Conectar
To examine the effectiveness of Internet-delivered Cognitive Behaviour Therapy (ICBT) in improving psychosocial well-being and promoting weight-loss in adults ≥ 18 years with BMI ≥ 25 kg/m2.
Global obesity engenders significant physical and psychosocial health consequences. Second-wave ICBT focused on restructuring negative thoughts and behaviours has been explored as a potential intervention for elevated BMI and mental health concerns, but its effectiveness remains to be fully established, making further evaluation essential.
Eight databases were searched from inception to January 2025 for randomised controlled trials (RCTs), including participants ≥ 18 years with BMI ≥ 25 kg/m2 and second-wave ICBT evaluating BMI, weight, depression, eating behaviours, and self-esteem. This review followed PRISMA 2020. Study quality was assessed using the Cochrane Risk of Bias (ROB 2) and GRADE. Data were extracted using a modified Cochrane form. Random-effects meta-analysis calculated Standardised Mean Differences (SMD) with 95% confidence intervals, with subgroup analyses exploring heterogeneity.
Nine trials with 2278 participants were included. Significant improvements were seen in BMI, weight, and depressive symptoms while self-esteem effects were small and non-significant. Compared with passive controls, ICBT showed greater improvements in BMI and weight, whereas differences versus active control were smaller and inconsistent. Face-to-face CBT demonstrated superior outcomes for depression and self-esteem. Male-tailored interventions showed greater improvements. Shorter programmes yielded larger short-term weight loss, while longer programmes supported more sustained effects. Narrative synthesis indicated improvements in emotional and external eating, with increased mindful and restrictive eating behaviours.
ICBT improved weight, BMI, and depressive symptoms, with limited evidence for self-esteem. Male-tailored interventions and longer programmes may enhance sustainable outcomes.
Future ICBT programs should integrate strategies targeting sustainable weight loss and psychosocial well-being to support long-term outcomes.
Patients or members of the public were not involved, as this study synthesised previously published data.
PROSPERO registration number: CRD42024497961
(1) To explore community health nurses' experiences of implementing trauma-informed care in a general health context to individuals impacted by sexual assault or domestic violence; and (2) to identify essential components of implementing trauma-informed care in general health settings.
A naturalistic inquiry approach was used, incorporating a focus group (n = 4) and a semi-structured interview (n = 1) with community health nurses who implement trauma-informed care in general health services in Victoria, Australia. Data were inductively analysed using reflexive thematic analysis.
Nurse descriptions of implementing trauma-informed care are described across four main themes demonstrating competence in translating theory into trauma-informed care. These nurses recognised what trauma can look like in patients. They were able to identify the essential components of trauma-informed care, determine when trauma-informed care is working, and describe the benefits to clinicians. Themes demonstrate that implementation of trauma-informed care enables recognition of trauma, can help reduce the risk of re-traumatisation (through anticipating and planning interventions to support the unique needs of trauma survivors), can strengthen patient-centred care for trauma survivors, and enhance the experiences of clinicians and survivors alike.
Implementation of trauma-informed care into general health settings has the potential to enhance person-centred care with professionals trained to anticipate, recognise, and respond to trauma. Recommendations from this study include future research on building capacity for all healthcare providers to understand the importance of taking a trauma-informed approach to care, and large-scale evaluation of the impact of trauma-informed care approaches in mainstream health services on trauma responsiveness, patient satisfaction, and staff morale.
This study provides an understanding of the benefits associated with implementing trauma-informed care in generalist settings with important implications for training, practice and research.
There was no involvement of patients in this study; however, one of the authors is a lived-experience researcher in this topic area.
EQUATOR guidelines were followed, using the Standards for Reporting Qualitative Research (SRQR) checklist.
