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by Zihang Zhao, Xiang Zhang, Xi Hou, Zihan Liu, Zhiyong Hou, Lianxin Song, Ruipeng Zhang
Percutaneous Bunnell repair and open modified Kessler repair remain debated options for acute Achilles tendon rupture (AATR). We retrospectively compared a minimally invasive percutaneous Bunnell technique (Group A) with an open modified Kessler repair (Group B) within a standardized early functional rehabilitation (EFR) protocol at a single center. Fifty-five adults with closed AATR treated between January 2021 and December 2022 were analyzed (Group A, n = 25; Group B, n = 30). Between-group comparisons used Welch t tests for continuous variables and χ² or Fisher exact tests for categorical variables; American Orthopaedic Foot & Ankle Society (AOFAS) and Achilles Tendon Total Rupture Score (ATRS) were assessed at 12 and 24 weeks, with Holm adjustment applied within each scale. Compared with Group B, Group A had shorter operative time (56.6 ± 15.1 vs 68.2 ± 23.2 minutes; mean difference −11.6; 95% CI −22.05 to −1.15; P = 0.030), less intraoperative blood loss (28.4 ± 8.4 vs 74.7 ± 19.4 mL; −46.3; 95% CI −54.22 to −38.38; Pby Natthakul Akarapredee, Chalirmporn Atasilp, Chonlaphat Sukasem, Pimonpan Jinda, Rattanaporn Sukprasong, Jiraporn Jensuriyarkun, Soravit Wongjitjanyong, Patompong Satapornpong, Natchaya Vanwong
IntroductionIrinotecan is a chemotherapy agent commonly prescribed for metastatic colorectal cancer but often leads to neutropenia. Variations in genes encoding drug-metabolizing enzymes and transporters may affect the toxicity and effectiveness of irinotecan. This study aimed to examine the impact of these genetic polymorphisms on irinotecan outcomes in Thai colorectal cancer patients.
MethodsThe study retrospectively analyzed 41 metastatic colorectal cancer patients treated with irinotecan-based chemotherapy. Genotyping was conducted for 23 single nucleotide polymorphisms in genes including UGT1A1, CYP3A4, CYP3A5, CES1, ABCB1, ABCC2, ABCC5, ABCG1, ABCG2, and SLCO1B1.Toxicity and efficacy were assessed, with statistical significance set at a Bonferroni-corrected P value Results
In terms of toxicity, UGT1A1*6 was significantly associated with both all-grade and severe neutropenia in the first cycle (p p p ABCC2 -24C > T variant was linked to all-grade neutropenia in the second cycle (p = 0.001). For efficacy, patients with the wild-type UGT1A1*6 had longer progression-free survival (PFS) (p SLCO1B1 521T > C variant was associated with improved PFS (p Conclusion
UGT1A1*6 and ABCC2 -24C > T variants emerge as potential predictors of irinotecan-induced neutropenia, while UGT1A1*6 and SLCO1B1 521T > C may serve as markers of prolonged PFS in Thai patients. Validation through larger prospective studies is essential to confirm and refine these genetic associations.
There are little available data on the prevalence, economic and quality of life impacts of musculoskeletal disorders in sub-Saharan Africa. This lack of evidence is wholly disproportionate to the significant disability burden of musculoskeletal disorders as reported in high-income countries. Our research aimed to undertake an adequately powered study to identify, measure and value the health impact of musculoskeletal conditions in the Kilimanjaro region, Tanzania.
A community-based cross-sectional survey was undertaken between January 2021 and September 2021. A two-stage cluster sampling with replacement and probability proportional to size was used to select a representative sample of the population.
The survey was conducted in 15 villages in the Hai District, Kilimanjaro region, Tanzania.
Economic and health-related quality of life (HRQOL) questionnaires were administered to a sample of residents (aged over 5 years old) in selected households (N=1050). There were a total of 594 respondents, of whom 153 had a confirmed musculoskeletal disorder and 441 matched controls. Almost three-quarters of those identified as having a musculoskeletal disorder were female and had an average age of 66 years.
Questions on healthcare resource use, expenditure and quality of life were administered to all participants, with additional more detailed economic and quality of life questions administered to those who screened positive, indicating probable arthritis.
