Conectar
To develop predictive models for early and overall tuberculosis (TB) deaths for prospective use at TB diagnosis in resource-constrained TB programme settings.
Statewide cohort study using routinely captured secondary data.
With the majority of TB deaths being early (within 2 months), India’s TB programme’s information management system (Ni-kshay)-dependent death prediction models (using age, gender, TB site, previous treatment, microbiological confirmation, HIV, diabetes and bank account availability) are not feasible for prospective use, as few variables are captured at diagnosis. Utilising routinely captured triage variables for severe illness at diagnosis (body mass index, pedal oedema, respiratory rate, oxygen saturation and ability to stand without support) from an ongoing statewide and state-specific differentiated TB care initiative to reduce TB deaths in Tamil Nadu state (southern India, 80 million population with 0.1 million annual notifications), robust models for prospective use were developed.
Adults (aged ≥15 years) with TB (not known to be drug-resistant at diagnosis) that were notified from public facilities of Tamil Nadu from July 2022 to June 2023.
Early and overall (within 12 months of notification) TB deaths. Area under the receiver operating characteristic curve (AUC) was used to assess accuracy of models built using modified Poisson regression.
Among 55 971 adults, the overall death rate was 7.4%, and 67.9% of the deaths were early. In predicting overall deaths, accuracy of the model using all Ni-kshay variables (AUC 0.716 (95% CI 0.707 to 0.725)) was as good as the model using triage variables for severe illness only (AUC 0.701 (95% CI 0.691 to 0.711)). To the latter, adding potentially capturable Ni-kshay variables at diagnosis (age, gender, TB site, previous treatment and microbiological confirmation) significantly improved model accuracy (AUC 0.754 (95% CI 0.745 to 0.763)). Further addition of remaining Ni-kshay variables did not improve accuracy significantly. Death prediction equations were generated for these models.
Simple and easily measurable triage variables for severe illness should be routinely captured at TB diagnosis. A death prediction calculator (http://44.208.93.99/) based on these variables (specifically triage variables for severe illness combined with age, gender, TB site, previous treatment and microbiological confirmation) may be used by Indian states and high TB burden countries seeking scalable, data-driven interventions to reduce TB deaths.
by Qian Li, Yilun Huang, Samuel Yeung-Shan Wong, Winnie W. S. Mak, Xue Yang
Background and objectiveA well-established link exists between depression and Internet gaming disorder (IGD) at the individual level, while it remains unexplored within the family system. This study aims to investigate the interdependent relationship between parent and adolescent depression and IGD, and to identify the potential mechanisms.
MethodsA cross-sectional dyadic study was conducted with adolescents and their parents (primary caregiver) in Hong Kong. Adolescents completed anonymous surveys in classrooms, and parents completed online surveys via WhatsApp or phone interviews. The Actor-Partner Interdependence Model (APIM) and Actor-Partner Interdependence Mediation Model (APIMeM) were utilized to test the interdependence and mediators between depression and IGD in parent-child dyads, respectively.
ResultsA total of 1,277 parent-child dyads were included. Depressive symptoms in parents (β = 0.072) and adolescents (β = 0.273, both p Conclusions
Adolescent depressive symptoms were positively associated with their own and parental IGD symptoms, which were mediated by adolescent-reported family relationships and adolescent gaming time. The influence of adolescents’ mental health problems on parents’ problematic behaviors within the family system should not be overlooked.
