Conectar
International migrants comprise 3.6% of the global population and face systemic barriers to accessing sexual and reproductive health (SRH) services, such as contraception, safe abortion care and sexual function support. In high-income countries, policy frameworks vary widely, with migration status significantly influencing entitlement and access to host countries. This protocol outlines a planned study to systematically analyse SRH policies in high-income countries with strong migrant integration frameworks, aiming to identify policy gaps, assess inclusivity and inform recommendations to strengthen Australia’s SRH policy landscape.
This study employs a systematic policy analysis using the Joanna Briggs Institute scoping review methodology. Countries with ≥10% migrant populations and a Migrant Integration Policy Index health score ≥70 will be included. 13 countries meet these criteria, including Australia, Canada and Sweden. A comprehensive search of academic databases (PubMed, Scopus, Web of Science, Cumulative Index to Nursing and Allied Health Literature and ProQuest Public Health) and grey literature from governmental and non-governmental sources will be conducted. Data extraction will follow Bacchi’s ‘What’s the Problem Represented to Be?’ approach. Thematic analysis will combine deductive and inductive methods to examine the extent to which SRH policies address migrant and refugee needs, including sexual function, safe abortion care and fertility care. A comparative policy matrix will identify strengths, limitations and best practices.
As this study analyses publicly available policy documents, ethics approval is not required. Findings will be disseminated through peer-reviewed publications and policy briefs targeting stakeholders involved in SRH policy and migrant health.
This protocol is registered with the Open Science Framework (OSF): https://doi.org/10.17605/OSF.IO/AYZ6P
by Berihun Agegn Mengistie, Getie Mihret Aragaw, Tazeb Alemu Anteneh, Kindu Yinges Wondie, Alemneh Tadesse Kassie, Alemken Eyayu Abuhay, Wondimnew Mersha Biset, Gebrye Gizaw Mulatu, Nuhamin Tesfa Tsega
BackgroundPrecancerous cervical lesions, or cervical intraepithelial neoplasia (CIN), represent a significant precursor to cervical cancer, posing a considerable threat to women’s health globally, particularly in developing countries. In Africa, the burden of premalignant cervical lesions is not well studied. Therefore, the main purpose of this systematic review and meta-analysis was to determine the overall prevalence of precancerous cervical lesions and identifying determinants among women who underwent cervical cancer screening in Africa.
MethodsThis study followed the Preferred Reporting Item Review and Meta-analysis (PRISMA) guidelines. The protocol for this systematic review and meta-analysis was registered on the International Prospective Register of Systematic Reviews (PROSPERO) (ID: CRD42025645427). We carried out a systematic and comprehensive search on electronic databases such as PubMed and Hinari. In addition, Google Scholar and ScienceDirect were utilized to find relevant studies related to precancerous cervical lesions. Data from the included studies were extracted using an Excel spreadsheet and analyzed using STATA version 17. The methodological quality of the eligible studies was examined using the Joanna Briggs Institute (JBI) assessment tool. Publication bias was checked by using the funnel plot and Egger’s tests. A random-effects model using the Der Simonian Laird method was used to estimate the pooled prevalence of pre-cancerous cervical lesions in Africa. The I-squared and Cochrane Q statistics were used to assess the level of statistical heterogeneity among the included studies.
ResultsA total of 112 eligible articles conducted in Africa, encompassing 212,984 study participants, were included in the quantitative meta-analysis. Thus, the pooled prevalence of pre-cancerous cervical lesions in Africa was 17.06% (95% confidence interval: 15.47%−18.68%). In this review, having no formal education (AOR = 4.07, 95% CI: 1.74, 9.53), being rural dweller(AOR = 2.38, 95% CI: 1.64, 3.46), history of STIs (AOR = 3.94, 95% CI: 2.97, 5.23), history of having multiple partners (AOR = 2.73, 95% CI: 2.28, 3.28), early initiation of coitus (AOR = 2.77, 95% CI: 2.11, 3.62), being HIV-seropositive women (AOR = 3.33, 95% CI: 2.32, 4.78), a CD4 count Conclusions
In Africa, the overall prevalence of pre-cancerous cervical lesions is high (17%). The findings of this review highlight that health professionals, health administrators, and all other concerned bodies need to work in collaboration to expand comprehensive cervical cancer screening methods in healthcare facilities for early detection and treatment of cervical lesions. In addition, increasing community awareness and health education, expanding visual inspection of the cervix with acetic acid in rural areas, offering special attention to high-risk groups (HIV-positive women), encouraging adherence to antiretroviral therapy for HIV-positive women, overcoming risky sexual behaviors and practices, and advocating early detection and treatment of precancerous cervical lesions.
