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Atrial fibrillation (AF) is the most common sustained arrhythmia worldwide, associated with significant morbidity, mortality and healthcare utilisation. AF rhythm control strategies demonstrate attrition with time. A number of modifiable AF risk factors contribute to an atrial cardiomyopathy culminating in incident AF but importantly also recurrence. We propose that a novel multidisciplinary lifestyle intervention (Super Rehab, SR) may improve symptoms and AF burden.
This is a single-centre, randomised controlled study. Patients aged ≥18 years with a body mass index ≥27 kg/m2 with paroxysmal or persistent AF will be randomised 1:1 to National Health Service (NHS) usual care (UC) or to SR (together with NHS UC). SR incorporates high-intensity exercise, personalised dietary advice and AF risk factor modification. SR will be undertaken over 12 months. In addition to baseline assessments, follow-up assessments will occur at the 6, 12 and 15-month time points. The primary outcome will be the difference in AF symptom burden at 12 months between groups. Secondary outcomes include AF burden (assessed by an implantable cardiac monitor), changes to cardiac structure and function and computed tomography-based assessment of epicardial adipose tissue.
Ethics approval was granted by London-Chelsea Research Ethics Committee (reference: 22/LO/0479 22/08/2022). All participants will provide written informed consent prior to enrolment. Study findings will be disseminated via presentations to relevant stakeholders, national and international conferences and open-access peer-reviewed research publications. A summary will also be communicated to the participants.
ClinicalTrials.gov ID NCT05596175.
The development of effective vaccines targeting human papillomavirus (HPV) has significantly contributed to disease prevention, highly relevant in immunosuppressed patients who have higher incidence of HPV-related cancers than their non-immunosuppressed counterparts. However, the acceptance and uptake of the HPV vaccine among immunosuppressed individuals pose unique challenges. Immunocompromised patients’ acceptance of the HPV vaccine is influenced by multifaceted factors, including concerns about safety and effectiveness, interactions with immunosuppressive medications and uncertainties due to their compromised immunity. This systematic review aims to identify the main factors influencing HPV vaccine acceptance among immunosuppressed patients.
A comprehensive search strategy will be executed across databases such as MEDLINE/PubMed, Embase, Scopus, Web of Science, ScienceDirect, Latin American and Caribbean Literature in Health Sciences, Cumulative Index to Nursing and Allied Health Literature and Cochrane Database. The review will encompass the three WHO-endorsed HPV vaccines (quadrivalent, bivalent and nonavalent) and will consider studies related to HPV vaccines and their administration. The scope includes study focusing on immunosuppressed patients who received organ transplants, cancer treatments or are HIV-positive. No temporal restrictions will be applied, and searches will be conducted until December 2025. Observational studies, including retrospective/prospective cohorts, case–control and cross-sectional studies, reporting factors influencing HPV vaccination in immunosuppressed populations will be included. Studies with overlapping patient populations will be excluded. Data extraction will include study details, demographics, vaccine type, risk/protective factors, outcomes and medical history. Validation and cross-verification will ensure data accuracy. Risk of bias will be assessed using ROBINS-I (Risk Of Bias In Non-randomised Studies of Interventions), and GRADE (Grading of Recommendations Assessment, Development and Evaluation) will rate evidence certainty. Meta-analysis, guided by Cochrane and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, will employ fixed/random-effects models, assessing heterogeneity using I² statistics.
This research will analyse previously published data, so ethical approval is not required. The results of the systematic review will be submitted for publication in a peer-reviewed journal.
