Conectar
To examine triggers, responses, and outcomes for patient-related violence and/or aggression events during acute hospitalisation.
This was a descriptive observational study undertaken at two healthcare organisations.
Pre-existing data were extracted from organisational incident reports and individual medical records during a retrospective period (1/1/2023 to 30/6/2023) and a prospective period (7/6/2024 to 16/11/2024). Violence and/or aggression events requiring an organisational response that involved patients hospitalised in general ward areas at a metropolitan (Site A) and a regional (Site B) site were included. Data were analysed using descriptive statistics and content analysis.
The sample included 100 retrospective cases and 42 prospective cases. The most prevalent causes for hospitalisation related to a medical or mental health condition and dementia. Confusion and irritability were the most common forms of behaviour of concern prior to the event. Physical restraint was utilised more frequently in the prospective period compared with the retrospective period. Chemical restraint was used in approximately half of the cases in both study periods. A form of physical violence was the most prevalent behavioural symptom in both periods, followed by verbal aggression and inability to be re-directed.
Patients with a pre-existing medical condition, confusion and/or dementia are frequently involved in violent and/or aggressive events in ward settings. Physical and chemical restraints are commonly used to manage violence and aggression.
Alternative strategies are needed to manage occupational violence and aggression to minimise the need for physical and/or chemical restraint.
This study addresses a gap in evidence regarding triggers, responses and outcomes for patients exhibiting violence and aggression in ward settings during hospitalisation. Patients with dementia, confusion and irritability frequently exhibit behaviours of concern, exposing healthcare workers to potential physical and psychological harm.
STROBE checklist.
This study did not include patient or public involvement in its design, conduct, or reporting.
Oxaliplatin is widely used in the treatment of gastric and gastro-oesophageal junction cancer. However, oxaliplatin-induced nausea and vomiting often complicate treatment and negatively affect patients’ quality of life. The current standard antiemetic regimen—dexamethasone (DEX) plus palonosetron—offers only limited efficacy, benefiting approximately 70% of patients, and is associated with steroid-related adverse effects, including insomnia and gastrointestinal bleeding. Consequently, there is a clear clinical need for effective DEX-free antiemetic regimens. This study aims to evaluate the efficacy and safety of megestrol acetate versus DEX in preventing oxaliplatin-induced nausea and vomiting in patients with gastric or gastro-oesophageal junction cancer.
This is an investigator-led, multicentre, randomised-controlled, open-label, phase III, non-inferiority trial. Chemotherapy-naïve patients scheduled to receive oxaliplatin-based chemotherapy are randomly (1:1) assigned to receive either megestrol acetate (megestrol acetate group) or DEX (DEX group) in combination with palonosetron. The primary endpoint is the complete response (CR; no vomiting and no rescue therapy) rate during the first 120 hours following the initiation of chemotherapy (0–120 hours). Secondary endpoints include the following indicators: CR rate in acute period (0–24 hours), CR rate in delayed period (24–120 hours), time to treatment failure, frequency of salvage medication use, nausea, anorexia, adverse events and quality of life.
The study will evaluate the efficacy and safety of megestrol acetate compared with DEX for prevention of oxaliplatin-induced nausea and vomiting in patients with gastric or gastro-oesophageal junction cancer. If proven effective, the results might inform future antiemetic strategies in the long term to (1) provide a novel DEX-free antiemetic treatment for prevention of moderate-emetogenic chemotherapy, (2) reduce DEX-related adverse effects and improve quality of life in patients with gastric or gastro-oesophageal junction cancer and (3) support the potential incorporation of megestrol acetate into standard antiemetic medications.
The study protocol is conducted in accordance with the Declaration of Helsinki and approved by the Certified Review Board of West China Hospital, Sichuan University (Ethics Approval No 1116/2023). The results of this study will be disseminated via presentations at national and international scientific conferences and publication in peer-reviewed journals.
ChiCTR2300075943.
To assess the level of alarm fatigue among intensive care unit (ICU), cardiac care unit (CCU) and emergency room (ER) nurses, identify associated demographic and occupational factors, determine the most frequent sources of alarms and evaluate nurses’ psychological reactions to alarms.
A cross-sectional, descriptive–analytical study.
