Conectar
To compare the effectiveness of multifactorial and exercise programs in preventing falls among older adults, with a specific focus on evaluating the individual and combined contributions of their key intervention components.
This study was a systematic review and component network meta-analysis. PubMed, Embase, and Web of Science were searched from inception to February 2025 for randomized controlled trials, focusing on four primary outcomes: fallers, recurrent fallers, injurious fallers, and fractured fallers. Risk of bias was evaluated using the Cochrane tool, and additive component network meta-analysis compared intervention group and component efficacy.
69 randomized controlled studies were included. In multifactorial interventions, traditional health education could increase fall risk (iRR: 1.10, 95% CI [1.03; 1.67]) and recurrent fall risk (iRR: 1.25, 95% CI [1.06; 1.48]). Medication management can increase recurrent fall risk (iRR: 1.35, 95% CI [1.09; 1.67]) and fracture risk (iRR: 2.11, 95% CI [1.48; 3.00]). Exercise (iRR: 1.24, 95% CI [1.01; 1.53]) increased fracture risk, and environment modification (iRR: 0.56, 95% CI [0.61; 0.79]) reduced it. The additive effect of risk assessment and advice, exercise, and environment modification reduced fall risk. In exercise programs, gait and balance (iRR: 0.58, 95% CI [0.36; 0.93]) can reduce recurrent fall risk. An intervention containing two components (gait and balance + strength and resistance) reduced the risk of falls and fall-related injuries.
Environment modification reduced fracture risk, emphasizing the value of creating safe living spaces. The combination of risk assessment, advice, exercise, and environment modification reduced fall risk, suggesting a holistic approach may be effective in preventing falls. Traditional methods of health education and medication management are in urgent need of updating to synergize with other exercise components and enhance the effectiveness of fall prevention. Prospective clinical trials are needed to optimize combinations of exercise components, particularly integrating gait and balance training with strength and resistance exercises.
The review was registered online in the International Prospective Register of Systematic Reviews (PROSPERO) under registration number (CRD42025643530)
This study aims to explore the history of prior abortions and the factors influencing them among young women seeking abortion services in Foshan, Guangdong, China.
This is a retrospective, cross-sectional study of young women seeking abortion care.
Gynaecological outpatient clinics at the Department of Gynaecology, Foshan Women and Children Hospital Affiliated to Guangdong Medical University, Foshan, Guangdong, China, between 2013 and 2023.
A total of 7361 young women aged 12–25 years seeking abortion services.
Data on abortion history, sociodemographic factors, contraceptive use and postabortion contraceptive choices were collected and analysed, with special emphasis on the incidence of repeat abortions and the factors associated with them.
Of the 7361 participants, 34.2% reported at least one previous abortion, underscoring a notable public health concern. The mean age of the participants was 22.30 years (SD=2.13). Women with a history of abortion were significantly older than those without (22.57 vs 22.08 years, p
This study underscores the need for targeted interventions to address the multifaceted factors leading to repeat abortions among young women in China. The results offer valuable insights for improving reproductive health outcomes in this vulnerable population and highlight the importance of expanding access to contraceptive education and services in China.
Pressure injury (PI) is common in the ICU and not well captured by single-risk tools such as the Braden scale. We aimed to develop and internally validate a machine-learning model to predict new-onset PI using routinely collected ICU data. This retrospective single-centre cohort included adult ICU patients with length of stay ≥ 48 h (2018–2023). The primary outcome was new-onset PI during ICU stay. Candidate predictors were pre-specified: minimum albumin, maximum lactate, SOFA, APACHE II, first recorded Braden score, age, BMI, a nutrition score and treatment indicators. Missing values were imputed (median/mode). A gradient boosting model (GBM) was evaluated with stratified 3-fold cross-validation; a random forest (RF) served as a benchmark (stratified 70/30 train–test split). Discrimination (AUC) was primary; calibration, Brier score, decision-curve analysis (DCA) and feature importance were secondary. Logistic regression quantified independent associations. Among included ICU stays, 14.6% developed PI. On multivariable analysis, higher lactate, lower albumin, lower Braden scores, older age, CRRT, prone positioning, enteral nutrition and analgesic exposure were associated with increased PI risk, whereas sedatives showed an inverse association. The GBM achieved AUC≈0.69 with acceptable calibration and net clinical benefit across thresholds commonly used in preventive workflows (≈0.10–0.50). Single markers or simple combinations displayed only modest discrimination. A GBM built from routine ICU data provided moderate, well-calibrated discrimination for predicting new-onset PI and demonstrated decision-relevant net benefit. The model can complement Braden-based screening by refining risk stratification and prioritising intensified prevention for patients most likely to benefit. External validation and prospective evaluation are warranted.