by Yizhuo Gong, Xinmeng Wang, Mingkun Yu, Peipei Zu
PurposeTo precisely evaluate the independent influence of two different optical zone (OZ) sizes (6.3 mm vs. 6.5 mm) on corneal biomechanical properties within 6 months after Small Incision Lenticule Extraction (SMILE) using multivariable-adjusted statistical models.
MethodsThis retrospective study included myopic patients who underwent SMILE between 2022 and 2024. Patients were grouped into two groups based on the planned OZ: Group A (6.3 mm, 44 eyes) and Group B (6.5 mm, 54 eyes). Corneal biomechanical parameters were measured using the Corvis ST preoperatively and at 1, 3, and 6 months postoperatively. Linear Mixed Models (LMM) were used to assess the independent effect of OZ size, adjusting for key baseline covariates and accounting for inter-eye correlation by including a random intercept for patient identifier (ID).
ResultsA total of 98 eyes were analyzed. Baseline analysis revealed a significant imbalance between the groups, with Group A (6.3 mm OZ) having higher myopia and a greater corneal stromal ablation depth (both P 0.05), with the sole exception of Ambrosio Relational Thickness Horizontal (ARTH) (P = 0.012). In contrast, several preoperative covariates, particularly corneal stromal ablation depth and preoperative central corneal thickness, were identified as significant predictors of multiple postoperative biomechanical parameters.
ConclusionThe independent effect of a 0.2 mm difference in optical zone size on corneal biomechanical properties after SMILE appears to be limited. After comprehensive statistical adjustment, the results suggest that preoperative anatomical and surgical parameters, especially corneal stromal ablation depth, are the primary drivers of the postoperative biomechanical response, rather than the minor difference in OZ size itself. This study underscores the importance of confounder adjustment in refractive surgery research and suggests that maximizing the residual stromal bed may be more critical for maintaining corneal biomechanical integrity than fine-tuning the optical zone diameter.
Dexamethasone is commonly used to prevent postoperative nausea and vomiting (PONV). However, PONV is an unresolved complex problem; even with preoperative dexamethasone administration, 14.0%–26.3% of patients undergoing minimally invasive endoscopic procedures still experience PONV within 24 hours postoperatively. Compared with dexamethasone, dexamethasone palmitate has a long-lasting anti-inflammatory effect, two to five times that of traditional water-soluble dexamethasone, with fewer adverse events. This trial aims to assess the efficacy and safety of preoperative dexamethasone palmitate administration on postoperative PONV.
The INDEX trial is a multicentre, open-label, randomised, positive-controlled trial. A total of 588 patients will be recruited from three centres in China. Eligible patients are adults (aged 18–65 years) who undergo elective minimally invasive endoscopic surgery (laparoscopic or thoracoscopic surgery) under general anaesthesia. Eligible patients will be randomly assigned (1:1) to the dexamethasone palmitate or dexamethasone group. Patients in the dexamethasone palmitate group will receive intravenous injection of 8 mg of dexamethasone palmitate (containing 5 mg of dexamethasone), and those in the dexamethasone group will receive 5 mg of dexamethasone after anaesthesia induction and before surgical incision. The primary endpoint will be the incidence of PONV within the first 24 hours postoperatively. Secondary outcomes will include the incidence of PONV, postoperative nausea, postoperative vomiting, number of vomiting or retching episodes, severity of PONV, participant satisfaction, use of rescue antiemetic drugs and quality of postoperative recovery. The safety of participants will be monitored. A primary analysis will be conducted to evaluate between-group differences in the incidence of PONV in the intention-to-treat population and within the first 24 hours postoperatively. We will also perform a sensitivity analysis to evaluate the effect of missing values in the outcome parameters on the results. There is no plan to conduct an interim analysis.
Ethical approval was obtained from the Institutional Review Board of Beijing Tiantan Hospital Affiliated to Capital Medical University (KY 2025-041-02-01). The results will be disseminated in open-access publications and plain-language summaries.
by Jun Zhang, Mengduan Pang, Ling Li, Chuanjia Guo
BackgroundEndometriosis is a common gynecological disorder among women of reproductive age worldwide. This study aims to examine global patterns of endometriosis disease burden among reproductive-aged women and to evaluate its correlation with socioeconomic development indices.
