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Hoy — Octubre 2nd 2025Tus fuentes RSS

Burnout and job stress in healthcare professionals: a single-centre cross-sectional study in an East China tertiary hospital after COVID-19 policy adjustment

Por: Ji · W. · Liu · Y. · Sun · Q. · Wu · D. · Liu · T. · Sun · P.
Objectives

To examine the relationship between job stress and job burnout among healthcare professionals (HPs) in a tertiary hospital in East China following the adjusted COVID-19 prevention policies and to explore the effects of demographic and work environment factors on burnout and its subtypes (emotional exhaustion (EE), depersonalisation (DP), personal accomplishment (PA)).

Design

Cross-sectional, using a questionnaire-based survey method.

Setting

A tertiary hospital located in Qingdao, East China.

Participants

A total of 434 HPs were included, with 138 men (31.8%) and 296 women (68.2%); the mean age was 35.05±7.96 years. Participants included physicians (37.1%), clinical nurses (49.5%), clinical pharmacists (3.9%), medical technicians (5.1%) and administrative staff (4.4%). Demographic factors (age, sex, marital status, education level, professional title, length of employment, income) and work-related factors (weekly working hours, sleep duration) were collected.

Interventions

No specific interventions were implemented; this was an observational study focusing on the burnout assessment and associated factors.

Primary and secondary outcome measures

Primary outcomes: burnout levels assessed via the Chinese version of the Maslach Burnout Inventory—Human Services Survey (MBI-HSS), including three subscales: EE (9 items), DP (5 items) and PA (8 items). Severe burnout was defined as meeting ‘high-level’ criteria for all three subscales (EE ≥27, DP ≥10, PA ≤33).

Secondary outcomes: demographic (sex, professional role, length of employment) and work-related (weekly working hours, daily sleep duration) factors associated with burnout.

Results

Among 434 HPs, 74 (17.1%) experienced severe burnout. The median scores of MBI-HSS subscales were 17 (IQR: 9–27) for EE, 3 (IQR: 0–7) for DP and 37 (IQR: 27.75–43) for PA. Multivariate logistic regression showed that: nurses had a higher risk of high EE than physicians (OR=2.86, 95% CI: 1.32 to 6.21, p40 hours (OR=2.30, 95% CI: 1.32 to 3.99, p

Conclusions

A high prevalence of severe burnout (17.1%) was observed among HPs after COVID-19 policy adjustment. Key risk factors include being a nurse, long working hours (>40 hours/week), short sleep duration (

Understanding structured medication reviews delivered by clinical pharmacists in primary care in England: a national cross-sectional survey

Por: Agwunobi · A. J. · Seeley · A. E. · Tucker · K. L. · Bateman · P. A. · Clark · C. E. · Clegg · A. · Ford · G. · Gadhia · S. · Hobbs · F. D. R. · Khunti · K. · Lip · G. Y. H. · de Lusignan · S. · Mant · J. · McCahon · D. · Payne · R. A. · Perera · R. · Seidu · S. · Sheppard · J. P. · Willia
Objectives

This study explored how Structured Medication Reviews (SMRs) are being undertaken and the challenges to their successful implementation and sustainability.

Design

A cross-sectional mixed methods online survey.

Setting

Primary care in England.

Participants

120 clinical pharmacists with experience in conducting SMRs in primary care.

Results

Survey responses were received from clinical pharmacists working in 15 different regions. The majority were independent prescribers (62%, n=74), and most were employed by Primary Care Networks (65%, n=78), delivering SMRs for one or more general practices. 61% (n=73) had completed, or were currently enrolled in, the approved training pathway. Patient selection was largely driven by the primary care contract specification: care home residents, patients with polypharmacy, patients on medicines commonly associated with medication errors, patients with severe frailty and/or patients using potentially addictive pain management medication. Only 26% (n=36) of respondents reported providing patients with information in advance. The majority of SMRs were undertaken remotely by telephone and were 21–30 min in length. Much variation was reported in approaches to conducting SMRs, with SMRs in care homes being deemed the most challenging due to additional complexities involved. Challenges included not having sufficient time to prepare adequately, address complex polypharmacy and complete follow-up work generated by SMRs, issues relating to organisational support, competing national priorities and lack of ‘buy-in’ from some patients and General Practitioners.

Conclusions

These results offer insights into the role being played by the clinical pharmacy workforce in a new country-wide initiative to improve the quality and safety of care for patients taking multiple medicines. Better patient preparation and trust, alongside continuing professional development, more support and oversight for clinical pharmacists conducting SMRs, could lead to more efficient medication reviews. However, a formal evaluation of the potential of SMRs to optimise safe medicines use for patients in England is now warranted.

Shift work sleep disorder and associated factors among healthcare professionals working at Jimma University Medical Center, Southwest Ethiopia, 2022: a cross-sectional study

Por: Dassale · C. · Alemu · B. · Dawud · B.
Objectives

Shift work sleep disorder is a circadian rhythm sleep-wake disorder characterised by insomnia and/or excessive sleepiness associated with a shift work schedule that overlaps with habitual sleep time. This study aimed to assess the prevalence of shift work sleep disorders and associated factors among healthcare professionals working at Jimma University Medical Center, Southwest Ethiopia.