Medical malpractice imposes a substantial clinical and economic burden worldwide. Pressure injuries (PIs) are amongst the most frequently litigated adverse events and represent a major source of preventable patient harm. To characterise the medicolegal landscape of PI-related malpractice, the Westlaw legal database was queried for cases litigated between 1990 and 2024. A total of 590 cases met inclusion criteria, with data extracted from court documents. The mean patient age was 71 years; 53.4% were female and 46.6% male. Nursing homes were the most commonly named defendants (59.8%), followed by hospitals and outpatient surgical practices (37.3%) and individual physicians (14.1%). The mean settlement was $383 099, compared with a mean jury award of $2 100 787. Adverse legal outcomes were strongly associated with allegations of inadequate care, poor clinical outcomes and gross provider negligence. When prevention and timely management fail, the consequences extend beyond patient harm to substantial legal and financial liability. Targeted interventions such as standardised risk assessment, rigorous documentation, staff education, appropriate staffing ratios and institutional accountability may mitigate both PI incidence and litigation risk. Strengthening these measures represents a critical opportunity to improve patient safety whilst reducing medicolegal exposure.
Spinal cord injury (SCI) predisposes patients to pressure injuries (PIs) often requiring surgery. Multiple factors influence postoperative complications and recurrence, though their associations remain unclear. We performed a PRISMA-guided systematic review and meta-analysis to assess predictors of acute postoperative complications and PI recurrence in SCI patients undergoing surgery. PubMed, Scopus and Embase were searched. Studies with ≥ 15 participants were eligible; 24 (n = 2566 subjects) were included, with 15 (n = 1976 subjects) quantitatively synthesized. Risk of bias was assessed with the Newcastle-Ottawa Scale. A random-effects model meta-analysis was performed, and odds ratios (OR) were pooled when > 2 studies were available; otherwise, findings were narratively synthesized. Moderate-quality evidence showed prior flap reconstruction increased complication risk (aOR = 4.98). Low-quality evidence linked diabetes (OR = 1.39) and smoking (OR = 1.35) with complications. Higher recurrence risk was associated with prior flap reconstruction (OR = 1.80) and thoracic injury (OR = 2.21), while cervical injury was protective (OR = 0.37). Prior flap reconstruction resulted as the strongest predictor of complications and significantly increased the odds of recurrence. These findings underscore the importance of a multidisciplinary approach for preventing the first occurrence of flap reconstruction and subsequent procedures.
Indigenous peoples living with diabetes face unique challenges accessing comprehensive specialty diabetes care. A small diabetes virtual care clinic oriented towards Indigenous individuals, and those in rural and remote communities, has provided care to over 400 individuals.
We characterised the distinguishing features of care provided at this clinic and used the Consolidated Framework for Implementation Research 2.0 (CFIR) to explore the enablers and barriers to implementing this model of care, from the perspective of the clinic’s staff and providers.
Guided by CFIR, we conducted eight semi-structured interviews with six clinic staff members. Deductive thematic analysis was used to identify relevant enablers and barriers.
The aspirational features of care were cultural safety, comprehensiveness and virtual delivery. The implementation of this model of care was enabled by an internal culture of relational care; a nimble, resourceful, pragmatic and client-centred approach to virtual delivery; wayfinding and resources from key external organisations; community engagement and a small team of motivated and independent providers. Key barriers included the lack of physical interactions and uncertain or limited resources and funding.
The identified enablers and barriers to implementing an Indigenous-focused virtual diabetes care clinic have implications for future interventions to improve rural Indigenous chronic disease care, and for governments and adjacent organisations tasked with meeting Canada’s Truth and Reconciliation Commission’s calls to action in healthcare. Further research examining the effectiveness of virtual diabetes care at this clinic is ongoing.
To explore siblings' and parents' experiences of, and perceived impacts of, a nurse-led school-based intervention (SUPREME) for siblings of children with cancer in Denmark.
A qualitative process evaluation.
Fifteen siblings (aged 6–14 years) and 16 parents were recruited through criterion-based sampling following siblings' participation in the SUPREME intervention. Data consisted of semi-structured interviews and open-ended responses from an evaluation form, and were analysed thematically. Data were collected between May 2024 and February 2025.
The intervention created a sense of normality for siblings by providing age-appropriate and credible information in the familiar school context, thereby strengthening the understanding of the family's cancer journey. The SUPREME nurse played a key role in easing the communication burden on siblings and parents, while also promoting recognition of siblings within the hospital setting as active participants in the family's cancer journey. Additionally, the intervention was perceived to accommodate varying levels of support needs across families.