ICUs, CCUs and ERs of six public teaching hospitals affiliated with Tehran and Kashan Universities of Medical Sciences in Iran.
Using a multistage stratified random sampling method, 285 nurses were approached, of whom 260 completed and returned the questionnaires (response rate: 91%). Participants were registered nurses with at least a bachelor’s degree or higher and 3 months of experience in ICUs, CCUs or ERs.
The primary outcome was the level of alarm fatigue measured using the validated Nurses’ Alarm Fatigue Questionnaire. Secondary outcomes included factors associated with alarm fatigue and nurses’ reported psychological responses to frequent alarms.
The mean score of alarm fatigue was 26.4±7.9, indicating a moderate level. After adjusting for confounders and hospital-level clustering using multivariable mixed-effects regression, higher monthly income was significantly associated with lower alarm fatigue (β=–0.15, p=0.03), and nurses working rotational shifts reported significantly higher fatigue compared with those with fixed shifts (β=0.18, p=0.02). Other demographic and occupational factors were not significant. Reported psychological reactions to alarms included indifference (14%), irritability (18%) and anxiety/stress (15%).
ICU, CCU and ER nurses experience a moderate level of alarm fatigue, with income and shift type as independent associated factors. The association between income and alarm fatigue may reflect the role of financial stress as an additional job demand that compounds the burden of frequent alarms, particularly in contexts where low base salaries lead nurses to rely on overtime and multiple shifts. These findings underscore the need for targeted managerial and educational interventions, including shift schedule optimisation and attention to workload-related stressors, alongside alarm prioritisation strategies. Due to the cross-sectional design, causal inferences cannot be drawn.
To examine workplace experiences, perspectives on coming out at work, organisational climate and mental health status of lesbian, gay, bisexual, transgender, queer/questioning and other sexual, and gender minority healthcare providers (LGBTQ+ HCPs) within an East Asian cultural context.
Observational, cross-sectional study.
An online cross-sectional survey was conducted among 173 Taiwanese LGBTQ+ HCPs between May and August 2024.
Most of the 173 respondents did not disclose their LGBTQ+ identities to any colleagues, and approximately two-fifths met the clinically significant threshold for depressive symptoms. Furthermore, compared to LGBTQ+ HCPs who disclosed to all, most, about half or a few colleagues, those who had not disclosed to any colleagues reported higher levels of depressive symptoms, lower self-esteem, less comfort with disclosure, greater perceived necessity to conceal their LGBTQ+ identities, lower scores for job stability or security, poorer interpersonal relations and lower agreement that an LGBTQ+-inclusive workplace climate would influence their willingness to remain in their current jobs. Although approximately 80% of the LGBTQ+ HCPs reported that they were familiar with national workplace antidiscrimination laws and that their organisations had grievance mechanisms, nearly two-fifths did not trust the grievance systems or procedures within their organisations.
Results emphasise the urgent need to create an LGBTQ+-inclusive workplace environment with clear and enforceable antidiscrimination policies and inclusive organisational practices to improve both disclosure safety and mental health outcomes for LGBTQ+ HCPs.
The study results extend existing knowledge by identifying the relationship between different levels of disclosure and mental health status among LGBTQ+ HCPs. They also highlight the importance of establishing support groups, a comprehensive mental health referral system and enforcement mechanisms that safeguard legal rights without compromising the privacy or safety of LGBTQ+ HCPs.
No patient or public contribution.
