Conectar
by Sadia Akter, Md. Nazid Bin Ibrahim, Zimam Mahmud, Sonia Tamanna, Md. Shakhawat Hossain Shawon, Farzana Ansari, Md. Zakir Hossain Howlader
Acute myocardial infarction (AMI) remains a leading cause of cardiovascular morbidity and mortality worldwide. Emerging evidence highlights vitamin D as a critical determinant of cardiovascular health. The CYP2R1 gene encodes the key 25-hydroxylase enzyme responsible for converting vitamin D to its principal circulating metabolite, 25-hydroxyvitamin D. However, the influence of CYP2R1 polymorphisms on AMI susceptibility, particularly within South Asian populations, has not been well characterized. This study investigates the association of two CYP2R1 variants, rs2060793 and rs12794714, with AMI risk and their relationship with serum vitamin D levels in a Bangladeshi cohort. A total of 502 participants comprising 251 AMI patients and 251 age- and sex-matched controls were analyzed. Genomic DNA was extracted and genotyped using PCR-RFLP, while serum 25-hydroxyvitamin D3 levels were quantified by HPLC. AMI patients exhibited markedly lower vitamin D concentrations (23.92 ± 0.94 ng/mL) than controls (30.3 ± 0.86 ng/mL; p p = 0.0064). The dominant model (TC + CC vs. TT) further confirmed this relationship (OR = 2.53, 95% CI: 1.39–4.61, p = 0.0016). In contrast, rs12794714 showed no significant association with AMI in this population. Stratified analysis indicated that rs2060793 was significantly linked to AMI in males but not females, while both variants were associated with increased risk in individuals aged ≤60 years, but not in those >60 years. Bioinformatic and molecular docking analyses (RegulomeDB, JASPAR, HADDOCK 2.4, DNAproDB) further demonstrated potential regulatory effects of these variants on CYP2R1 function. Collectively, our findings reveal a novel association between CYP2R1 rs2060793 and vitamin D deficiency with AMI risk in the Bangladeshi population, underscoring the interplay of genetic and metabolic determinants in the molecular pathogenesis of AMI.Acne vulgaris is a chronic inflammatory condition primarily caused by Cutibacterium acnes, which disrupts skin homeostasis, thereby triggering immune responses and sebum metabolism. Dysbiosis is an imbalance in the skin and gut microbiota identified as a significant factor contributing to acne progression. Standard therapy often relies on antibiotics, but the long-term use has increased antibiotic resistance, including in Indonesia. Consequently, alternative methods, such as probiotics and mesenchymal stromal cell secretomes, are gaining attention for immunomodulatory and regenerative properties. These novel therapies have shown promising results in modulating the skin and gut microbiota while reducing inflammation.
A phase 2 double-blind randomised controlled trial will be conducted using a parallel group design with four arms, namely: (1) standard therapy with oral probiotics and topical secretome (placebo), (2) standard therapy with oral probiotics (placebo) and topical secretome, (3) standard therapy with oral probiotics and topical secretome and (4) standard therapy with oral probiotics (placebo) and topical secretome (placebo). Sixty-four patients with mild to moderate acne vulgaris will be randomly allocated to these groups. Interventions will be administered over a period of 8 weeks, with outcomes to be measured at baseline and post-therapy. This study will be conducted at the Dermatology and Venereology Department of Bali Mandara General Hospital (RSBM). The primary outcome will be the reduction of comedones and inflammatory lesions, assessed using the Yolov8 method. Secondary outcomes will include gut and skin health parameters, such as tryptophan metabolites, collagen, pH, moisture, sebum levels and IL-6, to explore the relationship between microbiome balance, skin condition and inflammation in acne.
This study will be conducted in accordance with the ethical principles outlined in the Declaration of Helsinki and the International Conference on Harmonisation–Good Clinical Practice guidelines. Ethical approval has been granted by the Health Research Ethics Committee of Bali Mandara Regional Hospital (Approval Reference Number: 060/EA/KEPK.RSBM.DINKES/2024). All participants will provide written informed consent prior to enrolment. Data confidentiality and participant safety will be upheld throughout the trial. The results of this study will be disseminated through journals, scientific conferences and relevant academic platforms to ensure wide accessibility and to support further research and clinical application in the field of dermatology, particularly in addressing antibiotic resistance and microbiome-based acne therapies.