The SUPREME intervention benefited siblings—and, by extension, their families—by equipping siblings with essential information, guiding their class communities on how to offer appropriate support and fostering siblings' inclusion in the family's cancer journey. The SUPREME intervention constitutes a new strategy for accessible, universal sibling support.
The healthcare system should formally ensure that professionals working with families affected by severe paediatric conditions provide family-centred care that actively includes siblings.
What problem did the study address? The position of siblings of children with cancer is often complex, as they may simultaneously serve as visible front figures of the family while remaining overlooked. This study explored how parents and siblings of children with cancer experienced participating in a new sibling support intervention.
What were the main findings? Nurses play a central role in supporting siblings of children with cancer by bridging family, hospital and school contexts.
Where and on whom will the research have an impact? Nurse-led, cross-sectoral interventions such as SUPREME may help normalise siblings' everyday lives and promote their inclusion in the family's cancer journey.
This study followed the Standards for Reporting Qualitative Research checklist.
No patients, participants, or members of the public were involved in the design of this specific study.
This study aimed to comprehensively examine social and clinical factors contributing to postpartum depression among women in Nepal and identify their perspectives/experiences regarding postpartum mental health.
The explanatory sequential mixed-method study was conducted in two phases. In the quantitative phase, data were collected via survey of 200 postpartum women at immunisation clinics of two hospitals in Kathmandu Nepal. Measures included sociodemographic and perinatal factors and the Edinburgh Postpartum Depression Scale. Regression models were conducted to analyse data. In the qualitative phase, in-depth interviews were conducted with 15 participants having depression scores ≥ 10. Data were analysed using the thematic content analysis method. Qualitative and quantitative findings were integrated using the joint display and the narrative weaving approach to generate results.
Findings show that 28% of postpartum women screened positive for depressive symptoms, requiring referral for further evaluation. Integrated findings indicate that prenatal mental health problems, low birth weight or medical conditions among infants, intimate partner violence, partner substance abuse, and a lack of postpartum social support were major contributors to postpartum depression.
Depression is highly prevalent among women 6–12 months postpartum in Nepal and is associated with several clinical and social factors.
These findings have important implications, emphasising the need for routine screening using validated tools for early identification, timely treatment and referral of women at-risk for postpartum depression. Evidence-based clinical and community initiatives are needed to promote positive outcomes for women and their families.
External experts were consulted for survey questions and qualitative interview guide, then refined those instruments based on their feedback to improve construct validity. The immunisation clinic staff provided input during study design, for participant recruitment and data collection. Key findings were presented to stakeholders to validate the interpretation of findings.
by Verner N. Orish, Renosten E. Tetteh, David Adzah, Chinecherem A. Ndiokwelu, Emmanuel A. Allotey, Evans A. Yeboah, Sylvester Y. Lokpo, Kenneth Ablordey, Duneeh R. Vikpebah, Ekene K. Nwaefuna, Precious K. Kwadzokpui, Noble D. Dika, Elom Y. Dzefi, Kokou H. Amegan-Aho, Aninagyei Enoch, Senyo Tagboto
BackgroundToxoplasma gondii (T. gondii) is a successful protozoan parasite infecting up to a third of the human population. It has varied transmission routes including ingestion of food and water contaminated by cat feces containing oocysts of the parasite and ingestion of bradyzoites in poorly cooked meat. Blood transfusion is another possible route of transmission especially among people with medical conditions requiring blood transfusion, such as those with sickle cell disease (SCD). This study aimed at finding out the prevalence of T. gondii infection and the association of blood transfusion among patients with SCD.