by Stephen J. Flusberg, Asher Donnelly, J. D. Jarolimek, Esmé Nix, Lili B. Davis, Boshang Yin, Lindsey Anderson, Dylan Ciolfi, Kevin J. Holmes
A person accused of victimizing others may be described as the “real” victim by their defenders to garner empathy and mitigate blame. Recent research shows that this rhetorical strategy, known as “victim framing,” can increase support for a man accused of sexually assaulting a woman. Little is known, however, about its effects in other contexts. Across five experiments (N = 2,941), we investigated whether victim framing generalizes beyond prototypical sexual assault cases. Participants read fictionalized news reports where one party was labeled the victim (or neither was) and expressed support for the individuals involved. We found significant framing effects across diverse scenarios: (a) a man accused of sexual assault who self-described as the victim; (b) a woman accused of sexually assaulting a man; (c) same-sex assault allegations involving men or women; (d) a celebrity or stranger accused of physically assaulting his girlfriend; and (e) a police officer who shot an unarmed civilian. As in prior work, only participants who explicitly cited the victim-related language as influencing their evaluations showed robust and reliable framing effects. Multiple observer characteristics (e.g., gender, political ideology) predicted attitudes in expected ways, yet victim framing effects persisted when controlling for these individual differences. Taken together, these findings are consistent with a social-pragmatic account of victim framing: many people treat a victim label as communicating relevant information and adjust their evaluations accordingly, while others either do not draw this inference or weigh other information more strongly. Our findings highlight the power and limits of explicit forms of linguistic framing.Large language model tools are increasingly used in higher education, offering opportunities to support self-directed learning. In nursing education, course-specific AI virtual tutors may provide contextualised support while addressing concerns about content accuracy and alignment; yet empirical evidence remains limited.
This study evaluated the use and perceived impact of a co-designed AI-powered virtual tutor embedded in a graduate-level Master of Nursing (MN) course. We explored how students used the tutor, their perceptions of benefits and limitations, and its influence on learning and engagement.
A pilot study using a mixed-methods explanatory sequential design was employed. The tutor was trained on course-specific materials and integrated into the institutional learning management system. Data included anonymised usage logs and user interactions coded using Bloom's Taxonomy of Educational Objectives, post-course surveys assessing AI self-efficacy, usability, and learning impact, and semi-structured interviews with students and teaching assistants (TAs). Quantitative and qualitative strands were integrated through a joint display.
A total of 651 interactions by individuals within a group of ~120 MN students were logged. Interactions peaked in evenings and around assignment deadlines. Most interactions reflected lower-order education processes, with more application and analysis later in the course. Eleven participants completed surveys; students reported high AI self-efficacy and moderate tutor use. Perceived usefulness was mixed, but most reported the tutor enhanced both lower- and higher-level learning and recommended its future use. Interviews revealed that students valued the tutor's immediacy and course-specific accuracy, while TAs noted efficiency gains. Reported challenges included usability issues, scope limitations, privacy concerns, and risk of over-reliance on the tool.
A co-designed AI virtual tutor was feasible and valued for contextual relevance, though perceived usefulness was variable. Findings support responsible, pedagogically integrated use of AI tutors in graduate nursing education.
The United Nations (UN) Sustainable Development Goal 6 seeks to ensure universal access to safe drinking water by 2030, but vast inequities in access exist, especially among vulnerable communities including limited resource, rural, disaster-affected areas. Flood disasters, exacerbated by the climate crisis, hinder the ability of individuals and families to meet essential drinking water needs and increase their susceptibility to waterborne illnesses. Point-of-use (POU) water treatment is an effective solution for water-insecure populations during and immediately following flood emergencies. However, an initial literature search identified knowledge gaps surrounding implementation of POU water systems. This scoping review aims to synthesise published evidence between January 2015 and July 2025 on barriers and facilitators to utilisation of POU water treatment systems during and immediately following flood-related disasters. The findings will inform efforts to promote resilience and agency among water insecure communities, specifically by equipping them with actionable knowledge on sustainable access to safe drinking water.
This scoping review will be guided by the work of Arksey and O’Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. Search terms will be identified through an iterative process using the PICOT method and Boolean logic. Four databases—Scopus, PubMed, Web of Science and Google Scholar—with the addition of grey literature from UN agencies and non-governmental organisations focused on water-related issues will be searched. Two independent reviewers will apply a priori eligibility criteria to select studies. Conflicts will be resolved through discussion and a third independent reviewer absent agreement between the first two reviewers. Cohen’s kappa statistic will be calculated to assess inter-rater reliability. Data extraction will be guided by predefined data points, and the Consolidated Framework for Implementation Research will guide evidence synthesis through a solution-based approach.