by Mingming Pan, Yanhua Shen, Jiayu Wu, Chaonan Liu, Meihong Zhu, Zhengyu Zhou
This study aimed to investigate the therapeutic effects of ELASEM®Flex and ELASEM®ProFlex, two eggshell membrane (EM) products, on sodium iodoacetate (MIA)-induced osteoarthritis (OA) in rats. An OA model was established by a single intra-articular injection of MIA into the knee joint. After modeling, rats were administered diclofenac sodium, ELASEM®Flex, and ELASEM®ProFlex by gavage daily for 4 consecutive weeks. During the experiment, food intake, water intake, body weight, and plantar mechanical pain threshold (MPT) of rats were measured weekly. Serum levels of TNF-α, COX-2, IL-1β, and CTX-II were assessed at weeks 2 and 4. After 4 weeks, knee joints were harvested for histopathological examination (HE staining and Safranin-O fast green staining). Results indicated that knee joints of OA rats showed significant swelling, which was alleviated to varying degrees in all treatment groups. Both ELASEM®Flex and ELASEM®ProFlex significantly increased the MPT (P ®Flex and ELASEM®ProFlex can exert preventive and reparative effects on knee OA in rats by alleviating arthritis pain, inhibiting inflammatory factor expression, reducing type II collagen degradation, and promoting chondrocyte proliferation.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 Ayesha Bibi, Muhammad Hamza Afandi, Azra Mehmood, Usman Ali Ashfaq, Muhammad Shareef Masoud, Mohsin Ahmad Khan, Rashid Bhatti
Hepatocellular carcinoma (HCC) has a very significant mortality rate and is one of the most common cancers worldwide. Jacaranda mimosifolia is reported to have potential antitumor activities against various human cancers. However, the effects of J. mimosifolia on HCC are yet elusive. This study aimed to investigate the anti-HCC potential of methanolic extract of J. mimosifolia leaves using in vitro and in vivo studies and a network pharmacology approach. The effect of J. mimosifolia extract was assessed on Huh-7.5 cells using MTT assay, wound healing assay, and DNA fragmentation assay. These experiments found that J. mimosifolia extract significantly suppressed Huh-7.5 cell proliferation, impaired cell migration, and induced cell apoptosis. The real-time PCR validated the upregulation of p53 and Bax, alongside the downregulation of AFP and GPC3 in Huh-7.5 cells after treatment with J. mimosifolia extract. In vivo experiments confirmed the hepatoprotective effects of J. mimosifolia extract in mice models with CCl4-induced hepatic injury. In addition, through network pharmacological analysis, J. mimosifolia was found to play a critical role against HCC via targeting multiple potential targets and pathways. Docking analysis identified apigenin and kaempferol with the lowest binding energy against PTGS2 and EGFR, respectively, while flavonol glycoside showed the lowest binding energy against MMP9. However, detailed research is needed to isolate the potential phytochemicals from J. mimosifolia against HCC.Evidence-Based Practice (EBP) is essential to healthcare quality and safety, integrating scientific evidence with clinical expertise and patient preferences. Despite its importance, EBP implementation still faces major challenges. Educational interventions have proven effective in strengthening EBP competencies among healthcare.
To evaluate the impact of a personalized educational intervention on EBP competencies among healthcare professionals. Working at a private tertiary general hospital, comparing performance before and after the intervention.
A randomized controlled trial involving healthcare professionals was conducted. Eligible and consented participants were randomly assigned to either an Intervention Group (IG) receiving an Evidence-Based Practice (EBP) course or a Control Group (CG) not receiving the course, stratified by job level, role, and work shift. From the completers, 18 participants were randomly selected for the IG, and all 7 available CG participants were included in the final sample for analysis. All study participants completed two validated instruments: the Assessing Competencies in Evidence-Based Medicine (ACE) and the Fresno Test. The educational intervention consisted of a seven-week course with weekly three-hour sessions, for a total of 21 h. Comparative analyses were conducted using a Linear Mixed Model, adjusted for educational level, job level, time working at the hospital, and weekly workload.
A statistically significant increase in general EBP knowledge was observed in the IG following the intervention, with a mean gain of 19.1%. Separate analysis showed improvements of 10.8% in ACE and 24.2% in Fresno Test scores. No statistically significant changes were observed in the CG. Furthermore, after the intervention, the IG outperformed the CG for both general EBP knowledge and Fresno Test scores on both pre- and post-intervention comparisons.
The educational intervention had a positive statistically significant impact on EBP knowledge and skills among healthcare professionals in the IG compared to the CG. These findings underscore the potential of structured educational initiatives to enhance the quality of clinical practice through improved EBP competencies.
UTN U1111-1322-8443
To map and synthesise the main recommendations for arterial blood gas (ABG) collection in intensive care units (ICUs).
A scoping review was conducted according to the PRISMA-ScR Checklist, supported with The PAGER framework and guided by the Joanna Briggs Institute methodology to ensure methodological rigour and analytical comprehensiveness.