Commentary on: Taylor J, Hall R, Heathcote C, et al (2024). Clinical guidelines for children and adolescents experiencing gender dysphoria or incongruence: a systematic review of guideline quality (part 1)Archives of Disease in Childhood Published Online First: 09 April 2024. doi: 10.1136/archdischild-2023–3 26 499
Implications for practice and research Clinicians should exercise caution when following clinical guidelines for managing gender dysphoria in youth due to concerns about methodological issues and evidence quality. Research on long-term outcomes of interventions is urgently needed to inform robust and transparent guidelines, incorporating input from gender diverse youth and families.
The visibility and acceptance of transgender identities have increased, leading to more young individuals questioning their gender or identifying as transgender.
by Yu Chen, Xinjie Zhao, Ying Yue, Zhenyi Li, Si Chen
ObjectivesTo investigate factors associated with susceptibility to wild mushroom consumption using machine learning approaches and identify key predictors for targeted intervention development.
MethodsA cross-sectional survey of 216 Chinese university students employed three machine learning algorithms (Logistic Regression, Random Forest, Extremely Randomized Trees [ExtraTrees]) to predict consumption susceptibility based on demographics, media usage, and cognitive factors. Susceptibility was assessed through scenario-based questions following established frameworks from tobacco research. Model performance was evaluated using AUC with 95% confidence intervals calculated via bootstrap resampling (1,000 iterations). Sensitivity analyses were conducted using alternative susceptibility thresholds.
Results65.3% were classified as susceptible to consumption. Logistic Regression achieved highest performance (AUC = 0.776, 95% CI: 0.679–0.862). Risk perception emerged as the strongest predictor (importance = 0.133 ± 0.044), followed by mushroom picking experience (0.101 ± 0.017) and content impression (0.089 ± 0.018). Among the 63 participants (29.2%) who reported using AI models, 75.93% indicated trust levels of ‘fairly trust’ or above.
ConclusionsIn this exploratory study of Chinese university students from a single institution, cognitive factors, particularly risk perception and identification ability, showed the strongest associations with consumption susceptibility. These preliminary findings suggest that targeted interventions enhancing risk awareness may be relevant for this population, though replication across diverse samples is needed before broader conclusions can be drawn.
by Hang Sun, Haozhi Xu, Junying Li, Xiaoman Xie, Junmei Zhang, Hongjie Dong, Huanhuan Xie, Qi Wang, Guihua Zhao, Kun Yin, Jingyu Yang, Jianwei Zhou, Ruili Wu, Chao Xu
Gastric cancer (GC) is one of the most common and lethal cancers globally. methyltransferase-like 3 (METTL3)-mediated N6-methyladenosine (m6A) RNA methylation plays a crucial role in tumor initiation and progression by regulating RNA function. STM2457, a highly efficient METTL3 inhibitor, can inhibit METTL3 activity and may serve as a potential therapeutic strategy in cancers. However, the role of STM2457 for GC cells is still unknown. In this study, we analyzed the expression profile data of GC in TCGA and GEO databases, and further explored the expression involvement of METTL3 in GC cell line, investigated the therapeutic effect of STM2457 targeted inhibition of METTL3 in GC both in vitro and in vivo experiments. The results indicated that STM2457 could suppress GC cell proliferation and migration by inhibiting METTL3, and also promoted cell apoptosis and arrest the cell cycle in S phase. In addition, STM2457 could inhibit tumor growth in subcutaneous xenotransplantation mouse model. Our findings suggested that STM2457 had great potential for the treatment of GC and could serve as a foundation for future clinical applications.by Siyu Xie, Qiang Gu, Guiyin Zhuang, Xiaojing Guo, Bo Sun
ObjectivesTo explore the pharmacotherapeutic efficacy of heparin in the management of meconium-induced acute lung injury (ALI) in near-term newborn rabbits subjected to mechanical ventilation (MV) and ancillary respiratory medications.