Institutional research ethics review is not required because no human subjects are involved. Findings will be disseminated through a peer-reviewed publication, a policy brief, conference presentations and infographics for use by organisations serving flood disaster impacted communities.
To identify distinct dyadic coping patterns among prostate cancer patients undergoing androgen deprivation therapy and their spouses using a person-centred approach, and to explore factors associated with these patterns to inform the development of personalised interventions.
A cross-sectional, observational study design.
A total of 223 patient-spouse dyads were recruited from two tertiary urology departments in Guangdong Province, China, between October 2024 and August 2025. All participants completed a general information questionnaire and the Dyadic Coping Inventory. Latent profile analysis was used to identify distinct coping profiles. Univariate analysis and multivariate logistic regression were performed to examine factors associated with profile membership.
Among 223 patient-spouse dyads, four distinct dyadic coping profiles were identified: Efficient Coping (12.0%), Ambivalent Coping (30.0%), Stable Coping (53.8%), and Coping Distress (4.0%). The small Coping Distress subgroup (n = 9) was excluded from further analysis. Higher dyadic coping levels were associated with patient education of high school or above, absence of tumour recurrence, sufficient patient-perceived family support, low-to-moderate spouse-perceived medical burden, frequent dyadic communication, and sufficient spouse-perceived friend/colleague support. Spouse-perceived insufficient family support was unexpectedly associated with better dyadic coping.
Dyadic coping patterns among prostate cancer patients undergoing androgen deprivation therapy and their spouses are heterogeneous. Healthcare professionals should identify distinct dyadic coping characteristics and provide personalised nursing interventions based on the key influencing factors identified in this study.
This study provides a person-centred classification framework for dyadic coping in couples undergoing androgen deprivation therapy, enabling nurses and other healthcare professionals to deliver targeted, stratified psychosocial care. Early identification of vulnerable couples, particularly those in the ambivalent coping subgroup, helps prevent maladaptive coping and alleviate psychological distress. By addressing modifiable factors including communication, family support, and caregiver burden, clinical practice can more effectively improve the psychosocial well-being and quality of life of both patients and their spouses throughout androgen deprivation therapy.
This study adheres to the relevant EQUATOR guidelines (STROBE) for cross-sectional studies.
Patients and their spouses were involved in the design of the study by providing feedback on the clarity and relevance of the questionnaire items during a pilot phase. They also participated in data collection by completing the self-report measures, and their input informed the interpretation of the findings related to dyadic coping experiences.
Dyspnea is a prevalent and profoundly distressing symptom. Fan therapy, a simple nonpharmacologic intervention, has shown potential in alleviating dyspnea. However, its effects remain unclear.
We aimed to update and expand the existing evidence on the effectiveness and perceptions of fan therapy in adults with dyspnea to inform clinical symptom management.
This review followed PRISMA 2020. A comprehensive literature search was performed across multiple databases, including PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, Wanfang Data and Chinese Scientific Journals Full-text Database, from inception through March 20, 2025. Two reviewers independently screened studies, extracted data and assessed risk of bias. Quantitative synthesis was performed using Review Manager software, version 5.3. Qualitative findings were synthesized narratively.
This review included 15 studies (623 participants). In meta-analysis, the overall effect on dyspnea severity was not statistically significant; however, post hoc subgroup analysis by outcome assessment timing showed a significant short-term reduction within 5–10 min after fan therapy (SMD = −0.41, 95% CI: [−0.70, −0.11], p = 0.007, I 2 = 32%). No significant differences were observed in physiological parameters, physical activity levels, self-efficacy, or caregiver-related outcomes. Furthermore, qualitative evidence indicated that patients, clinicians and caregivers generally expressed positive views toward fan therapy, considering it an effective and accessible nonpharmacological intervention.