Design

Institutional-based cross-sectional study.

Setting

Tertiary hospital in Southwest Ethiopia.

Participants

The data were collected using a self-administered questionnaire from health professionals recruited using a simple random sampling technique.

Outcome

Shift work-sleep disorder was assessed by the International Classification of Sleep Disorders, the Insomnia Severity Index and/or the Epworth Sleepiness Scale. A logistic regression analysis was conducted to determine the association between the predictor and the outcome variable. The ORs and 95% CIs were determined. Variables with a p value

Result

370 participants were involved in the study, yielding a response rate of 97.6%. The prevalence of shift work sleep disorder was 35.9% (n=133). Working in three shifts (Adjusted OR (AOR) 3.25, 95% CI=1.92 to 5.57), more than 11-night shifts per month (AOR 2.83, 95% CI=1.49 to 5.37), absence of nap (AOR 2, 95% CI=1.14 to 3.52), stress (AOR 4.4, 95% CI=2.36 to 8.2), fatigue (AOR 2.7, 95% CI=1.26 to 3.73), alcohol (AOR 3.9, 95% CI=1.79 to 8.47) and khat (AOR 4.40, 95% CI=1.76 to 10.96) use in the last 3 months was significantly associated with shift work sleep disorder.

Conclusion

One in three healthcare professionals working at Jimma University Medical Center had a sleep disorder related to shift work. Working in three shifts per day, having more than 11-night shifts per month, lack of naps, presence of stress, fatigue and substance use were found to be associated with shift work sleep disorder.

Patient-reported outcome measured by EQ-5D and influencing factors among patients of systemic lupus erythematosus in China: a multicentre cross-sectional study from CSTAR Registry

Por: Li · L. · Bai · W. · Yu · B. · Zou · K. · Wang · Y. · Zuo · K. · Wang · L. · Wu · C.-Y. · Zhao · J. · Zeng · X. · Wang · Y. · Li · M.
Objectives

Until now, there has still been a lack of sufficient evidence on patient-reported outcomes (PROs) measured by the EuroQol-5 Dimension (EQ-5D) in patients with systemic lupus erythematosus (SLE) in China. This study aims to comprehensively assess EQ-5D outcomes and influencing factors in Chinese patients with SLE.

Design

A multicentre, cross-sectional study based on the Chinese Systemic Lupus Erythematosus Treatment and Research Group registry.

Setting

101 hospitals across 27 provinces of China.

Participants

1336 patients with SLE.

Outcome measures

The information on EQ-5D was collected via an online questionnaire. Medical records were obtained from the Chinese Rheumatology Data Centre (CRDC). Clinical influencing factors related to the reported health problems were identified using multivariate logistic regression. Then, each health state was converted into a health utility score based on the Chinese 2014 tariff. Given the ceiling effects, Tobit regression models were used to analyse the factors influencing health utility scores.

Results

A total of 1336 patients with SLE were included. Of them, 626 patients (46.9%) reported health problems using EQ-5D. The proportions of patients reporting problems in mobility, self-care, usual activities, pain/discomfort and anxiety/depression were 12.80%, 5.24%, 14.90%, 27.47% and 30.46%, respectively. The mean utility score was 0.89 (SD: 0.15), and the mean Visual Analogue Scale (VAS) score was 76.80 (SD: 16.54). There was a statistically significant correlation (r=0.503, p

Conclusions

EQ-5D may be a useful, preference-based PRO measure for SLE and could potentially be integrated into routine clinical monitoring of patients with SLE and applied in economic evaluations in the future.

Comparison of thyroid hormone abnormalities among men with primary and secondary infertility: a cross-sectional study in Benin City, Nigeria

Por: Asiriuwa · I. · Emokpae · M. A. · Osaikhuwuomwan · A. J.
Objective

Male infertility can be primary or secondary, depending on whether pregnancy has been achieved before or not, but thyroid gland involvement is rarely investigated in the laboratory work-up. This study aimed to assess thyroid hormone abnormalities among primary and secondary infertile men.

Design

This is a cross-sectional study involving male partners of infertile couples presenting at the fertility clinic with an established diagnosis of infertility after review by the clinician. Males with proven fertility served as controls.

Setting

The study was conducted at the Human Reproduction and Research Programme unit and the Chemical Pathology Laboratory of the University of Benin Teaching Hospital, Benin City, Edo State, Nigeria.

Participants

This study involved 200 participants who consisted of 50 controls (fertile men) and 150 infertile men (80 primary infertile men and 70 secondary infertile men). The participants were reviewed by a clinician, and a semen analysis was done to ascertain their fertility status.

Results

The results show that sperm indices, such as sperm count, total motility, progressive motility, viable sperm cells, normal forms and volume were significantly lower (p

Conclusion

Thyroid abnormalities were more predominant among secondary infertile men than primary infertile men in this study.