MethodThis study was a cross-sectional study involving SCD patients attending the SCD clinic at the Ho Teaching Hospital in the Volta Region of Ghana. Questionnaire administration was employed to obtain sociodemographic information, cat ownership, consumption of poorly cooked meat, as well as blood transfusion history. A blood sample was collected and anti-T. gondii IgG and IgM were detected using Rapid Diagnostic Test (RDT), while Enzyme-linked Immunosorbent Assay (ELISA) was used as the gold standard and reference. Seropositivity was defined as either positive for IgG, IgM or both. Data was analyzed using SPSS version 23, with frequency distribution done for the sociodemographic variables and the prevalence of RDT and ELISA anti-T. gondii IgG and IgM. Pearson Chi-square analysis was performed to find any significant association between diagnosis of T. gondii infection with sociodemographic variables and blood transfusion. Logistic regression analysis was performed to investigate the odds of seropositivity (ELISA) with sociodemographic variables and blood transfusion.
ResultsA total of 156 SCD patients participated in this study of which 124 (79.5%) and 32(20.5%) were HbSS and HbSC respectively. Among the study participants, 105 (67.3%) had a history of blood transfusion. A total of 60 (38.5%) and 83 (53.2%) patients were positive for RDT and ELISA respectively. No significant association was seen between T. gondii diagnosis and cat ownership (RDT,20[37.7%], p = 0.891; ELISA, 27[50.9%], p = 0.673) and consumption of poorly cooked meat (RDT,37[41.6%],p = 0.370;ELISA,53[59.6%], p = 0.211). However there was a significant association between T. gondii diagnosis and age, with seropositive results predominantly seen among older patients (≥20 years) (RDT, 38[52.1%], p = 0.002; ELISA 49 [67.1%, p = 0.002]. Blood transfusion had a significant association with T.gondii diagnosis (RDT, p = 0.003; ELISA, p = 0.001). A total of 66 (62.9%) of SCD patients who had history of blood transfusion tested positive for ELISA and they had 3 times the odds of testing positive for ELISA (adjusted OR 3.14[95% CI 1.50–6.58]; p = 0.002).
ConclusionThe prevalence of T. gondii infection was higher by ELISA (53.0%) than by rapid diagnostic testing (RDT) (38.5%), and sickle cell disease patients with a transfusion history had higher odds of seropositivity. These findings highlight the need to strengthen transfusion safety protocols and consider screening strategies for T. gondii among high-risk populations such as patients with sickle cell disease. Also, there is the need for longitudinal research to help elucidate the true contribution of blood transfusion transmission of T. gondii since a cross-sectional study, causality could not be established.
by Jacqueline Muts, Danée Knevel, Dick den Hertog, Rachel K. Wong, Timothy C.Y. Chan, Britt J. van Keulen, Johannes B. van Goudoever, Chris H.P. van den Akker
Background and aimsThe macronutrient composition of donor human milk (DHM) can vary substantially due to several factors such as maternal age, diet, and lactation duration. However, consistent macronutrient levels in DHM facilitate the administration of the required amounts to preterm infants. The current pooling strategy at most human milk banks combines milk from different batches from a single donor. This study aims to stabilize the macronutrient quality of DHM by pooling milk from different donors by utilizing machine learning prediction and optimisation techniques.
MethodsThe current pooling strategy is compared with a new theoretical approach that pools milk batches from up to 5 donors. To predict the crude protein and energy content, we used the following variables: body mass index, the donor’s diet (vegetarian or non-vegetarian), maternal age, full-term or preterm delivery, lactation stage, and volume pumped. These predictions are then used within an optimisation model to create milk pools that minimize the deviations from the target macronutrient levels (1.0 g protein/100 mL and 70 kcal/100 mL).
ResultsThe prediction model is based on 2236 created single-donor pools from 480 donors. Random forest regression models provided the most accurate predictions of macronutrient content. The new pooling strategy using multiple donors shows reduced deviations from target values compared to the current single-donor approach (average total absolute deviation 0.402 versus 0.664).
ConclusionThis study proves the potential of data-driven methods to improve operational efficiency in human milk banks, and improving the consistency of donor human milk.
Adverse neurological complications, including postoperative delirium (POD) and stroke, remain one of the major risks after cardiac surgery. A lack of comprehensive knowledge about their causes and neuroprotective strategies has hindered the development of effective interventions to reduce these events. Personalised cerebral autoregulation (CA)-oriented blood pressure monitoring aims to identify blood pressure targets tailored to each individual patient, thereby reducing brain injury. The PRECISION study aims to assess whether perioperative duration and magnitude of mean arterial pressure (MAP) deviation from an individual’s CA limits are associated with adverse neurological complications.