Fan therapy may provide short-term relief of dyspnea in adults, with limited evidence of sustained benefit and no consistent effects on physiological or other related outcomes. Given its acceptability, low-cost and portability, it may be considered a practical adjunct for dyspnea management, although longer-term trials are needed.
Fan therapy can be used as an adjunct to disease-targeted treatments in the management of dyspnea, particularly in community nursing, low-cost and resource-limited settings.
Not applicable.
To examine the association of India’s publicly funded health insurance (PFHI), mainly Ayushman Bharat–Pradhan Mantri Jan Arogya Yojana, with healthcare utilisation, out-of-pocket expenditure (OOPE) and catastrophic health expenditure (CHE).
Cross-sectional study using nationally representative data from the Comprehensive Annual Modular Survey 2022–2023. Multivariable logistic regression and Heckman two-stage models were applied, adjusting for socioeconomic and demographic covariates and survey design.
All states and union territories of India.
302 086 households (173 096 rural; 128 990 urban) surveyed between July 2022 and June 2023.
PFHI coverage was associated with higher outpatient (adjusted OR 1.404, 95% CI 1.328 to 1.484, p
PFHI was associated with improved access to inpatient services and partial financial protection, but association with outpatient care indicates a major source of financial burden. Policy reforms should expand PFHI benefits to outpatient services, strengthen primary care through Ayushman Arogya Mandirs and tailor implementation to state contexts and vulnerable populations to achieve equitable and comprehensive financial protection.
Adolescent mothers are at increased risk of rapid repeat pregnancy during the postpartum period, particularly in low-and middle-income countries where unmet need for contraception remains high. Stigma, limited autonomy and inadequate youth-friendly services contribute to low uptake of postpartum contraception. Digital health interventions have been proposed as scalable approaches to improve access to contraceptive information and support. However, evidence specifically focusing on digital interventions to enhance postpartum contraception among adolescent mothers has not yet been comprehensively mapped. This scoping review aims to identify and describe the available evidence in this area.
This review will follow the Arksey and O’Malley framework, with refinements by Levac et al and guidance from the Joanna Briggs Institute. Reporting will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. MEDLINE, Embase, Scopus and Web of Science along with relevant grey literature sources will be searched. Studies involving adolescent mothers (10–19 years) within 12 months after childbirth and evaluating digital interventions for postpartum contraception will be included. Two reviewers will independently screen and extract data using a standardised charting form. Findings will be synthesised descriptively to map intervention types, outcomes and research gaps. No formal quality appraisal will be undertaken.
Ethical approval is not required. Findings will be disseminated through peer-reviewed publication, conference presentations and engagement with relevant stakeholders to inform research, policy and programme development.
Medication for the disease of obesity has improved, and clinical trials based on natural gut hormones such as tirzepatide, showed only mild side effects and ~22% weight loss maintenance. However, patients with type 2 diabetes only lose 15% bodyweight with tirzepatide while tolerating the medications very well, but little is known in patients with the disease of obesity who also have type 1 diabetes, especially regarding safety of the medications. Tirzepatide’s licence in the Gulf countries and Europe for obesity does not exclude patients with obesity and type 1 diabetes, unlike the USA. In Kuwait, more than a quarter of patients with type 1 diabetes also have the disease of obesity. Tirzepatide is not approved for glycaemic control in patients with type 1 diabetes, because it is unlikely to make a difference. Because tirzepatide is approved for the treatment of obesity in patients who also have type 1 diabetes we can now test how effective treatments for obesity such as tirzepatide are for patients with obesity and type 1 diabetes. Concerns regarding the safety of the medication in type 1 diabetes can also be addressed thus addressing an important knowledge gap.
This will be a randomised double blind controlled trial of 60 patients with obesity and type 1 diabetes to test usual care with or without maximum tolerable dose of tirzepatide to achieve weight loss. We will investigate the safety of the medications in patients with obesity and type 1 diabetes to address important knowledge gap which can change clinical practice.