CRD42023452537.
by Juliana Rodrigues Tovar Garbin, Franciéle Marabotti Costa Leite, Ana Paula Brioschi dos Santos, Larissa Soares Dell’Antonio, Cristiano Soares da Silva Dell’Antonio, Luís Carlos Lopes-Júnior
A comprehensive understanding of the factors influencing the epidemiological dynamics of COVID-19 across the pandemic waves—particularly in terms of disease severity and mortality—is critical for optimizing healthcare services and prioritizing high-risk populations. Here we aim to analyze the factors associated with short-term and prolonged hospitalization for COVID-19 during the first three pandemic waves. We conducted a retrospective observational study using data from individuals reported in the e-SUS-VS system who were hospitalized for COVID-19 in a state in a southeast state of Brazil. Hospitalization duration was classified as short or prolonged based on a 7-day cutoff, corresponding to the median length of hospital stay during the second pandemic wave. Bivariate analyses were performed using the chi-square test for heterogeneity. Logistic regression models were used to estimate odds ratios (ORs) and their respective 95% confidence intervals (CIs), with statistical significance set at 5%. When analyzing hospitalization duration across the three waves, we found that 51.1% (95%CI: 49.3–53) of hospitalizations in the first wave were prolonged. In contrast, short-duration hospitalizations predominated in the second (54.7%; 95% CI: 52.4–57.0) and third (51.7%; 95% CI: 50.2–53.2) waves. Factors associated with prolonged hospitalization varied by wave. During the first wave, older adults (≥60 years) (OR=1.67; 95%CI: 1.35–2.06), individuals with ≥10 symptoms (OR=2.03; 95%CI: 1.04–3.94), obese individuals (OR=2.0; 95%CI: 1.53–2.74), and those with ≥2 comorbidities (OR=2.22; 95%CI: 1.71–2.89) were more likely to experience prolonged hospitalization. In the second wave, he likelihood of extended hospital stays was higher among individuals aged ≥60 years (OR=2.04; 95%CI: 1.58–2.62) and those with ≥2 comorbidities (OR=1.77; 95%CI: 1.29–2.41). In the third wave, prolonged hospitalization was more frequent among older adults (OR=1.89; 95%CI: 1.65–2.17,), individuals with 5–9 symptoms (OR=1.52; 95%CI: 1.20–1.92), obese individuals (OR=2.2; 95%CI: 1.78–2.73), and those with comorbidities (OR=1.45; 95%CI: 1.22–1.72 and OR=2.0; 95%CI: 1.69–2.45). In conclusion, we identified variations in hospitalization patterns across the pandemic waves, although the differences were relatively subtle. These variations likely reflect gradual shifts in the risk factors associated with prolonged hospital stays. Our findings highlight t the importance of implementing targeted public health interventions, particularly those designed to reduce disease severity and improve clinical outcomes among vulnerable populations at greater risk of extended hospitalization.To evaluate the predictive capacity of the Integrated Care for Older People screening tool for the risk of falls in older people receiving care at a healthcare service.
A cross-sectional study.
This study was conducted in a geriatric healthcare service in the southeast region of Brazil. The convenience sample included older people aged 60 and over living at home. The study used the Fall Risk Score to assess the risk of falls and the Integrated Care for Older People screening tool to track intrinsic capacity. The data was analysed using logistic regression to analyse the association between the six Intrinsic Capacity domains, for the early detection of impairment and risk of falls.
A total of 253 older adults participated in the study, most of whom were identified as having a high risk of falls. Logistic regression analysis across six association models revealed that the models including the Intrinsic Capacity domains of locomotion and hearing had a significant association with having a higher risk of falls. Care plans should prioritise the domains most strongly associated with fall risk, guiding targeted strategies to enhance older adults' safety.
The Integrated Care for Older People screening tool, in the locomotion and hearing domains, is associated with the risk of falls in older people from the community receiving care in a geriatric healthcare service. Future longitudinal studies could show whether other domains of intrinsic capacity can predict the occurrence of falls.
This study highlights the Integrated Care for Older People screening tool as essential in nursing practice, especially for assessing the locomotion and hearing domains of intrinsic capacity. Early detection of impairments helps identify increased fall risk in older adults, enabling nurses to implement targeted, person-centred interventions that enhance safety, autonomy and overall quality of life.
No patient or public contribution.
This study complied with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines for cross-sectional studies.
Violence against girls and women (VAWG) is a public health problem and a violation of human rights. The prevalence of different forms of VAWG indicates that this is a recurring global issue that provokes economic, social and health consequences. In this paper, we outline a scoping review protocol to characterise risk factors for VAWG from an intersectional and intergenerational perspective and discuss the consequences of such experiences for women’s health.
