients who were diagnosed between 1 January 2018 and 30 December 2022 at the University of Gondar Comprehensive Specialized Hospital.
The primary outcome was the time from diagnosis to the achievement of the first optimal glycaemic control, measured in months. A Cox proportional hazards regression model was fitted to identify predictors of time to first optimal glycaemic control. Data were collected with KoboToolbox from patient medical charts and exported to Stata V.17. The log-rank test was used to determine the survival difference between subgroups of participants.
Median time to first optimal glycaemic control was 10.6 months. Among 423 adult diabetic patients, 301 (71.16%) achieved the first optimal glycaemic control during the study period. Age category (middle age (adjusted HR (AHR)=0.56, 95% CI 0.41 to 0.76), older age (AHR=0.52, 95% CI 0.33 to 0.82)), comorbidity (AHR=0.52, 95% CI 0.35 to 0.76), therapeutic inertia (AHR=0.20, 95% CI 0.13 to 0.30) and medication non-compliance (AHR=0.49, 95% CI 0.27 to 0.89) were significant predictors of time to optimal glycaemic control.
The median time to first optimal glycaemic control was prolonged. Diabetic care should focus on controlling the identified predictors to achieve optimal glycaemic control early after diagnosis.
by Tadesse Tarik Tamir, Berhan Tekeba, Alebachew Ferede Zegeye, Deresse Abebe Gebrehana, Mulugeta Wassie, Gebreeyesus Abera Zeleke, Enyew Getaneh Mekonen
IntroductionSolitary childbirth—giving birth without any form of assistance—remains a serious global public health issue, especially in low-resource settings. It is associated with preventable maternal complications such as hemorrhage and sepsis, and poses significant risks to newborns, including birth asphyxia, infection, and early neonatal death. In Ethiopia, where many births occur outside health facilities, understanding the spatial and socio-demographic patterns of solitary childbirth is vital for informing targeted interventions to improve maternal and child health outcomes. This study aims to identify and map the spatial distribution of solitary childbirth across Ethiopia and to analyze its determinants using data from the 2019 national Interim Demographic and Health Survey.
MethodWe analyzed data from the 2019 Interim Ethiopian Demographic and Health Survey to determine the spatial distribution and factors of solitary birth in Ethiopia. A total weighted sample of 3,884 women was included in the analysis. Spatial analysis was used to determine the regional distribution of solitary birth, and multilevel logistic regression was employed to identify its determinants. ArcGIS 10.8 was used for spatial analysis, and Stata 17 was used for multilevel analysis. The fixed effect was analyzed by determining the adjusted odds ratio with a 95% confidence interval.
ResultThe prevalence of solitary childbirths in Ethiopia was 12.73%, with a 95% confidence interval spanning from 11.71% to 13.81%. The western and southern parts of Oromia, all of Benishangul-Gumuz, most parts of the SNNPR, and the west of Amhara regions were hotspot areas for solitary birth. Having no formal education, not attending ANC visits, and residing in pastoral regions were significantly associated with higher odds of solitary birth in Ethiopia.
CocnlusionA notable proportion of women are experiencing childbirth alone, which highlights a significant aspect of maternal health in the country, reflecting both the challenges and improvements in childbirth practices. The distribution of solitary births exhibited spatial clustering with its hotspot areas located in western and southern parts of Oromia, all of Benishangul-Gumuz, most parts of the SNNPR, and west of Amhara regions. Lack of education, not having an ANC visit, and being a resident of pastoral regions were significant determinants of solitary birth. The implementation of maternal and child health strategies in Ethiopia could benefit from considering the hotspot areas and determinants of solitary birth.
Heroin users have a high burden of respiratory morbidity, including premature lung function impairment. Further, methadone treatment has been found to aggravate lung function impairment and can independently cause asthma. However, the lung function status among heroin users on medication-assisted therapy (MAT) in Tanzania is yet to be studied. This study aimed to assess the magnitude, pattern and factors associated with lung function impairment among heroin users on MAT.