School feeding programmes reach over 466 million children globally, making them one of the largest social safety nets worldwide. Beyond providing immediate nutritional benefits, school feeding programmes increasingly aim to strengthen local food systems through procurement from smallholder farmers, support for sustainable agriculture, community kitchen involvement and broader development outcomes. However, evidence on how school feeding programmes can simultaneously improve nutrition and educational outcomes while transforming food systems in low and middle-income countries (LMICs) remains fragmented. This systematic review will synthesise evidence on the effects of school feeding interventions with explicit food system components on health, nutrition, education and food system outcomes among school-age children and adolescents in LMICs.
We conducted comprehensive searches in MEDLINE (PubMed), Embase (Ovid), CENTRAL (Cochrane Library), Web of Science, Google Scholar, completed on 18 February 2026, with grey literature searches ongoing and to be completed subsequently. We will include randomised controlled trials (RCTs), non-RCTs and quasi-experimental studies with comparison groups examining school feeding interventions with food system components among school-age children and adolescents (5–19 years) in LMICs. Two reviewers will independently screen titles and abstracts, review full texts, extract data and assess study quality using the Cochrane Risk of Bias tools (RoB 2 for RCTs and Risk Of Bias In Non-Randomized Studies - of Interventions (ROBINS-I) for non-randomised studies). Certainty of evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. We will conduct narrative synthesis using the Synthesis Without Meta-analysis (SWiM) guidelines and meta-analysis where appropriate.
Ethical approval is not required for this systematic review as no primary data will be collected. Findings will be disseminated through peer-reviewed publication, conference presentations and policy briefs targeting international organisations, governments and development partners working on school feeding and food systems in LMICs.
Registration: Open Science Framework https://osf.io/p83tb/
The COVID-19 pandemic had significant physical and psychosocial impacts on nurses. While the initial phases of the pandemic presented considerable challenges, these appear to have diminished over time. This study aimed to explore the lived experiences of Iranian nurses working in clinical settings during the post-pandemic period of COVID-19.
This is a qualitative study conducted using the conventional content analysis approach proposed by Granheim and Lundman (2004).
This study was conducted at secondary care hospitals in northwest Iran that served as referral centres for multiple provinces during the COVID-19 pandemic.
A total of 18 nurses with at least 1 year of clinical experience in COVID-19 wards were recruited using purposive sampling. Participants were diverse in terms of gender, age and educational background. Nurses temporarily transferred from other wards were excluded.
‘Return to Normalcy’ emerged as the overarching theme, encompassing five main categories: Expansion of Knowledge, Changing Attitudes Toward the Disease, Improved Disease Management, Changing Nature of the Disease and Expansion of Facilities.
The findings suggest that, like other crises, the COVID-19 pandemic represents a temporary disruption. However, certain factors can expedite the transition back to normalcy. These include enhanced awareness of the disease, effective crisis management and improved access to diagnostic, therapeutic and protective resources.
To examine and map the available literature on outcomes associated with interventions carried out by advanced practice nurses in chronic wound care.
The role of the advanced practice nurses in wound care is identified as a key element in the management of patients with chronic wounds. However, the literature offers fragmented knowledge of the outcomes associated with their practice.
Scoping review.
This scoping review was conducted following the methodological framework proposed by Arskey and O'Malley, following the Preferred Reporting Item for Systematic Review and Meta-analysis for Scoping Review. PRISMA-ScR Checklist is included in the manuscript. Observational or experimental studies related to patients affected by chronic wounds and cared for by advanced practice nurses in wound care were included.
The following databases were queried: PubMed, CINAHL, Cochrane Library, and Scopus from 01 May 2025 to 31 October 2025.
The search strategy in the consulted databases identified 1956 studies; 31 met the inclusion criteria. Different types of chronic wounds were investigated: diabetic foot ulcers, venous leg ulcers, and pressure injuries. The most frequently measured outcomes were clinical responses (healing, recurrence, complications), organizational efficiency (referrals, resource utilization), and patient-reported outcomes.