MethodsThis study conducted a comprehensive analysis of endometriosis disease burden using epidemiological parameters from the Global Burden of Disease (GBD) 2021 database, including incidence rates, prevalence rates, Disability-Adjusted Life Years (DALYs), and corresponding age-standardized rates. Through stratified analyses at global, regional, and national levels, we systematically evaluated the disease burden patterns among reproductive-aged women and performed correlation analysis with socioeconomic development indices.
ResultsWe found that the highest incidence of endometriosis among women of reproductive age globally occurs in the 20–24 age group, with an incidence rate of 399.49 per 100,000 in 1990 and 304.31 per 100,000 in 2021. The results show that the global disease burden of endometriosis is mainly influenced by population size, followed by epidemiological changes. Compared to countries with a medium Social Development Index (SDI), the disease burden of endometriosis in low and high SDI regions fluctuated significantly from 1990 to 2021. In most countries with SDI values between 0.2 and 0.6, the burden of endometriosis showed a gradual decline.
ConclusionEndometriosis remains a significant public health issue for women of reproductive age globally. Although the global disease burden of endometriosis among women of reproductive age showed a slight decline from 1990 to 2021, the disease burden continues to fluctuate in certain regions and countries. In light of the differences in the disease burden of endometriosis across regions and countries, regionalized disease management strategies are expected to be developed in the future.
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 Mengsi Peng, Peng Shen, Kyung-In Joung, Kwang Joon Kim
BackgroundAlthough metformin is the first-line medicine for type 2 diabetes (T2D), its safety profile in adolescents remains poorly understood. This study seeks to investigate the adverse events linked to metformin use in adolescents diagnosed with T2D.
MethodsData from the Food and Drug Administration Adverse Event Reporting System (FAERS), spanning Q1 2004 to Q2 2024, were retrospectively analyzed in this study. Adverse reactions were standardized using the Medical Dictionary for Regulatory Activities, then significant adverse drug reaction signals were identified through disproportionality analysis employing reporting odds ratio (ROR) and information component (IC) methods.
ResultsOf 17,956,653 FAERS reports, 80,187 involved metformin, including 973 in adolescents (10–19 years), with 174 cases were identified with a T2D indication. Analysis at the system organ class level revealed that congenital, familial, and genetic disorders [ROR: 8.8 (4.0, 19.3); IC: 2.2 (1.1, 2.9)] and pregnancy conditions [ROR: 4.9 (2.5, 9.5); IC: 1.8 (0.8, 2.5)] showed the most significant signals. At the preferred term (PT) level, three signals were identified across all sexes and subgroups: treatment noncompliance [ROR: overall 4.14 (2.44, 7.02), male 4.27 (2.00, 9.12), and female 4.65 (2.22, 9.74); IC: overall 1.67 (0.88, 2.22), male 1.60 (0.46, 2.36), and female 1.74 (0.60, 2.50)], lactic acidosis [IC: overall 2.99 (1.91, 3.72), male 2.53 (0.76, 3.61), and female 2.76 (1.34, 3.67)], and gastrointestinal disorder [ROR: overall 13.09 (4.73, 36.23), male 54.33 (6.05, 487.96), female 5.34 (1.10, 25.84)]. Neurological disorders were observed only in males, while pregnancy-related adverse effects and renal disorders occurred exclusively in females. Additionally, the study identified potential new signals not documented in metformin labeling, including areflexia, muscle weakness, ataxia, decreased vibratory sense, rhabdomyolysis, substance use, and axillary pain.
ConclusionThe study reveals a complex safety profile of metformin in adolescents with T2D, warranting further research to confirm risks.
Secondary prevention strategies for coronary heart disease (CHD) can play a crucial role in averting acute coronary events and enhancing the overall well-being of CHD patients. This study aimed to investigate the knowledge, attitude and practice (KAP) of CHD patients in Shandong Province, China, toward secondary prevention medication regimens for CHD.
A multi-centre cross-sectional study.
Using a self-administered questionnaire.
This survey was conducted between October 2023 and February 2024 across four tertiary hospitals in Shandong Province, including the Provincial Hospital Affiliated with Shandong First Medical University, Qilu Hospital of Shandong University, Jinan Central Hospital and Jinan Fourth People’s Hospital.