The protocol will be conducted according to the Joanna Briggs Institute Methodology for Scoping Reviews and will involve six consecutive steps: (1) formulating the research question, (2) search strategy, (3) study selection, (4) eligibility criteria, (5) data extraction, (6) data analysis and presentation of results and (7) stakeholder consultation. The search strategy will include eight indexed databases (PubMed, BVS, Scopus, Web of Science, EMBASE, Cinahl, Cochrane Library and PsycInfo) and recommendations from professional organisations and international agencies. The search will be limited to publications in English, Spanish and Portuguese, according to the Health Sciences Descriptors/Medical Subject Headings and free terms. Two independent researchers will select articles based on the inclusion criteria, and a third author will be consulted to establish consensus. Data extraction will involve a form with information on study characteristics, methodological issues and main results from the sources of evidence. Extracted data will be analysed using descriptive and content analysis. The NVIVO 14 software will be used to organise and validate the data. The protocol was registered in the Open Science Framework (DOI 10.17605/OSF.IO/P6H2S).
Ethical approval is not required as data from publicly available literature sources will be used. The results will be disseminated through publications in scientific journals and presentations of the evidence to stakeholders.
To synthesise current evidence on physiotherapists’ use of electronic health records (EHRs), with a focus on the determinants of adoption, implementation processes and associated implementation outcomes.
A systematic review employing a narrative synthesis approach.
PubMed, Cochrane, Scopus and Web of Science, covering all records from the inception of each database to 10 May 2024.
Studies conducted in physiotherapy clinical settings and using the International Classification of Functioning, Disability and Health (ICF).
Two authors independently screened articles and assessed methodological quality. Risk of bias was assessed using the Critical Appraisal Skills Programme tool for qualitative and for cohort studies, the Mixed Methods Appraisal Tool for mixed-methods studies and the JBI Critical Appraisal Checklist for analytical cross-sectional studies.
From 3820 records screened, 9 observational studies met inclusion criteria. Key factors influencing EHR adoption included organisational readiness, perceived usefulness, managerial support and training availability. Implementation patterns clustered into three domains: recorded content, ICF framework integration and record quality. Reported outcomes focused on care quality metrics and evidence of clinical effectiveness.
Persistent challenges in physiotherapy EHR use were identified, notably in data quality, completeness and alignment with the ICF framework. Improving EHR practices is crucial to improve clinical assessment and support digital health integration. However, limited evidence and methodological heterogeneity remain key limitations.
CRD42023420267.
The prevalence of women with primary dysmenorrhoea is high and negatively impacts physical and mental health. The intense cyclic episodes of pain generate central nervous system dysfunctional processing. In this sense, strategies focused on the central nervous system are important to re-establish normal functioning. Home-based self-administered transcranial direct current stimulation (tDCS) emerges as a strategy to modulate dysfunctional brain areas and improve the symptoms. This protocol aims to evaluate the effects of home-based self-administered tDCS for pain, premenstrual symptoms, physical performance, quality of life, electroencephalography and patient global impression in women affected by primary dysmenorrhoea.
This is a single-centre, parallel, randomised, double-blinded clinical trial protocol. 40 women affected by primary dysmenorrhoea will be randomised into two groups (active-tDCS or sham-tDCS). Then, 20 consecutive sessions of home-based self-administered tDCS will be performed. The assessments will occur at five time points: baseline, after the 20th sessions, at the first, second and third cycles after tDCS interventions (follow-ups). Primary outcome will be pain according to visual analogue scale. Quality of life, premenstrual symptoms screening, depression, anxiety, physical performance, electroencephalography and participants’ satisfaction will be the secondary outcomes. A mixed analysis of variance will calculate the effect of stimulation.
The study was approved by the ethics committee of the Federal University of Rio Grande do Norte (No. 6.037.756) and registered in the Brazilian Clinical Trials Registry (n° RBR-747k8vb). Participants may withdraw at any time without penalty. Free support will be available from the lead researcher if needed. All procedures will follow Good Clinical Practice and international ethical standards.