Evidence from the included studies suggests that Advanced practice nurses led wound care models may be associated with faster healing, lower recurrence and complication rates, and more efficient care pathways, across different settings. This review highlights the global applicability of APN-led models, showing consistent improvements in clinical, organizational, and patient-reported outcomes through core interventions.
This scoping review follows Arskey and O'Malley's methodological framework and the Preferred Reporting Item for Systematic Review and Meta-analysis for Scoping Review.
No Patient or Public Contribution.
The revision protocol was registered on the OSF (https://doi.org/10.17605/OSF.IO/P9TA4).
To explore healthcare professionals’ experiences with medication errors (MEs) in terms of types and factors that contribute to them.
A mixed-methods study was conducted to explore the MEs experiences of healthcare professionals. Quantitative data were collected through a cross-sectional, self-administered questionnaire, whereas qualitative data were collected via face-to-face semi-structured interviews.
The study was conducted at Diwan Polyclinic in Muscat, a primary and secondary healthcare institute.
The study population included healthcare workers who were practising (not retired) and actively involved in patient care and the medication-use cycle, either by prescribing, dispensing or administering medication. The total number of participants was 83 (55 females and 28 males) healthcare professionals, comprising doctors (38), nurses (32), pharmacists and assistant pharmacists (13). Omani participants accounted for 72%, whereas non-Omani participants accounted for 28%. Six of 83 healthcare professionals were purposefully selected to provide additional qualitative insights into their experiences with MEs and the measures they use to reduce them.
None.
The primary outcomes focused on identifying types, causes and effects of MEs, and the secondary outcomes aimed to explore the emotional and professional implications on healthcare workers as well as suggested strategies to minimise MEs.
A total of 83 participants (55 females and 28 males) were included, with 72% Omani and 28% non-Omani. Of these, 44 participants (53%) encountered MEs during their practice at Diwan Polyclinic. The most common type of MEs was prescribing errors (51%), followed by dispensing errors (39%) and administering errors (10%). Incorrect dosing was the most typical cause of prescribing errors.
In the qualitative part of the study, the interviewed participants implemented these measures to reduce MEs: 1) double-checking the prescribed medicines, patients ‘names and identity before dispensing and administering drugs, 2) patient education on polypharmacy and 3) alerting prescribing doctors to errors in their prescriptions or orders. Several measures have been suggested to mitigate MEs, including better communication among health professionals and between them and patients, focusing on staff well-being and development and innovative built-in modules and programmes in electronic medical records for drug verification.
The most common type of MEs was prescribing errors. Focusing on better communication and staff well-being, as well as the innovative development of electronic medical records, will help minimise MEs.
Diabetic foot ulcers (DFUs) are one of the most serious and common complications that, if not treated properly, can lead to potential damage and even amputation. The aim of this systematic review and meta-analysis was to assess the drug-resistant Candida species in DFU. PubMed, Web of Science, Scopus and Google Scholar databases were systematically searched for eligible articles up to 22 June 2024. All articles on Candida diabetic foot infections that reported data on drug resistance were included in the study. In addition to general information, data on the type and number of fungi and the percentage of resistance to each drug were collected for analysis. A total of 238 studies were screened and finally, 16 articles were selected and analysed. Candida albicans was the most frequently isolated species in DFUs, followed by Candida tropicalis and Candida parapsilosis. For antifungal agents, the highest resistance was reported to Nystatin (32.48%, p-value = 0.30), Itraconazole (19.46%, p-value = 0.001) and Fluconazole (16.4%, p-value = 0.001). Miconazole (1.18%, p-value = 0.54) and Caspofungin (4.69%, p-value = 0.01) had the lowest resistance rates. For all drugs, resistance was higher in C. albicans than in non-albicans. This study found that antifungal drug resistance in Candida species is high in patients with DFUs, especially to itraconazole and fluconazole. Caspofungin, micafungin and voriconazole were more effective. Antifungal treatment in these patients should prioritize agents with lower resistance rates to improve outcomes and reduce the risk of treatment failure.