This international, multicentre, prospective cohort study is conducted at two Swiss and one British hospital. Patients aged 65 years or older undergoing elective primary or re-operative coronary artery bypass graft and/or valvular and/or ascending aorta surgery requiring cardiopulmonary bypass are included. Preoperatively, the patient’s baseline of physical, cognitive and mental status is established. Intraoperatively, near-infrared spectroscopy (NIRS) and transcranial Doppler (TCD) are recorded in real-time to generate NIRS-derived and TCD-derived CA indices. The primary endpoint is POD, assessed daily on postoperative days 0 to 7 or up to discharge, whichever occurs earlier with the 3D-Confusion Assessment Method (3D-CAM) or CAM-Intensive Care Unit. Secondary endpoints include a composite neurological outcome of POD and overt stroke, postoperative neurocognitive disorders, major morbidity and mortality. Associations between neurologic outcomes, neurobiomarkers and genetic variation will be explored.
A total of 500 participants is required to achieve 90% power to find a statistically significant effect of the area under the curve MAP
Ethical approval has been obtained from all responsible ethics committees (Swiss lead ethics committee EKNZ 2022-01457 and Health Research Authority and Health and Care Research Wales, UK, REC 23/SW/0076). Results will be disseminated at national and international conferences and published in peer-reviewed journals.
by Xiangxiang Kong, Lujie Karen Chen, Sancharee Hom Chowdhurry, Ryan B. Felix, Shiming Yang, Peter Hu, Neeraj Badjatia, Jamie Erin Podell
Paroxysmal sympathetic hyperactivity (PSH) is a syndrome that occurs in a large subset of critically ill traumatic brain injury (TBI) patients and is associated with complications and poor recovery. PSH is defined by recurrent episodic vital sign elevations in the appropriate clinical context. However, standard diagnostic criteria rely heavily on subjective judgment, leading to challenges and delays in recognition, monitoring, and management. The objective of this study was to develop automated PSH detection and quantification tools that exclusively utilize objective bedside continuous vital sign data. Using a cohort of 221 critically ill acute TBI patients with at least 14 days of continuous physiologic data (of which 107 were clinically diagnosed with PSH) we developed a high-resolution clinical feature scale based on established PSH-Assessment Measure criteria and two artificial intelligence-based episode detection models including an expert system approach and a machine learning model approach, using a clinician-annotated case example as ground truth. For the episode detection methods, PSH was quantified as the number, duration, and overall temporal burden of detected episodes. To evaluate performance, we compared quantifications across PSH cases and controls and explored precision and recall. All three methods demonstrated initial face validity to delineate PSH cases from non-PSH TBI controls. Future optimization and implementation of the described computational frameworks with real-time patient data could improve the standard monitoring and management of this challenging clinical syndrome.Recognising peripheral arterial disease and chronic venous insufficiency early and managing them appropriately improves patient outcomes and prevents ulceration. However, few studies consider the influence patient skin tone has on this assessment. The study aimed to explore the experiences of healthcare professionals when assessing the cutaneous manifestations of chronic venous insufficiency and peripheral arterial disease in people with dark skin tones. We conducted semi-structured online interviews with healthcare professionals working in the United Kingdom between July and December 2023. The ‘theoretical domains framework of behaviour change’ (TDF) guided the interview schedule and data analysis. 24 healthcare professionals were interviewed (18 nurses, 5 doctors, 1 physiotherapist) with an average experience of 15 years (IQR 9.75–21.75 years). We found the environmental context domain best explains clinical behaviour, which included effective teamworking, referral pathways and training, and adequate lighting. Environmental factors also influenced other aspects of the TDF such as skill development, focus and concentration, and belief about capabilities. Some participants also found personal challenges in asking questions exploring patients' behaviour and skin care practices as they did not want to cause offence. Findings will inform the development of interventions to support lower limb assessment in those with dark skin tones.