The study has received ethical approval from the Dasman Diabetes Institute Ethical Review Committee (HR-RA-2025-03) and is registered at ClinicalTrials.gov (NCT07096908). Written informed consent will be obtained from all participants, with no financial compensation provided. Data will be reported in accordance with Consolidated Standards of Reporting Trials guidelines, ensuring participant anonymity. Findings will be disseminated through peer-reviewed publications and presentations at national and international conferences.
To explore nurses' lived experiences of a generative artificial intelligence-enabled shift handover innovation.
A descriptive phenomenological study guided by Husserl's philosophical framework and operationalized through Colaizzi's seven-step analytical method.
Purposive sampling was used to recruit 18 registered nurses at an Integrated General Hospital in Singapore. Semi-structured individual interviews (n = 12) served as the primary data source, followed by two confirmatory focus group discussions (n = 6 per group) incorporating six previously interviewed participants alongside six additional participants to validate and refine emerging themes. Data were collected between January and June 2025 and analysed using Colaizzi's seven-step phenomenological method.
Five interconnected themes emerged: (1) the burden of fragmented documentation; (2) navigating technological change with cautious optimism; (3) anchoring innovation in familiar clinical frameworks; (4) anticipating barriers to seamless integration; and (5) envisioning enhanced patient safety and professional practice.
Participants experienced a tension between documentation demands and direct patient care. Their conditional acceptance of AI assistance, contingent upon accuracy, clinical oversight, and workflow integration, reflects a sophisticated professional stance rather than resistance. The findings illuminate the essence of navigating the intersection of traditional practice and technological innovation.
This study offers insights into nurses' lived experiences of AI-enabled handover innovation. The findings can inform user-centred implementation strategies that align technological innovation with nursing values and workflow realities.
This study adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines.
Nursing staff contributed to the refinement of interview guides through pilot testing and provided feedback on preliminary findings through member checking procedures.
Research and innovation are essential for advancing clinical practice and safeguarding patient safety in healthcare. This review aims to assess the research capacity of Advanced Practice Nurses in Australian healthcare settings. By identifying the barriers and enablers to, the findings aim to inspire research engagement of paediatric nurses.
A rapid review methodology was used to systematically identify, appraise and synthesise data relevant to Advanced Practice Nurses' research capacity.
A comprehensive search of Ovid Medline and Cumulative Index to Nursing and Allied Health Literature databases was conducted, covering publications from 1 July 2010 to May 2024. Additional reference checks and grey literature searches were undertaken to identify relevant studies.
Data extraction and quality appraisal were conducted independently and checked by the research team. The Mixed Methods Appraisal Tool was used for quality assessment and a descriptive narrative synthesis approach integrated findings across qualitative, quantitative, and mixed methods studies.
Eight studies met the inclusion criteria. Findings revealed that while Advanced Practice Nurses value research and evidence-based practice, barriers—such as time constraints, limited resources, and lack of organisational support—restricted their engagement. Leadership support and structured mentorship were identified as critical enablers of research capacity.
This review highlights the need for targeted strategies to enhance Advanced Practice Nurses' research capacity within Australian healthcare. Addressing identified barriers and fostering a supportive environment can empower Advanced Practice Nurses to better utilise their roles, contributing to improved patient care and healthcare innovation.
This research addresses the limited understanding of research capacity among Advanced Practice Nurses identifying challenges and opportunities for engagement. It is particularly relevant for healthcare organisations, policymakers, and educational institutions seeking to strengthen research capacity among APN roles. Findings will inform evidence-based practice, patient outcomes, and research culture in Australian healthcare services.