Protocol Registration: PROSPERO—CRD42024567133.
by Lateef Oluwatoyin Busari, Zarat Oyindamola Iwalewa, Olabanji Ahmed Surakat, Adedapo Olufemi Adeogun, Akinlabi Mohammad Rufai, Kamilu Ayo Fasasi, Monsuru Adebayo Adeleke
Insecticide resistance in malaria vectors remains a global public health problem; however, little is known about resistance levels in Osun State, despite relatively high rates of malaria and distribution of insecticide-treated nets in the area. This study evaluates the resistance status of adult female Anopheles gambiae s.l to pyrethroids (permethrin, deltamethrin and alpha-cypermethrin) and an organophosphate (pirimiphos-methyl) insecticides and knockdown resistant (KDR) gene detection in six locations (Ido-Osun, Ipetumodu, Inisa, Ejigbo, Ijebu-Jesha and Ila) across the three senatorial districts in Osun State, Nigeria. Larval sampling was done between 0700hr and 1100hrs weekly between January and December 2022. Collected larvae were reared to the adult stage in the Department of Animal and Environmental Biology laboratory of Osun State University, Osogbo, Nigeria and then identified morphologically using morphological keys. Insecticide bioassay was conducted with permethrin (0.75%), deltamethrin (0.05%), alpha-cypermethrin (0.05%) and pirimiphos-methyl (0.25%) using WHO procedure. The mosquitoes were subjected to molecular analysis to detect the KDR gene. Pirimiphos-methyl showed significantly higher knockdown at 60 minutes (KD60) and achieved 100% mortality compared with the pyrethroids tested (p Anopheles gambiae s.l as compared to pyrethroids. Therefore, there is a need to intensify insecticide resistance surveillance of Anopheles in Osun State to plan indoor residual spraying with pirimiphos-methyl and explore the use of PBO or dual active ingredient insecticides treated nets (ITNs) to address the potential impacts of pyrethroid resistance.To document the first application of the WHO New Vaccine Introduction Prioritization and Sequencing Toolkit (NVI-PST) in the WHO Eastern Mediterranean Region and to describe how Iran’s National Immunization Technical Advisory Group (NITAG) adapted and implemented the framework to develop a prioritised roadmap for vaccine introduction during 2025–2030.
Policy implementation case study applying a structured multicriteria decision analysis-informed prioritisation framework through a three-phase process including framework adaptation, evidence synthesis, ordinal ranking of candidate vaccines, weighted aggregation and development of sequencing scenarios.
National immunisation governance process in Iran, coordinated by the Ministry of Health and Medical Education and Iran’s NITAG, with technical support from the WHO Country Office.
Core and non-core members of Iran’s NITAG and key immunisation stakeholders involved in the deliberative prioritisation process.
Human papillomavirus (HPV) vaccine ranked highest in both importance and feasibility, followed by pneumococcal conjugate vaccine (PCV) for high-risk adults and seasonal influenza vaccine for high-risk groups. Two sequencing scenarios were proposed: both placed HPV first, with either PCV or influenza third after the already-approved hexavalent vaccine. Respiratory syncytial virus (RSV) and varicella vaccines were classified as low priority for the 5-year horizon. The toolkit enabled structured multistakeholder deliberation, improved the transparency and reproducibility of prioritisation, and supported systematic integration of epidemiological, economic and programme evidence. The main implementation challenges arose from national evidence constraints, particularly gaps in adult RSV and pneumococcal disease burden, limited locally generated cost-effectiveness analyses and uncertainty in long-term budget impact estimation under macroeconomic instability, rather than from limitations of the toolkit itself.
The NVI-PST proved feasible under national leadership and generated credible, consensus-based recommendations aligned with Iran’s public health priorities and programme constraints. Minor refinements (streamlined evidence compendium, simpler weighting, stronger secretariat support) would make the toolkit lighter and more sustainable, especially for resource-constrained settings. This Iranian experience provides a replicable model for structured multi-vaccine prioritisation in the Eastern Mediterranean Region and beyond.
To describe the prevalence and determinants of workplace violence against nurses in the Italian home care setting.
Secondary cross-sectional analysis of data from the multicentre study AIDOMUS-IT.
Nurses employed in home care services provided by Italian Local Health Authorities were interviewed using a variety of instruments. A multivariable binary logistic regression model was performed to model the risk of workplace violence against nurses in the last 12 months. Variables related to violence were selected among sociodemographic characteristics (such as age and gender), work-related factors (including years of experience, team composition, overtime working, previous experience in mental health care, burnout) and organisational elements (including leadership and support, workload, staffing and resources adequacy, and time to reach the patients' homes). Adjusted odds ratios (aOR) were used to present the results.
