Conectar
Asthma, chronic obstructive pulmonary disease (COPD) and obstructive sleep apnoea (OSA) are prevalent chronic respiratory diseases associated with increased comorbidity, mortality and healthcare costs. Physical activity and exercise are widely recommended as part of treatment for these conditions, yet the specific effects of Nordic walking (NW) remain underexplored. The aims of this randomised controlled trial (RCT) are to improve physical fitness, functional capacity and respiratory health and increase regular physical activity and quality of life of older adults with asthma and/or COPD and/or OSA through a supervised 3-month group-based NW intervention combined with resistance, balance and mobility training.
This single-blinded, parallel-group RCT will recruit 100 adults aged 55–80 years diagnosed with asthma and/or COPD and/or OSA in the Northern Savo region of Finland. Participants will be randomly allocated to either an intervention group or a control group.
The intervention group will participate in a 12-week supervised exercise programme consisting of progressive NW sessions twice per week and resistance, balance and mobility training once per week. The primary outcome is a change in cardiorespiratory endurance. Secondary outcomes include functional capacity, physical activity level, spirometry parameters and quality of life. The control group will continue their usual physical activity and receive physical activity guidance after 12 weeks. Measurements were conducted at baseline, three and 9 months. Data will be analysed according to the intention-to-treat principle. Group differences over time will be examined using appropriate parametric or non-parametric methods depending on data distribution.
Ethical approval was obtained from the Regional Medical Research Ethics Committee of Eastern Finland Collaborative Area (892/13.00/2023). Findings will be disseminated through publications in peer-reviewed journals and presentations at scientific conferences.
The trial is registered at ISRCTN12097135, registration date: 7 June 2024.
To assess the prevalence of workplace violence (WPV) against clinical nursing students during internships and quantify the prevalence of different types of violence, such as physical, verbal and sexual.
Systematic review and meta-analysis.
Eligible cross-sectional studies that reported WPV prevalence among clinical nursing students were included. Two researchers independently screened literature and extracted data. The Joanna Briggs Institute tool was used to evaluate bias risk. Pooled prevalence rates, heterogeneity and publication bias were examined.
A comprehensive search was conducted across eight databases, from the inception of each database to 31 March 2025.
A total of 16 cross-sectional studies from eight countries involving 8037 nursing students were included in the analysis, with 11 studies (n = 5550) contributing to the overall pooled estimate. Using a random-effects model, the pooled prevalence of WPV of any type was found to be 40%, with substantial heterogeneity. Verbal violence emerged as the most prevalent subtype (47%), followed by sexual violence (12%) and physical violence (10%). Significant publication bias was detected for both physical and sexual violence, indicating a potential underestimation of the true prevalence.
This systematic review indicated that WPV is a significant occupational hazard encountered by clinical nursing students across diverse international contexts represented during internships.
These findings highlight the urgent need for educational and healthcare institutions and policymakers to implement coordinated measures, such as enhanced preventive training, comprehensive reporting and support systems and a zero tolerance safety culture to protect the future nursing workforce.
This systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
This study did not include patient or public involvement in its design, conduct or reporting.
The research protocol was registered with PROSPERO (CRD420251027354).
In many countries, a high or increasing rate of sickness absence is challenging the sustainability of present sickness absence benefit schemes. Most sickness absence is certified on the grounds of common mental disorders or musculoskeletal disorders, and substantial effort has been invested in developing interventions promoting return to work for these patients. In Norway, the Health in Work ((HelseIArbeid), HIA) clinics were established as outpatients’ services within the specialised healthcare system, with the aim of improving health and supporting return to work. The HIA service admits patients with low-to-moderate anxiety/depression and/or musculoskeletal disorders. In this protocol, we describe the naturalistic multicentre randomised controlled trial Norwegian Sickness Absence Clinic Efficacy study, which aims to determine the effect of HIA on work participation and health.