International Prospective Register of Systematic Reviews (PROSPERO) registration number: CRD42024539163
Obesity is a global public health issue, with its effects a particular issue in Kuwait. Advances in pharmaceutical treatment (eg, glucagon-like peptide-1s) offer an effective solution, with the magnitude of weight lost something to celebrate. However, this level of weight loss also results in dramatic reductions in lean mass, reflecting loss of muscle mass and muscle strength which can predispose people to sarcopenia. This is a particular issue in people with type 2 diabetes in Kuwait, where the prevalence of muscle weakness is extremely high. Solutions to mitigate this loss of muscle mass and strength are needed, with a pragmatic resistance exercise intervention and increasing dietary protein intake having potential. This trial aims to determine whether resistance exercise and/or protein intake can preserve muscle mass and improve physical function in people with obesity initiating semaglutide/tirzepatide therapy.
This single-centre, 6-month, randomised controlled trial at Dasman Diabetes Institute will enrol 232 adults with obesity, randomised (1:1:1:1) to control, resistance exercise, protein supplementation or combined resistance exercise and protein in conjunction with semaglutide or tirzepatide therapy. Resistance exercise will be home-based and involve three sessions per week, progressing from one to three sets targeting major muscle groups. Protein supplementation will target 1.6 g/kg/day via dietary adjustment and protein products. Assessments at baseline and 6 months will include MRI measured quadriceps cross-sectional area (primary outcome), plus measures of secondary outcomes of MRI measured liver fat content and stiffness and intramuscular fat, body composition (dual energy X-ray absorptiometry), strength, physical function, dietary assessment, physical activity levels, sleep patterns, quality of life, glycaemic control and metabolic biomarkers.
The study has received ethical approval from the Dasman Diabetes Institute Ethical Review Committee (HR-RA-2025-01, 19 February 2025) and is registered at ClinicalTrials.gov (NCT06885736, 26 June 2025). Written informed consent will be obtained from all participants, with no financial compensation provided. Data will be reported in accordance with Consolidated Standards of Reporting Trials (CONSORT) guidelines, ensuring participant anonymity. Findings will be disseminated through peer-reviewed publications and presentations at national and international conferences.
To identify and evaluate conceptual frameworks for studying neighbourhood deprivation and access to cancer services in nursing research.
Discussion paper.
We searched the literature to identify conceptual models used in peer-reviewed articles that examined neighbourhood-level factors influencing access to cancer services. As a first step in the evaluation, the Theories, Models and Frameworks Comparison and Selection Tool (TCaST) was used to assess the rigour and applicability of eligible models. The two models with the highest TCaST scores were then further evaluated using Fawcett and DeSanto-Madeya's 2013 criteria.
A total of 546 articles were screened after searching PubMed, EBSCO Cumulated Index to Nursing and Allied Health Literature and Elsevier Co. Scopus from 2014 to 2025.
Of eight eligible models, two met the criteria for further analysis. Revision 6 of Andersen's Behavioral Model (ABM) includes the full nursing metaparadigm and has been widely applied. It is logically and socially congruent, offers testable hypotheses and holds global significance. However, full utility requires familiarity with its unique vocabulary. The Concept of Access Model also demonstrates congruence, testable hypotheses and has greater parsimony than ABM, but its omission of the health metaparadigm limits its application in nursing research.
ABM most comprehensively provides clear and measurable concepts for neighbourhoods as well as realised, effective and equitable access for nursing research. It also supports the identification of highly mutable factors for clinical and policy intervention.
Nurses can play a central role in applying frameworks to ensure research aligns with the holistic nature of profession values, captures contextual realities of patients and informs equitable care delivery.
Neighbourhood deprivation continues to drive disparities in cancer care, making it a pressing research priority. This evaluation equips nurses with a clear conceptual foundation to study access inequities and support actionable cancer care solutions.
There are no relevant EQUATOR guidelines for this discursive paper.
This study did not include patient or public involvement in its design, conduct or reporting.
This study aimed to co-design a model of brilliant care for older people that provides clear, actionable principles to guide how brilliant care for older people can be realised.