Data collection was conducted from February to April 2024. The data sources included: Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, PubMed Central, Scientific Electronic Library Online (SciELO), Web of Science (WoS), SCOPUS, Science Direct, Virtual Health Library (VHL), Excerpta Medica database (Embase), CAPES Thesis and Dissertation Catalogue, Brazilian Digital Library of Theses and Dissertations (BDTD), Scientific Open Access Repository of Portugal (RCAAP), Theses Canada and the Oswaldo Cruz Foundation (Fiocruz) repository.
Key findings recommend the radial artery as the preferred puncture site, an insertion angle of 30° to 45°, the use of 1 or 3 mL syringes and 20G or 23G gauge needles. Transport and storage at room temperature are advised. Cryoanalgesia and subcutaneous analgesia methods were found to be effective for pain management.
The review highlights the best practices for arterial blood gas collection in critical care. The synthesized evidence strengthens clinical practice, informs guidelines for intensive care nursing and promotes safer, higher-quality care for critically ill patients.
The evidence-based recommendations identified can enhance nursing care related to arterial blood gas collection. Adherence to these practices promotes safer, more humanised and evidence-based care during the procedure.
The report of this study followed the PRISMA-ScR Checklist.
There was no patient or public involvement in this scoping review.
To explore factors affecting research engagement among Nurses, Midwives and Allied Health Professionals (NMAHPs) in England by examining perceptions of research capacity at organisational, team and individual levels.
Research engagement strongly correlates with improved care quality. However, NMAHPs face persistent participation barriers compared to medical colleagues, limiting the development of a multi-professional research workforce.
National descriptive cross-sectional study using a validated survey tool.
Data from NMAHPs across England were collected using the validated Research Capacity and Culture tool. Quantitative data were analysed descriptively and inferentially; qualitative free-text responses were evaluated thematically.
Perceived capacity was moderate organisationally and in teams. Organisational strengths included promoting evidence-based practice (68.7%) and leadership support (61.6%). Teams offered moderate research opportunities (58.6%) but limited mentorship (47.9%). Individually, participants showed competence in literature review (69.5%) and data collection (63.4%) but required support for funding acquisition (43.8%) and publication (50.0%). Qualitatively, research was a highly valued aspect of professional identity, though participation is severely constrained by structural conditions, including extreme resource pressures, unclear career pathways, and professional inequality.
Despite strong motivation for evidence-based practice, significant structural barriers restrict NMAHP research engagement. Strengthening capacity demands coordinated action across clinical and policy systems, ensuring equitable access to protected time, mentorship, and vital research infrastructure.
Supporting NMAHPs in research enhances evidence-informed decisions and service innovation. Embedding research into everyday clinical work, rather than viewing it as optional, builds a sustainable multi-professional culture.
This survey pinpoints the specific factors most strongly influencing NMAHP research engagement. It provides healthcare leaders actionable insights to build sustainable research infrastructure and inclusive clinical academic pathways.
This study adhered to STROBE guidelines for cross-sectional research.
No patient or public contribution.
To investigate whether patient safety culture is associated with nurses' turnover intention and to examine correlational sequential pathways involving burnout and job satisfaction, drawing on Conservation of Resources theory.
A descriptive, correlational design.
This study used data collected during 2023 from a hospital-wide patient safety culture survey conducted in four hospitals in South Korea. The sample comprised 3082 nurses from diverse units. Relationships among patient safety culture, burnout, job satisfaction, and turnover intention were examined using a mediation model within a structural equation modelling framework (WLSMV estimator with probit link), controlling for age and hospital tenure.
Patient safety culture was associated with lower burnout and higher job satisfaction. Burnout was associated with lower job satisfaction and with a higher likelihood of turnover intention, whereas job satisfaction was associated with a lower likelihood of turnover intention. When burnout and job satisfaction were considered together, the association between patient safety culture and turnover intention was explained through these two factors rather than by a direct pathway.
Patient safety culture functions as an organizational resource that relates to reduced burnout and enhanced job satisfaction, which together relate to lower intention to leave.
Strengthening patient safety culture—alongside efforts to reduce strain and foster positive job attitudes—may support nurse well-being and improve retention, thereby supporting continuity and safety of patient care.