The HIA outpatient service is staffed by clinical psychologists, physiotherapists, medical specialists in physical medicine and rehabilitation and employment support supervisors from the Norwegian Labour and Welfare Administration. Patients admitted to HIA have access to multidisciplinary assessment and treatment. The trial recruits’ patients from five HIA outpatient clinics in Northern Norway. Patients are randomised in equal proportions to either (1) rapid HIA (assessment within 4 weeks), (2) delayed HIA (assessment within 10–14 weeks) or (3) active control, which consists of a monodisciplinary examination at HIA close to diagnosis-specific deadline for examination as suggested by guidelines (8–26 weeks). The trial commenced recruitment on 16 January 2023 and will recruit 2500 patients. The aim is to assess the effect of the HIA service, with the hypothesis that the HIA concept is superior to what resembles treatment as usual, in improving employment and preventing long-term welfare dependency. Secondary outcomes include self-reported symptoms of health problems. We also examine the effect the service has on other healthcare utilisation. To date, no research has been conducted to assess the efficacy of the HIA service. If proven efficacious, and if there is an economic case for this investment in tailored healthcare delivery, the policy implication may be implementation of the service at scale. If not, adaptations or investments into other viable paths of treatment may be considered.
The study is approved by the Regional Committee for Medical Research Ethics (REC North, #122770). Results from the study will be disseminated at national and international scientific conferences, to funders and participating outpatient clinics in seminars and in peer-reviewed scientific journals.
To synthesise the best available evidence on mentors' experiences in mentoring nursing students during peer learning clinical practice.
A systematic review of qualitative studies.
Qualitative or mixed-methods (with a qualitative component) studies that met the inclusion criteria based on the phenomenon of interest were included. The selected studies were critically appraised using the standardised JBI Critical Appraisal Checklist. Findings from qualitative research were extracted and synthesised by using the JBI meta-aggregation approach.
A comprehensive search was conducted in September 2024 across six databases: Scopus, CINAHL, Ovid MEDLINE, Web of Science, ProQuest (Education collection) and MEDIC.
A total of 542 studies were screened, and 17 met the inclusion criteria. Three synthesised findings were identified: (1) Importance of pedagogical support for peer learning, (2) Mentors' support needs for mentoring in a peer learning model and (3) Characteristics of a favourable peer learning environment in clinical practice.
Mentors perceive peer learning as beneficial for nursing students' learning. The transition from the traditional mentoring model to the peer learning model requires distinct pedagogical approaches and competences from mentors, which can be enhanced by strengthening mentors' peer-learning competence.
It is essential to support mentors' competence in mentoring through peer learning by providing mentoring education. Learning models based on collaborative learning are beneficial for improving performance in clinical placements because they enable more nursing students to learn simultaneously in clinical practice.
This systematic review provides synthesised evidence of mentors' experiences in mentoring nursing students during peer learning in clinical practice. Mentors' role is to provide pedagogical support for nursing students in clinical practice conducted with peer learning. Before implementing peer learning in clinical practice, it is essential to consider the conditions for peer learning across various clinical settings and to provide support for mentors as they mentor nursing students through peer learning. These findings can support healthcare administrators, educators, mentoring education providers and mentors of peer learning in clinical practice.
This review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement.
This study did not include patient or public involvement in its design, conduct or reporting.
The protocol is registered in The Open Science Framework (OSF): 10.17605/OSF.IO/5F9HP
Pressure ulcers remain a major cause of morbidity in skilled nursing facility populations, where frailty and comorbid conditions hinder healing. Numerous studies have established Nitric oxide's role in tissue repair, angiogenesis, and infection control, suggesting therapeutic potential for nitric oxide in chronic wound healing. A retrospective observational cohort study was conducted using de-identified data from skilled nursing patients presenting with pressure ulcers. Two matched cohorts (200 patients per group) were compared: Those treated with a nitric oxide–delivering foam and historical controls receiving standard of care. Propensity score matching accounted for baseline wound size, stage, sex, comorbidities, and treatment start date. The primary endpoint was complete closure (epithelialized or had an area of zero) within 12 weeks. Bayesian hierarchical hurdle–gamma regression estimated treatment effects using posterior means and 95% credible intervals. Within 12 weeks, closure or resolution rates had a significant benefit in the treatment group across most stages: 94% versus 79% for Stage 1, 80% versus 45% in Stage 2, 64% versus 28% in Stage 3, 39% versus 12% in unstageable, 34% versus 10% in Stage 4, and 67% versus 31% for Deep Tissue Pressure Injuries. Overall, 63% (95% CrI 50%–75%) of NODF-treated wounds healed compared with 34% (21%–47%) of SOC wounds. Posterior probabilities of superior healing with NODF exceeded 99% for most comparisons.