by Clarisse Kagoyire, Albert Ndagijimana, Gilbert Nduwayezu, Jean Nepo Utumatwishima, Jean Pierre Mpatswenumugabo, Marie Anne Mukasafari, Diane Rinda, Vedaste Ndahindwa, Kristina Elfving, Gunilla Krantz, Torbjörn Lind, Ali Mansourian, Renée Båge, Ewa Wredle, Elias Nyandwi, Aline Umubyeyi, Jean Baptiste Ndahetuye, Petter Pilesjö
Despite national progress, stunting remains prevalent in specific regions of Rwanda, highlighting the limitations of coarse-resolution data for effective mapping and intervention planning. This study explored optimal spatial resolution and analytical approach to capture localised dynamics and the multifactorial nature of stunting. A cross-sectional, population-based study was conducted in the Northern Province of Rwanda, focusing on children aged 1–36 months. Data were collected using structured questionnaires covering socio-demographic, economic, health, childcare, livestock factors and anthropometric measurements. Environmental characteristics were obtained from national datasets, while household geographic coordinates were captured using a customized mobile geodata platform (emGeo). After data cleaning, predictors were analysed using univariable and multivariable logistic regression as well as geographically weighted logistic regression (GWLR) to account for spatial heterogeneity. Among 601 children, stunting prevalence was 27% (boys 33.8%; girls 20.9%). GWLR improved model fit, increasing adjusted deviance explained from 34% to 39%. Significant predictors included child age (adjusted OR = 2.46; 95% CI: 1.78–3.39), male sex (OR = 2.83; 95% CI: 1.65–4.86), birthweight (OR = 0.71; 95% CI: 0.54–0.94), maternal autonomy (ability to refuse sexual intercourse; OR = 0.48; 95% CI: 0.27–0.86), inconsistent maternal social support (OR = 2.30; 95% CI: 1.20–4.42), household electricity access (OR = 0.48; 95% CI: 0.27–0.84) and handwashing facilities (OR = 0.21; 95% CI: 0.07–0.67). GWLR revealed substantial spatial heterogeneity in these factors, delineating areas where each factor matters most. This household-level, spatially explicit analysis reveals localised risk patterns often masked by aggregated national data. Prioritising context-specific interventions (such as electrification, hygiene promotion, and enhanced maternal social support), can enhance effectiveness. The proposed analytical workflow provides a model for addressing persistent stunting in other resource-limited settings.Findings of previous studies on associations between dairy consumption and metabolic health status were inconsistent. This study aimed to assess the link between consumption of dairy foods and metabolic health status, brain-derived neurotrophic factor (BDNF) and adropin levels in adults.
Cross-sectional.
An observational study in Isfahan, Iran.
Adults (n=527) selected by multistage cluster random sampling. Dietary intakes were assessed via a validated 168-item food frequency questionnaire.
Anthropometric indices, blood pressure and biochemical parameters were assessed. The criteria proposed by Wildman et al were used to categorise participants into metabolically healthy and metabolically unhealthy (MU).
Participants had a mean age of 42.66 years (45.7% women). Moderate consumption of total dairy was, respectively, linked to 58% lower odds of MU (OR T2 vs T1=0.42; 95% CI 0.18 to 0.96), after taking all confounders into account. Participants in the middle versus low tertile of low-fat dairy intake showed 51% marginally lower odds of MU (OR T2 vs T1=0.49; 95% CI 0.22 to 1.08; p=0.08). No significant association was discovered between high-fat dairy intake and MU chance. However, higher total dairy intake was associated with lower odds of hypertension (OR T3 vs T1=0.36; 95% CI: 0.14 to 0.93). No significant associations were observed between dairy intake and BDNF or adropin levels.
Moderate consumption of total and low-fat dairy was associated with lower odds of being metabolically unhealthy in Iranian adults, but high-fat dairy intake was not. Hypertension was less common among individuals with higher dairy intake. No association was found between dairy intake and serum levels of BDNF or adropin.