There is a statistically significant reduction in HRQOL, on average 25% from a utility score of 0.862 (0.837, 0.886) to 0.636 (0.580, 0.692) for those identified as having a musculoskeletal disorder compared with those without. The attributes ‘pain’ and ‘discomfort’ were the major contributors to this reduction in HRQOL.
This research has revealed a significant impact of musculoskeletal conditions on HRQOL in the Hai district in Tanzania. The evidence will be used to guide clinical health practices, interventions design, service provisions and health promotion and awareness activities at institutional, regional and national levels.
by Yong Seok Jo, Seung Jae Lee, Hyun Jin Lee, Jeon Mi Lee
ObjectivesThis study aimed to determine the preferred timing and measurement sites for electroneuronography (ENoG) to predict early recovery from acute peripheral facial paralysis.
MethodsWe retrospectively evaluated 42 patients with acute peripheral facial paralysis who received standard treatment with oral corticosteroids. The severity of facial paralysis was assessed at the initial visit and after 1 month using the House–Brackmann grading system. Patients were classified into recovery and non-recovery groups according to changes in the grade. ENoG was performed at the initial visit and after 2 weeks. ENoG amplitudes of four facial muscles (frontalis, nasalis, orbicularis oculi, and orbicularis oris) at the initial visit and after 2 weeks, as well as age, sex, affected side, and diagnosis, were compared between the two groups.
ResultsNo differences were observed in degeneration ratios across all subsites in the initial ENoG, which can be explained by the fact that Wallerian degeneration is not yet complete at this early stage. However, the second ENoG, performed after degeneration had progressed, showed significant differences across all subsites. Binary logistic regression analysis revealed that the degeneration ratio of the orbicularis oris muscle was the best predictor of early recovery (odds ratio, 0.961; p = 0.014). Receiver operating characteristic curve analysis also revealed that the degeneration ratios of all subsites measured in the second ENoG were useful in predicting early recovery, with the highest possibility at the orbicularis oris muscle (area under the curve = 0.789). When the degeneration ratio exceeded 60% in all subsites in the second ENoG, a favorable prognosis was not expected.
ConclusionThis study provides the preferred testing time and measurement sites for ENoG to predict early recovery from facial paralysis. Given the personal and social impact of facial paralysis, predicting early recovery is crucial for reassuring patients, providing better treatment, and encouraging early reintegration into society.
by Moe Thi Thi Han, Tay Zar Myo Oo, Busayamas Chewaskulyong, Sakorn Pornprasert, Kanyamas Choocheep, Khanittha Punturee, Warunee Kumsaiyai, Yupanun Wuttiin, Sawitree Chiampanichayakul, Ratchada Cressey
Non-smoking-related lung cancer is increasingly associated with environmental factors such as particulate matter (PM) exposure. Using deep small RNA sequencing, we identified distinct miRNA expression patterns in lung cancer patients compared to non-cancer controls, stratified by smoking status. Notably, hsa-miR-125b-5p and hsa-miR-100-5p were significantly downregulated in non-smoking lung cancer patients. Pathway enrichment analysis revealed smoking amplifies pathways related to glycan biosynthesis, signal transduction, and transcriptional regulation, while non-smoking lung cancer is characterized by immune dysfunction and metabolic alterations, including oxidative phosphorylation and natural killer cell cytotoxicity. Validation in a larger cohort using quantitative RT-PCR confirmed the suppression of miR-125b-5p and miR-100-5p in non-smoking lung cancer patients. Additionally, miR-203a and miR-199a-3p were identified as potential biomarkers for lung cancer, independent of smoking status. Chronic PM exposure in primary bronchial/tracheal epithelial cells initially elevated miR-125b-5p and miR-100-5p expression, but prolonged exposure suppressed these miRNAs while increasing their target genes, TXNRD1 and HOXA1, suggesting stress-induced dysregulation. Functional studies using miRNA mimics demonstrated that miR-125b-5p and miR-100-5p suppress PM-induced cancer cell mobility and colony formation, with miR-125b-5p exhibiting broader effects. These findings underscore the critical roles of miR-125b-5p and miR-100-5p in PM-associated lung cancer progression and their potential as biomarkers and therapeutic targets. This study highlights distinct mechanisms of lung carcinogenesis in smokers and non-smokers, providing a foundation for targeted interventions in PM-associated lung cancer.To explore peer volunteers' experiences of delivering online support through SMART to at-risk mothers during the perinatal period, to inform future improvements to mobile-health-application (mHealth app) based peer-support interventions.