Chronic wounds cause a significant burden to affected patients and to society. Effective and objective diagnostic and monitoring methods are needed in wound care, and artificial intelligence offers one promising alternative. In this study, real-world wound images were used to train a convolutional neural network to automatically segment wound area and wound tissues on an image. The study included altogether 362 images of venous, arterial, vasculitis and pyoderma gangrenosum wounds. The model was based on a convolutional neural network architecture U-Net, and fully supervised learning was utilised during the training phase. Wound area reached a Dice Similarity Coefficient (DSC) of 0.927 and Intersection over Union (IoU) of 0.868 using an augmented dataset with pretraining. Fibrinous exudate and granulation performed fairly well with DSC 0.750 and 0.696, and with IoU 0.659 and 0.601, respectively. Necrosis present in only 56 images achieved lower performance with DSC 0.503 and IoU 0.502. In conclusion, this study suggested that it is possible to train a neural network to perform well with images taken for purely clinical purposes. Besides wound area, several wound structures can be identified, but wound structure identification performance is dependent on the number of images featuring the structure.
To explain the relationship between occupational well-being dimensions and overall occupational well-being among nurse and social care educators, with particular focus on hybrid work status.
A cross-sectional survey study.
The quantitative data were collected from Finnish nurse and social care educators (n = 367) in autumn 2023 and analysed using multiple regression with interaction analysis.
Overall personal occupational well-being was rated higher than work community occupational well-being, especially among hybrid-working educators. In models including all occupational well-being dimensions (working conditions, work community, worker's resources and work, and professional competence), only work community and worker's resources and work remained statistically significant positive relationships with occupational well-being. Hybrid work status moderated these relationships: the relationship between work community and occupational well-being was stronger among on-site educators, and professional competence was associated with work community occupational well-being only among them.
Voluntary hybrid work may support personal occupational well-being among nurse and social care educators, yet the enduring importance of work community—particularly for on-site educators—highlights the need to sustain work community resources across all work modalities.
Occupational well-being strategies in educational institutions could benefit from reflecting diverse work arrangements. For hybrid models, emphasis might be placed on combining flexible work options with support for self-leadership and virtual community-building to ensure equitable well-being across modalities. Strengthening team-based collaboration can help maintain connection, competence, and resilience regardless of work setting.
This study provides evidence on the factors supporting occupational well-being among nurse and social care educators depending on the hybrid work status. Work community and individual resources are key predictors, with implications for tailoring support strategies in institutions adapting to hybrid work models.
The Strengthening the Reporting of Observational Studies in Epidemiology STROBE guidelines.
No Patient or Public Involvement.
Increasing demand for haematological specialist care makes the optimisation of referrals and outpatient workflow a priority. Automated placing of standardised test orders prior to the first appointment may provide haematologists with necessary information to reach diagnoses and initiate treatment at the first patient encounter, reducing low-value follow-up appointments. We aimed to evaluate rates of patient participation in an initiative using artificial intelligence to place standardised test orders as well as reasons for non-participation, differences in the number of participants and non-participants discharged back to primary care with a diagnosis or appropriate treatment plan, and potentially avoidable referrals.
A retrospective, multicentric cohort study.
Four academic hospitals in Madrid, Spain.
18 190 patients referred for a first haematologist appointment for 11 included presenting complaints.
Referral notes from primary care were classified using natural language processing and automated placement of standardised test order sets was carried out prior to first appointment for participating patients.