To assess the levels of knowledge, attitudes and practices (KAP) toward skin cancer prevention among Malaysian adults and to examine differences in KAP across socio-demographic groups.
Cross-sectional online survey.
Community-based study conducted in Malaysia using social media recruitment.
A total of 386 adults aged ≥18 years residing in Malaysia. Most participants were young adults (86.3%), female (55.4%) and of Chinese ethnicity (65.5%). Healthcare professionals were excluded.
Primary outcomes were levels of knowledge, attitude and preventive practices toward skin cancer, measured using the validated KAP-SC-Q (Knowledge, Attitude and Practice of Skin Cancer Questionnaire) and categorised as poor, moderate or good. Secondary outcomes included differences in KAP across socio-demographic and clinical characteristics, analysed using independent t-tests and 2 tests.
Over half of participants demonstrated poor knowledge of skin cancer (56.0%) and the vast majority showed inadequate preventive practices (84.2%), while attitudes toward skin cancer were predominantly positive (62.4%). Significant differences in mean KAP scores and categorical levels were observed across several socio-demographic variables. Participants with tertiary education had higher knowledge (14.32 vs 12.61) and attitude scores (20.01 vs 15.95; p
Malaysian adults exhibited limited knowledge and very poor preventive practices toward skin cancer despite generally positive attitudes. These findings highlight substantial gaps between awareness and behaviour and support the need for targeted public health interventions to correct misconceptions, improve risk perception especially in high-risk groups and promote effective ultraviolet protection behaviours.
To assess anaesthesia capacity and practice in Sierra Leone by enumerating the anaesthesia workforce by volume, training level and distribution across urban and rural areas and facility ownership; estimating the prevalence of anaesthesia methods used for common surgical procedures by provider category; and evaluating hospital infrastructure and the availability of essential anaesthesia-related medications and equipment.
A nationwide, cross-sectional, facility-based study combining structured questionnaires administered through face-to-face interviews with facility leads and retrospective review of surgical and anaesthesia logbooks.
Public and private hospitals and clinics in Sierra Leone providing surgical care with general, regional or local anaesthesia within an operating theatre.
69 of 78 eligible surgical facilities nationwide were included. Facilities providing surgical services between September 2022 and August 2023 were eligible; facilities without registries or declining participation were excluded.
Across participating facilities, the anaesthesia workforce comprised 198 full-time positions, predominantly non-physician providers, with only 40.4% (80/198) trained to administer anaesthesia independently. Ketamine-based and spinal anaesthesia were most common, while general anaesthesia with a protected airway accounted for just 5.0% (415/8339) of procedures. Anaesthesia practices varied by provider training level. Essential infrastructure, equipment and medications fell below international minimum standards, with shortages most pronounced in rural facilities.
Severe shortages of certified anaesthesia providers, limited anaesthesia techniques and inadequate material resources remain major barriers to safe anaesthesia and surgical care in Sierra Leone. Targeted investments in workforce development, infrastructure and resource allocation—particularly in rural areas—are required to improve the safety, quality and equity of anaesthesia care nationwide.
Since 1985, the international healthcare community has recommended the ideal rate of caesarean section (CS) to be 10%–15% at the national level. The literature has reported that overused CS without necessary medical indications can be harmful to both maternal and child health. To generate evidence to support policy on CS, this study evaluated the trend over time of CS in Thailand during January 2016 to October 2021 (which included the COVID-19 pandemic period) and explored predictors of CS use.
This study was a retrospective secondary data analysis of de-identified hospitalisation data under the Universal Coverage Scheme (UCS) from the National Health Security Office’s e-Claims database. Descriptive analyses were conducted to explore the number and rate of CS over time and across different characteristics (ie, age, hospital type, COVID-19 status and delivery day) including a multivariable logistic analysis to explore predictors of CS. Interrupted time series analysis was adopted to investigate the effect of the COVID-19 pandemic on CS rate.
569 321 CS cases under UCS from 2016 to 2021.
The results showed an increasing trend of CS rate, from 30% in January 2016 to 35% in October 2021. Both clinical (eg, medical indication and age) and non-clinical (eg, region and day of delivery) factors were significantly associated with CS. Furthermore, the COVID-19 pandemic had no significant effect on CS rate (level: –0.0016, 95% CI –0.0085 to 0.0053, p=0.66).