Protocol for an observational cohort study integrating real-world data and microsimulation to assess imaging surveillance strategies in stage I-IIIA NSCLC patients in OneFlorida+

Por: Braithwaite · D. · Karanth · S. D. · Bian · J. · Meza · R. · Jeon · J. · Tammemagi · M. · Wheeler · M. · Cao · P. · Rackauskas · M. · Shrestha · P. · Yoon · H.-S. · Borondy Kitts · A. · Verma · H. · Blair · M. C. · Chen · A. · Das · D. · Lou · X. · Wu · Y. · Han · S. · Hochhegger · B. · Guo · Y
Introduction

Although lung cancer remains the leading cause of cancer deaths in the US, recent advances in early detection and treatment have led to improvements in survival. However, there is a considerable risk of recurrence or second primary lung cancer (SPLC) following curative-intent treatment in patients with early-stage non-small cell lung cancer (NSCLC). Professional societies recommend routine surveillance with CT to optimise the detection of potential recurrence and SPLC at a localised stage. However, no definitive evidence demonstrates the effect of imaging surveillance on survival in patients with NSCLC. To close these research gaps, the Advancing Precision Lung Cancer Surveillance and Outcomes in Diverse Populations (PLuS2) study will leverage real-world electronic health records (EHRs) data to evaluate surveillance outcomes among patients with and without guideline-adherent surveillance. The overarching goal of the PLuS2 study is to assess the long-term effectiveness of surveillance strategies in real-world settings.

Methods and analysis

PLuS2 is an observational study designed to assemble a cohort of patients with incident pathologically confirmed stage I/II/IIIA NSCLC who have completed curative-intent therapy. Patients undergoing imaging surveillance will be followed from 2012 to 2026 by linking EHRs with tumour registry data in the OneFlorida+ Clinical Research Consortium. Data will be consolidated into a unified repository to achieve three primary aims: (1) Examine the utilisation and determinants of CT imaging surveillance by race/ethnicity and socioeconomic status, (2) Compare clinical endpoints, including recurrence, SPLCs and survival of patients who undergo semiannual versus annual CT imaging and (3) Use the observational data in conjunction with validated microsimulation models to simulate imaging surveillance outcomes within the US population. To our knowledge, this study represents the first attempt to integrate real-world data and microsimulation models to assess the long-term impact and effectiveness of imaging surveillance strategies.

Ethics and dissemination

This study involves human participants and was approved by the University of Florida Institutional Review Board (IRB), University of Florida IRB 01, under approval number IRB202300782. The results will be disseminated through publications and presentations at national and international conferences. Safety considerations encompass ensuring the confidentiality of patient information. All disseminated data will be de-identified and summarised.

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Association between anthropometric indices and early arterial stiffness in patients with type 2 diabetes in China: a cross-sectional study

Por: Luo · J. · Zhou · H. · Yu · F. · Zhou · Q. · Wu · X. · Liu · Q. · Gan · S.
Objective

The waist-hip ratio (WHR) and waist-height ratio (WHtR) are associated with arterial stiffness (AS), yet there is limited research on this topic in patients with type 2 diabetes mellitus (T2DM). This study aims to investigate the relationship between WHR, WHtR and AS in patients with T2DM.

Setting

This cross-sectional study used data from patients with T2DM enrolled in the Metabolic Disease Management Center (MMC) at Changde Hospital, Xiangya School of Medicine, Central South University between May 2020 and October 2023.

Participants

A total of 3201 patients were collected, and after applying the exclusion criteria, data from 3006 patients were finally analysed.

Primary outcomes

The primary outcome of AS was assessed using brachial-ankle pulse wave velocity (baPWV).

Results

After adjusting for gender and age, there was an increasing trend in baPWV across the quartiles of WHR and WHtR. In the multivariate regression analysis adjusting for confounding factors, it was observed that for each one-unit increase in the WHR z-score, baPWV increased by 18.1 cm/s (95% CI: 7.8 to 28.4). Similarly, for each one-unit increase in the WHtR z-score, baPWV increased by 28.6 cm/s (95% CI: 16.6 to 40.6). In the multivariate logistic regression analysis, after fully adjusting for confounding factors, it was found that for every one-unit increase in the WHR z-score, the OR for elevated baPWV was 1.2 (95% CI: 1.1 to 1.4). Similarly, for every one-unit increase in the WHtR z-score, the OR for elevated baPWV was 1.3 (95% CI: 1.1 to 1.5). According to the generalised additive model, we found that WHR and WHtR were positively correlated with baPWV and elevated baPWV. Subgroup analysis revealed that elevated WHR and WHtR are significant predictors of AS, with this association being substantially amplified by poor glycaemic control (glycated haemoglobin ≥7%).

Conclusion

In Chinese patients with T2DM, both WHR and WHtR are positively and independently associated with baPWV and the presence of elevated baPWV.

Causal mediation analysis of a randomised controlled trial in China: evaluating whether the pay-it-forward strategy increases HPV vaccine uptake by reducing vaccine delay intention and increasing vaccine confidence

Por: Lu · Y. · Yang · Y. · Li · Y. · Qin · C. · He · Y. · Gong · W. · Tang · S. · Li · J. · Wu · D.
Objective

To explore whether vaccine confidence and vaccine delay intention mediated the effect of the pay-it-forward intervention on human papillomavirus (HPV) vaccine uptake.

Design

This secondary mediation analysis of a two-arm randomised controlled trial was conducted among female adolescents aged 15–18 years in Chengdu, China, from July 2022 to June 2023.