We compared demographic differences between participants and non-participants, the main motives for not participating, and the number of patients discharged back to primary care at first appointment with a diagnosis and treatment plan. Most frequent International Classification of Diseases, tenth revision codes for each of the included presenting complaints were described.
During the study period, 18 190 (41%) patients were referred for a first haematologist appointment for presenting complaints included in the intervention (‘eligible patients’), of which 612 (3.3%) patients agreed to participate in the intervention. Participants were significantly younger than non-participants. Most common motives for not participating were administrative reasons (6268, 76.9%). Only 122 (1.5%) patients expressed explicit unwillingness to participate. A significant increase in the number of patients discharged upon first appointment was observed for participants (146 (23.9%) vs 3375 (19.36%); p=0.041), signifying a 22% relative reduction in avoidable follow-up. The diagnosis ‘haematological disorders ruled out’ was constantly observed as one of the ten most common diagnoses made by the haematology specialist for all but one of the included presenting complaints.
Natural language processing of referrals from primary to specialist haematology care with automated placing of standardised test orders can decrease low-value follow-up appointments. Explicit refusal to participate was low. Participants tended to be younger than non-participants, underlining the importance of designing strategies to target the older population in order to improve participation.
We aim to identify trajectories of probable maternal common mental disorders (CMD), as well as risk and protective factors associated with maternal mental health among postpartum women during the pandemic using life course theory approach.
Prospective individual level cohort study from the Iracema-COVID Study.
Mothers (n=335) at postpartum period who delivered during the COVID-19 pandemic in the fourth largest city in Brazil.
Probable CMDs were accessed using validated instruments in five cohort waves at postpartum period. Sequence analyses (SA) were employed to extract CMD trajectories, and a set of generalised binomial logistic and log-Poisson multivariable regression models with robust variance were employed to assess risk and protective factors for probable CMDs diagnosis.
Trajectories patterns of probable maternal common mental disorders.
Fit indices demonstrated a two-cluster-SA solution of probable CMD. The patterns of probable CMDs indicated that 335 mothers were clustered into occasional/transitory (n=240, 71.64%) and mostly/persistent (n=95, 28.36%) CMD trajectories. We found that mothers with low education (OR: 2.44; 95% CI 1.13 to 5.23), single (OR: 1.97; 95% CI 1.03 to 3.75) or in a stable union (OR: 2.00; 95% CI 1.02 to 3.90) and travel time spent to access the nearest primary healthcare unit (OR: 1.02; 95% CI 1.006 to 1.04) were associated with increased OR of belonging to the mostly/persistent CMD trajectory. Deprived green areas acted as a risk factor to maternal CMDs prevalence (OR: 1.37; 95% CI 1.002 to 1.87).
This study provides evidence that individual vulnerabilities and neighbourhood deprivation play an important role in understanding maternal mental health, beyond the patterns and trajectories of probable maternal CMD due to issues confronted during the COVID-19 outbreak in the northeastern region of Brazil. Policies to prevent and treat maternal mental health issues and improvement in neighbourhood deprivation need to be developed and addressed to avoid exacerbation of probable maternal CMDs.
Systematic reviews (SRs) require comprehensive, reproducible searches, yet developing search strategies is resource-intensive and demands specialized expertise. Generative AI offers potential to streamline this process, but empirical evaluations for GAI-assisted SR searching remain scarce. The objectives of this study are to: demonstrate a step-by-step process for developing a custom ChatGPT-based chatbot to support SR search strategy development, and evaluate its performance.
A cross-sectional evaluation study.
We used ChatGPT-4.0 to create a chatbot designed to mimic a medical librarian, generating PICO-informed searches. Its knowledge base was augmented with two methodological references. After piloting testing, we refined its instructions. For evaluation, we randomly sampled 50 Cochrane SRs published in 2024. Standardized P–I–O prompts produced database-ready queries for PUBMED and EMBASE. The primary outcome was per-review success rate, summarized by median and inter-quartile range. A sensitivity analysis was conducted.