This study highlighted an increasing trend of CS in Thailand and could present supportive evidence that Thailand might have been facing an overuse of CS. More awareness and actions are warranted to ensure the movement towards reduction of unnecessary CS in Thailand.
To determine the safety and efficacy of ruxolitinib (RUX) and fostamatinib (FOS) compared with standard of care (SOC) in patients requiring hospital admission for the treatment of COVID-19 pneumonia.
Adaptive multiarm, multistage, randomised, open-label trial (three arm, two stage).
Five hospitals in England between October 2020 and September 2022.
Hospitalised patients (≥18 years) with COVID-19 pneumonia defined by a modified WHO COVID-19 severity grade of 3 or 4.
Participants were randomly assigned 1:1:1 to receive RUX (10 mg two times per day for 7 days then 5 mg two times per day for 7 days), FOS (150 mg two times per day for 7 days then 100 mg two times per day for 7 days) or SOC.
Primary outcome was development of severe COVID-19 pneumonia (modified WHO severity grade≥5) within 14 days of randomisation. Secondary outcomes included mortality, invasive and non-invasive ventilation, venous thromboembolism, duration of hospital stay, readmissions, inflammatory markers and serious adverse events (SAEs).
At stage 1, 181 patients were randomised, with 4 assessed as ineligible post randomisation. FOS was stopped early for futility with 16 participants (27.6%, n=58) developing severe COVID-19 pneumonia compared with 15 (25.0%, n=60) in the SOC arm (adjusted odds ratio (aOR) compared with SOC: 1.12; 95% CI 0.49 to 2.58; p=0.608). RUX progressed to stage 2 but the trial was stopped early due to slow recruitment. At the final analysis, 10 participants (16.1%, n=62) developed severe COVID-19 pneumonia in the RUX arm compared with 15 (24.6%, n=61) in the SOC arm (aOR: 0.63; 95% CI 0.25 to 1.57; p=0.161). Four (7.4%) participants in the FOS arm, none in the RUX arm and three (5.5%) in the SOC arm died within 14 days of randomisation. Infections were the most frequently reported SAE and were numerically higher in the FOS (10, 17.2%) and RUX (10, 16.1%) arms compared with SOC (7, 11.5%). Two unexpected serious adverse reactions occurred in the RUX arm only.
We found no evidence that FOS was superior to SOC for the treatment of COVID-19 pneumonia in patients requiring hospital admission. Due to early stopping, the trial was underpowered to establish RUX’s effect in this population. Further study is needed.
NCT04581954; EUDRA-CT:
To explore the familial, emotional, social and school-related challenges experienced by school-aged siblings of children with cancer, focusing on how these challenges intersect across hospital, home and school in their everyday lives.
Qualitative, two-phase, multi-site study.
Fieldwork was conducted at two distinct paediatric oncology wards, followed by semi-structured interviews with 11 siblings (aged 7–19 years) and 20 parents, recruited through criterion-based sampling. The data were analysed using reflexive thematic analysis.
Analysis showed that siblings were often marginalised in hospital life due to (1) family logistics; (2) hospital-induced restrictions, rules and physical spaces and (3) perceptions of their presence as ‘problematic’, ultimately limiting their access. In family life, siblings experienced peripheral roles because (1) they were cared for by others, (2) had their needs subordinated and (3) faced shifting expectations. At school, siblings encountered (1) limited understanding from classmates and teachers and (2) insufficient support resources.
Siblings of children with cancer face significant, interconnected challenges, often amplified by the structural frameworks of healthcare, family and school contexts.
Siblings of children with cancer are often marginalised in their own lives. In healthcare, a family-centred approach to care should formally and actively include siblings. Nurses are well-positioned to promote this, ensuring whole-family support. Siblings would benefit from coordinated support bridging hospital, home and school.
This study adheres to the SRQR Checklist.
Parents helped shape the study focus by discussing preliminary observations and potential support needs.
FreshRSS 