This was a quantitative, analytical cross-sectional study.
This study was conducted at MAT Clinic at Muhimbili National Hospital in Dar-es-Salaam, Tanzania.
Individuals aged 18 years or above with heroin use disorder on stable dose of methadone without heroin withdrawal symptoms (Maintenance Phase of Treatment) were recruited.
Participants were enrolled through systematic sampling technique. Data were collected using a questionnaire, and lung functions were measured using a spirometer. Lung function impairment was defined as the percentage of participants with forced expiratory volume in 1 s (FEV1)
We enrolled 302 participants into the study (mean age of 42.78±7.56 years). Lung function impairment was observed in 28.5% of participants, with an average age of 44±8 years. Restrictive lung disease was the most common pattern of lung function impairment affecting 13.2% of the participants. The predictors of lung function impairment were being underweight (OR) 4.73, 95% CI) 2.61–8.59, p
Heroin users on MAT have a high magnitude of lung function impairment. Routine lung function testing is recommended.
This study aims to describe the knowledge, attitude and practice (KAP) regarding surgical scars among patients who had postorthopaedic surgery, and to explore correlations between these factors.
A multicentre, cross-sectional, observational study.
Conducted across multiple secondary/tertiary care hospitals between July and September 2024.
Of 816 enrolled participants undergoing orthopaedic surgery, 54.5% were male, 43.6% were aged 31–45 years, 73.9% were urban dwellers, 31.2% had a bachelor’s degree and 65.4% were married.
None (questionnaire-based assessment).
Primary outcomes were KAP scores (knowledge: 0–22; attitude: 9–45 and practice: 7–35), analysed via correlation and regression.
Mean scores: knowledge (12.5±6.9), attitude (27.6±3.3) and practice (28.2±6.5). Knowledge was negatively correlated with attitude (r=–0.24, p
Patients who had postorthopaedic surgery demonstrated poor scar-related knowledge and negative attitudes but proactive practices. Greater knowledge correlated with better practice, suggesting targeted education could optimise scar management. Further research should explore causal relationships and the efficacy of interventions.
The aim of this research was to describe factors that influence Intensive Care Unit liaison nurses' decision to stand down a medical emergency team call response. The decision to end a medical emergency team response for a deteriorating patient is referred to as the medical emergency team call stand-down decision. Intensive Care Unit liaison nurses, also known internationally as critical care outreach nurses, make medical emergency team call stand-down decisions in complex and challenging clinical environments. However, the factors influencing these decisions are not well described in the literature.
Exploratory descriptive qualitative study.
Seven Intensive Care Unit liaison nurses who attended medical emergency team calls in a large acute metropolitan tertiary referral public hospital, with a mature three-tiered rapid response system, were observed and interviewed. Observations of 50 medical emergency team call responses and 50 post medical emergency team call interviews were conducted between March 2022 and August 2022. Findings were analysed using inductive content analysis.
Intensive Care Unit liaison nurse decisions to stand down MET call responses were influenced by three intrinsic factors: (1) propositional knowledge, (2) experiential knowledge, (3) situational knowledge and information processing styles. Intensive Care Unit liaison nurses utilised these intrinsic factors to support their decision to terminate medical emergency team call response.
This study explored the intrinsic influences on individual Intensive Care Unit liaison nurses in deciding to end a medical emergency team call. By highlighting these individual influences on decision-making, the findings may be used to support medical emergency team responders educational needs and identification of potential heuristics and biases inherent in clinical decision-making which contribute to adverse events.
No patient or public contribution.
By understanding the influences on an individual's clinical decision-making, strategies can be put in place for educational development and support for experiential learning. The study highlights areas of potential bias and heuristic use that may lead to sub-optimal clinical decisions and increased risk for deteriorating patients. Research findings can be applied internationally to a range of rapid response systems and critical care outreach teams that respond to deteriorating patients.