Pilot testing achieved a retrieval rate of 41/49 (83.7%). In the main sample (1169 studies; median 13.5 studies per SR), the chatbot identified a median of 67.4% of included studies (IQR: 43.1%–88.4%). When limited to indexed studies (n = 1114), retrieval rose to 72.0% (IQR: 46.0%–92.5%). Lower performance was observed when outcomes were absent from the abstracts or interventions had many lexical variants.
A GAI-based chatbot can rapidly generate SR searches (~67%–72% identification), serving as a useful starting point but not a replacement for expert-led approaches. Integration of librarian expertise, structured prompts, and controlled vocabularies may improve performance. Further benchmarking and transparent reporting are needed to guide adoption.
Individuals experiencing moderate to severe mental illness have low rates of workforce inclusion, with a consequence of high welfare dependency, affecting both societal costs and health. Individual Placement and Support (IPS) is an approach to supported employment where the goal is to help people obtain jobs on the open rather than sheltered labour markets. Despite multiple randomised controlled trials (RCTs) indicating that the IPS model enables employment better than treatment as usual, with widespread adoption in some jurisdictions, the broader impacts of this large-scale implementation on mental health, quality of life and social functioning remain unknown.
Between 2012 and 2019, Norway introduced IPS through both local and national government projects. This study assesses the social and economic benefits of the implementation of IPS using Norwegian registry data, focusing on 18–45-year-old people receiving specialist mental healthcare, and who did not have steady employment at treatment start. Instead of assessing IPS efficacy in an RCT design, we use a naturalistic study design, evaluating IPS effectiveness by comparing aggregate population-level outcomes over time between areas where IPS was not available.
In work package (WP) 1, we mapped the availability and implementation of IPS across Norway. This involved analysing information on funding, resource and capacity levels to understand how IPS had been rolled out across the country. While completed, we include a description of WP1 here, as it informs WP2 and WP3. WP2 is an effectiveness evaluation investigating the population-level outcomes of implementing IPS, focusing on health, mortality, quality of life and social functioning. Finally, in WP3, we assess the financial implications of implementing IPS from a public purse perspective, synthesising data on resource use and costs of implementation with data from WP2.
Overall, we will examine the societal effects of IPS implementation on employment, welfare dependency, mental healthcare use, emergency care visits, self-harm and suicide, general mortality, crime and victimisation. Emphasis will be on long-term outcomes, and we will model the economic consequences of IPS. This study aims to inform policy making and strategies for implementing IPS at scale.
This is an effectiveness study using registry data. The Regional Committee for Medical Research Ethics Northern Norway, REK North has approved the use of registry data without informed consent for this project (approval number 134553).
The findings will be disseminated both in academic peer-reviewed journals, directly to informants in WP1, to the public through media and the project website, and at relevant conferences and seminars for specific relevant target groups.
Not applicable
by Oksana Kovtun, Olga Cheshun, Oksana Pashchuk, Kostyantyn Dumchev
BackgroundUkraine’s HIV epidemic remains concentrated among key populations, with sex workers (SWs) facing overlapping vulnerabilities, including a history of injection drug use. Although overall HIV prevalence has declined, prevention coverage remains below national and global targets. Accurate mapping of sex work hotspots is essential for effective outreach, yet existing data are fragmented and incomplete, especially in privatized and digitally mediated environments. This study aimed to systematically identify and characterize sex work venues across eight Ukrainian cities and assess their coverage by HIV prevention services.
MethodsIn 2021, we conducted a two-stage, multi-informant mapping study across eight Ukrainian cities, interviewing 1,212 secondary and 2,277 primary key informants, including SWs. Hotspots were characterized by type, perceived safety, access modality, operating schedule, and presence of SW subgroups. We used descriptive statistics, exploratory factor analysis, and multivariable mixed-effects regression to identify factors associated with HIV prevention service coverage.
ResultsOf 2,581 identified hotspots, 2,118 (82.1%) were validated as active. Apartments (43.2%), virtual platforms (11.7%), and street-based sites (11.1%) were the most common. Only 13.7% of hotspots were registered in the national HIV service registry, while 34.1% received prevention service delivery and 18.9% were reached by mobile vans. Coverage was highest at street-based and office-type venues and consistently lowest in private, virtual, and pimp-mediated settings. Service coverage was positively associated with 24/7 or daytime operation, higher perceived safety, open access, and the presence of SWs who inject drugs.