MethodsNewborn rabbits at 30-day gestation (term 31 days) were anesthetized, intratracheally intubated and received human meconium-saline suspension, followed by parallel MV with individually adjusted tidal volume in a multi-plethysmograph-ventilator system. When ALI was induced after initial 3-h MV, therapeutic effects of single or combined subcutaneous heparin (100 U/kg), surfactant (200 mg/kg), and inhaled nitric oxide (iNO, 10 ppm), were compared for lung protective ventilation and survival as outcome, analyzed with linear regression models.
ResultsSignificantly reduced respiratory compliance by meconium was reinstalled during ensuing 7-h MV, with improved survival, among the treatment groups. The impact was verified by lung injury severity, surfactant phospholipid pools, and multiple mRNA expressions of surfactant proteins, lung fluid clearance-related factors, inflammatory mediators, growth factors, endothelial cell injury and coagulation-related factors as subphenotyping biomarkers. The overall benefits of heparin alone, or exerted with the dual and triple regimens, were discernible by both generalized linear model and Cox proportional hazard ratio regression for survival and other major variables as outcome. Its adverse effects were intangible.
ConclusionThe comparable efficacy of heparin, alongside the PS and NO, was corroborated in attenuating meconium-mediated, ventilator-induced ALI, which should warrant clinical investigation to validate.
Post-COVID-19 respiratory infection patterns require updated epidemiological data. To investigate the prevalence and infection patterns of upper respiratory tract infections (URTIs), a survey was conducted to assess the presence of influenza A (IFV A), influenza B (IFV B), respiratory syncytial virus (RSV), human rhinovirus (HRV), adenovirus (Adv), and SARS-CoV-2 among outpatients diagnosed with URTIs.
A community-based cross-sectional study.
Three cities in Sichuan, China.
1174 outpatients diagnosed with URTIs from December 2023 to February 2024.
Oropharyngeal swabs were collected using sterile flocked swabs, preserved at 4°C and analysed within 24 hours. Viral nucleic acid was extracted automatically and detected via multiplex PCR-melting curve analysis.
Results showed in positive detection rates varied significantly by age (p
This study reveals persistent influenza dominance and age-stratified co-infection risks and provides critical baseline data for optimising respiratory infectious disease control in the post-pandemic era.
To explore the complex relationships among non-suicidal self-injury, depression and anxiety symptoms in adolescents, identify key symptoms and provide a theoretical foundation for targeted interventions.
A cross-sectional study.
In total, 1126 adolescents from a tertiary hospital in Shandong Province were assessed using the Adolescent Self-Injury Questionnaire, Patient Health Questionnaire and Generalised Anxiety Disorder Scale. Network analysis was employed to construct symptom networks and identify central and bridging symptoms.
The network analysis revealed that nodes GAD5 (Restlessness), GAD2 (Uncontrollable worry), and GAD4 (Trouble relaxing) exhibited the highest centrality indices, establishing them as core symptoms within the overall symptom network. The highest bridge intensity nodes were GAD1 (Nervousness), GAD5 (Restlessness) and non-suicidal self-injury.
By accurately identifying core and bridging symptoms, a scientific foundation is provided for developing precise and effective symptom management plans.
The study identified the most influential nodes in anxiety and depression among adolescents with non-suicidal self-injury. The findings would help in carrying out personalised and precise interventions to reduce non-suicidal self-injury occurrence and alleviate anxiety and depression symptoms among adolescents.
This study adheres to the STROBE guideline of reporting.
This study did not include patient or public involvement in its design, conduct or reporting.
Death preparedness is an important prerequisite for improving the quality of life and the quality of death in advanced cancer patients. However, research on the level of death preparedness in patients is insufficient, and there is little understanding of the current status and influencing factors of death preparedness in advanced cancer patients.