A total of 3949 nurses participated in the study and 20.49% of them reported to have experienced an episode of violence in the last 12 months. Determinants of higher risk of violence episodes were younger age (aOR = 1.02, p = 0.002), higher workload (aOR = 1.01, p = 0.002), working in a multiprofessional team (aOR = 1.24, p = 0.018), perception of inadequate managerial leadership and support (aOR = 1.38, p = 0.003), and higher burnout levels (aOR = 1.01, p < 0.001).
The prevalence of workplace violence against Italian home care nurses is high. Several modifiable determinants were found to be associated with a higher risk of violence, which can potentially be mitigated with tailored interventions.
Effective preventive strategies must be developed to lessen workplace violence against nurses in the home care setting. These strategies should focus on strengthening nursing managers' leadership and support skills, enhancing team-building strategies, avoiding inadequate workload, monitoring nurses' burnout, estimating optimum staffing levels, and assigning advanced-career nurses to home care services. These measures are imperative to guarantee the quality and safety of home care organisations and to attain favourable outcomes in the provision of care.
This study aimed to explore the prevalence and determinants of workplace violence against nurses in the Italian home care settings. We found that out of the 3949 nurses surveyed, 20% of the sample reported one episode of violence during the last 12 months. Determinants of this violence included younger age, higher workload and burnout, being in a multiprofessional team, and perception of lack of leadership and support by the nurse manager. The results of this study can be used to tailor interventions aimed at mitigating the risk factors of violence, particularly those that can be modified (e.g., workload, burnout, and leadership).
The study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.
No patient or public contribution.
The FirstCPR cluster randomised trial delivered multimodal basic life support (BLS) learning opportunities to community organisations. An a priori process evaluation examined intervention implementation, including participation, reach, uptake and member engagement.
The study used a multimethod process evaluation. Data were collected via semistructured interviews, focus group discussions, participant surveys, study records, web analytics and in-field observations. These sources captured participation patterns and implementation measures (delivery, reach, uptake and engagement: opt-in to digital messages and attendance at training sessions), as well as reasons for refusals and withdrawals. Qualitative data were analysed thematically and organised using the UK Medical Research Council process-evaluation framework. Qualitative and quantitative data were analysed separately and subsequently interpreted collectively to contextualise implementation patterns and identify barriers and enablers that influenced trial successes and failures.
Intervention uptake and engagement varied significantly across organisations, with greater success observed in social and faith-based groups. Of the 82 intervention clusters, 78 (95%) received intervention materials; 74 (90%) engaged in at least one activity and 15 (18%) engaged in all activities. Participation was primarily driven by the organisation’s leadership interest and support in providing BLS training to members, and by the time available to facilitate intervention activities. The presence of a dedicated liaison/champion emerged as the most critical enabler of member engagement and implementation. Feedback recommended concise, simple and culturally tailored modules, with practical components delivered in shorter, convenient sessions. Intervention delivery was affected by contextual challenges, including COVID-19 disruptions that limited in-field recruitment and group activities.
Process evaluation can strengthen community-based interventions by identifying mechanisms and contextual factors that shape implementation and engagement. Partnering with social and faith-based organisations may be an effective approach to disseminating educational programmes such as life-saving skills to lay communities. Minimising research burden and ensuring organisational leadership support may improve participation while brief, practical and culturally tailored training may enhance engagement.
ACTRN12621000367842.
To estimate the proportion of Italian nurse managers (NMs) intending to leave (ITL) their positions and to identify associated socio-demographic, job-related, and psychosocial factors.
Cross-sectional study.
Between September and November 2023, 464 NMs from 19 public hospitals completed a case-report form and the short version of the Copenhagen Psychosocial Questionnaire II (COPSOQ II). Latent Class Analysis (LCA) identified ITL profiles, and multiple logistic regression assessed factors associated with ITL.