This study addresses persistent nurse turnover intention in hospitals and identifies patient safety culture as an organizational lever that operates through reduced burnout and improved job satisfaction. The findings can guide nurse leaders and policymakers in hospitals to implement culture-focused strategies that support staff well-being, enhance retention, and sustain safe patient care.
STROBE guidelines were followed.
No patient or public contribution.
This study aims to explore the history of prior abortions and the factors influencing them among young women seeking abortion services in Foshan, Guangdong, China.
This is a retrospective, cross-sectional study of young women seeking abortion care.
Gynaecological outpatient clinics at the Department of Gynaecology, Foshan Women and Children Hospital Affiliated to Guangdong Medical University, Foshan, Guangdong, China, between 2013 and 2023.
A total of 7361 young women aged 12–25 years seeking abortion services.
Data on abortion history, sociodemographic factors, contraceptive use and postabortion contraceptive choices were collected and analysed, with special emphasis on the incidence of repeat abortions and the factors associated with them.
Of the 7361 participants, 34.2% reported at least one previous abortion, underscoring a notable public health concern. The mean age of the participants was 22.30 years (SD=2.13). Women with a history of abortion were significantly older than those without (22.57 vs 22.08 years, p
This study underscores the need for targeted interventions to address the multifaceted factors leading to repeat abortions among young women in China. The results offer valuable insights for improving reproductive health outcomes in this vulnerable population and highlight the importance of expanding access to contraceptive education and services in China.
Suicide is a major public health concern among youth in Canada and worldwide. The most rapid increases in suicidal ideation, self-harm, and suicide attempts have been observed among adolescent girls, particularly since the COVID-19 pandemic. Recent studies report disproportionately high rates of emergency department visits and hospitalisations for suicide-related concerns among adolescent girls. Despite these concerning trends, limited evidence exists on the life trajectories, needs, and service pathways of adolescent girls who attempt suicide. This protocol describes a qualitative suicide audit focused on adolescent girls aged 12–17 who were hospitalised following a suicide attempt in two regions of the province of Québec, Canada. The aim is to understand developmental trajectories, document services received and identify individual, relational and systemic factors influencing these trajectories to generate recommendations that inform suicide prevention.
Using a narrative qualitative design and a community-based research approach, data will be collected from semi-structured interviews with adolescents and parents, parent questionnaires and hospital health records. These data will be integrated to develop anonymised case vignettes. A multidisciplinary panel, including clinicians, health system stakeholders, community partners and individuals with lived experience, will review each case to identify gaps and strengths in care and generate case-level and cross-case recommendations for clinical practice, health policy and professional training.
Ethics approval was obtained from the research ethics committee (REC) of the Centre intégré de santé et de services sociaux de Chaudière-Appalaches, which serves as the reviewing REC, with administrative reviews underway at two other health authorities. Findings will be disseminated through peer-reviewed publications, conference presentations and collaborative knowledge-mobilisation activities with clinical and community partners, including practice-oriented tools and accessible materials for adolescents and parents.
Early screening of non-alcoholic fatty liver disease (NAFLD) is critical for early diagnosis and management. The disease was renamed and its diagnostic criteria revised as metabolic-associated FLD (MAFLD) in 2020 and further updated to metabolic dysfunction-associated steatotic liver disease (MASLD) in 2023. This study evaluated the predictive performance and clinical feasibility of non-invasive diagnostic indicators across the NAFLD, MAFLD and MASLD diagnostic criteria.
Cross-sectional study.
Health Management Centre in China.
A total of 5810 participants aged ≥18 years were enrolled. Individuals with missing laboratory data, imaging results or self-reported information were excluded.
Disease-specific indicators included Fatty Liver Index (FLI), Hepatic Steatosis Index and Zhejiang University index (ZJU). Non-disease-specific indicators included lipid accumulation product (LAP), Visceral Adiposity Index and the Triglyceride and Glucose Index. Subgroup analysis was performed by gender and Body Mass Index (BMI).