The KAP of CHD patients toward secondary prevention medication regimens.
A total of 495 participants were finally enrolled, 347 (70.1%) were male and 248 (50.1%) were aged greater than or equal to 65 years. The mean score of KAP was 6.73 (5.19) (range: 0–20), 29.15 (3.81) (range: 7–35) and 28.61 (3.90) (range: 7–35), respectively. The structural equation model demonstrated that knowledge had a direct effect on attitude (β=0.427, p
CHD patients demonstrated insufficient knowledge, positive attitude and proactive practice toward secondary prevention medication regimens for CHD. It is recommended that healthcare providers implement targeted educational interventions to enhance patients’ knowledge levels regarding secondary prevention medication regimens for CHD.
The global prevalence of chronic kidney disease (CKD) has continued to rise over time. Pharmacological therapy is the mainstay of conventional CKD treatment; however, many CKD patients find it difficult to adhere to their medication regimen.
To systematically evaluate and compare the effects of various self-management support strategies for patients with CKD.
We searched PubMed, Embase, The Cochrane Library, Web of Science, and Scopus to identify quasi-randomized and RCTs comparing the effectiveness of different self-management support strategies in CKD patients, The search spanned from database inception to June 24, 2025. Two reviewers independently screened the literature, extracted information, assessed the quality of studies, and we performed analysis using RevMan 5.0 and STATA 14.0 software.
Eighty-one studies were included, examining 10 strategies. Compared to conventional interventions, face-to-face combined tele-guidance, group visits, tele-guidance, and multi-component structured interventions significantly improved patients' self-efficacy. Surface under the cumulative ranking curve (SUCRA) of different self-management support strategies influencing self-efficacy ranked in the top three were face-to-face combined tele-guidance, group visits and tele-guidance. Empowerment interventions, cognitive behavioral therapy (CBT) and tele-guidance enhanced quality of life compared to conventional interventions. The SUCRA for quality of life ranked highest for empowerment, CBT and face-to-face combined tele-guidance. Additionally, we found that these strategies were beneficial in improving patients' blood pressure, IDWG, renal disease knowledge, and self-management.
The study offers evidence on effective self-management support strategies for CKD patients, highlighting face-to-face combined tele-guidance might be the most effective intervention for increasing self-efficacy, while empowerment might be the most effective intervention for increasing quality of life in CKD patients. These findings can help healthcare providers design better programs to improve patient outcomes. However, more high-quality RCTs are needed to confirm findings.
PROSPERO: CRD42024596581
by Mengzhi Cheng, Jianbin Zhang, Lili Jin, Caihua Yu, Zhonghai Xie, Dong Li, Qinhua Gu, Qibin Shen
Primary results of the CORIN trial indicated that, compared with chemotherapy, icotinib significantly improved 3-year disease-free survival (DFS) in patients with Epidermal Growth Factor Receptor (EGFR)-mutated stage IB non-small cell lung cancer (NSCLC). However, evidence regarding the outcomes of adjuvant icotinib in patients with high-risk factors remains limited. This retrospective study evaluated the efficacy and safety of adjuvant icotinib in patients with EGFR-mutated high-risk stage IB NSCLC. We enrolled 37 patients with completely resected EGFR-mutated high-risk stage IB NSCLC. The median follow-up time was 31 months, and the 3-year DFS rate was 91.4%. Two patients experienced disease recurrence and were successfully switched to osimertinib upon identification of an EGFR (T790M) mutation. Although overall survival (OS) and central nervous system (CNS)-DFS data were not mature, no deaths or central nervous system metastases were observed by the end of follow-up. 29 (78.4%) patients experienced grade 1–2 adverse events (AEs), no grade 3 or higher AEs occurred. This study suggests a potential DFS benefit and well-tolerated profile of adjuvant icotinib in patients with EGFR-mutated high-risk stage IB NSCLC. However, longer-term follow-up is necessary to assess the long-term outcomes.Talaromycosis is a severe fungal infection caused by Talaromyces marneffei that predominantly affects people living with HIV (PLWH), particularly in southern China where it contributes substantially to AIDS-related mortality. While liposomal amphotericin B (L-AMB) is preferred for induction therapy due to its superior safety profile over conventional amphotericin B deoxycholate (AmBD), the efficacy of a single high-dose L-AMB regimen in talaromycosis remains unestablished. Furthermore, current guidelines recommend initiating antiretroviral therapy (ART) within 1 week of antifungal treatment, though real-world evidence in Chinese populations is limited. This study aims to evaluate the efficacy and safety of single high-dose L-AMB for AIDS-associated talaromycosis and provide clinical evidence on early initiation of bictegravir/emtricitabine/tenofovir alafenamide fumarate (B/F/TAF) in this population.