The consolidated criteria for reporting qualitative research (COREQ) guidelines were used for reporting this study.
Patients receiving long-term ventilation (LTV) in out-of-hospital intensive care facilities often suffer from persistent impairments of their cognition, mental health and physical health, limiting their social participation. Chronically ill patients are often unable to express their care preferences. Thus, their medical care often lacks integration of patients’ wishes and values. Telemedicine may be used to collect patient-reported outcome measures (PROMs) from these patients to align medical care with their preferences. Early integration of teleconsultation to provide rapid support for specific patient symptoms can reduce economic costs.
This is a multicentre, prospective, non-blinded, single-arm interventional trial with a pre-post design and follows the Standard Protocol Items: Recommendations for Interventional Trials statement. 10 out-of-hospital intensive care facilities in Berlin and Brandenburg, Germany, are grouped into three clusters. The study population includes adult patients (≥18 years) receiving LTV and residing in participating care facilities. During the preintervention phase, standard patient care remains unchanged. From the start of the intervention phase, enrolled patients receive telemedicine rounds in addition to standard care. These telemedicine rounds, conducted at least weekly, involve on-site healthcare professionals, patients and their relatives. Data are collected at predefined time points—study months 1,3, 9, 15 and 21—with a target of 57 participants at each time point. The study aims to evaluate whether a structured telemedicine intervention (1) increases the proportion of patients receiving record-documented PROMs in routine care and (2) reduces hospital readmissions. Secondary outcomes include the evaluation of post-intensive care syndrome, healthcare costs and the usability, applicability and perceived benefits of telemedicine. Additionally, qualitative interviews with patients, their relatives and healthcare professionals will explore individual experiences with chronic critical illness, the perceived quality of life of the patients and how team members manage moral distress in caregiving contexts. A mixed-effects logistic regression model will be used to analyse patients’ access to PROMs, while a mixed-effects Poisson regression model will be employed to evaluate hospital readmission rates. The findings may provide valuable insights into how telemedicine can improve patient-centred care for this particular patient group.
This study protocol received approval from the Ethics Committee of Charité—Universitätsmedizin Berlin, Germany (EA2/136/22). The findings will be disseminated through publication in a peer-reviewed scientific journal and presented at international conferences.
This study was registered in the ‘German Register of Clinical Studies’ (DRKS; DRKS00029326).
Sickle cell disease (SCD) is due to the mutation of haemoglobin (Hb), from HbA to HbS and characterised by recurrent vaso-occlusive crises (VOC), which can progress to acute chest syndrome (ACS), a leading cause of death in adults with SCD. Hypoxia is a key modifiable factor in the polymerisation of HbS and the pathogenesis of VOC. High-flow nasal oxygen (HFNO) delivers humidified gas at high oxygen concentrations and flow rates: the former may reverse sickling (metabolic effect) to accelerate VOC resolution and prevent ACS, while the latter may reduce the risk of ACS by mitigating hypercapnia and generating positive airway pressure that limits hypoventilation and atelectasis (pulmonary effect). The study hypothesises that HFNO is a safe and effective strategy for treating VOC and preventing secondary ACS, and will assess this using a multi-arm multi-stage (MAMS) trial design.
This is a prospective, multicentre, randomised, open-label controlled trial following an MAMS design with three phases and four arms: one control (low-flow oxygen) and three HFNO intervention arms with varying fraction of inspired oxygen levels (low, intermediate, high). The pilot stage will assess safety and feasibility, using the rate of cardiac and neurological events as the primary endpoint. In the activity stage, arms demonstrating acceptable safety will be compared for efficacy based on the rate of VOC resolution without complications by day 5, allowing selection of the most promising arm. The final efficacy stage will compare the selected HFNO strategy to control, with prevention of secondary ACS by day 14 as the primary endpoint. The study aims to enrol up to 350 VOC episodes in total.