Setting

This study was conducted in four residential areas representing diverse economic backgrounds in Chengdu.

Participants

A total of 321 parents of girls aged 15–18 years who had not received the HPV vaccine participated in the study.

Intervention

Participants were randomly allocated into two arms. Pay-it-forward participants received a community-contributed subsidy (47.7 USD) to support the HPV vaccination, along with educational postcards and an opportunity to donate to support others. In the standard-of-care arm, participants paid for their vaccination.

Primary and secondary outcome measures

Primary outcome was the receipt of the first HPV vaccine dose within a 3-month period following an intervention. Based on previous literature, we hypothesised that vaccine confidence and vaccine delay intention were potential mediators. Vaccine confidence was measured using the vaccine confidence index. Vaccine delay intention refers to the caregiver’s preference to postpone HPV vaccination for their daughter until the preferred vaccine type becomes available, rather than accepting the immediately accessible HPV vaccine. Data on these mediators were collected via a self-administered online questionnaire conducted after the intervention but before vaccination.

Results

Among urban participants, when compared with the standard-of-care arm, about 39% of the effect of the pay-it-forward intervention on vaccine uptake was mediated by a reduction in vaccine delay intention. Notably, vaccine confidence did not appear to mediate the effect of the intervention on vaccine uptake. Among suburban participants, no mediation effects were observed. In the suburban setting, caregivers who vaccinated their daughters showed poorer prior awareness of the HPV vaccine before participating in the trial compared with those who did not vaccinate their daughters (41.5% vs 21.1%; p=0.011).

Conclusion

Our findings indicate that among urban participants, the pay-it-forward may have effectively reduced vaccine delay intention, which was associated with an increased uptake of the HPV vaccine. However, in suburban areas, enhanced awareness might be a potential contributing factor to improved vaccine uptake, but further research is necessary to affirm this.

Trial registration number

Chinese Clinical Trial Registry: ChiCTR2200055542.

Impact of intraoperative explanation combined with surgical video review on anatomy learning in laparoscopic distal gastrectomy

Por: Ding · Y. · Liu · X. · Cai · Y. · Cheng · F. · Shi · L. · Wu · K.
Objective

To investigate the educational value of combining intraoperative explanations with laparoscopic surgical video reviews for teaching the local anatomy of the stomach.

Methods

Thirty resident physicians undergoing standardised training in our hospital, including undergraduate resident physicians and clinical-type postgraduates in surgery who had not participated in radical gastrectomy for gastric cancer, were selected as study subjects. They were randomly divided into an experimental group and a control group, with 15 participants in each group. The experimental group received instruction through intraoperative explanations combined with laparoscopic surgical video reviews, while the control group participated in surgery without additional instructional methods. After the teaching sessions, both groups underwent clinical practice assessments, theoretical examinations and evaluations of teaching satisfaction. The distribution of the data was assessed using the Shapiro-Wilk normality test along with Quantile-Quantile plots. Two-way analysis of variance was employed to evaluate the main effects and interaction effects of clinical practice scores across different groups and student types. Statistical power was examined through post hoc power analysis.

Results

The clinical practice assessment results, theoretical examination scores and teaching satisfaction ratings of the experimental group were significantly higher than those of the control group, with all differences reaching statistical significance (p

Conclusion

Combining intraoperative explanations with laparoscopic surgical video reviews for teaching local anatomy during distal gastrectomy is more effective than participation in surgery alone. This approach allows students to review surgical videos at their convenience, enhancing their understanding and mastery of local anatomical structures and significantly improving the quality of local anatomy education for resident physicians.

Ventilator-associated pneumonia biomarker evaluation (VIBE) study: protocol for a prospective, observational, case-cohort study

Por: Albin · O. · Nadimidla · S. · Saravolatz · L. · Barker · A. · Wayne · M. · Rockney · D. · Jean · R. · Nguyen · A. · Diwan · M. · Pierce · V. · Roman · A. · McSparron · J. · Dickson · R. · Rao · K. · Napolitano · L. M. · Wunderink · R. · Kaye · K.
Introduction

Current guideline-recommended antibiotic treatment durations for ventilator-associated pneumonia (VAP) are largely standardised, with limited consideration of individual patient characteristics, pathogens or clinical context. This one-size-fits-all approach risks both overtreatment—promoting antimicrobial resistance and adverse drug events—as well as undertreatment, increasing the likelihood of pneumonia recurrence and sepsis-related complications. There is a critical need for VAP-specific biomarkers to enable individualised treatment strategies. The Ventilator-associated pneumonia Biomarker Evaluation (VIBE) study aims to identify a dynamic alveolar biomarker signature associated with treatment response, with the goal of informing personalised antibiotic duration in future clinical trials.

Methods and analysis

VIBE is a prospective, observational, case-cohort study of 125 adult patients with VAP in Michigan Medicine University Hospital intensive care units. Study subjects will undergo non-bronchoscopic bronchoalveolar lavage on the day of VAP diagnosis (Day 1) and then on Days 3 and 5. Alveolar biomarkers (quantitative respiratory culture bioburden, alveolar neutrophil percentage and pathogen genomic load assessed via BioFire FilmArray polymerase chain reaction) will be assessed. An expert panel of intensivists, blinded to biomarker data, will adjudicate each patient’s Day 10 outcome as VAP clinical cure (control) or treatment failure (case). Absolute biomarker levels and mean-fold changes in biomarker levels will be compared between groups. Data will be used to derive a composite temporal alveolar biomarker signature predictive of VAP treatment failure.