This multicentre, randomised controlled phase II clinical trial compares the efficacy and safety of single high-dose L-AMB (10 mg/kg), followed by itraconazole capsule 200 mg every 12 hours for the remaining 13 days of induction therapy, versus AmBD (0.5 mg/kg/day for 14 days) as induction therapy for AIDS-associated talaromycosis in PLWH adults with microbiologically confirmed diagnosis. Eligible participants (n=116) will be randomly assigned (1:1) at four Chinese centres to receive either treatment, followed by 10 weeks of itraconazole capsule consolidation therapy and secondary prophylaxis until CD4+ T-lymphocyte counts exceed 100 cells/mm3 for ≥6 months, with ART initiated within 7 days of antifungal treatment according to current ART guidelines. The primary endpoint is clinical resolution rate after induction, while secondary endpoints include overall survival, organ function recovery and adverse event incidence.
This study was approved by the Institutional Review Board of Shanghai Public Health Clinical Centre (Approval No. 2025-S039-01) and the ethics committees of all participating study centres: Guiyang Public Health Treatment Centre, Mengchao Hepatobiliary Hospital of Fujian Medical University and Chest Hospital of Guangxi Zhuang Autonomous Region. All procedures were conducted in accordance with the ethical standards of the Declaration of Helsinki and national regulations. Written informed consent was obtained from all participants prior to enrolment. The findings of this study will be disseminated through publications in international peer-reviewed journals and presentations at scientific conferences. Participants who express interest in the study results will be provided with a summary report following the release of the primary findings.
ClinicalTrials. gov NCT06926569.
To synthesise literature about horizontal violence or workplace bullying among Intensive Care Unit nurses, exploring its awareness, factors, impacts, and strategies.
Following PRISMA standards, a mixed systematic review using a narrative synthesis approach and thematic analysis design of the Joanna Briggs Institute.
Four electronic databases from 2013 to 2023 studies published were searched.
Eight studies were included: three qualitative and five quantitative. Four key themes emerged: (i) awareness and understanding of horizontal violence or workplace bullying, (ii) factors affecting horizontal violence or workplace bullying, (iii) impacts of horizontal violence or workplace bullying, and (iv) strategies to address horizontal violence or workplace bullying.
Addressing horizontal violence or workplace bullying requires hospitals should adopt conflict resolution policies, stress management programs, and supportive supervision to improve nurse retention. Nurse management should establish confidential reporting mechanisms, provide training on interpersonal respect, and implement supportive structures to promote psychological safety. Intensive care unit nurses are encouraged to take proactive steps to address workplace bullying, ensuring improved staff well-being and care quality.
This paper addresses a significant gap in the literature regarding horizontal violence or workplace bullying among Intensive Care Unit nurses.
The findings will impact on healthcare administrators, policymakers, and educators. By understanding horizontal violence or workplace bullying, strategies can be implemented to improve workplace environment, support nurses' well-being, increase nurse retention, and improve the quality of patient care.
This systematic review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The review methodology, including data selection, extraction, and synthesis, follows PRISMA standards to ensure clarity, transparency, and reproducibility.
This study did not include patient or public involvement in its design, conduct, or reporting.
There is a protocol that does not require registration, it made accessible at: https://doi.org/10.17605/OSF.IO/CFNEJ.
This study aims to develop dynamic networks and examine the longitudinal relationships of mental health symptoms among persons living with HIV (PLWH).
A longitudinal study.
We collected data between October 2022 and December 2022 using Wenjuanxing (Questionnaire Star), an online survey platform. The study tracked weekly data across 10 sessions, involving 123 PLWH in Beijing, China. A total of 40 mental health symptoms with six dimensions (somatization symptoms, negative affect, cognitive processes, cognitive function, interpersonal communication and social adaptation) were included in the symptom network, which consists of temporal, contemporaneous and between-person networks.