The study has been granted ethical approval (CPP SUD MEDITERRANEE IV). Following the provision of informed consent, patients will be included in the study. The results will be submitted for publication in peer-reviewed journals.
This study aimed to assess the global, regional and national burden of non-rheumatic degenerative mitral valve disease (nrDMVD) from 1990 to 2021 using data from the global burden of disease (GBD) Study 2021, focusing on trends in incidence, prevalence, mortality and disability-adjusted life-years (DALYs). The analysis evaluated disparities by age, sex and sociodemographic index (SDI).
This was a systematic analysis leveraging GBD 2021 data and employing decomposition and frontier analyses to quantify the contributions of ageing, population growth and epidemiological transitions. Age-standardised rates (ASRs) and absolute case numbers were analysed across 204 countries and territories.
Global, regional and national data spanning 1990 to 2021, stratified by SDI quintiles (low to high), 21 GBD regions and age-sex groups.
Individuals diagnosed with nrDMVD, with data representing global populations categorised by age, sex and SDI.
Primary outcomes included incidence, prevalence, mortality and DALYs. Secondary outcomes encompassed age-standardised rates (ASR) (age-standardised incidence rate (ASIR), age-standardised prevalence rate (ASPR), age-standardised mortality rate (ASMR) and age-standardised DALYs rate (ASDR)) and temporal trends.
In 2021, there were 15.49 million prevalent cases (ASPR: 182.13 per 100 000 population) and 36 843 deaths (ASMR: 0.46 per 100 000 population) globally. From 1990 to 2021, ASRs for prevalence, mortality and DALYs declined significantly (estimated annual percentage change range: –0.17% to –0.31%), while absolute case numbers increased by 85% due to population ageing. High-SDI regions exhibited the highest ASIR (28.49 per 100 000) and ASPR (364.24 per 100 000), while low-SDI regions showed underdiagnosis. Sex disparities were pronounced, with higher ASIR (16.13 vs 11.38) and ASPR (385.09 vs 241.64) in females. Projections to 2050 indicated continued ASR declines, yet rising absolute cases. Frontier analysis identified Serbia, Georgia and high-SDI countries (eg, the Netherlands) as having the largest gaps between actual and achievable disease burden.
Despite declining ASRs, nrDMVD remains a critical global health challenge, driven by ageing populations and regional inequalities. Targeted interventions addressing gender disparities, ageing-related healthcare and resource allocation in low-SDI regions are urgently needed to mitigate future burdens.
To compare the presenting demographic and clinical characteristics of rhegmatogenous retinal detachment (RRD) with other RD types, investigate risk factors of blinding RD and the outcome of surgical intervention.
Prospective, cross-sectional and multicentre.
Four ophthalmic centres in three geographic locations of Nigeria.
264 eyes from 237 patients diagnosed with RRD, tractional retinal detachment (TRD) and exudative retinal detachment (ERD) seen between April 2019 and March 2020.
264 eyes of 237 patients were diagnosed out of 35 641 patients screened. RRD was the most common RD (n=167 (70.5%), TRD 61 (25.7%) and ERD 9 (3.8%) patients). The hospital-based prevalence of all RD is 6.6 per 1000 patients (0.66%), and for RRD alone, 4.7 per 1000 patients (0.47%). The most common symptom was a sudden decline in vision, 100 patients (42.2%); floaters and flashes were uncommon, 5 (2.1%). RRD presented earliest, with a median symptom duration of 2 months, and TRD and ERD at 7.5 months each.
The 46–65-year age group had the highest representation, RRD (n=70, 41.9%), TRD (n=41, 67.3%), ERD (n=4, 44.4%). The mean age was highest in TRD (52.3±12.7 years) and lowest in RRD (44.0±17.5 years) and ERD (45.2±20.4 years). Males dominated (RRD 70.1%, TRD 62.3%, and ERD 66.7%). Ocular trauma was highest in RRD 29.3%, TRD 7.5% and ERD 10%; fellow eye RD was highest in TRD 47.5%, ERD 20%, RRD 8% and myopia was highest in RRD 27.6%.