Descriptive qualitative research.
The study was conducted between February 2024 and June 2025 in a tertiary public healthcare institution in Singapore. Twenty peer volunteers were recruited via convenience and snowball sampling and participated in individual semi-structured interviews. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis.
Four themes were identified: (a) Giving and receiving: the inner world of peer volunteers; (b) Navigating relational complexity in digital peer support; (c) Facilitating connection and continuity in digital peer support; and (d) Building better connections through supportive ecosystems.
Peers reported experiencing reciprocal benefits, such as a sense of fulfilment and achievement, while supporting mothers. Shared experiences and psychosocial vulnerabilities enhanced relatability, reassurance and rapport, which sustained supportive relationships. Challenges encountered by peers highlighted the need for strengthening both intervention design and peer training.
Regular check-ins by programme facilitators, alongside clear information, flexible guidelines and reassurance, can improve peer volunteers' motivation and resilience, thereby ensuring consistent and sustainable support for at-risk mothers.
Examined peer volunteers' experiences in providing online perinatal support to mothers with diverse psychosocial vulnerabilities. Peers offered emotional, informational and practical support, while mothers benefited from learning how peers had coped with their psychosocial vulnerabilities. Shared experiences fostered confidence and reassurance among mothers that they, too could overcome similar adversities. Valuable in providing both medically accurate perinatal information and meaningful social support to perinatal mothers.
The reporting of the study adheres to the standards outlined in the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist.
Mothers and peer volunteers contributed valuable insights and suggestions that helped in the design of the intervention.
by Yong Jae Lee, Nam Kyeong Kim, Kidong Kim, Chel Hun Choi, Keun Ho Lee, Jong-Min Lee, Kwang Beom Lee, Dong Hoon Suh, Sunghoon Kim, Min Kyu Kim, Seok Ju Seong, Myong Cheol Lim
ObjectiveTo identify the effect of fascial closure using barbed sutures on the incidence of incisional hernia in patients undergoing elective midline laparotomy for gynecological diseases.
MethodsIn this multicenter, non-blind randomized controlled trial conducted from February to December 2021, patients with a BMI 2 and aged >18 years, scheduled for midline laparotomy, were randomly assigned to receive either barbed (experimental) or non-barbed sutures (control) for fascial closure. The primary outcome was the cumulative incidence rate of incisional hernia up to 1-year post-surgery. Secondary outcomes included incisional hernia up to 2-years post-surgery, wound complications, and postoperative pain assessed by Brief Pain Inventory-Korean scores, and Numeric Rating Scale.
ResultsOut of 174 patients (experimental, 86; control, 88), 36 were excluded due to dropout or loss to follow-up, leaving 138 patients (experimental, 67; control, 71) included in the analysis. The groups were balanced in terms of cancer surgeries, mean wound length, and mean surgery time. The cumulative incidence rates of incisional hernia up to 1-year (0.0% vs. 1.4%; p > 0.999) and 2-years (0.0% vs. 3.4%, p = 0.496) post-surgery did not differ significantly between the experimental and control groups. Additionally, no significant differences were observed in the incidence of wound dehiscence 4 weeks post-surgery, cumulative incidences of wound dehiscence and wound infection up to 4 weeks post-surgery, or postoperative pain scores between the groups.
ConclusionsFascial closure using barbed sutures resulted in no cases of incisional hernia up to 2-years post-surgery, but did not demonstrate a significant reduction in incisional hernia rates compared with the non-barbed suture.
Trial registrationClinicalTrials.gov NCT04643197
To explore the experiences of different stakeholders on the balance of package training and deployment of highly skilled Human Resources for Health for specialised services in Tanzania.
An exploratory qualitative case study was used as part of a larger tracer study conducted by Muhimbili University of Health and Allied Sciences (MUHAS) for its postgraduate programmes being a requirement for quality assurance. Semi-structured interview guides were used for in-depth interviews (IDIs) and focus group discussions (FGDs). Qualitative content analysis was adopted to analyse the data.
The trace study was carried out in all seven geopolitical zones of the Tanzania mainland and Unguja in Zanzibar.
We conducted 14 FGDs and 301 IDIs. Participants included alumni, immediate supervisors at employment sites, MUHAS faculty, continuing students at MUHAS and management of professional councils in Tanzania.