Ethics and dissemination

Ethical approval was obtained from the University of Michigan Institutional Review Board (IRB #HUM00251780). Informed consent will be obtained from all study participants or their legally authorised representatives. Findings will be disseminated through peer-reviewed publications, conferences and feedback into clinical guidelines committees.

Exposure to Violence for Nurses Across Ethnic Groups: A Qualitative Study

ABSTRACT

Aim

To explore the social context of violence for hospital-based and community nurses from different ethnic groups, the types of violence experienced or witnessed both in and outside the workplace, and its impact on mental and physical health.

Design

Cross-sectional, qualitative study using semi-structured interviews.

Methods

Semi-structured interviews were conducted online with 12 hospital-based and community nurses recruited from London, England, between May and August 2021. Data were analysed using reflexive thematic analysis.

Results

The sample comprised seven hospital nurses and five community nurses. Four themes were identified: (i) the social context in which nurses from different ethnic groups are exposed to community violence; (ii) types of workplace violence experienced or witnessed by hospital-based and community nurses from different ethnic groups; (iii) perceptions of the factors contributing to workplace violence; (iv) impacts of violence on mental and physical health outcomes. Using the social ecological framework and sociological theory of stress, these findings informed a conceptual stress process model of violence exposure for nurses.

Conclusion

Nurses from different ethnic groups are exposed to violence both in and outside the workplace which negatively affects their mental and physical health. Effective violence prevention requires a multi-factorial approach that addresses the social and institutional factors contributing to violence, shifting the focus from individual measures to systemic organisational changes.

Impact

The NHS workforce is currently more diverse than ever, and healthcare leaders must improve access to mental health and well-being resources for staff affected by workplace violence, particularly for those who hold multiple social identities at the intersection of ethnicity, gender and age. Prioritising this support is essential not only to safeguard against negative health outcomes but also to improve the recruitment and retention of healthcare professionals.

Patient or Public Contribution

No patient or public contribution.

Randomised controlled study investigating standard dose continuous renal replacement therapy (CRRT) versus low-dose CRRT in critically ill patients with acute kidney injury (AKI): study protocol for a prospective, randomised, controlled, international, mu

Por: Strauss · C. · Sadjadi · M. · von Groote · T. · Booke · H. · Schöne · L. M. · Hegner · C. · Wempe · C. · Meersch · M. · Gerss · J. · Bernard · A. · Haeberle · H. A. · Rosenberger · P. · Rahmel · T. · Unterberg · M. · Adamzik · M. · Arndt · C. · Wulf · H. · Romagnoli · S. · Bonizzoli · M.
Introduction

The only supportive therapy for patients with severe acute kidney injury (AKI), a common complication among the critically ill, is dialysis. Based on the literature and current guidelines, continuous renal replacement therapy (CRRT) with a total effluent dose of 20–25 mL/kg/hour and adjustments to ensure such dose is delivered despite down time (eg, due to surgical procedures) is recommended. However, experimental and clinical studies suggest that azotaemia, which can be induced by lowering the effluent dose, may accelerate renal recovery. This clinical study investigates whether a lower effluent dose (10–15 mL/kg/hour) for a maximum of 7 days or until successful (>24 hours) liberation of CRRT in critically ill patients with a dialysis-dependent AKI accelerates renal recovery and reduces time on CRRT compared with guideline-directed standard dose (25–30 mL/kg/hour).

Methods and analysis

The Ketzerei trial is an international, multicentre randomised, controlled trial, designed to investigate if a lower effluent dose (10–15 mL/kg/hour) accelerates renal recovery and reduces the time on CRRT compared with the guideline directed standard effluent dose (25–30 mL/kg/hour). The study aims to enrol 150 critically ill patients with a dialysis-dependent AKI. Eligible patients will be randomised to receive either a standard effluent dose (control group, 25–30 mL/kg/hour) or lower effluent dose (interventional group, 10–15 mL/kg/hour). The primary endpoint is the number of days free from CRRT and alive (from randomisation through day 28). Key secondary endpoints include the number of (serious) adverse events due to potential uremia, the duration of RRT and intensive care unit survival.

Ethics and dissemination

The Ketzerei trial has been approved by the Ethics Committee of the Chamber of Physicians Westfalen-Lippe (2023–343 f-s), the University of Muenster and subsequently by the corresponding Ethics Committee of the participating sites. Results will be disseminated widely and published in peer-reviewed journals, presented at conferences and will guide patient care and further research.

Trial registration number

clinicaltrials.gov (NCT06021288).