284 NMs (61.2%; 95% CI 57–66) reported an intention to leave within 12 months. LCA identified two classes: (1) Low-ITL (54%)—mainly outpatient NMs from Central regions with strong relationships with management, good support, work–life balance, and autonomy (55.9% probability of being unlikely to leave). (2) High-ITL (46%)—mainly surgical or critical-care NMs, often from Northern regions, marked by poor management relations, low support and high work–family conflict (80.9% probability of being likely to leave). Multiple regression confirmed that stronger management relations reduced ITL (OR 0.60, 95% CI 0.46–0.79) whereas high job demands and work–health conflict increased it (OR 1.56, 95% CI 1.19–2.04). Northern location also predicted higher ITL (OR 1.58, 95% CI 1.03–2.44). Demographics, education, and clinical setting were not significantly associated.
These findings suggest that healthcare organizations should prioritize managerial and organizational strategies targeting modifiable work-related factors to reduce nurse managers' intention to leave. Interventions aimed at improving organizational support, work environment, and job satisfaction may contribute to workforce retention at the managerial level. Future research should evaluate the effectiveness of targeted organizational interventions in sustaining nurse manager retention.
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
by Ana Laura Januário Lelis, Leandro Aparecido Ferreira da Silva, Daniel Moretto Casali, Tiago Leiva, Murilo Chuba Rodrigues, José Paulo Roman Barroso, Pedro Veloso Facury Lasmar, Camila Lisboa Tomaz, Anabelle Jorge Barbosa, Camila Cesario Fernandes Sartini, Johnny Maciel de Souza, Danilo Domingues Millen
This study evaluated the effects of increasing narasin doses on ruminal fermentation, nutrient digestibility, ruminal pH stability, papillae histology, and microbial composition in Angus cattle fed feedlot diets. Three rumen-cannulated Angus steers (average body weight: 680 kg) were assigned to a 3 × 3 Latin square design and received diets containing 13, 20, or 27-ppm of narasin. Each experimental period consisted of 14 days of adaptation followed by seven days of sampling. Ruminal degradability was assessed on days 15–17, apparent digestibility on days 15–19, continuous ruminal pH on days 19–20, and samples for short-chain fatty acids (SCFA), microbiota, and ruminal histology were collected on days 20 and 21. Ruminal degradability was not affected by narasin dose. Digestibility of acid detergent fiber (ADF) was significantly influenced, with the greatest values observed at 27-ppm (P = 0.01). Increasing narasin doses improved ruminal pH stability, as indicated by a linear increase in minimum pH (P = 0.01) and a reduction in the duration of pH below 5.6 (P = 0.10). At 13 ppm, SCFA production, particularly acetate and propionate, increased (P P P = 0.02), and butyrate (P P P = 0.03). Narasin supplementation altered ruminal microbial composition, increasing the relative abundance of Lachnospiraceae and Isotricha while reducing lactic acid–producing bacteria. In terms of ruminal morphology, supplementation with 20-ppm of narasin increased the keratin layer thickness of ruminal papillae (P = 0.02), suggesting enhanced epithelial development. Overall, narasin supplementation modulated ruminal function and microbial ecology, with doses between 13 and 20-ppm providing the most favorable balance between fermentative efficiency and ruminal health in feedlot cattle.To critically examine the policy logic of the EU-funded WHO Nursing Action Initiative and assess its capacity to address the structural drivers of Europe's nursing workforce instability, with a specific focus on retention governance as the missing determinant of sustainability.
Although Europe reports high aggregate numbers of nurses, persistent workforce shortages are driven not by insufficient supply but by systemic governance weaknesses that undermine retention. The Nursing Action Initiative provides the first coordinated, multi-country framework aligned with the WHO's 2023–2030 strategic priorities, yet several structural gaps, including the absence of binding retention metrics, enforceable safe staffing standards, harmonized advanced practice pathways, interoperable workforce intelligence, and mandatory accountability, limit its transformative potential. A shift from production-centric policies to a retention-driven governance architecture is therefore essential.
The Nursing Action Initiative represents an important step toward strengthening European nursing workforce policy, but its success will depend on Member States' willingness to implement structural reforms that ensure safe staffing, protect nurses' well-being, expand autonomous practice roles, and stabilize workforce distribution. Without a robust architecture of retention governance, neither the sustainability of Europe's nursing workforce nor the resilience of its health systems can be assured.