ConclusionsThis study provides comprehensive mapping of sex work hotspots in Ukraine, revealing persistent gaps in HIV prevention for less visible and harder-to-reach SWs. Community-led mapping achieved high validation rates (86.8%) and identified substantial unmet needs in digital and concealed hotspots. Routine hotspot mapping, combined with engagement with SW communities, is essential for data-driven, equitable, and adaptive HIV responses in rapidly changing contexts.
To describe the factors associated with work engagement in newly graduated nurses.
Systematic review of original quantitative studies according to Joanna Briggs Institute guidelines.
The systematic review utilised PEO inclusion criteria. Original peer-reviewed quantitative studies were identified. Two researchers independently conducted a screening of study eligibility based on title, abstract, and full text. The JBI critical appraisal tool for analytical cross-sectional studies was employed to perform a rigorous methodological quality assessment. The data was extracted, tabulated, and then analysed narratively.
The literature search was conducted in November 2023 by screening four databases: Scopus, CINAHL (Ebsco), ProQuest, and Ovid Medline.
The review included 19 articles, presenting an overview of factors associated with newly graduated nurses' work engagement. Factors were classified into seven categories explaining supportive workplace, transition and orientation to workplace, competence and career development in nursing practice, personal and psychological characteristics, work environment characteristics, stress and challenges in a work environment, and satisfaction with work.
To support newly graduated nurses' work engagement, nurse leaders should provide a supportive working environment and focus on new nurses' effective support systems in the workplace. Their abilities to develop and educate themselves need to be prioritised to enhance their knowledge and skills in nursing. Additionally, organisations should have policies and procedures to ensure quality orientation, and units need to implement transition and mentorship programmes.
This research could be valuable to health care when wanting to develop and improve work engagement, especially among newly graduated nurses. The economic significance of nurses' work engagement is evident, as the cost of nurse turnover is considerable. Reducing nurse turnover and improving retention relies on understanding the factors influencing nurses' decisions to leave the organisation and the profession.
What problem did the study address? The global shortage of nurses, worsened by newly qualified nurses leaving the health sector, necessitates understanding factors influencing their work engagement; The factors associated with newly graduated nurses' work engagement were supportive work environment, transition and orientation to work, success and career development in nursing, personal and psychological characteristics, characteristics of the work environment, stress and challenges in the work environment, and job satisfaction. Where and on whom will the research have an impact? The results can be used by health care organisations to plan the preceptorship/mentoring programmes of new nurses. Identifying and understanding the factors associated with the retention of newly qualified nurses can help to attract and retain nurses and to promote the adaptation and integration of new nurses into healthcare organisations.
The YNEPR author checklist has been completed and implemented during this systematic review process. Also, the Prisma 2020 checklist has been used.
No patient or public contribution: systematic review.
PROSPERO number: CRD42023408705 (https://www.crd.york.ac.uk/PROSPERO/)
Young children and children living with HIV are at high risk of progressing to tuberculosis (TB) disease following Mycobacterium tuberculosis (Mtb) exposure and infection, and also of developing severe forms of disease and TB-related mortality. Identifying children who have very early (sub-clinical) TB disease, prior to progression to clinically apparent TB, would mean that TB preventive treatment (TPT) could be more efficiently targeted to this group. Identifying biomarker changes on drug therapy in children with Mtb infection or very early disease could pave the way for the development of tests that can identify which children have viable bacilli and are therefore at increased risk of disease progression.
The INTREPID study will use already collected samples taken from well-phenotyped paediatric cohorts in three clinical studies conducted in South Africa in children Mtb exposure to disease and from children treated for Mtb infection and early TB disease, as well as targeted Mtb antibody analysis. Data on viral co-infections and relevant clinical and epidemiological parameters will be integrated and evaluated to identify the optimal biosignatures that can predict future progression to clinically overt disease in children below 5 years of age, including those living with HIV.