Association of small dense low-density lipoprotein cholesterol with cardiovascular risk in premature acute coronary syndrome and multivessel disease: a single-centre retrospective cross-sectional study

Por: Keremu · M. · Li · X.-L. · Li · X.-M. · Wulamu · A. · Ding · S.-Y. · Aizezi · A. · Li · Y.-P. · Liu · F. · Li · X. · Wang · Y.-N. · Adi · D. · Ma · Y.-T.
Objectives

Premature acute coronary syndrome (PACS) presents with a poor prognosis and significant risks. This study aimed to investigate the association between small-dense low-density lipoprotein cholesterol (sdLDL-C) levels and the severity of coronary lesions, as well as its potential role in risk stratification for PACS patients with multivessel disease (MVD).

Design

Retrospective cross-sectional study.

Setting

First Affiliated Hospital of Xinjiang Medical University in China, between May 2022 and November 2023.

Participants

900 PACS patients with MVD confirmed by coronary angiography (CAG) and 600 age-matched and sex-matched controls with normal CAG results.

Methods

Patients with PACS and MVD were stratified by the Global Registry of Acute Coronary Events (GRACE) score, and sdLDL-C levels were compared among the different GRACE score groups. The association between sdLDL-C and the GRACE score was evaluated using Pearson’s correlation analysis. Multivariate logistic regression analysis was employed to identify factors associated with PACS and MVD. The discriminatory ability of sdLDL-C for PACS with MVD was assessed using receiver operating characteristic (ROC) curve analysis. Restriction cubic spline (RCS) analysis was used to examine the potential nonlinear association between sdLDL-C levels and the high-risk groups of PACS with MVD.

Results

Patients with PACS and MVD exhibited significantly higher sdLDL-C levels compared with control group (p

Conclusions

Elevated sdLDL-C levels demonstrated a significant association with the risk of PACS and MVD. These findings indicate sdLDL-C may serve as a potential biomarker for risk stratification in this high-risk population. However, causal inferences require validation in prospective studies.

Trial registration number

ChiCTR2300074166

Management and outcomes of fractures over cranial venous sinuses: a scoping review protocol

Por: Takoutsing · B. · Wunde Njineck · U. · Wah · P. S. · Sebopelo · L. · Ngouanfo Tchoffo · J. · Bah · E. S. · Esene · I. N.
Introduction

Fractures over venous sinuses (FOVSs) are associated with difficulties in diagnosis and treatment resulting in a high level of morbidity and mortality. Despite its importance, there are limited aggregate data to guide the management of these fractures ultimately inflicting a major callenge to neurosurgeons. This protocol describes the methodology of a scoping review that aims to synthesise contemporary evidence on the management and outcomes of FOVSs.

Methods and analysis

The proposed study will be conducted in accordance with the Arksey and O’Malley’s framework for scoping reviews. The research question, eligibility criteria and search strategy were developed based on the population, intervention, comparator and outcome strategy. The following electronic bibliographic databases will be searched without restrictions on language and date of publication: PubMed, WHO Global Index Medicus, African Journals Online, SCOPUS, Embase, Cochrane and ProQuest Central. All peer-reviewed studies of primary data reporting on the management and outcomes of FOVSs will be included. The data extracted from included articles will be presented through descriptive statistics, pooled statistics and a narrative description.

Ethics and dissemination

Because this study did not directly involve human individuals, ethical approval was not necessary. Dissemination strategies will include publication in a peer-reviewed journal, oral and poster presentations at local, regional, national and international conferences and promotion over social media.

Prevalence of and factors influencing elevated blood pressure among Chinese adolescents: a cross-sectional study

Por: Zheng · L. · Xiang · W. · Zheng · R. · Min · X. · Dai · L. · Chen · J. · Lu · J. · Wang · Y. · Liu · X. · Wu · W. · Xu · H.
Objective

This study aims to examine the prevalence of elevated blood pressure (BP) among adolescents aged 13–17 years in Shiyan city, Hubei province, China. Additionally, it analyses the distribution characteristics and potential factors influencing elevated BP, providing a scientific foundation for the prevention and management of hypertension in adolescents.

Design

Cross-sectional study.

Setting

A total of 11 schools in central China.

Participants

From October 2023 to January 2024, a cross-sectional study involving 8534 students aged 13–17 years from 11 schools in central China was conducted. Convenience sampling was used to select participants, and data were collected through questionnaires and medical physical examinations.

Primary outcome measures

This study used physiological measurement to assess BP levels, while questionnaire surveys and anthropometric measurements were employed to identify associated factors.

Results

The overall detection rate of elevated BP was 22.7% (20.2% for boys and 25.6% for girls). Increased body mass index (BMI) (OR: 1.026, 95% CI: 1.003 to 1.048), neck circumference (OR: 1.099, 95% CI: 1.073 to 1.126) and chest circumference (OR: 1.015, 95% CI: 1.007 to 1.023) were associated with an increased risk of elevated BP. Conversely, longer screen time was linked to a lower risk of elevated BP (OR: 0.961, 95% CI: 0.942 to 0.98). Girls (OR: 1.592, 95% CI: 1.419 to 1.787) were at higher risk than boys. Additionally, not consuming meat or poultry (OR: 2.029, 95% CI: 1.171 to 3.514) was identified as a risk factor for elevated BP.

Conclusion

The distribution of elevated BP among adolescents exhibited population heterogeneity. Elevated BP was found to be associated with higher BMI, neck circumference and chest circumference, as well as the absence of meat consumption. Additionally, targeted attention to girls is essential for preventing elevated BP.