Two-thirds of eyes were blind (Snellen best-corrected visual acuity
Shorter symptom duration is associated with better preoperative and postoperative vision. In contrast, longer durations are connected to poorer outcomes. Eyes with symptoms lasting less than a week had a 17% rate of postoperative blindness, compared with 30% in cases lasting 1–3 months, and 51% in cases exceeding 6 months.
Delays in diagnosing and treating RD result in high rates of preoperative blindness, which can be reversed with surgery even after several weeks of symptoms. Understanding the associations between RD and the risk of blinding RD in developing countries will benefit early diagnosis, treatment and improve treatment outcomes.
Scoliosis-specific exercises require specialist supervision, frequent clinical visits, and high costs, limiting accessibility. Additionally, females with idiopathic scoliosis (IS) engage in less physical activity (PA) than sex- and age-matched peers, leading to poorer bone and muscle health. These challenges underscore the need for accessible, home-based interventions targeting both musculoskeletal health and spinal alignment.
This single-blinded, randomised controlled trial aims to investigate the efficacy of a 16-week home-based exercise intervention on bone mineral density (BMD), Cobb angle, spinal flexibility, core muscle endurance, lean body mass, and quality of life (QoL) in females with IS. 28 participants will be randomly assigned (1:1) to either an intervention group (IG) or a control group (CG). Both groups will perform Schroth and core stabilisation exercises three times per week, while the IG will additionally perform impact-loading exercises. The primary outcome is BMD. Secondary outcomes include Cobb angle, lean body mass, cosmetic trunk deformity, spinal flexibility, core muscle endurance, and QoL. All outcomes will be assessed at baseline and post-intervention, with interim evaluations (excluding BMD, Cobb angle, and lean body mass) conducted at weeks 4, 8, and 12. All assessors, radiologists, and statisticians will remain blinded to group allocation. Treatment effects between groups over time will be analysed using two-way mixed-design analysis of variance (ANOVA).
This study addresses a critical gap in IS management by integrating a preventive and therapeutic home-based programme. The approach aims to improve musculoskeletal health, spinal alignment, and overall QoL. Its accessible format may inform future guidelines for conservative treatment and early intervention. Such interventions could significantly enhance bone health, reduce the risk of progression, and improve long-term musculoskeletal outcomes in young females with mild to moderate IS.
This study has received ethical approval from the Research Ethics Committee, Faculty of Associated Medical Sciences, Chiang Mai University (No. AMSEC-67EX-045). The findings will be disseminated through a peer-reviewed publication.
TCTR20241001001.
This study aimed to assess the proportion of nutrition-related information-seeking behaviour and its associated factors among pregnant women attending antenatal care at public hospitals in Bahir Dar City, northwest Ethiopia, 2023.
A cross-sectional quantitative supplemented with qualitative study design was conducted from March to April 2023 among 406 pregnant women. Pre-tested structured interviewer-administered and semistructured open-ended questionnaires were used to collect quantitative and qualitative data, respectively. Data were collected using the Kobo toolbox, and SPSS V.25 was used for analysis. Descriptive statistics were used to describe study subjects, and multivariate logistic regression analysis was employed to investigate the associated factors. The strength of associations was described using the OR with the corresponding 95% CI.
The study included 406 pregnant mothers with a median age of 28 with an IQR of 8 and 212 (52.2%) from rural settings. Of the total respondents, 173 (42.6%; 95% CI 37.7 to 47.6) of pregnant mothers were nutrition-related information seekers. Educational status, residence, monthly income and nutrition information literacy were significantly associated with nutrition-related information-seeking behaviour.
The proportion of nutrition information seeking among pregnant mothers in Bahir Dar City public hospitals was low. Lower educational status, low nutrition information literacy level, being from a rural residence and low monthly income are significantly associated factors.