As the demand for and international importance of care for older people grows, so too does the negative discourse about care for older people. This ongoing focus on deficiencies can have implications for patients, carers, clinicians, health services, and policymakers, overshadowing opportunities for innovation and positive change.
Experience-based co-design informed this study, grounded in the lived experiences of key stakeholders.
Three scaffolded co-design workshops were facilitated, involving lived experience experts, managers, professionals, clinicians, and an academic (n= 13). The data collected during these workshops were analysed using a qualitative descriptive method and documented according to COREQ guidelines to optimise rigour and transparency.
The participants co-designed a model of brilliant care for older people, comprising principles to promote connection and innovation. To promote connection, the model includes protecting staff member time to deliver meaningful care and demonstrating that everyone matters. To promote innovation, it encourages role flexibility, curiosity, small improvements, and the recognition of brilliant practices.
This article presents a co-designed model of brilliant care for older people, incorporating principles of connection and innovation that can be enacted through simple, resource-efficient practices.
For those who manage and deliver care for older people, the model encompasses simple, accessible, and cost-effective principles to: positively deviate from norms within the sector, offering care to older people; and to deliver brilliant care for older people. Furthermore, given that the model was co-designed with lived experience experts, managers, professionals, and clinicians, its principles are imbued with their experiential insights, which served to bring particular priorities to the fore.
The co-designers, who included lived experience experts, were invited to participate in workshops to co-design a model of brilliant care for older people, during which they discussed and critiqued the findings constructed from the data and co-designed the model.
To analyse how refined living arrangements, in the context of digital access, affect elderly healthcare resource utilisation and satisfaction with healthcare needs.
A prospective cohort study. The study reporting is conformed to the STROBE checklist.
This longitudinal study utilised data from the 2018–2020 waves of the United States-based Health and Retirement Study and the 2013–2015 waves of the China Health and Retirement Longitudinal Study.
Baseline living arrangement was categorised into living alone, intergenerational living, living with spouse, nuclear living and proximate residence. Unmet healthcare needs at follow-up waves (i.e., 2020 wave of Health and Retirement Study and 2015 wave of China Health and Retirement Longitudinal Study) were classified into unmet clinical care needs and unmet preventive care needs, which were measured using three measurements on whether the participant had disorders, whether the participants use any clinical care, and whether the participants use any preventive care. Digital exclusion was assessed using a single question about internet access at baseline.
A total of 7116 participants from the China Health and Retirement Longitudinal Study cohort (female: 48.6%, mean age: 57.4 years) and 7266 from the Health and Retirement Study cohort (female: 64.9%, mean age: 65.1 years) were included. Compared with older adults living a nuclear arrangement, those living an inter-generational arrangement with digital exclusion had higher clinical care utilisation, but not necessarily lower risk of unmet clinical needs; they also had lower preventive care utilisation in the Health and Retirement Study cohort, while living with spouse led to higher preventive care utilisation in the China Health and Retirement Longitudinal Study cohort.
Living arrangements can affect older adults' healthcare utilisation and unmet healthcare needs, which can be moderated by digital exposure.
These findings suggest that healthcare providers should tailor care strategies by considering both living situations and digital literacy. Enhancing digital access, especially for those in inter-generational households, could help address unmet healthcare needs and improve overall care satisfaction.
This study using the STROBE CHECKLIST for reporting guideline.
No patient or public contribution.
By comparing data from both the United States and China, it highlights the importance of considering family structure and digital inclusion when addressing healthcare needs globally. The findings suggest that older adults in inter-generational living arrangements without digital access face higher clinical care demands but still struggle with unmet healthcare needs. This underscores the need for healthcare systems worldwide to address digital exclusion and adapt care strategies to individual living circumstances to enhance healthcare outcomes for the elderly population.