This study aims to assess the current status of death preparedness and its influencing factors in advanced cancer patients.
Based on the PRECEDE-PROCEED model, a structured survey questionnaire was designed to collect data on personal factors (such as gender, age and residence area), interpersonal factors (such as social support, caregiver readiness and healthcare worker readiness) and social factors (such as care resources, policy support and information supply). Through multiple linear regression and BP neural network analysis, the study explores the impact and significance of these influencing factors on death preparedness in advanced cancer patients.
A total of 930 valid questionnaires were collected in this study. The death preparedness score in advanced cancer patients was 72.18 ± 22.82, indicating a moderate level, with the highest score being the ‘reflexive care’ dimension and the lowest score being the ‘hospice programme’ dimension. Multivariate analysis revealed that meaning in life and social support were the most significant predictors of death preparedness in advanced cancer patients. In addition, personal factors such as dignity, household income and coping style, also played an important role. Interpersonal factors like social support, as well as social factors such as care resources and policy support, also had an impact on patients' death preparedness to some extent.
Death preparedness in advanced cancer patients is generally at a moderate level, and death preparedness is influenced by a combination of personal factors, interpersonal factors and social factors.
This study is based on the PRECEDE-PROCEED model to comprehensively explore the influencing factors of death preparedness in advanced cancer patients. It provides theoretical support for improving life services for advanced cancer patients. It offers valuable practical experience and insights for societal attention and reform in end-of-life care.
No Patient or Public Contributions were included in this paper.
To explore multidisciplinary clinical, academic, policy and governance stakeholders' perceptions of enablers and barriers to implementing designated registered nurse prescribing in Australia, using a systems-thinking approach.
A two-phase explorative study using a systems-thinking lens to investigate complex health-system interdependencies.
Fifty-three participants were recruited from all Australian states and territories, including registered nurses, nurse practitioners, pharmacists, medical practitioners and health-service planners. Phase 1 involved interviews and focus groups conducted between February 2024 and April 2024 (n = 45), analysed using deductive content analysis, guided by the Sustainability of Innovation Framework. Phase 2 was a face-to-face workshop conducted in August 2024 (n = 28), with data from participant discussions and observer field notes analysed inductively and refined through reflexive dialogue. Reflexive analysis of the findings allowed the construction of recommendations for implementation in various healthcare contexts.
In Phase 1, participants representing all Australian jurisdictions and healthcare contexts identified that successful adoption of designated registered nurse prescribing is contingent upon several interrelated system components. These interconnected factors influence each other within the broader healthcare system and serve as the focus for Phase 2.
In Phase 2, participants reported context-specific service models, stakeholder engagement, financial support, clear messaging and workforce/organisational readiness for new models of care and service delivery were recognised as dynamic interrelated elements. Three overarching themes for successful implementation were generated: The Standard—just one piece of the puzzle. Harnessing collective capability. Shared wisdom for success.
National implementation of registered nurse prescribing requires consistent but context-responsive reforms. A systems-thinking approach underscores the need for whole-of-system strategies, acknowledging interdependencies and avoiding rapid, unplanned implementation. This study highlights that sustainable adoption of registered nurse prescribing in Australia depends on recognising system interdependencies and their dynamic nature.
Designated registered nurse prescribing has the potential to improve timely access to medicines and enhance patient-centred care when implemented with whole-of-system support.
This study provides key systems-level recommendations to guide policymakers and healthcare services to successfully implement designated registered nurse prescribing across various settings.
This study highlights key stakeholders' perspectives, providing valuable insights on the essential elements required for the successful adoption of this expanded practice.
Broad systems-level recommendations are offered to guide policymakers and healthcare services to successfully implement designated prescribing across various settings, taking into account the complexity of the healthcare system.
Consolidated criteria for reporting qualitative research guidelines.
This study did not include patient or public involvement in its design, conduct or reporting.
Not registered.
To synthesise qualitative evidence on how patients, caregivers and healthcare professionals perceive and respond to cancer-related anorexia (CRA), and to develop a multi-level framework for improving CRA care.
A qualitative meta-synthesis using the Joanna Briggs Institute (JBI) methodology, informed by the Social Ecological Model (SEM).