The study protocol received ethical approval from the Stellenbosch University Health Research Ethics Committee (N23/03/025). The study findings will be disseminated through peer-reviewed publications, scientific conferences and formal presentations to healthcare professionals and to local communities, in collaboration with the Desmond Tutu TB Centre Community Advisory Board.
by Marwa Elshazly, Sondus Jawad, Ayesha Ahmed, Hager ElGeed, Kazeem Babatunde Yusuff
There is a paucity of studies focused on the predictors of community pharmacists’ readiness to deprescribe inappropriate medications for older adults especially in developing settings. The study aimed to use the situational theory of leadership to determine community pharmacists’ readiness to implement deprescribing of inappropriate medications for older adults, and as well as its significant predictors. A theory-driven cross-sectional assessment of the readiness (knowledge and confidence) of 252 community pharmacists was conducted in Qatar with a pre-tested 40-item questionnaire. Knowledge and confidence were assessed with a 2-point and 4-point Likert-type scale respectively. The maximum obtainable score for readiness was 16. Readiness was categorized as high (≥ median) or low (Low physical functioning and frailty are prevalent in non-geriatric vulnerable populations such as people experiencing homelessness, addiction and mental health challenges. The objective of this study was to explore the feasibility and impact of a targeted exercise intervention with protein supplementation for women experiencing homelessness, addiction and mental health challenges.
Mixed-methods feasibility study.
A women’s-only day service for people with homelessness and addiction issues, in Dublin, Ireland.
Women experiencing homelessness, addiction and mental health challenges.
The intervention was a 10-week low-threshold exercise and protein supplementation pre-post programme (LEAP-W). Qualitative interviews were conducted following the intervention with programme participants and key stakeholders.
The primary outcome was feasibility measured by recruitment, retention, adherence, safety and acceptability, and secondary outcomes measured pre-post intervention change in physical function, pain, nutritional and frailty status, and overall health status.
Overall, 33 participants were recruited. Data generated demonstrated that LEAP-W was feasible by its safety, acceptability and high retention in certain subgroups, and high adherence to the exercise and protein supplement; its impact was demonstrated by pre-post intervention improvement in multiple domains (strength (chair stand test), balance (the single leg stance test), pain and quality of life/mental health (mental component summary of the Short Form-12; 95% CI, p
Targeted exercise interventions with trauma-sensitive, flexible design can be successfully delivered and yield impact in women with complex needs who experience homelessness, addiction and mental health challenges. Service design should be considered when delivering interventions to this population. Further higher-powered longitudinal studies are warranted.
In response to global outcries of poor healthcare, organisational interventions have been implemented with the aim of promoting compassionate care. An overall synthesis of qualitative data, including the perspectives of healthcare staff who have attended interventions, can establish ‘what works’ and inform future interventions.
To synthesise existing research exploring how healthcare staff experience organisational interventions for compassionate care.
Qualitative evidence synthesis.
A qualitative evidence synthesis was conducted in August 2023. Five databases were searched: MEDLINE, Academic Search Premier, CINAHL, APA PsycInfo and APA PsycArticles. Articles met the following criteria: (a) reported on the experiences of healthcare staff who had participated in organisational interventions for compassionate care, (b) taken place in a healthcare setting, (c) use of a qualitative or mixed-methods methodology, (d) published in English and (e) published since 2010. A thematic synthesis was conducted using NVivo software to synthesise findings. Data from the complete ‘findings/results’ sections were included in the synthesis. The final search protocol and search strategy were registered on PROSPERO (ID: CRD42023472404) and are reported using the PRISMA guidelines.
Eighteen qualitative or mixed-methods studies were included in the review, encapsulating the experiences of healthcare staff across eight countries. Four themes were identified: (1) holding back, (2) humanising healthcare, (3) values are instilled and (4) sustainability is important.
Organisational interventions for compassionate health care are valued and appreciated by healthcare staff and foster reflection and connection. Interventions facilitate clinical creativity, improve staff well-being and strengthen communication between staff.