Key findings revealed variations in demands and recognition within the scheme of services, even after registration by professional councils. Five main themes emerged from the qualitative interviews: Package training to improve service provision, Unprofessional collegial relationships or issues related to professionalism within interdisciplinary teams, Silence of scheme services on super specialisation in the medical cadre, Silence of scheme services on specialisation in the nursing cadre, Integrated scheme of services for specialties in pharmacy.
The findings highlight the demand for specialised training, challenges with professionalism and inconsistencies in the recognition and remuneration of specialists across medical, nursing and pharmacy cadres within existing service schemes. There is a need for harmonisation between specialisation/super specialisation and the scheme of services. This harmonisation is crucial to ensure the provision of quality healthcare services. Furthermore, harmonisation requires multistakeholder engagement to realise universal health coverage strategies.
To synthesise the current research on long-term care workers' perceptions (i.e., attitudes, concerns, and expected functions) of robot-assisted care and their perceived effects of different types of robot-assisted care for older adults in long-term care facilities.
Scoping review.
A search was conducted in July 2024 using five databases. Articles published between 2010 and 2024 on the perceptions and/or perceived effects of robot-assisted care for older adults among frontline long-term care workers in long-term care facilities were identified. Additionally, the reference lists of the included articles were manually searched.
A five-step framework that guided the development of research questions, screening of studies, and synthesis and presentation of data was adopted. Two authors independently screened and analysed the identified articles. Conflicts were resolved through joint-discussions.
Forty-one articles were included in the review. Data were narratively synthesised into three categories: expected function of care robots, perceived effects of robot-assisted care, and attitudes and concerns regarding robot-assisted care. Subcategories were identified and presented in tabular form.
This review shows the physical, psychological, social, and practical benefits and limitations of different types of robot-assisted care. It also contributes to understanding long-term care workers' attitudes, concerns, and expectations regarding the function of robot-assisted care.
Having a priori discussion with long-term care workers about their expectations regarding using robot-assisted care is needed. Improvements in the design and in the digital literacy of the workers are also necessary.
This review provides an overview of the perceptions and perceived effects of different types of robot-assisted care among care workers in long-term care facilities. The findings provide practical implications and highlight areas in need of further studies.
Scoping Review (PRISMA-ScR) checklist.
No Patient or Public Contribution.
by Wenlong Qian, Kou Xu, Shuo Li, Zhuo Zhang, Xiaoxiao Hou, Bingjie Min, Jia Ling, Xinyu Zhu, Hui Zhou, Wenjuan Xu, Wenming Yang, Shijian Cao, Yonghua Chen
BackgroundPenicillamine(D-Penicillamine) and trientine are first-line therapies for Wilson’s Disease (WD), yet real-world data on their adverse events (AEs) remain scarce. We analyzed the FDA Adverse Event Reporting System (FAERS) to comprehensively assess the safety of penicillamine and trientine in WD treatment.
MethodsAEs for penicillamine and trientine (2004Q1–2024Q4) were analyzed using Proportional Reporting Ratio (PRR), Reporting Odds Ratio (ROR), and Bayesian Confidence Propagation Neural Network (BCPNN).
ResultsWe found 1,452 and 760 AEs related to penicillamine and trientine, respectively. In all adverse event (AE) reports, the ratio of females to males was approximately 1.3, with the highest proportion of AE reports in the 21–30 age group, and the largest number of AE reports coming from the United States. Signal detection showed that the most commonly reported AEs for penicillamine and trientine were drug hypersensitivity and tremor, respectively, with the highest proportions in the SOC categories of immune system disorders and gastrointestinal disorders. The main AEs for both drugs involved condition aggravated, and identified potential safety signals requiring further validation for the two drugs, such as decreased bone density and brain atrophy for penicillamine, and memory impairment, oesophageal ulcer and starvation for trientine. In addition, we found that women were more likely to experience drug hypersensitivity in penicillamine adverse event reports, while men were more likely to experience cutis laxa.
ConclusionThis study reveals the characteristics of AEs and potential associated risks in the clinical application of penicillamine and trientine, emphasizing individualized medication and vigilant monitoring strategies to provide guidance for safe medication use.
This study aims to investigate whether higher levels of depression predict increased physical frailty over time and whether worsening physical frailty predicts higher levels of depression over time, at both the between-person and within-person levels.
A longitudinal study.