This commentary advances the policy debate by framing retention as the central determinant of workforce sustainability. It calls for urgent political commitment to move the Nursing Action Initiative beyond aspirational coordination and toward enforceable, system-level reform capable of delivering lasting improvements in workforce stability and quality of care across the European Union.
This study aimed to identify underserved regions and evaluate the population coverage based on travel time and distance to hospitals with gynaecologic oncologists in Indonesia.
The travel time and distance to hospitals with gynaecologic oncologists were evaluated using the Quantum Geographic Information System. Data from 139 gynaecologic oncologists and their affiliated hospitals were obtained from the Indonesian Society of Gynecologic Oncologists (November 2024) and cross-referenced with the Ministry of Health records. The female population density data were sourced from Facebook’s high-resolution settlement layer. Isochrones were generated to estimate travel times and distances using zonal statistics, which facilitated the calculation of population coverage.
A total of 139 gynaecologic oncologists were identified nationwide, practising in 243 hospitals (7.6% of the 3202 hospitals in Indonesia), with a concentration in Java (60.4%). 11 of the 38 provinces lack sub-specialists. Population coverage varies sharply: the travel time to a hospital with gynaecologic oncologists is ≤2 hours for 79.1% of women in Java, compared with 4.9% in Papua; overall, 34.4% reside more than 100 km away from hospitals with gynaecologic oncologists. Hospitals with gynaecologic oncologists are predominantly urban class B general hospitals, and 83.1% participate in the National Health Insurance Schemes. Exploratory district-level correlations showed positive associations between the number of such hospitals and total female population (r=0.44, p
Gynaecological oncology services in Indonesia remain heavily concentrated in Java, leaving nearly one-fifth of women residing more than 100 km away. The travel time is greater than 2 hours for many. Targeted expansion of the gynaecologic oncologists workforce, diagnostic and treatment infrastructure, and sustainable financing mechanisms are required to close these gaps.
This study examines the relationships between wage satisfaction, union perceptions, expectations, and union membership among Turkish nurses, identifying factors associated with union participation.
Sequential explanatory mixed-methods design.
This two-phase study (January–July 2023) included: (1) a quantitative survey of 210 nurses assessing wage satisfaction, union perceptions, and expectations, analysed using regression and PROCESS Macro (Model 4); and (2) qualitative interviews with 22 nurses, including 15 with union leadership experience, analysed through thematic analysis using MAXQDA.
Quantitative findings indicated that wage satisfaction was associated with nurses' perceptions of unions but did not independently predict union expectations. The study hypothesises that union perception functions as a key mediating mechanism, translating wage dissatisfaction into expectations for union action. Qualitative findings supported this pattern, showing that although wage dissatisfaction was widespread, nurses' expectations were primarily shaped by perceptions of unions' transparency, political independence, democratic participation, and representational capacity rather than by wages alone.
Union participation among nurses is influenced by both economic conditions and normative evaluations of unions. While wage dissatisfaction provides an important contextual background, expectations and engagement are mainly driven by perceptions of union credibility, fairness, and representational effectiveness.
Nursing unions should prioritise transparent governance, democratic participation, and political independence to enhance trust, member engagement, workforce stability, and quality of care.
This study addresses persistent wage dissatisfaction alongside declining union membership and trust. The findings demonstrate that union engagement depends not only on economic dissatisfaction but also on perceived representational fairness. The results are particularly relevant for nursing unions, professional organisations, and policymakers aiming to strengthen union legitimacy and workforce engagement in healthcare systems.
Compliant with COREQ guidelines and mixed-methods reporting standards.
No patient or public contribution.
This systematic review aims to synthesise current evidence on gut microbiome profiles among children with sickle cell disease (SCD), assess the influence of analgesic and antibiotic use, and explore the contributions of environmental factors on their gut microbiota diversity. Through identification of consistent microbial patterns and gaps in the existing literature, this review will provide vital insight into potential microbiome-targeted strategies for improving health outcomes in paediatric SCD care.
Studies describing the gut microbiota among paediatric SCD human subjects (
Ethical approval will not be required as this is a systematic review of published data. The findings will be disseminated through publications in peer-reviewed journals and presentations at relevant scientific conferences.
CRD420251102736.
FreshRSS 