The implementation of organisational interventions for compassionate care should be encouraged in healthcare settings. Interventions that consider organisational cultures are driven by organisational values and are embedded with sustainability in mind can improve staff well-being and positively impact the provision of patient care.
PRISMA guidelines were followed in the reporting of this review.
Falls represent the most frequent reason older people are admitted to hospital and significantly increase the likelihood of functional decline, healthcare utilisation and early mortality. The aim of this study is to comprehensively delineate the burden of falls amongst community-dwelling older people in Ireland.
Population-representative analysis of Wave 6 of the Irish Longitudinal Study on Ageing (TILDA) estimating incidence of falls requiring medical attention and emergency department (ED) attendance, fractures and fear of falling over 12 months. Additional data detailing falls-risk increasing drugs (FRIDs) and prior falls were also analysed.
Using Central Statistics Office Census 2022, the population of older people in Ireland was multiplied by the proportion of TILDA participants with each outcome of interest to yield population-level estimates.
Population-representative sample of 2299 (55% female) community-dwelling people in Ireland aged ≥70 years.
Almost 12% (proportion 0.12 (95% CI 0.10 to 0.13)) of participants, corresponding to almost 62 000 older people in Ireland, reported a fall requiring medical attention in 12 months, with 6% (proportion 0.06 (95% CI 0.05 to 0.07)), or over 32 000 people, attending ED due to a fall. Over 3% (proportion 0.03 (95% CI 0.03 to 0.04)) reported sustaining a fracture. Almost half of participants reporting a fall requiring medical attention were prescribed FRIDs, and over half had also reported a fall when assessed at the prior wave of the study (ie, 2 years ago).
The burden of falls amongst community-dwelling older people is considerable; 1 in 8 required medical attention for a fall and 1 in 16 attended the ED with falls over 12 months.
Currently, there is no national falls strategy in Ireland. These findings, alongside our ageing population, underscore the need for strengthened falls-prevention strategies to reduce avoidable morbidity and healthcare utilisation.
by Sangram Biswas, Lutfor Rahman, Md. Taofiqur Rahman, Susmita Chowdhury, Fahmida Khatun, Azimun Nahar, Sabina Yasmin
Probiotics are live, non-pathogenic microorganisms that help to improve the host’s gut health when administrated in sufficient proportions and are now serving as effective alternatives to antibiotics for managing animal infections and enhancing production. The objective of this study was to isolate, identify and characterize lactic acid bacteria (LAB) strains with excellent probiotic properties from the gastrointestinal tract (GIT) of retail broiler chickens. Samples were enriched in MRS broth at 37°C and plated on MRS agar to isolate distinct colonies of potential probiotic candidates. The isolates underwent a series of standard morphological and biochemical analysis to fulfill the criteria for presumptive identification of LAB and probiotic characteristics. These analyses included Gram staining, catalase testing, hemolytic activity assays, tolerance assays to NaCl, simulated gastric juice and bile salts, antagonistic activity assays, antibiotic susceptibility testing, cell adhesion assay and genotypic identification through 16S rRNA gene sequencing. A total of 40 microbial strains were isolated from the GIT of 20 retail broiler chickens. Among these, 4 LAB strains showed the best probiotic results and were genotypically identified as Enterococcus faecium MCI7, Pedicoccus pentosaceus MCI10, Pediococcus pentosaceus MCC6 and Pediococcus pentosaceus MCC12. The selected strains exhibited non-hemolytic activity and were able to survive in simulated gastric juice at pH 3. Furthermore, the strains displayed bile salt tolerance in the presence of 0.3% bile salt for 4 hours, ranging from 21.91 to 32.77% and a wide range of antimicrobial activities against various pathogenic bacterial strains with inhibition zones ranging from 10 to 16.5 mm. Moreover, three P. pentosaceus strains (MCI10, MCC6, MCC12) were sensitive to most of the tested antibiotics and demonstrated good adherence abilities. Our study identified four LAB strains as promising probiotic candidates for poultry feed additives to effectively establish intestinal microflora, enhance meat quality and growth, and control pathogens.
FreshRSS 