A total of 269 patients who underwent cardiac surgery were included in this study at T1 (admission). We followed up depression and physical frailty at T2 (the seventh day after surgery), T3 (the day before discharge), and T4 (the three-month follow-up). To determine the temporal order of the association between depression and physical frailty at both between-person or within-person levels, we employed the cross-lagged panel model (between-person effects), and random intercept cross-lagged panel model (within-person effects).
The cross-lagged panel model findings revealed a time-dependent shift in directionality: physical frailty initially predicted depression between T1 and T2, whereas depression subsequently emerged as a significant predictor of physical frailty from T2 to T4. These between-person effects suggest that the dominant direction of influence may vary across different perioperative stages. Notably, the random intercept cross-lagged panel model results identified a robust unidirectional within-person effect, indicating that increases in depression consistently predicted subsequent increases in physical frailty over time, while the reverse pathway was not statistically significant. This finding underscores the potential causal role of depression in driving physical frailty progression, beyond the influence of stable between-person characteristics.
This study advances understanding of the depression-physical frailty relationship in middle-aged and older cardiac surgery patients by delineating temporal precedence and disentangling within- and between-person effects. Depression emerges as a key driver of physical frailty, underscoring the need to prioritize its management in postoperative care protocols. Future research should explore mechanisms linking intraindividual depression to physical frailty progression and evaluate integrated psychosomatic interventions to optimize recovery outcomes.
We have adhered to the STROBE guideline.
This study did not include patient or public involvement in its design, conduct, or reporting.
This study aimed to explore the perceived preparedness and psychosocial well-being of general ward nurses prior to their deployment into the outbreak intensive care units (ICUs) during the COVID-19 pandemic.
With the surge in COVID-19 cases requiring ICU care, non-ICU nurses maybe deployed into the ICUs. Having experienced through SARS, hospitals in Singapore instituted upskilling programs to secure general ward nurses’ competency in providing critical care nursing. However, no studies have explored the perceptions of general ward nurses on deployment into the ICUs during the COVID-19 pandemic.
Qualitative descriptive study.
The study was conducted at Singapore’s epicentre of COVID-19 management. Five focus groups were conducted following purposive sampling of 30 general ward nurses identified for outbreak ICU deployment. Focus groups were audio-recorded, transcribed verbatim and data thematically analysed. This study was conducted and reported in accordance with the COREQ checklist.
Three salient themes arose, exemplifying the transition from clinical experts in the general wards to practising novices in the outbreak ICUs. Firstly, ‘Into the deep end of the pool’ described general ward nurses’ feelings of anxiety and stress associated with higher exposure risk and expanded responsibilities to nurse critically ill patients. Secondly, ‘Preparing for “war”’ illustrated deployed nurses’ need for clear communication and essential critical care nursing training. Lastly, ‘Call of duty’ affirmed the nurses’ personal and professional commitment to embrace this transition into the ICUs, and their desire for greater psychosocial support.
The study findings highlight that though general ward nurses perceived their impending ICU deployment positively, they require ongoing support to facilitate a smoother transition.
Findings provided an evidence base to improve the preparedness of general ward nurses deployed into the ICUs during the COVID-19 pandemic within key areas of training, information dissemination and psychosocial resilience.
Chronic limb ischemia (CLI) is a significant health issue, particularly among patients with diabetes who are at elevated risk of diabetic foot ulcers (DFU) due to peripheral neuropathy and ischemia. In Singapore, approximately one in six adults is affected by diabetes, with a lifetime risk of developing DFU ranging from 15% to 25%. This paper examines the indications, surgical techniques and postoperative protocols for transverse tibial transport (TTT), an innovative limb salvage procedure implemented in a general hospital in Singapore and presents our early experience with this technique. All six patients in our study successfully achieved limb salvage with complete wound healing, with a median healing time of 4 months. Four patients required additional wound debridement and skin coverage to facilitate healing. Importantly, none of the patients experienced pin site infections during the procedure or throughout the postoperative healing phase. Our study demonstrates favourable outcomes and underscores the clinical utility of TTT in augmenting the multimodal treatment of recalcitrant DFUs.
Frailty is a key predictor of adverse surgical outcomes in older adults, contributing to increased postoperative complications, prolonged hospitalisation and delayed recovery. Prehabilitation—targeting improvements in physical function before surgery—can mitigate these risks. However, traditional programmes often face low adherence due to logistical barriers. Integrating smart wearable devices into tele-supervised, home-based prehabilitation may enhance adherence, engagement and clinical outcomes.