Human papillomavirus, sexually transmitted infections, and antimicrobial resistance in West Africa: Estimating population burden and understanding exposures to accelerate vaccine impact and drive new interventions: The PHASE survey protocol

by Adedapo Olufemi Bashorun, Larry Kotei, Abdoulie F. Jallow, Ousubie Jawla, Emmanuel U. Richard-Ugwuadu, Muhammed Jagana, Lamin Bah, Amadou Tijan Bah, Karamo Conteh, Mamadou S.K. Jallow, Mehrab Karim, Bai Lamin Dondeh, Anne Segonds-Pichon, Gary M. Clifford, Iacopo Baussano, Bruno Pichon, David Jeffries, Ed Clarke

Human papillomavirus (HPV) infection is a primary cause of preventable deaths from cervical cancer, a condition of profound inequality with approximately 90% of deaths occurring in low- and middle-income countries, particularly in sub-Saharan Africa. In May 2018, the WHO Director-General declared a Joint Global Commitment to Cervical Cancer Elimination, highlighting the critical role of HPV vaccines in achieving this goal. However, there is a lack of systemically collected data on HPV prevalence in The Gambia, and impact data from high-income countries may not be reliably extrapolated to West African settings due to geographical variation in HPV types and distinct behavioural, biological, and sociodemographic exposures. The Gambia introduced a two-dose HPV vaccination schedule in 2019, but coverage has been very low, interrupted mainly by the COVID-19 pandemic. This presents a key opportunity to generate vital baseline data on HPV prevalence in the population before potential scale-up of vaccination efforts. The PHASE survey, a multi-stage cluster survey, aims to establish the baseline, population prevalence estimates of high-risk and low-risk, vaccine-type and non-vaccine-type HPV infection in 15- to 49-year-old females in The Gambia by measuring urinary HPV-DNA. The survey will also quantify the effects of various exposures on HPV prevalence, including sexual behaviour, the presence of other sexually-transmitted infections (STIs) - Neisseria gonorrhoea (NG), Chlamydia trachomatis (CT), Trichomonas vaginalis (TV), Mycoplasma genitalium (MG), syphilis, as well as blood borne viruses, human immunodeficiency virus (HIV), hepatitis B and hepatitis C; obstetric history, socio-demographic characteristics, and cervical cancer screening and/or treatment. Additionally, the study will provide important antimicrobial resistance (AMR) data for NG and MG in sub-Saharan Africa, a region poorly represented in global surveillance programs. This data is needed to guide regional treatment guidelines and advocate for new solutions, including gonococcal vaccines. The AMR data are expected to immediately influence recommendations regarding the appropriate choice of antibiotics for syndromic STI management in West Africa and hence to address an important driver of AMR in the sub-region. Leveraging on the Medical Research Council Unit The Gambia funded Health Demographic Surveillance system (HDSS) as its sampling frame, the survey will utilize validated diagnostic assays and culturally sensitive data collection methods, to ensure both scientific rigor and local relevance. Tools such as Audio Computer-Assisted Self-Interviewing (ACASI) technology, developed in consultation with local community advisory boards, are included to reduce social desirability bias in reporting sexual behaviour. This approach aims to maximize both the reliability and cultural appropriateness of the findings. This study directly addresses the critical need for baseline epidemiological data on HPV in a West African setting to accelerate vaccine impact and drive new interventions towards cervical cancer elimination. By understanding other factors that influence HPV (like other STIs, sexual behaviour, etc.), the study aims to ensure that, when the vaccine’s impact is measured later, changes in other confounding factors that may impact on HPV prevalence can be accounted for. The study will also establish the population prevalence of the measured STIs and their relationship to common symptoms and other adverse health outcomes related to STIs.

Post-marketing safety of solriamfetol: A retrospective pharmacovigilance study based on the us food and drug administration adverse event reporting system

by Lingling Wu, Kaijian Zhu

Purpose

Excessive daytime sleepiness (EDS) seriously affects quality of life and may increase the risk of life-threatening situations, such as motor vehicle accidents. Solriamfetol is a novel medication approved for the treatment of EDS and serves as an alternative to traditional stimulants. This retrospective pharmacovigilance study aimed to analyze adverse events (AEs) related to solriamfetol based on real-world data.

Methods

Data regarding solriamfetol-related adverse events were retrieved from the FDA Adverse Event Reporting System (FAERS) from Q3 of 2019 to Q1 of 2024. A total of 1550 reports on solriamfetol-related AEs were analyzed using disproportionality analysis to identify AE signals across various organ systems.

Results

A large proportion of AEs were reported among female patients (64.06%), primarily including those with narcolepsy (38.13%) and obstructive sleep apnea (3.68%). The most frequently reported AEs included headache, anxiety, and drug ineffectiveness, with 46.8% of AEs occurring within 7 days of treatment initiation. Furthermore, solriamfetol was significantly associated with psychiatric and nervous system disorders as well as cardiac and general disorders.

Conclusions

Solriamfetol-related adverse events were mainly psychiatric, neurological, cardiac, and general disorders, with headache, anxiety, and drug ineffectiveness being the most common. Nearly half of the events occurred within the first week of treatment. Given the limitations of the FAERS database, further prospective studies are needed to confirm these findings.