In the temporal network, ‘feeling inferior to others’ had the largest in-strength value, whereas ‘suicidal ideation’ exhibited the largest out-strength value. In the contemporaneous network, ‘feeling inferior to others’ showed the highest bridge strength, indicating it had the most connections to other mental health symptoms.
We found that ‘feeling inferior to others’ had the highest number of predictors, with up to seven mental health symptoms potentially triggering this particular symptom. Additionally, ‘suicidal ideation’ emerged as a powerful predictor, influencing the greatest number of mental health symptoms across five dimensions.
Our study enhances the understanding of the sequential development and consequences of mental health symptoms among PLWH, which may provide an important basis for designing precise mental health symptom management interventions.
This study was reported according to the STROBE checklist.
No patient or public contribution.
This study aims to assess the burden and predictors of age-related macular degeneration (AMD) among older age patients with diabetes attending comprehensive specialised hospitals in Northwest Ethiopia.
A multicentre cross-sectional study was conducted among older patients with diabetes using a systematic random sampling technique.
The study was conducted at five comprehensive specialised hospitals in Northwest Ethiopia from 8 May to 8 June 2023.
The study included 832 diabetic individuals aged 40 years and above.
Data were collected using a pretested structured questionnaire and physical examinations.
In this study, a total of 832 participants were involved, with a response rate of 96.85%. The burden of AMD was 15.4% (95% CI 13.0% to 18.0%). Male sex (adjusted OR (AOR) 2.04, 95% CI 1.17 to 3.56), older age (AOR 6.91, 95% CI 3.17 to 15.08), diabetes duration of 10 and more years (AOR 3.00, 95% CI 1.91 to 4.69), higher body mass index (AOR 2.56, 95% CI 1.15 to 5.71), presence of hypertension (AOR 2.45, 95% CI 1.56 to 3.85) and family history of diabetes mellitus (DM) (AOR 2.29, 95% CI 1.40 to 3.76) were positively associated with AMD.
This study found that the prevalence of AMD among patients with diabetes was 15.4%. Older age, male sex, longer DM duration, higher body mass index, presence of hypertension and family history of DM were significantly associated with AMD. Targeted screening of at-risk individuals for AMD, public health awareness campaigns focusing on these factors and further research to understand the burden and underlying mechanisms of these associations with AMD are recommended.
by Xinfeng Xu, Xinyao Jiang, Meng Zou, Jinyan Hui, Guang Huang, Qian Wu
Perfluorinated compounds (PFCs) are persistent environmental pollutants with near-universal human exposure, yet their respiratory health impacts during adolescence remain insufficiently explored. This investigation evaluated single and combined effects of serum PFCs on pulmonary function and respiratory morbidity in a nationally representative adolescent cohort (n = 976, ages 12–19 years) utilizing 2007–2012 NHANES data. Advanced analytical approaches including multivariable regression, mixture modeling (BKMR and WQS), and mediation analysis were employed to assess associations with spirometric parameters (FEV1, FVC, FEV1/FVC) and respiratory symptoms while examining inflammatory and oxidative stress pathways. Computational approaches integrating network toxicology and molecular docking identified key protein targets. Analytical results demonstrated significant associations between specific PFC congeners (PFOA, PFHS, PFOS) and pulmonary function measures, with age-stratified effects observed for wheezing symptoms. Mixture analyses revealed PFOA as the predominant contributor to observed respiratory effects, partially mediated through oxidative stress pathways (6.8–8.2% mediation). Molecular investigations identified critical signaling nodes (INS, AKT1, TP53, TNF, IL6, ALB and PPARγ) potentially linking PFC exposure to respiratory outcomes. These findings provide mechanistic insights into PFC-induced pulmonary effects during adolescence, highlighting the need for continued investigation of these environmentally persistent compounds’ impact on developing respiratory systems. The integrated epidemiological-computational approach demonstrates the utility of combining population-level data with mechanistic modeling to elucidate environmental health effects.by Lakew Desta Zewude, Embialle Mengistie, Amanuel Ejeso
BackgroundIn developing countries, animals are often slaughtered and dressed in unsanitary settings, thus endangering the microbiological quality and safety of the meat obtained. In addition, slaughterhouses and retail outlets are the regions most vulnerable to cross-contamination with meat. As a result, the objective of this study was to evaluate slaughterhouse and meat retail shop hygiene practices and to determine the causes of unsanitary meat handling in slaughterhouses and retail shops.