This trial protocol describes the PREhabilitation of frail elderly PAtients undergoing majoR surgEry at HOME study with the objective to evaluate the effectiveness of a wearable-enhanced, tele-supervised prehabilitation programme (swSEP) versus standard care (unsupervised prehabilitation, uSEP) on improving preoperative functional capacity and postoperative outcomes in frail older adults undergoing major elective surgery.
This single-centre, prospective, randomised controlled trial will enrol 190 patients aged ≥65 years scheduled for major elective, non-cardiac surgery at Singapore General Hospital. Participants with frailty (Edmonton Frail Scale ≥6) will be randomised 1:1 to either the swSEP group (tele-supervised exercise with Fitbit Inspire 3 monitoring) or the uSEP group (standard physiotherapy education, exercise booklet and inspiratory muscle training if maximal inspiratory pressure 2O). The primary outcome is change in 6 min walk test distance from baseline to 1–3 days presurgery. Secondary outcomes include 30 s sit-to-stand test, handgrip strength, postoperative complications (per American College of Surgeons National Surgical Quality Improvement Program), hospital length of stay, readmissions, five-level version of the EuroQol five-dimensional questionnaire (EQ-5D-5L) and adherence. Data will be analysed using t-tests, analysis of covariance, logistic regression and Cox models, with stratification by baseline nutritional status.
Approved by the SingHealth Institutional Review Board (CIRB Ref: 2024/2242). Trial registered on ClinicalTrials.gov (NCT06633614). Results will be disseminated via peer-reviewed publications and academic conferences. Contact: irb@singhealth.com.sg
ClinicalTrials.gov Identifier: NCT06633614
To explore participants’ experiences of potential adverse effects of the Informed Health Choices secondary school intervention across three trial sites and to revise a framework of potential adverse effects of interventions to improve critical thinking about health choices.
This was a qualitative study. We extracted and analysed relevant data from separate process evaluations in each country. Data came from surveying teachers, observing lessons and group and individual interviews with students, teachers and other stakeholders. We modified and applied framework analysis, including five stages: (1) development of an initial framework of potential adverse effects, (2) familiarisation with the data, (3) indexing, (4) abstraction and synthesis and (5) revising the framework. We applied reflexive strategies individually and as a team.
Lower secondary school in five randomly sampled subcounties of Kisumu County in Kenya, districts representing all five provinces in Rwanda, and six districts in the central region of Uganda, between 2022 and 2024.
Students and teachers in the intervention arms of the trials, parents of students in the intervention arms and administrators at intervention schools, as well as curriculum developers and policy-makers.
The intervention involved providing teachers with a 2–3-day training workshop, and digital classroom resources, including lesson plans for 10 lessons to be delivered over the course of one semester.
We generated findings about potential increases in adverse misunderstandings, anxiety related to transfer of learning, adversely experienced cognitive dissonance, work or schoolwork-related stress, inequity, conflicts and waste. The revised framework includes the same categories of potential adverse effects as our initial framework: decision-making harms, psychological harms, equity harms, group and social harms, waste and other harms. We revised other elements of the framework, including definitions of the categories and its structure.
This study provides insight into the potential adverse effects of interventions to improve critical thinking about health choices. The findings complement those of the trials and country-level process evaluations.
To examine the perinatal experiences of at-risk mothers and their engagement with mobile-health-based care.
A qualitative descriptive study.
One-to-one semi-structured interviews were conducted with 30 at-risk mothers, defined as those who were single, had low income, were at risk of depression, had adverse childhood experiences, gave birth to a baby with congenital disorders, or had a history of mental health conditions. Participants were purposively sampled at 6 months postpartum from a tertiary public hospital in Singapore between February and September 2024. Interviews continued until data saturation was achieved, were audio-recorded, transcribed verbatim and analysed using thematic analysis.
The study identified four overarching themes: (a) Me and my baby versus the world, (b) navigating vulnerability and strength in motherhood, (c) generational tensions in modern parenting and (d) reimagining perinatal care for every mother. Across the perinatal period, both intervention and control group mothers reported social isolation, emotional and physical strain and challenges balancing traditional family expectations with modern parenting practices. While mothers in the intervention group described receiving holistic support through the SMART program, those in the control group relied on ad hoc sources of support, such as social media platforms.