Awareness creation for pregnant mothers from rural areas and with low educational status and improving nutrition information literacy of pregnant mothers are important activities to improve their nutrition information-seeking behaviour.
This scoping review investigates the use of point-of-care infrared thermography devices for assessing various wound types. A comprehensive search across four databases yielded 76 studies published between 2010 and 2024 that met the inclusion criteria. The review highlights thermography applications in burns, surgical wounds, diabetic foot ulcers, pressure injuries, and other lower limb wounds. Key findings indicate its effectiveness in detecting early signs of inflammation and healing delays, facilitating timely interventions. The technology shows promise in accurately predicting wound healing trajectories and assessing treatment outcomes. Recent advancements have made thermographic devices more affordable and user-friendly, expanding their clinical potential. However, challenges persist, including reimbursement, training requirements, and integration with electronic medical records (EMRs), with EMR integration identified as a critical barrier to widespread adoption. While preliminary findings are promising, the current evidence base is constrained by small sample sizes, retrospective study designs, and limited consideration of skin tone variability. Large, prospective studies are essential to validate the clinical utility of thermography in wound care and to inform the development of standardised protocols that support equitable, bias-reduced assessment across diverse populations. Addressing these gaps is critical for advancing research, enhancing clinician training, and improving patient outcomes in wound care. Overall, point-of-care thermography demonstrates significant potential to enhance wound assessment and monitoring, thereby elevating care quality and patient outcomes.
To extract and interpret quantitative data exploring the effectiveness of family health conversations (FHCs) on family functioning, perceived support, health-related quality of life, caregiver burden and family health in families living with critical or chronic health conditions.
Addressing the health of families affected by critical or chronic illnesses requires focused attention. The effective integration of FHCs is hampered by a scarcity of rigorous quantitative studies that provide solid evidence on best practices and outcomes.
A systematic review following the Joanna Briggs Institute guidelines.
The review is reported according to the PRISMA 2020 checklist. Appropriate studies were searched in PubMed, CINAHL, PsycINFO, Scopus and Cochrane Databases. Results of the search were imported into the Covidence web-based program. Included were studies with a quantitative research design, delivered to families with critical or chronic health conditions, describing FHCs based on the Calgary Family Assessment Model and/or the Calgary Family Intervention Model, and/or the Illness Beliefs Model, using reliable and validated instruments, published between 2008 and 2023, and written in English.
In total, 24 papers met the inclusion criteria. Sixteen papers used a quasi-experimental design, eight of which included a control group. Two papers used a mixed methods design, and six papers were randomised controlled trials (RCTs). A statistically significant effect of FHCs on family functioning was reported in two RCTs and three quasi-experimental papers. We also found that a statistically significant effect of FHCs was reported on perceived support in 9 of 15 papers, quality of life in 4 of 11 papers and caregiver burden in 1 of 3 papers.
The interventions reviewed revealed variability and partial results concerning the effectiveness of FHCs on family functioning. More rigorous research about short-term, intermediate- and long-term effectiveness is needed before conclusions can be drawn.
The study is reported according to the PRISMA 2020 (Preferred Reporting Items for Systematic reviews and Meta-Analyses) (File S1).
No patient or public contribution. Data were gathered from previously published studies.