Chronic wounds may develop when there is a delay or disturbance in one of the stages of the healing process, presenting challenging financial, clinical, and quality-of-life costs. Therefore, continuous efforts have been made to develop dressings that optimise wound healing. In recent years, nanotechnology has revolutionised wound care, enabling the development of innovative materials with high efficiency that positively impact the healing process. Nanoparticles have been extensively used in wound dressings because of their specific properties, such as a high surface area-to-volume ratio, increased surface reactivity, and improved biocompatibility, representing a unique tissue repair tool. This review article addresses advances in the use of organic nanoparticles in the field of skin regeneration, considering papers published in the last 5 years, and highlighting the effects of this class of materials on the wound healing process. The analysis of the literature shows that the materials being considered are carbon-based and organic materials, including polymeric, cellulosic, lipid, and liposome nanoparticles, which are covered in this review (inorganic nanoparticles are not considered). Furthermore, important aspects to prevent the development of chronic wounds are presented, as well as general characteristics of wounds, the healing process, and their particularities.
Respiratory viral infections (RVIs) are a significant cause of morbidity and hospital admission worldwide. However, the management of most viral infection-associated diseases remains primarily supportive. The recent COVID-19 pandemic has underscored the urgent need for a deeper understanding of RVIs to improve patient outcomes and develop effective treatment strategies. The Understanding Infection, Viral Exacerbation and Respiratory Symptoms at Admission-Longitudinal Study is an observational study which addresses this need by investigating the heterogeneity of RVIs in hospitalised adults, aiming to identify clinical and biological predictors of adverse outcomes. This study aims to bridge critical knowledge gaps in the clinical course and the economic impact of RVIs by characterising the phenotypic diversity of these infections and their recovery patterns following hospital admission and thus assisting with the optimal design of future interventional studies.
This prospective longitudinal observational study (V.6, 20 September 2023) will be conducted across multiple UK secondary care sites from August 2022 onwards, with an aim to enrol 1000 participants testing positive for RVI. Adults admitted with respiratory symptoms who test positive for RVIs via the BioFire® FilmArray® System or other validated diagnostic PCR tests will be enrolled. The data collected include patient demographics, clinical history, comorbidities and symptoms experienced prior to, during and after hospitalisation with follow-up after discharge at weeks 1, 2, 4, 8, 12 and 26. In addition, biological samples are collected at multiple time points during the hospital stay. The primary endpoints are to study the impact of different RVIs and identify predictors of disease progression and length of stay. Secondary endpoints include time to recovery and healthcare cost. Exploratory endpoints focus on biomarker profiles associated with virus type and clinical outcomes.
The study protocol received ethical approval from the relevant committees (English Ethics Reference Number: 22/WM/0119; Scottish Ethics Reference Number: 22-SS-0101, 20/09/2023). For patients who lack the capacity to consent, the study complies with the Mental Capacity Act 2005, using a consultee process where a family member, carer or an independent clinician may provide assent on behalf of the patient. Data from all the study centres will be analysed together and disseminated through peer-reviewed journals, conference presentations and workshops. The study group will ensure that participants and their families are informed of the study findings promptly and in an accessible format.
by Nádia Cristina Pinheiro Rodrigues, Joaquim Teixeira-Netto, Denise Leite Maia Monteiro, Mônica Kramer de Noronha Andrade
BackgroundThe COVID-19 pandemic has significantly impacted global health, with diverse factors influencing the risk of death among reported cases. This study mainly analyzes the main characteristics that have contributed to the increase or decrease in the risk of death among Severe Acute Respiratory Syndrome (SARS) cases classified as COVID-19 reported in southeast Brazil from 2020 to 2023.
MethodsThis cohort study utilized COVID-19 notification data from the Sistema de Vigilância Epidemiológica (SIVEP) information system in the southeast region of Brazil from 2020 to 2023. Data included demographics, comorbidities, vaccination status, residence area, and survival outcomes. Classical Cox, Cox mixed effects, Prentice, Williams & Peterson (PWP), and PWP fragility models were used to assess the risk of dying over time.