At-risk mothers experienced significant challenges during the perinatal period, and those who used a mobile-health-based perinatal intervention felt supported through its peer support and multimedia educational resources.
Mobile-health-based interventions can be integral aspects of standard nursing care. Future researchers must ensure that support rendered to at-risk mothers is culturally compatible and specific to the psychosocial vulnerabilities they experience. Increased contact and funding are vital, whereas artificial intelligence, multiple shared access and health monitoring trackers can shape future perinatal interventions.
A mobile-health-based perinatal intervention can have an enormous positive impact on the psychological well-being of vulnerable mothers worldwide.
This study followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist.
This study did not include patient or public involvement in its design, conduct or reporting.
ClinicalTrials.gov (Registration ID: NCT06363019). Registered 4/12/23, first recruitment on 26/02/2024.
by Wananit Wimuttisuk, Pisut Yotbuntueng, Pacharawan Deenarn, Punsa Tobwor, Kamonluk Kittiwongpukdee, Surasak Jiemsup, Rapeepun Vanichviriyakit, Chanadda Kasamechotchung, Suganya Yongkiettrakul, Natthinee Munkongwongsiri, Siriwan Khidprasert, Vanicha Vichai
The microsporidian Enterocytozoon hepatopenaei (EHP) is a highly contagious pathogen that causes severe growth retardation in penaeid shrimp. EHP infection damages the hepatopancreatic tubules, causes hematopoietic infiltration, and recruits granulocytes and inflammatory cells to the shrimp stomach and intestine. In this study, we investigated whether EHP infection induced the eicosanoid biosynthesis pathway in the gastrointestinal tract of the Pacific white shrimp Litopenaeus vannamei. Shrimp hepatopancreases, stomachs, and intestines were collected on days 0, 7, and 21 of the EHP cohabitation experiment for analysis. On day 7, the levels of cyclooxygenase (COX) and prostaglandin F synthase (PGFS) enzymes, which catalyze the production of prostaglandins, were elevated in the hepatopancreas of EHP-infected shrimp. The stomach of EHP-infected shrimp also contained higher levels of 12-hydroxyeicosatetraenoic acid (12-HETE) and 12-hydroxyeicosapentaenoic acid (12-HEPE) than the control shrimp. Nevertheless, the most significant impact of EHP infection on day 7 was observed in shrimp intestines, in which the levels of prostaglandin F2α (PGF2α), 8-HETE, and four isomers of HEPEs were higher in the EHP-infected shrimp than in the control shrimp. As the EHP infection progressed to day 21, the upregulation of COX and PGFS persisted in the EHP-infected hepatopancreas, leading to increasing levels of PGF2α and 15-deoxy-Δ12,14-prostaglandin J2 (15d-PGJ2). The upregulation of prostaglandins was in contrast with the decreasing levels of HETEs and HEPEs in the hepatopancreas of EHP-infected shrimp. Meanwhile, the stomach of EHP-infected shrimp contained higher levels of prostaglandin D2, PGF2α, 15d-PGJ2, and most of the hydroxy fatty acids than the control shrimp. The levels of eicosanoid precursors, namely arachidonic acid and eicosapentaenoic acid, were upregulated in the shrimp gastrointestinal tract collected on days 7 and 21, suggesting that substrate availability contributes to the increasing levels of eicosanoids after EHP infection. Our study provides the first comprehensive analysis of the eicosanoid biosynthesis pathway in response to EHP infection. Moreover, the results indicate that eicosanoids are part of the host-pathogen interactions in crustaceans.by Zhizhong Wang, Sen Xu, Ailong Lin, Chunxian Wei, Zhiyong Li, Yingchun Chen, Bizhou Bie, Ling Liu
Vascular dementia (VaD), a neurodegenerative disease driven by vascular pathology, requires multi-targeted therapeutic strategies. This study employs an integrated in silico approach to evaluate the neuroprotective potential of natural ligands against key proteins implicated in VaD pathogenesis. Using molecular docking and normal mode analysis (NMA), four natural compounds (Galangin, Resveratrol, Curcumin, and Licocumarone) were assessed for their binding affinity and structural influence on six target proteins: APLP1, APOE, CLDN5, SOD1, MMP9, and MTHFR. Docking analysis revealed that galangin exhibited the highest binding affinity to APLP1 (−8.5 kcal/mol), resveratrol to MTHFR (−8.1 kcal/mol), and curcumin showed dual efficacy toward APOE (−7.2 kcal/mol) and MMP9 (−8.0 kcal/mol). Licocumarone demonstrated notable stabilization of CLDN5 and SOD1. The NMA results indicated ligand-induced stabilization of protein cores and enhanced flexibility in loop regions, which may impact amyloid aggregation, oxidative stress, and blood-brain barrier integrity. Pathway enrichment using the KEGG and Reactome databases identified significant involvement of the IL-17 and TNF signaling pathways, along with leukocyte transendothelial migration, linking inflammation with vascular dysfunction. APOE emerged as a central node within the protein-protein interaction network, highlighting its regulatory importance. This study highlights the therapeutic relevance of natural ligands as cost-effective modulators of multiple VaD-associated pathways. The combined use of molecular docking, protein dynamics, and enrichment analyses provides a comprehensive computational framework for early-stage drug discovery. These findings warrant further experimental validation to advance the development of targeted, mechanism-driven interventions for vascular dementia.To assess the preliminary effectiveness and cost-effectiveness of a culturally tailored, music-based broadcast intervention delivered through schools and community radio to improve referral adherence among schoolchildren to inform the need for a definitive trial.