The area under the receiver operating characteristic curve (AUROC) for all six non-invasive indicators exceeded 0.7. FLI showed the optimal predictive performance across the three criteria (NAFLD-AUROC: 0.802, MAFLD-AUROC: 0.847 and MASLD-AUROC: 0.811), with comparable performance observed for ZJU (0.797, 0.838 and 0.809, respectively). Pairwise z-tests demonstrated a significant difference between FLI and ZJU for MAFLD (p0.05). Subgroup analyses revealed that ZJU performed better in males (NAFLD-AUROC: 0.790, MAFLD-AUROC: 0.839 and MASLD-AUROC: 0.803), while FLI was superior in females (NAFLD-AUROC: 0.832, MAFLD-AUROC: 0.838 and MASLD-AUROC: 0.838) and in participants who were overweight (NAFLD-AUROC: 0.709, MAFLD-AUROC: 0.765 and MASLD-AUROC: 0.709). LAP exhibited the highest predictive efficacy in the normal BMI subgroup (NAFLD-AUROC: 0.758, MAFLD-AUROC: 0.804 and MASLD-AUROC: 0.796).
FLI exhibited the highest predictive efficacy across all diagnostic criteria, and ZJU showed comparable performance. Considering diagnostic accuracy and clinical practicality, ZJU is recommended as a favourable, non-invasive tool for population-based screening in the Chinese population.
Non-communicable diseases (NCDs) have become the leading cause of mortality globally, with a sharp rise in Iran due to lifestyle changes and urbanisation. Although many NCD risk factors are modifiable, limited understanding of their determinants hinders effective prevention. To address this, the Prospective Epidemiological Research Studies in Iran (PERSIAN) Cohort was established in 2014 to study NCDs nationwide. The Sabzevar PERSIAN Cohort Study (SPECS) is the first in northeastern Iran, aiming to investigate environmental and social factors influencing NCDs in a unique regional context.
SPECS enrolled 5174 adults (aged 35–70 years) in northeastern Iran between January 2018 and January 2019 through a census and an online registration process. The baseline data collection included demographic verification, informed consent, health questionnaires, anthropometric measurements and biological samples (blood, urine, hair, nails). The annual follow-up began in April 2019, with full reassessments every 5 years over a 15-year period. The data is gathered via an active and passive follow-up, supported by trained staff and registry linkages.
Of the 5174 participants, 4241 (81%) remained in the study. Among the cohort, 54.5% were female, with a mean age of 50.5 years. The majority were married (93.5%), and nearly half had at least high-school education (46.5%) and moderate socioeconomic status (49.4%). Drug abuse history (smoking/drugs) was reported by about 15% of the sample. The mean body mass index was 26.9 kg/m², and the average blood pressure was higher in males (118.1/74.0 mm Hg) than in females (111.5/70.2 mm Hg). The common conditions included hypertension (22.8%), kidney stones (22.4%), fatty liver (15.4%) and diabetes (13.8%). Cancer had the highest treatment rate (100%), while fatty liver had the lowest (70.1%). Stroke had the highest mean age of onset (51.2 years), and epilepsy the lowest (23.7 years). All health data were self-reported.
SPECS, part of the national PERSIAN cohort initiative, is the only adult NCD-focused study in Khorasan Razavi. Its 15-year follow-up aims to generate region-specific insights into the incidence of NCDs and their risk factors. The ethnically homogeneous sample enhances statistical power, and the findings may inform culturally tailored health policies. While self-reported data have limitations due to bias, high initial participation and access to free healthcare support long-term engagement, especially among lower-income groups.