ResultsAcross 987,534 cases, 956,961 hospitalizations, and 330,343 deaths were recorded over the period. Mortality peaked in 2021. The elderly, males, black individuals, lower-educated, and urban residents faced elevated risks. Vaccination reduced death risk by around 20% and 13% in 2021 and 2022, respectively. Hospitalized individuals had lower death risks, while comorbidities increased risks by 20–26%.
ConclusionThe study identified demographic and comorbidity factors influencing COVID-19 mortality. Rio de Janeiro exhibited the highest risk, while São Paulo had the lowest. Vaccination significantly reduces death risk. Findings contribute to understanding regional mortality variations and guide public health policies, emphasizing the importance of targeted interventions for vulnerable groups.
Objective of the study was to find the association of vitamin D receptor (VDR) polymorphisms (Fokl, Taql and Apal) with vitamin D levels in diabetic foot ulcer (DFU) patients in South India. In this case–control study, plasma vitamin D levels and VDR genotype frequencies of 70 cases (DFU patients) were compared with 70 diabetic (diabetes mellitus [DM] [non-DFU]) patients and 70 apparently healthy controls (HC) from South India. Plasma vitamin D levels were measured using the ELISA technique, and genotyping of VDR polymorphisms was carried out using real-time polymerase chain reaction. Logistic regression was used to find the association between DFU versus HC and DFU versus DM traits. Association analysis was performed based on additive, dominant and recessive models with age and gender as covariates. A 45.7% of DFU patients have sufficient vitamin D levels than 48.6% and 40% of DM patients and HC, respectively. Linkage disequilibrium analysis for DFU versus HC and DFU versus DM traits shows that single nucleotide polymorphisms (SNPs) Taq1 (rs731236) and Apal (rs7975232) are in strong linkage disequilibrium in DFU patients. The alleles and genotype frequencies were similar in all three groups. Although the additive model does not show statistical significance, age and sex correlate with the three SNPs (Fokl, Taql and Apal). No association was found between VDR gene polymorphisms and vitamin D levels in DFU patients in Southern India. On the other hand, age and sex correlate with the three SNPs.
Objetivo: identificar las necesidades humanas básicas de las embarazadas de alto riesgo hospitalizadas con base en la Teoría de Wanda Horta. Método: investigación asistencial realizada con dieciséis gestantes de alto riesgo hospitalizadas en una maternidad de referencia en Ceará entre septiembre y noviembre de 2019. Se recolectó información a través de diario de campo y ficha de caracterización de las gestantes y registros de necesidades humanas básicas. Los resultados se analizaron mediante estadística descriptiva simple y un enfoque integral a la luz del marco de Wanda Horta. Resultados: las gestantes presentaron necesidades psicobiológicas, psicosociales y psicoespirituales, siendo prevalentes: ausencia de actividades de ocio, inseguridad emocional, escaso conocimiento, sueño y descanso perjudicados, y actividades físicas restringidas por indicación de descanso. Consideraciones finales: se cree que el razonamiento crítico y el juicio clínico de los enfermeros se centraron en la individualidad de las gestantes, identificando necesidades en los tres niveles propuestos por la teoría, apuntando caminos para cualificar el cuidado de enfermería a las gestantes de alto riesgo.
Objetivo principal: Conocer la percepción de la persona sometida a una cirugía general programada sobre su preparación preoperatoria. Método: Estudio cualitativo y exploratorio. Se realizaron diez entrevistas semiestructuradas con personas que se habían sometido a una cirugía general programada en los últimos seis meses en un hospital universitario de la región central de Portugal. Para analizar los datos se utilizó la técnica del análisis de contenido. Resultados principales: Surgieron cinco unidades temáticas, percepción de la experiencia quirúrgica, sentimientos/emociones percibidas, necesidades de información, expectativas sobre los cuidados de enfermería preoperatorios y perspectivas sobre la existencia de una consulta de enfermería, que se subdividieron en varias categorías y subcategorías. Conclusión principal: Algunas personas siguen viendo la experiencia quirúrgica como algo traumático y consideran el entorno quirúrgico como un generador de estrés. Este estudio refuerza la relevancia del personal de enfermería en la preparación de las personas en situaciones perioperatorias y puede proporcionar importantes contribuciones a la estructuración de una consulta de enfermería.