Pilot randomised interventional study.
18 schools across Unguja and Pemba islands, Zanzibar.
Schoolchildren (6–18 years old) who failed vision screening and were referred for care recruited from January to February 2024. The registered sample size reflects the full cohort, including children and adults. This manuscript reports on the child cohort only, as per the predefined analysis plan.
Group 1 received 3 months of school-based broadcasts of culturally tailored 3–6 min songs (played three times daily on 2 days per week), followed by 3 months of community radio broadcasts of additional songs (3–6 min, aired three times daily); Group 2 received the community broadcasts during the same period as Group 1.
The primary outcome was change in referral adherence assessed at two time points: 3 months after school broadcast and 3 months after community broadcast, expressed in difference-in-difference estimates and effect sizes. Secondary outcomes included reporting of adverse events and contamination, and cost-effectiveness calculated as cost per child reached and cost per referred child accessed care in study groups and combined intervention.
374 children were referred to eye care services, including 246 in Group 1 and 128 in Group 2. Referral adherence was 69.8% in Group 1 and 42.9% in Group 2 (p=0.0006). The school broadcast phase yielded an effect size of 0.26 and a cost of US$4.65 per referred child accessing services. The community broadcast produced an effect size of 0.21, with a cost of US$0.29 per person reached. The combined intervention reached individuals at a cost of US$0.37 per person. No adverse event and contamination was reported.
A combined school and community broadcast intervention improved referral adherence in this pilot trial, with evidence of cost-effectiveness. These findings support the conduct of a fully powered definitive trial.
To synthesise evidence on nurses' roles in long-term care settings and map their interactions.
Systematic review with network analysis.
Thematic synthesis was used to identify nurses' roles, and network analysis mapped their interactions across domains.
Six databases—Cumulative Index to Nursing and Allied Health Literature, PubMed, Embase, Cochrane Library, Research Information Sharing Service and Database of Periodical Information Academic—were searched for peer-reviewed articles from 2014 to 2024. The Mixed Methods Appraisal Tool assessed study quality.
Fifteen studies were included. Nurses' roles spanned six domains: collaboration, education, leadership, resident-centred care, quality improvement and resource management. Network analysis revealed collaboration and leadership as the most central, each with a degree centrality of five, acting as bridges across domains. Three thematic clusters emerged: collaboration and resource management focused on operational teamwork; leadership and quality improvement centred on systemic care enhancements; and education and resident-centered care emphasised training and resident-focused care. A technological competence gap was identified, alongside barriers like staffing shortages and role ambiguity.
Nurses' interconnected roles are critical for resident-centered care; however, they require systemic support to address barriers and technological gaps.
Enhanced interprofessional training, leadership development and digital skill integration can improve care quality and nurse well-being in long-term care settings.
This study addressed the complexity of nurses' roles in long-term care and their structural interactions, finding collaboration and leadership as pivotal with three role clusters and a technological gap, impacting long-term care nurses, educators and policymakers to inform workforce strategies.
This study adhered to the PRISMA 2020 guidelines and was preregistered in PROSPERO (CRD42024588422).
This study did not include patient or public involvement in its design, conduct or reporting.
PROSPERO: CRD42024588422
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