Combined application of BNLF2b antibody with VCA-IgA, Rta-IgG, and Zta-IgA in nasopharyngeal carcinoma screening in the Guangxi region

by Ruilan Lin, Ru Qin, Yunlong Zhang, Yao Guan, Boheng Wu, Shangyang Li, Shenhong Qu, Yulin Yuan

Background

This study aims to assess the diagnostic value of the Epstein-Barr virus (EBV) BNLF2b antibody(P85-Ab), alone or in combination with VCA-IgA, Rta-IgG, and Zta-IgA antibodies, in the context of nasopharyngeal carcinoma (NPC).

Methods

The study included 100 NPC patients and 100 healthy controls. Chemiluminescent microparticle immunoassay was utilized to measure P85-Ab levels in the serum samples of both NPC patients and healthy controls. Additionally, the ELISA method was employed to detect serum levels of VCA-IgA, Rta-IgG, and Zta-IgA antibodies. The study analyzed the roles of serum P85-Ab in conjunction with VCA-IgA, Rta-IgG, and Zta-IgA antibodies in the diagnosis of NPC.

Results

Serum levels of P85-Ab, VCA-IgA, Rta-IgG, and Zta-IgA antibodies in NPC patients were significantly higher than those in the normal control group (P  Conclusion

The combined detection of P85-Ab with VCA-IgA, Rta-IgG, and Zta-IgA antibodies demonstrates high diagnostic value for nasopharyngeal carcinoma. Serum P85-Ab may serve as a potential marker for the diagnosis of NPC.

Mixed methods implementation research of oral antiviral treatment for COVID-19 in low- and middle-income countries: a study protocol

Por: Narayanasamy · S. · Gambanga · F. · Boeke · C. E. · Udayakumar · K. · Brothers · L. · Wolfe · C. R. · Agwuocha · C. · Asamoa-Amoakohene · M. N. · Detleuxay · K. · Griffith · B. C. · Hamza · N. · Joseph · J. · Kimani · P. · Kirungi · R. · Lufesi · N. · Mbewe · N. · McCarthy · E. · Mulenga
Introduction

There is an absence of real-world evidence, especially from low- and middle-income countries (LMICs), on the implementation successes and challenges of COVID-19 Test and Treat (T&T) programmes. In 2022, nirmatrelvir/ritonavir was provided as standard of care for mild to moderate COVID-19 treatment in eight LMICs (Ghana, Kenya, Laos, Malawi, Nigeria, Rwanda, Uganda and Zambia). This manuscript describes a research protocol to study novel drug introduction during the COVID-19 health emergency, with implications and learnings for future pandemic preparedness. The goal of the study is to provide simultaneous programme learnings and improvements with programme rollout, to fill a gap in real-world implementation data on T&T programmes of oral antiviral treatment for COVID-19 and inform programme implementation and scale-up in other LMICs.

Methods and analysis

This multiple methods implementation research study is divided into three components to address key operational research objectives: (1) programme learnings, monitoring and evaluation; (2) patient-level programme impact; and (3) key stakeholder perspectives. Data collection will occur for a minimum of 6 months in each country up to the end of grant. Quantitative data will be analysed using descriptive statistics for each country and then aggregated across the programme countries. Stakeholder perspectives will be examined using the Consolidated Framework for Implementation Research implementation science framework and semistructured interviews.

Ethics and dissemination

This study was approved by the Duke University Institutional Review Board (Pro00111388). The study was also approved by the local institutional review boards in each country participating in individual-level data collection (objectives 2 and 3): Ghana, Malawi, Rwanda, Nigeria and Zambia. The study’s findings will be published in peer-reviewed journals and disseminated through dialogue events, national and international conferences and through social media.

Trial registration number

NCT06360783.

Do-not-resuscitate status in patients with shock in the emergency department in a tertiary hospital in China: a retrospective observational study

Por: Zhang · H. · Jiang · J. · Lv · L. · Liang · L. · Tian · W. · Wu · Q.
Objectives

The study aims to define the prevalence of Do-Not-Resuscitate (DNR) orders among patients with shock in the emergency department (ED) and explore their impact on clinical management and mortality outcomes.

Design

A retrospective observational cohort study was conducted involving patients presenting to the ED with shock.

Setting

An ED in a tertiary hospital in western China.

Participants

2001 patients (aged ≥18 years) presenting to the ED with shock from 1 January 2022 to 31 December 2023.

Methods

The enrolled patients were divided into DNR (order issued within 24 hours of ED admission)/non-DNR groups. Demographics, vitals, comorbidities, laboratory values, medications and prognoses were obtained from electronic healthcare records. DNR prevalence and its associations with mortality, ICU admission, vasopressor administration and antibiotic administration were assessed via logistic regression.

Results

Compared with patients without DNR orders, patients with DNR orders (n=399 (19.9%)) were older (p

Conclusions

Compared with patients with shock in the ED who did not have DNR status, those with DNR status (prevalence ~20%) had higher in-hospital and 30-day mortality (but most survived) and similar ICU admission and intervention treatments.

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