Objetivo principal: Identificar los factores que subyacen al juicio clínico de las enfermeras sobre el empoderamiento del cuidador. Metodología: Estudio cualitativo y exploratorio. Los participantes fueron 10 enfermeras expertas que pertenecían a un grupo que apoya a sus colegas en el diseño de los cuidados apoyados en modelos teóricos y enfermeras expertas en el empoderamiento de los cuidadores, en un hospital universitario. Se realizaron entrevistas semiestructuradas con grabación de audio. Los datos se analizaron mediante la técnica de análisis de contenido. Resultados principales: Emergieron tres temas, las enfermeras, los cuidadores y las dificultades y limitaciones, que se subdividieron en ocho subtemas. Se identificaron factores facilitadores, así como limitaciones y dificultades asociadas a la asunción y gestión del rol de cuidador. Conclusión principal: El empoderamiento del cuidador es un proceso complejo, en el que los cuidados de enfermería se centran más en la persona dependiente y menos en el cuidador, lo que demuestra que es un área que requiere mayor atención y conceptualización por parte de las enfermeras.
Objetivo: evaluar la calidad de vida de los cuidadores de niños con necesidades especiales de salud. Método: estudio cuantitativo, en una Unidad de Pediatría, con 16 madres de niños con necesidades especiales de salud. La recolección de datos se produjo mediante la aplicación del instrumento WHOQOL-bref. Para el análisis de los datos se utilizó la estadística descriptiva e inferencial. Resultados: la calidad de vida de los familiares cuidadores es influenciada por los aspectos físicos; psicológica; del medio ambiente y de las relaciones sociales. Conclusiones: la percepción general de la calidad de vida de estos cuidadores no puede considerarse satisfactoria, ya que los valores asociados a todos los ámbitos son relativamente bajos.
Objetivo principal: El objetivo fue identificar y analizar eventos adversos en la atención de pacientes en hemodiálisis en la Unidad de Cuidados Intensivos. Metodología: Estudio descriptivo y retrospectivo desarrollado en una clínica de hemodiálisis, que subcontrata el servicio de hemodiálisis a 10 unidades de cuidados intensivos en hospitales de Goiânia, Goiás, Brasil. Se realizó una evaluación de los indicadores de evaluación de los servicios de hemodiálisis con el fin de elevar los eventos adversos en los últimos seis meses. Resultados principales: La mayoría de los pacientes fueron sometidos a hemodiálisis mediante catéter venoso central de doble lumen, con predominio del sexo masculino y mayores de 60 años. En los seis meses se identificaron 1.988 sesiones de hemodiálisis, 228 eventos adversos que generaron interrupción del tratamiento, producto de fallas en tecnología sanitaria, fallas en el acceso vascular, alteración hemodinámica y metabólica del paciente o por orden médica. Conclusión principal: Los eventos adversos identificados en la atención de pacientes en hemodiálisis en una unidad de cuidados intensivos provocaron la interrupción de la sesión de tratamiento de diálisis. Fueron: fallas en la tecnología de la salud, fallas en el acceso vascular y cambios hemodinámicos y metabólicos.
Objetivo: analizar el proceso de enseñanza-aprendizaje de la medición de la presión arterial, a través de una aplicación web, desde la perspectiva de los estudiantes de enfermería. Método: estudio cualitativo con 19 estudiantes de enfermería. Los datos se recopilaron en 2017, en dos etapas: presentación y uso de la aplicación web y realización del grupo focal. Se utilizó el análisis del benchmark de Análisis Temático. Resultados: a partir del análisis de los datos, se elaboró un tema central: la construcción del conocimiento sobre la medición de la presión arterial a través de una aplicación web y dos subtemas, La mirada en la tecnología y La mirada en diferentes formas de aprendizaje. Conclusión: la educación mediada por el uso de la aplicación web contribuyó al proceso de enseñanza del aprendizaje, tanto en relación con el contenido teórico como práctico sobre la medición de la presión arterial. La aplicación web se consideró dinámica, innovadora y favoreció la incautación del conocimiento y la actualización a una práctica clínica más segura.
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