Methods165 butcher men from a municipal slaughterhouse and every retail meat store in Hawassa city participated in this investigation, which was carried out using an institution-based cross-sectional study design between March 22 and May 30, 2022. Data was collected through interviewer-administered standardized questionnaires and an observation checklist. Data was entered using Epidata software version 3.1.1, and it was exported for further analysis using SPSS version 25. A cutoff point of P.V Results
The prevalence of good hygienic practices was 25.5% [95% CI: (18.2–32.1)]. Attitude (fair attitude) [AOR = 0.157; 95% CI: (0.037, 0.659)], cleanness and disinfection of waste container status [AOR = 12.64; 95% CI: (3.936–40.562)], regular supervision by health offices [AOR = 0.176; 95% CI: (0.35–0.894)], health and safety training [AOR = 3.46; 95% CI: (1.054–11.344)], and Removal of personal items during meat processing [AOR = 0.036; 95% CI: (0.008–0.150)] were factors that were significantly associated with poor hygienic practices.
ConclusionThe prevalence of good hygienic practices was low. After adjusting for possible confounding factors, attitudes, cleanness and disinfection of waste containers, regular supervision by health offices, health and safety training and Removal of personal items during meat processing (behavioral factor) were significantly associated with hygienic practices. These findings could call for appropriate prevention strategies based on cognitive domains and practice.
Mistreatment and obstetric violence constitute significant human rights violations with profound implications for maternal mental health. These detrimental practices persist globally, particularly in contexts where underfunded health systems, workforce shortages and entrenched gender inequalities intersect, depriving women of adequate psychosocial support and culturally sensitive mental healthcare. Although awareness of the immediate harms of mistreatment is increasing, its cumulative effects throughout the maternal care continuum remain insufficiently understood. This review will synthesise evidence on the impact of mistreatment on perinatal mental health, identify critical gaps and advocate for systemic change.
This systematic review and meta-analysis protocol complies with the guidelines set forth by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols. A thorough literature search will be executed across multiple electronic databases, including CINAHL—Cumulative Index to Nursing and Allied Health Literature, Embase via Ovid, MEDLINE, PsycInfo, PubMed, Scopus, as well as other significant or specialised databases and grey literature. The review will incorporate only non-randomised study types and observational studies (cohort, cross-sectional, case-control), along with mixed-method and qualitative studies. Abstract and full-text screening will be performed by two reviewers using Covidence. The methodological quality of the included studies will be assessed using the Newcastle-Ottawa Scale for observational studies, the Risk of Bias in Non-Randomised Studies of Interventions, the Critical Appraisal Skills Programme and the Mixed Methods Appraisal Tool. Statistical heterogeneity will be evaluated using the Higgins test. Meta-analysis will be conducted using R statistical software V.4.4.4, employing random effects models to determine the weights. The study results will be reported sequentially, beginning with primary outcomes, followed by secondary outcomes and significant subgroup outcome analyses.
Ethical approval is not required as no original data will be collected. The findings of this review will be disseminated through publication and conference presentations.
CRD420251044379.
To investigate the occurrence of unintentional injuries among children aged 3 to 12 in China over the past 5 years, and to provide a scientific basis for the prevention and control of such injuries.
A systematic review and meta-analysis. A random-effects model was specified a priori to synthesise study estimates given anticipated clinical and methodological heterogeneity across studies.
We searched CNKI, WanFang and PubMed for studies published between 1 January 2018 and 30 June 2024.
We included observational studies conducted in China with children aged 3–12 years, reporting incidence or person-time incidence of unintentional injuries and using clear injury definition criteria. Exclusion criteria included reviews, studies on special populations, duplicated datasets or incomplete data.
Two independent reviewers screened studies, extracted data and assessed study quality using Loney’s criteria. Heterogeneity was quantified with the I² statistic and Q test. Publication bias was assessed with funnel plots, Egger’s regression and fail-safe N. Certainty of evidence for primary outcomes was rated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.