by Eleni Christoforidou, Jordan S. Rowe, Fabio A. Simoes, Raphaelle Cassel, Luc Dupuis, Peter Nigel Leigh, Majid Hafezparast
Impaired cytoplasmic dynein function has been implicated in amyotrophic lateral sclerosis (ALS) pathogenesis, yet the contributions of spinal interneurons to disease phenotypes remain unclear. We tested the hypothesis that hypomorphic dynein function in cholinergic neurons disrupts the development, survival, or positioning of inhibitory interneuron populations in the lumbar spinal cord. Using ChAT-Cre recombination, we generated four mouse genotypes with graded reductions in dynein activity in ChAT+ cells: Dync1h1+/+ (wildtype), Dync1h1−/+ (hemizygous wildtype), Dync1h1+/Loa (heterozygous Loa mutation), and Dync1h1−/Loa (hemizygous Loa). At 52 weeks of age, lumbar spinal cords (L3–L6) were harvested, cryosectioned, and immunostained for ChAT, GAD-67, Parvalbumin, and Calbindin. Cell counts were performed on confocal images from eight sections per mouse (N = 3 male mice/genotype), and radial distances from the central canal were normalised to gray matter width. Angular distributions were analysed via circular statistics. There were no significant genotype-dependent differences in the numbers of ChAT+, GAD-67+, Parvalbumin+, or Calbindin+ cells, nor in ChAT+ subpopulations (motor neurons versus interneurons) or double‐positive interneuron subsets (e.g., ChAT+–GAD-67+, Parvalbumin+–GAD-67+, Parvalbumin+–Calbindin+). Radial positioning relative to the central canal was similarly preserved across all markers and genotypes. Circular‐median tests revealed statistically significant shifts in mean angle for ChAT+, GAD-67+, and certain double‐positive cells, but these amounted to only 5–10° displacements, translating to lateral shifts of ~10–20 µm, well within single laminar bands, and are unlikely to impact circuit connectivity. Despite substantial motor deficits and hallmark TDP-43 pathology previously seen in these models, impaired dynein function does not precipitate interneuron loss or gross migratory defects in the lumbar spinal cord. Instead, our findings suggest that the primary contributions of dynein to ALS-like phenotypes likely arise from functional disruptions in axonal transport, synaptic maintenance, and neuronal physiology rather than from structural alterations or loss of interneuron populations.by Mary Yeboah, Richard Abeiku Bonney, Loretta Adu-Boahemaa Antwi, Pius Amponsah Anane, Obed Kwabena Offe Amponsah, Peter Agyei-Baffour
BackgroundNon-communicable diseases (NCDs) cause 74% of global deaths, disproportionately affecting LMICs like Ghana. Chronic treatment remains hindered by medicine shortages and high costs, consuming over 50% of the minimum wage incomes. Despite Ghana’s NCD policies, supply chain gaps and price inflation persist. This study assesses access to medicine, operationally defined as availability and affordability, in three municipalities to inform reforms for Universal Health Coverage and achieve SDG 3.4 targets.
MethodsThis cross-sectional mixed study assessed the availability and affordability of NCD medicines in three municipalities in Ghana using WHO/HAI methods. Data on 62 medicines were collected from nine health facilities, supplemented by interviews with pharmacy managers.
ResultsThis study assessed access to NCD medicines across three municipalities in Ghana, revealing stark disparities. Availability varied significantly by location (Oforikrom 70% vs. Juaben 48.6%, p Conclusion
This study highlights inequities in access to NCD medicines in Ghana, with stark gaps in availability and affordability, especially in underserved areas. Findings reveal high costs, stock-outs, and geographic disparities as key factors, underscoring the need for supply chain reforms, price regulation, and municipal oversight to advance equitable, sustainable, universal health coverage.
by Hongjun Park, Beechui Koo, Jungwook Shin, Byoung Hyuck Kim, James J. Sohn
Approximately one-third of US adults have tattoos, yet the dosimetric impact of intradermal tattoo pigments during radiation therapy remains uncharacterized. Commercial tattoo inks contain unregulated metallic impurities including chromium, lead, and nickel, raising concerns about dose perturbations in tattooed skin. This work quantifies radiation dose perturbations induced by high-atomic-number (Z) tattoo pigments under clinically relevant radiotherapy conditions. Monte Carlo simulations (TOPAS) modeled layered skin phantoms with a 0.3-mm intradermal tattoo layer embedded at 1.25–1.55 mm depth. Three commercial inks were evaluated: carbon-based (black) and metal-containing (Fe-rich brown, Al-containing orange) at pigment loadings of 5–100 vol% within the tattoo layer, to establish upper-bound effects. Electron (6, 18 MeV) and photon (6, 18 MV) beams were simulated with standard clinical geometry (1 × 1 cm² field, SSD = 100 cm). Photon irradiation produced pronounced, depth-localized dose enhancement, with peak dose enhancement factor (DEF) reaching 2.5 for brown ink at 18 MV, a 62% mean increase relative to non-tattooed skin driven by high-Z–mediated secondary electron production. Electron beams exhibited energy-dependent behavior: 6 MeV produced modest enhancement (peak DEF ~ 1.07), while 18 MeV unexpectedly generated dose deficits (DEFSocioeconomic inequalities in neonatal mortality are observed globally but gaps remain in the evidence from current reviews, specifically: a wider range of socioeconomic indicators at the individual, household and area level than previous reviews, and alternative time frames to define neonatal mortality. Thus, a comprehensive updated review of the literature is required, focusing on multiple measures of socioeconomic status and alternative time frames, to assess the relationship between maternal socioeconomic status and neonatal mortality in high-income countries.