by Meirong Shan, Qian Guo, Ruofei Li, Ni Li, Yanhua Fu, Huanyu Qi, Ge Zhang, Qian Wang, Xingli Xu, Jinchuan Lai
Hypertension is one of the main causes of cardiovascular diseases worldwide, affecting over one billion people. Although aliskiren offers a valuable option for inhibiting the renin-angiotensin system, its safety profile in the real world remains insufficiently explored, especially for rare or under-recognized adverse events (AEs), which have not been fully clarified. Therefore, leveraging large-scale post-marketing surveillance data is crucial for identifying rare AEs and guiding safer clinical practice. This study aims to elucidate pharmacovigilance signals associated with aliskiren (an antihypertensive drug) by systematically analyzing the characteristics of adverse events (AEs) from the U.S. Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS) database and WHO-VigiAccess database, which provides a reliable scientific basis for clinical practice and regulatory decision-making. We conducted a retrospective quantitative analysis of aliskiren-related AE reports from the aforementioned two databases, employing the Proportional Reporting Ratio (PRR), Reporting Odds Ratio (ROR), Bayesian Confidence Propagation Neural Network (BCPNN), and Multi-item Gamma Poisson Shrinker (MGPS) algorithms for signal detection. The results indicate that there were 5,596 and 5,549 aliskiren-related reports in the FAERS and WHO-VigiAccess databases, respectively. The median duration of these AEs during the observation period was 62 days, with an interquartile range (IQR) of 7–282 days. In both databases, signals for aliskiren were distributed across 28 System Organ Classes (SOCs), among which investigations, cardiac disorders, renal and urinary disorders, vascular disorders, and metabolism and nutrition disorders exhibited significant signals based on specific criteria applied across the four algorithms. A total of 607 preferred terms (PTs) with significant disproportionality signals were detected using the four algorithms, including potential AEs not previously well-documented, such as palpitations, myalgia, proteinuria, muscular weakness, pulmonary edema, and pollakiuria. This study not only confirms the known adverse reactions of aliskiren but also uncovers new potential risks, highlighting the importance of strengthening drug safety monitoring to enhance therapeutic efficacy and reduce the risk of adverse reactions. It provides valuable safety insights for physicians considering the use of aliskiren in the management of primary hypertension.by Jocshan Loaiza-Moss, Michael Leitges
Cancer remains a leading cause of mortality worldwide and a significant barrier to improving quality of life across all populations. The protein kinase D family, including PRKD3, has been demonstrated to play a crucial role in cancer development through its involvement in regulating key cellular processes. Although growing evidence highlights the role of PRKD3 in the tumorigenesis of certain cancers, a comprehensive pan-cancer analysis of PRKD3 remains unavailable. To address this, we performed an integrative pan-cancer analysis of PRKD3 using multi-omics datasets from The Cancer Genome Atlas, the Genotype-Tissue Expression project, and cBioPortal. We examined PRKD3 expression, copy number variation, mutation, and DNA methylation, and evaluated their associations with clinicopathological features, patient survival, and diagnostic potential across 33 cancer types. Immune relevance was further assessed through correlations with immune infiltration, checkpoint gene expression, and immunotherapy response-related genomic biomarkers. Our results revealed that PRKD3 expression was highly heterogeneous, showing significant upregulation in liver cancer, gastric cancer, and adrenocortical carcinoma, and downregulation in others. Elevated expression was consistently associated with poor prognosis and increased stromal, neutrophil, and cancer-associated fibroblast infiltration in adrenocortical carcinoma, liver cancer, and stomach cancer, whereas paradoxical associations with favorable outcomes were observed in kidney clear cell carcinoma. PRKD3 expression also correlated with immune checkpoint molecules including PD-1, PD-L1, and CTLA-4, supporting an immunosuppressive role, while context-dependent associations with TMB and MSI highlighted its potential influence on tumor immunogenicity and responsiveness to immune checkpoint blockade. Collectively, these findings identify PRKD3 as a potential context-dependent modulator of tumor biology, prognosis, and immune interactions, underscoring its potential as a biomarker of diagnostic, prognostic, and therapeutic relevance in precision oncology.
FreshRSS 