Seven databases were searched for qualitative studies from inception to April 2025. Studies were assessed using the JBI Critical Appraisal Checklist. Meta-aggregation was used to synthesise findings, and the ConQual method assessed confidence levels.
PubMed, Embase, CINAHL, PsycINFO, Cochrane Library, CNKI and WanFang.
Seventeen studies from 10 countries were included, reflecting the perspectives of patients, caregivers and healthcare professionals. Four synthesised findings were identified. At the individual level, CRA was linked to physical decline, emotional distress and changes in identity. The interpersonal level involved feeding-related tensions and caregiver burden. Organisational barriers included delayed care and poor cultural responsiveness. Policy-level factors such as limited insurance coverage and rural access further impeded care. Overall confidence in these synthesised findings was low to moderate.
CRA is not solely a biological condition but a multidimensional experience. Addressing CRA requires integrated and context-sensitive strategies across personal, relational, organisational and policy domains.
Nurses and clinicians should address not only physical symptoms but also the emotional and social dimensions of eating. Structured support for caregivers and improved service access, particularly in underserved settings, are needed.
This study provides a multi-level understanding of CRA. The findings support better patient care, caregiver support and more equitable healthcare policy design.
JBI methodology and ENTREQ guideline.
No Patient or Public Contribution.
PROSPERO Database: CRD420251041265
To explore how, under what circumstances and why telerehabilitation can improve adherence to pulmonary rehabilitation in patients with chronic respiratory diseases.
A realist review.
Embase, MEDLINE, CINAHL, PsycINFO, Web of Science, and the Cochrane Library were searched from inception to 2 July 2024 to identify relevant literature.
Initial programme theory was developed through research team meeting, informal literature reading and the use of Capability, Opportunity, Motivation, Behaviour model. After completing the literature search, key evidence was appraised, extracted and synthesised into context-mechanism-outcome configurations.
The review included 23 studies. Seven context-mechanism-outcome configurations were identified. Accessibility and convenience of pulmonary rehabilitation; social interaction and support; technical support; individuality and flexibility of program; getting feedback and seeing results; real-time monitoring of diseases; and diverse motivational incentives were found to be critical for telerehabilitation to improve adherence to pulmonary rehabilitation in patients with chronic respiratory diseases.
This review explains the key mechanisms by which telerehabilitation improves adherence to pulmonary rehabilitation in patients with chronic respiratory diseases, which may contribute to the development and improvement of future pulmonary telerehabilitation interventions.
The program theory developed in this study may guide researchers and clinical staff in the development or improvement of pulmonary telerehabilitation interventions to improve patients' adherence to pulmonary rehabilitation and further support better pulmonary rehabilitation outcomes.
This study adheres to The RAMESES reporting standards.
No patient or public contribution.
Open Science Framework (https://osf.io/). DOI: https://doi.org/10.17605/OSF.IO/YWMQ8
To examine determinants of nurses' adoption of generative artificial intelligence outputs in clinical practice using a technology acceptance model and an integrated structural equation modelling framework.
Cross-sectional online survey.
Registered nurses in mainland China completed an anonymous questionnaire assessing perceived performance benefits, perceived ease of use, perceived information quality, perceived source credibility, social influence, facilitating conditions, adoption intention and adoption behaviour. Structural equation modelling was used to evaluate the measurement model and estimate a primary mediation model in which perceived performance benefits and perceived ease of use predicted adoption intention, and adoption intention predicted adoption behaviour. An integrated model added information quality, source credibility, social influence and facilitating conditions as additional determinants. Sensitivity analyses were conducted using an ordinal estimator to assess robustness.
The analytic sample comprised 330 nurses. In the primary model, higher perceived performance benefits and greater perceived ease of use were associated with stronger adoption intention, and stronger adoption intention was associated with higher self-reported adoption behaviour. The integrated model showed that perceived information quality contributed to adoption intention beyond core expectancy beliefs, while perceived source credibility showed a small direct association with adoption behaviour. Social influence demonstrated a modest association with adoption intention, whereas facilitating conditions showed weaker associations after accounting for other determinants. Model conclusions were consistent across estimation approaches.