by Pengfei Li, Lingkun Kong, Nan Mao, Chenwei Gu
High-performance anti-skid asphalt mixtures are essential for improving skid resistance and pavement durability. This study investigates the skid resistance performance of small-aggregate-size SMA-7 asphalt mixtures using calcined bauxite (CB) aggregates. Four types of aggregates—75#, 85#, and 88# CB and limestone—were used in the mixture preparation. Various laboratory tests, including pavement performance, Polished Stone Value (PSV) of aggregates, three-wheel polishing, and dynamic friction tests, were conducted to evaluate the performance and friction characteristics of the mixtures at various polishing stages. The results indicate that the optimal coarse-to-fine aggregate ratio for SMA-7 is 75:25, with a maximum particle size of 6.35 mm. The PSV of 88# CB aggregate stabilizes after 120,000 polishing cycles, exhibiting a decay rate 30% slower than that of limestone aggregates. Among the mixtures, 88#CB-SMA demonstrates superior high-temperature stability (1.5 times higher than limestone), slightly better low-temperature crack resistance, and significantly enhanced polishing resistance. Additionally, the dynamic friction coefficients of CB mixtures show slower attenuation, retaining 29.4–36.3% higher residual friction compared to limestone even after prolonged polishing. Strong correlations (R2 > 0.85) between the attenuation rates of PSV and dynamic friction coefficients confirm that the enhanced wear resistance of CB aggregates is key to long-term skid resistance, particularly at lower speeds. These findings suggest that high-grade CB aggregates greatly improve both the skid resistance and overall performance of asphalt mixtures, providing valuable insights for designing durable small-size asphalt wear layers.To provide guidance on food equity-oriented nurse engagement in education, research, and practice and to develop a glossary of food equity terms to serve as a resource to nurse educators and to fuel nurse engagement in food equity work.
A discussion paper outlining guidance for nurse engagement in food equity efforts.
We provide guidance for nurse engagement in three areas: Education, Research and Community Care. Additionally, through literature review, we created a glossary of food-related terms that can be used in nurse advocacy for food equity. Although not an exhaustive list, we compiled and provided definitions of equity-oriented food-related concepts across three categories: food environment, consumer/community-based and social safety net/anti-hunger terms.
Nurses can be instrumental in advancing food equity, thereby helping to prevent chronic diseases related to poor nutrition, yet nutrition and food equity content are not typically integrated into nursing education.
No patient or public contribution.
To present a model of the determinants of maternal mortality for Indigenous women—social, structural, political and biological.
Non-Indigenous academicians and an Indigenous tribal citizen and scholar partnered to amplify Indigenous women's voices.
With epistemic decolonisation and Indigenist feminism as our theoretical basis, we used theory derivation to create a model of the determinants of Indigenous maternal mortality.
Risk factors include biological warfare and ongoing cultural genocide. We also identified protective factors like resilience and cultural connectedness. Finally, we illustrate complex and multifaceted relationships among and between these concepts in a model of the determinants of Indigenous maternal mortality.
Solutions that address determinants of Indigenous maternal mortality are critical for Indigenous families to flourish. Academic researchers and tribal communities must continue to partner to support the safety and vitality of Indigenous women.
Our model can inform nursing and other research, including interdisciplinary research, policy development and trauma-informed, culturally relevant clinical practice to address disparities in maternal mortality that Indigenous women experience.
Despite increasing attention to the United States' maternal health crisis, stark disparities persist between groups of women. At its peak in December 2021, Indigenous maternal mortality was 118.7 deaths per 100,000 live births—the highest of all groups, and almost 5 times higher than that of their White counterparts (26.6).
Not applicable.
Three members of the public who identify as Indigenous agreed to review and comment on the model specifically from their Indigenous lens.
Research suggests that hormonal fluctuations may contribute to sleep-related physiological and psychological outcomes that differentially affect women’s overall health and well-being. Yet, systematic enquiries on this potential interaction across the menstrual cycle are scant.