A total of 16 studies involving 37 877 participants were included. The results indicated that the combined effect size of the incidence of unintentional injuries among children aged 3 to 12 in China was 14.0% (95% CI 9.5% to 20.3%), and the person-time incidence was 15.3% (95% CI 8.6% to 25.8%), with falls demonstrating the highest combined effect size. Further subgroup analysis revealed several trends: the incidence of unintentional injuries was higher in boys (16.1%) than in girls (11.2%), among children aged 3–6 years (15.2%) compared with those aged 6–12 years (12.4%), in the western region (14.3%) versus the eastern region (13.1%) and when applying the 1996 injury criteria (17.7%) compared with the 2004 criteria (15.6%). All differences were statistically significant (p
The incidence of unintentional injuries among Chinese children aged 3–12 remains high, especially from falls. Injury rates differ significantly by gender, age, region and other factors. Future efforts should prioritise the safety of kindergarten children in western China, with a strong emphasis on preventing falls, which are a common type of injuries among children.
CRD42024604890.
To evaluate bioecology and environmental influences of patients presenting with alopecia regarding decisions made for hair camouflage.
A descriptive qualitative design was used.
Sixteen adult patients with alopecia were purposefully recruited from two specialised trichology clinics across the Jiangsu Province, China. Surveys and in-depth semi-structured interviews were conducted between October 2024 and December 2024. Practical thematic analysis of transcribed data was informed through Bronfenbrenner's ecological systems theory.
Five major facilitators (camouflaged demands drive, camouflaged psychological resilience, habituation and dependence, family resilience and cross-border support, social acceptance) and four major barriers (limited future orientation, perceived coordination barriers, marginalisation of camouflage-related information, runaway costs) to hair camouflage were identified. These themes align with different levels of the ecological systems theory.
This study captures the complex ecological and intersectional nature of choice, experience and decision-making in patients' views on hair camouflage amid alopecia. Nursing professionals must understand these complexities to provide informed support and evidence-based interventions throughout patients' experiences with alopecia.
This study uses patient voices to offer ecological insights for a holistic understanding of their experiences. It provides knowledge relevant to nursing practice and alopecia patient support. Understanding patient-identified barriers and facilitators in alopecia camouflage is essential to inform more patient-centred approaches to choice, decision-making and psychological adaptation. Nurses are pivotal in this process, making enhanced understanding crucial for improving patients' psychological wellbeing and quality of life.
Our research reveals factors that equip nurses and the broader healthcare team to develop targeted counselling strategies, educational programs and resources related to camouflage for patients with alopecia. The hair-camouflage industry can use these insights to create more personalised and accessible products, better addressing patients' concealment needs and preferences.
Standards for Reporting Qualitative Research.
No patient or public contribution.
This study aims to assess the extent of organisational silence among new nurses, analyse how structural empowerment and role ambiguity influence this silence, and determine whether role ambiguity mediates the relationship between structural empowerment and organisational silence. The findings intend to offer practical guidance for nursing managers in supporting new nurses by minimising role ambiguity and fostering open communication during the transition into clinical practice.
New nurses commonly exhibit organisational silence during their transition process. Although research indicates that structural empowerment, role ambiguity and organisational silence are interrelated, the underlying mechanisms among these three factors remain unclear.
A cross-sectional design.
A convenience sampling approach was adopted between September 2024 and March 2025. The study recruited 680 new nurses from 15 tertiary A-level hospitals located in Guangzhou, Changsha and Hangzhou. Data collection instruments included a demographic information form, the Chinese version of the Nursing Role Conflict and Role Ambiguity Scale, the Employee Silence Behaviour Questionnaire and the Job Efficiency Conditions Scale. To examine the mediating role of role ambiguity in the relationship between structural empowerment and organisational silence, structural equation modelling (SEM) was applied.
A total of 628 new nurses participated in the survey. Structural empowerment was negatively correlated with role ambiguity (p < 0.01) and organisational silence (p < 0.01). The mediation analysis indicated that role ambiguity partially mediated the relationship between structural empowerment and organisational silence. Specifically, the mediating effect of role ambiguity was –0.14, accounting for 31.11% of the total effect.
This research indicated that new nurses exhibited a below-average level of structural empowerment, while their levels of role ambiguity and organisational silence were above average. Specifically, structural empowerment had a negative impact on both role ambiguity and organisational silence; role ambiguity positively predicted organisational silence. Furthermore, role ambiguity played a significant mediating role in the relationship between structural empowerment and organisational silence.
The findings indicate that nursing managers should not only focus on enhancing the structural empowerment of new nurses but also strengthen their role awareness, ensuring it plays a key role in reducing levels of organisational silence.
This study did not involve patients, service users, caregivers, or members of the public.
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