Nurses' adoption of generative artificial intelligence outputs is shaped by perceived performance benefits, ease of use and perceived information quality, with adoption intention functioning as the proximal determinant of self-reported use. Implementation strategies should focus on demonstrable workflow gains, reducing interaction burden and strengthening governance and verification to support safe adoption.
To evaluate whether type 2 diabetes mellitus (T2DM) presence and severity are associated with differences in global and domain-specific cognitive function among US adults, using standardised Montreal Cognitive Assessment (MoCA) testing.
Cross-sectional study
Three U.S academic medical centres participating in the Artificial Intelligence–Ready and Equitable Atlas for Diabetes Insights (AI-READI) study.
Adults aged ≥40 years enrolled in the AI-READI cross-sectional study at three US academic medical centres were eligible. The study excluded individuals with type 1 diabetes, pregnancy or inability to speak, read and understand English. For this secondary analysis, 1067 participants from the first publicly released AI-READI data set who had MoCA data and assigned glycaemic status were included. Participants were classified into four prespecified glycaemic groups: controls without diabetes (n=371), pre-diabetes (n=239), medication-controlled type 2 diabetes (n=323), and insulin-dependent type 2 diabetes (n=129).
The primary outcome was global cognitive function measured by the MoCA total score. Secondary outcomes included MoCA domain scores and the prevalence of cognitive impairment, defined as MoCA
Significant differences in MoCA total scores were observed across glycaemic groups (p
Individuals with more advanced T2DM, particularly those on insulin, had significantly higher risk of cognitive impairment. These findings support routine cognitive screening in patients with T2DM, especially those on insulin therapy. Early identification of cognitive impairment may improve diabetes management and cognitive outcomes.
by Xuying Zhang, Johanna Mainzer, Isabella Giambra, Tong Yin, Petra Engel, Hannah Hümmelchen, Henrik Wagner, Axel Wehrend, Christiane Egerer, Katharina Gerhards, Gerald Reiner, Sven König
Long tails trigger tail biting in pigs and increase the risk of flystrike infections in sheep. Tail docking has been a common management practice in both species for decades, but increasingly conflicts with legal animal welfare guidelines. Sustainable solutions require breeding strategies targeting shorter tails. In consequence, the aims were to conduct whole-genome sequencing (WGS)-based genome-wide association studies (GWAS) and comparative genomic analyses (CGA) to explore functional elements influencing tail traits. Phenotypically divergent experimental populations of pigs and sheep were established through unified selection and mating experiments. Tail traits included tail length (TL) measured at birth, and tail abnormalities (TA) assessed radiographically at 14 weeks of age. WGS-based GWAS identified a significant locus on SSC18 in pigs and suggestive loci for TL in both species, which, together with previously reported loci for TA, were further analyzed by CGA. The genomic windows of the significant locus on SSC18 in pigs and the TL GWAS locus on OAR4 in sheep were found to be conserved, harboring six common genes with predicted functional variants. These variants were jointly associated with TL (Plm ) in both species in linear regression models adjusted for sex, age of the dam, body length, and body weight. In other GWAS locus windows (±1 Mb), species-specific TL candidate genes were identified in sheep (HOXB13, MUC5B, EPB41L3, MTCL1, PIEZO2, MPPE1, and LOXHD1) and in pigs (KNL1, DISP2, SPRED1, TGFB2, and HAND1), each harboring associated putative functional variants. For TA, sheep-specific candidates (PGM2, LRRC66, CRACD, LOC105601916, and SH2D4B) and pig-specific candidates (MYOT, TMCO6, and PCDHAC2) were revealed using logistic regression models (Pglm ). GO analyses of candidate genes predicted shared biological processes between sheep and pigs, whereas pathway analyses indicated that common carbohydrate metabolism pathways, along with species-specific immune and inflammatory signaling, and pig-specific TGF-β signaling and endochondral ossification, may contribute to tail length variation and abnormalities. These findings provided deeper insights into the genetic basis of differential embryonic tail morphogenesis and perinatal tail development across species.by Job Kasule, Julius L. Tonzel, Natalie Burns, Tyler Hamby, Roger Ying, Grace Mirembe, Immaculate Nakabuye, Hannah Kibuuka, Margaret Yacovone, Betty Mwesigwa, Trevor A. Crowell, for the Multinational Observational Cohort of HIV and other Infections (MOCHI) Study Group
BackgroundPeople with behavioral vulnerability to HIV face barriers to healthcare engagement that may impede uptake of non-pharmaceutical and other interventions to prevent COVID-19. Understanding COVID-19 knowledge, attitudes, and practices in this population can inform disease prevention efforts during future pandemics.