This protocol paper describes a pilot observational study investigating changes in objective and subjective sleep measures, metabolic biomarkers (body temperature, blood glucose and hormonal concentrations) and psychological outcomes (depressive symptoms, menstrual cycle-related pain and psychological distress), in a cohort of healthy premenopausal women aged 18–35, regularly menstruating, and without sleep disorders. Participants’ sleep is monitored every night over the course of two full menstrual cycles using a Food and Drug Administration (FDA)-approved diagnostic ring from SleepImage and via next morning self-reports (ie, sleep diaries). To minimise the likelihood of undiagnosed sleep disorders, participants also complete two nights of at-home polysomnography. Daily hormonal concentrations are assessed via morning urinalysis using the Mira Fertility Monitor while transitions between hormonal phases are further confirmed by biochemical assays. Body temperature, blood glucose concentrations, diet and physical activity behaviours are continuously recorded using wearable devices and smartphone apps from Oura and Levels. The primary outcomes of this study are total sleep time and sleep quality. Secondary outcomes include sleep onset latency, wakefulness after sleep onset, sleep staging, daytime sleepiness, respiratory rate, resting heart rate, heart rate variability and subjective mood. This study will provide novel data to disentangle the intricate relationship between sleep behaviours, mental well-being and menstrual health in premenopausal women.
The study was approved by the Institutional Review Board at Parker University (protocol number PUIRB-2025-3). Study findings will be presented in peer-reviewed publications and at academic conferences.
This study aimed to estimate the prevalence of depression and anxiety and associated risk factors among non-communicable diseases (NCD) clinic attendees in rural Rwanda.
Cross-sectional.
44 health centres in three rural districts in Rwanda.
Adults aged 18 years and older with a clinical diagnosis of diabetes, hypertension and/or asthma, who were attending a follow-up appointment during the study period (n=595).
Primary outcome measures were depression (measured by Patient Health Questionnaire-9) and anxiety (measured by Generalised Anxiety Disorder-7). Explanatory measures included sociodemographic and behavioural risk factors associated with depression and anxiety.
Of 595 participants, 265 (44.5%) had depression (95% CI: 40.5% to 48.6%) and 202 (33.9%) had anxiety (95% CI: 30.1% to 37.9%). Comorbidity of depression and anxiety was found in 137 participants (23%). Participants with no formal education had significantly higher odds of reporting depression and anxiety compared with those with primary and secondary/higher education (adjusted OR (aOR)=2.08; 95% CI=1.27 to 3.33, p=0.004, aOR=5.00; 95% CI=1.12 to 25.00, p=0.035, respectively). In addition, participants who were unemployed were more likely to report depression and anxiety (aOR=3.03; 95% CI=1.62 to 5.67, p
The overall prevalence of depression and anxiety was found to be significantly high among the study participants. The risk factors that were associated with depression and anxiety included level of education, district of residence, employment status and past trauma exposure. The findings emphasise the need for integrating mental health screening into NCD care, district-specific interventions, employment support services and trauma-focused care.
This study assessed husbands’ knowledge of neonatal danger signs in Dessie City, Northeast Ethiopia, focusing on fathers of infants born within the preceding 6 months (2023).
Community-based cross-sectional study.
Dessie City, Northeast Ethiopia.
We systematically selected 613 husbands of postpartum women (sampling period: December 15, 2022,–January 15, 2023).
Data were collected via structured questionnaires, entered into EpiData (v4.6) and analysed using SPSS (v26). Binary logistic regression identified factors associated with knowledge; statistical significance was set at p
Among the 613 respondents, slightly over half (53%, n=325) demonstrated good knowledge of neonatal danger signs. Several factors were significantly associated with higher knowledge levels. Husbands residing in urban areas were nearly seven times more likely to have good knowledge compared with their rural counterparts (adjusted OR (AOR)=6.93; 95% CI, 3.23 to 14.90). Educational attainment also played a critical role: those with primary education or higher had 6.44 times higher odds of good knowledge than those with no formal schooling (95% CI, 1.83 to 22.61). Parity was another predictor, with fathers of 2–4 children showing markedly greater knowledge (AOR=10.39; 95% CI, 4.68 to 23.05) than those with only one child. Most notably, receiving information from health professionals had the strongest association—respondents who accessed such guidance were 11 times more likely to be knowledgeable (AOR=11.05; 95% CI, 5.46 to 22.36).
Nearly half of the participants lacked adequate knowledge. Thus, integrating targeted health education into maternal and child health programmes could improve awareness and neonatal outcomes.
FreshRSS 