Three different search approaches will be used: electronic searching of three databases, grey literature searching and reference list checking. First, the three databases Medline, Scopus and Web of Science will be searched using relevant synonyms and adapted terms from medical subject heading terms (MeSH) in Medline for maternal socioeconomic status and neonatal mortality identified from previous systematic reviews on inequalities in adverse pregnancy outcomes. Second, grey literature will be searched by entering the relevant terms into Google. Title, abstract and full text screening will be conducted by the review team against the inclusion and exclusion criteria, with at least 10% checked by a second reviewer to assess for any bias and errors. We will also conduct the kappa statistic for inter-rater reliability. Third, the reference lists of included studies will be reviewed for any additional studies that meet the criteria. Data will be extracted using a data extraction form and extracted studies will be assessed using the Liverpool Quality Assessment Tool. A narrative synthesis will be conducted and, where appropriate, meta-analysis will be performed. If the data allow, subgroup analysis by neonatal care population and specific gestational ages will be performed.
Ethical approval is not required as all studies in this systematic review will be publicly available. The findings of this review will be presented at conferences and disseminated in peer-reviewed publications.
CRD42022315407.
Knee osteoarthritis (KOA) is a prevalent degenerative joint disorder, often accompanied by comorbidities like type 2 diabetes mellitus (T2DM). These conditions have a significant impact on patients’ sleep quality and metabolic health. Current treatments for KOA primarily focus on symptom management, while innovative approaches targeting interconnected health outcomes remain underexplored. The lumbar knee recovery device, a non-invasive device patented in Iran, offers potential benefits by enhancing lumbar-knee synchronisation, improving blood circulation and optimising cellular metabolism. This randomised controlled trial (RCT) aims to evaluate the device’s effectiveness in improving sleep quality and regulating blood glucose levels in diabetic patients with KOA.
This RCT aims to evaluate the impact of using the lumbar knee recovery device (Kamarasa) on sleep quality, blood glucose levels, HbA1c (blood glucose control level over the past 90 days) and body mass index (BMI) in patients with T2DM and grade 1–3 KOA. The study will be conducted at the Orthopedic Clinic of Imam Khomeini Hospital, Tehran, and the Health and Wellness Clinic. Eligible participants will be randomly allocated into two groups: the intervention group (receiving 10 supervised sessions using the Recovery device over 3 months) and the control group (receiving standard KOA and diabetes care). A total of 37 participants will be included in each group. The primary outcome, sleep quality, will be assessed using the Pittsburgh Sleep Quality Index at baseline and 3 months post intervention. Secondary outcomes will include random blood glucose levels, which will be measured at 10 intervals during the study; BMI, measured at the start and end of the study and HbA1c, assessed at both baseline and post intervention. The Western Ontario and McMaster Universities Arthritis Index will be used to assess pain, stiffness and physical function, also at both baseline and 3 months. Appropriate statistical tests, including two-sample t-tests, ² tests, analysis of covariance or linear regression, will be performed based on the type of variables using SPSS V.23. Additionally, standardised intervention effect sizes will be calculated for each outcome.
Ethical approval for this study was obtained from the Research Ethics Committee of the School of Nursing and Midwifery at Tehran University of Medical Sciences with reference number (IR.TUMS.FNM.REC.1403.145). Additionally, the study protocol was registered with the IRCT under the identifier IRCT20191027045257N7 on 24 November 2024.
Iranian Registry of Clinical Trials (IRCT20191027045257N7). This clinical trial was registered on 24 November 2024.
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