Materials and methodsFrom October 2022 to September 2024, we enrolled participants aged 14–55 years without HIV who endorsed recent sexually transmitted infection, injection drug use, transactional sex, condomless sex, and/or anal sex with male partners. At enrollment, we collected socio-behavioral data, including assessments of COVID-19 knowledge, attitudes, and practices. Robust Poisson regression with purposeful variable selection was used to estimate prevalence ratios with 95% confidence intervals for factors associated with COVID-19 preventive practices.
ResultsAmong 418 participants, 228 (56.9%) were female, the median age was 21 years (interquartile range 19−24), and 362 (84.9%) reported sex work. Knowledge about SARS-CoV-2 transmission routes was high (95.4%) but lower for the consequences of genetic variants (48.5%−69.7%) and possibility for asymptomatic infection or transmission (66.7%−80.8%). Handwashing was practiced by 90.8% of participants in the preceding month, whereas mask-wearing (76.5%), avoiding symptomatic people (73.7%), and any history of COVID-19 vaccination (46.9%) were less prevalent. Males were more likely to report avoiding symptomatic people (adjusted prevalence ratio 1.16 [95% confidence interval 1.03–1.31]) and COVID-19 vaccination (1.30 [1.05–1.60]). Enrollment during the BQ.1/BQ.1.1 Omicron wave was associated with less mask-wearing (0.81 [0.67–0.99]) but more vaccination (1.59 [1.29–1.95]).
DiscussionWe observed variable COVID-19 knowledge and attitudes among Ugandan adolescents and adults with little impact on COVID-19 preventive practices. Efforts to address suboptimal uptake of disease preventive practices during this and future disease outbreaks will require more than just improving knowledge.
Postoperative sleep disturbance (PSD) is a common complication following major surgery, occurring in 15%–72% of patients. PSD poses a significant threat to both postoperative recovery and long-term outcome, leading to elevated risks of cognitive decline, pain sensitivity and cardiovascular events in patients. The current pharmacological treatments for PSD are typically reactive, administered only after symptoms have manifested, highlighting a critical unmet need for effective prophylactic strategies during the perioperative period. Recently, an increasing number of studies have demonstrated the effect of esketamine on preventing PSD, but their findings are inconsistent. This protocol outlines a systematic review and meta-analysis to examine the effect of perioperative esketamine on the prevention of PSD.
A comprehensive search will be conducted in MEDLINE (via Ovid), EMBASE (via Ovid), the Cochrane Central Register of Controlled Trials (via Ovid), PubMed and Web of Science by two authors independently. The search terms will comprise indexed and free-text terms to encompass the concepts of esketamine and PSD. The primary outcome is the incidence of PSD at postoperative days 1, 3 and 7. Two authors will independently conduct study screening, data extraction and risk of bias assessment with the Cochrane Collaboration’s tool. RevMan V.5.4.1 and Stata V.17.0 software will be used to conduct the statistical analysis. Subgroup analysis, sensitivity analysis and assessment of publication bias will be performed to verify the strength of our conclusions. Finally, the Grading of Recommendations Assessment, Development and Evaluation approach will be used to recommend evidence quality.
Ethical approval is not required for this study. The findings will be presented at national or international conferences and submitted to a peer-reviewed journal.
CRD420251232636.
To evaluate the feasibility, effectiveness, and acceptability of a spherical video-based virtual reality training programme aimed at helping nurses manage workplace violence.
A convergent mixed-methods study.
This study included nurses from a tertiary medical centre in Taiwan. The training programme involved four interactive 360° scenarios focused on recognising, de-escalating, and responding to workplace violence. Quantitative measures included risk perception, confidence in coping with aggression, and technology acceptance. Qualitative measures included the participants' learning experiences. Quantitative and qualitative findings were integrated through joint displays.
The programme was feasible, with all participants completing the training. Nurses reported high levels of perceived usefulness and ease of use. Quantitative data revealed considerable improvements in risk awareness and confidence in responding to incidents of violence. Qualitative data revealed that immersion and emotional resonance enhanced engagement, fostered self-reflection, and reinforced learning. Technical challenges included subtitle placement and speech recognition accuracy.
Spherical video-based virtual reality is a feasible, acceptable, and effective training approach that improves nurses' preparedness for managing workplace violence by enhancing situational awareness and confidence in addressing high-risk situations.
Integrating spherical video-based virtual reality into continual education may strengthen nurses' workplace safety competencies, prevent harm from incidents of violence, and improve patient care in stressful environments.
Workplace violence undermines nurse safety and patient care. Current training modules often lack contextual realism. Our programme improved nurses' awareness, confidence, and reflective learning and was feasible and well accepted. The findings are relevant to nursing educators, hospital administrators, and policymakers seeking sustainable strategies for addressing workplace violence.
This study adhered to the Revised Standards for Quality Improvement Reporting Excellence.
Patients or the public were not involved in the design, conduct, or reporting of this study.
To identify the latent frailty trajectory and explore corresponding predictors among older adults living with frailty who experience hip fracture surgery within 3 months after discharge.
From December 2022 to November 2024, 178 individuals were consecutively enrolled in a longitudinal observational study conducted at a tertiary hospital in Zhejiang Province, China.
The Reported Edmonton Frail Scale measured the frailty level at 5 points, which included baseline (pre-fracture), at discharge, 2 weeks, 1 and 3 months after discharge. Latent class growth models were set up for the frailty trajectory. Multinomial logistic regression was performed to explore the predictors of frailty trajectory classes.
One hundred fifty-three participants completed the full follow-up. Latent class growth models identified 3 frailty trajectories. Class 1: moderate frailty transformed to severe frailty (n = 27; 17.65%); Class 2: mild frailty transformed to moderate frailty (n = 86; 56.20%); Class 3: pre-frailty transformed to mild frailty (n = 40; 26.15%). A higher-level D-Dimer at admission and the five-item version of the Geriatric Depression Scale increased the incidence of Class 2 compared to Class 3. The higher scores of the Abbreviated Mental Test decreased the incidence of Class 2 compared to Class 3. Longer surgical waiting time, a higher-level five-item version of the Geriatric Depression Scale and the Age-Adjusted Charlson Comorbidity Index increased the incidence of Class 1 compared to Class 3. The higher scores of the Abbreviated Mental Test and Mini Nutritional Assessment Short Form decreased the incidence of Class 1 compared to Class 3.
Three frailty trajectory classes were identified among older adults living with frailty who experience hip fracture surgery after discharge within 3 months. D-Dimer at admission, surgical waiting time, depressive symptoms, cognitive status, comorbidity index and nutritional status are associated with these fluctuating frailty trajectories.
Modifiable factors such as improving nutrition and cognitive status and managing depression, comorbidities and preoperative evaluations provide methods for future interventions to prevent or mitigate frailty among this population.
What problem did the study address? Frailty is an inherent dynamic among older adults living with frailty who experience hip fracture surgery after discharge within 3 months. Some factors affect the mitigated frailty process in this population. What were the main findings? Three frailty trajectory classes were identified in this study. And the level of their frailty worsens 3 months after surgery compared to pre-fracture. D-Dimer at admission, surgical waiting time, depressive symptoms, cognitive status, comorbidity index and nutritional status are associated with these fluctuating frailty trajectories. Where and on whom will the research have an impact? The findings of this study provide screening, intervention and discharge plan evidence for healthcare workers in orthopaedics and geriatrics Departments. Helping community healthcare workers and primary caregivers set the theoretical basis for home-based intervention programs.
We have adhered to relevant EQUATOR guidelines using the STROBE reporting method.
No patient or public contribution.
FreshRSS 