Conectar
The second phase of the Chiba Study of Mother and Child Health (C-MACH) was initiated to investigate how environmental exposures from the fetal period to early childhood influence maternal and child health outcomes. The sub-cohort focuses specifically on detailed assessments of indoor environmental factors and neighbourhood-built and social environments. By integrating environmental metrics with biological, behavioural and sociodemographic data, the study aims to elucidate their role in the development of allergies, neurodevelopmental disorders and other non-communicable diseases in early life.
Between June 2021 and April 2023, 505 pregnant women were enrolled in the second phase of the C-MACH main study. Of these, 298 participants consented to join the sub-cohort study, including 258 in the sleep and physical activity monitoring option (Option 1) and 148 in the indoor allergen exposure sub-study (Option 2). The study includes biological sampling, environmental monitoring and repeated questionnaire surveys. At baseline, 253 live births were recorded from 251 pregnancies.
Of the 298 women, 272 completed early pregnancy questionnaires. The mean maternal age was 33.1 years (SD 4.6); 97.8% were married. University-level education was reported by 51.0% of mothers and 53.7% of fathers. Most households had an annual income of 6 to
Longitudinal follow-up will continue until the children reach age 15. Future analyses will examine associations between environmental exposures and allergic, developmental, endocrine/metabolic and obesity-related outcomes.
by Deborah Baron, Nisha Gottfredson O’Shea, Alexandra Lightfoot, Caroline Kuo, Sheri Lippman, F. Xavier Gómez-Olivé, Kathleen Kahn, Audrey Pettifor, Suzanne Maman
BackgroundSouth African women are disproportionately impacted by HIV. Among these women, adverse childhood experiences (ACEs) are common and have been linked to HIV risk behaviors, including transactional sex (TS). Resilience—or multi-level processes related to overcoming adversity—provides a strengths-based lens that may buffer effects between ACEs and TS.
MethodsWe conducted a convergent mixed methods study among women aged 18–25 years in Mpumalanga, South Africa. We used logistic regression to assess the association between ACEs and TS; and tested moderation effects of five resilience scales across social-ecological levels hypothesized to dampen the effect of ACEs on TS. In parallel, we conducted a photovoice study that utilized participant-generated images and narratives, and thematic and sequence analysis to explore how women exposed to ACEs perceive and use resilience to navigate TS relationships.
ResultsOur analysis included 1,222 women aged 18–25 years, of whom 714 (58.43%) reported ACE exposure, with 519 (42.47%) reporting 1–2 ACEs and 195 (15.96%) reporting ≥3 ACEs; 340 (27.82%) reported TS. Women reporting ACE exposure had increased odds of TS compared to those without ACE exposure, controlling for confounders (AOR = 1.52, 95% CI: 1.17–1.99, P = 0.002). Among women with histories of ACEs, women with ≥3 ACES had 2.55 times the odds of TS than those reporting 1–2 ACEs (95% CI: 1.79–3.63, P= Conclusion
We examined the interplay between resilience, ACEs, and TS. Although quantitative results showed resilience did not buffer negative effects of ACEs on TS, the photovoice findings suggest resilience was salient and influential in women’s lives. Future research should explore resilience measures and interventions that address the complex gender and power dynamics that exacerbate women’s exposure to TS and HIV.
To develop a grounded theory that explains how formal care service providers experience caring for and supporting persons with early-onset dementia (EOD).
A grounded theory approach.
Thirty formal care service providers of persons with EOD were recruited from community-based dementia care facilities in northern and central Taiwan from August 2021 and February 2022 using purposive and theoretical sampling. Transcribed face-to-face, semi-structured interview data were analysed with constant comparative analysis. A theoretical framework was constructed from the data to describe the experience of being a formal care service provider for persons with EOD.
The core category of ‘client-as-partner care’ was the theoretical framework that explained the experience of formal care service providers and described how participants met the needs of persons with EOD. Five categories described the components of the process: (1) identifying clients' characteristics; (2) establishing a personal relationship; (3) enhancing self-esteem; (4) maintaining dignity; and (5) the influence of family members and community members. The first four categories were interactive and key to delivering client-as-partner care; the fifth category could alter any key component and reduce or improve the quality of care. Reflections shared by participants offered a window into the outcomes of successful client-as-partner care: quality of life improved for clients and job satisfaction increased for providers.
The client-as-partner care model for persons with EOD required knowledge of the client's unique characteristics, a strong provider-client relationship, offering strategies tailored to the client's abilities and interests, and fostering independence.
Client-as-partner care provides a person-centred approach that enhances support quality for persons with EOD and increases job satisfaction for formal care providers. Successful strategies can inform case management, strengthen support for this population and indirectly improve family caregivers' competencies.
No patient or public contribution.
COREQ (COnsolidated criteria for REporting Qualitative research).
Early-onset dementia, also referred to as young-onset dementia, affects people younger than 65 years of age. A diagnosis of dementia is often not considered when patients with symptoms of cognitive decline are < 65 years old, often resulting in a delayed diagnosis. Therefore, family caregiving for persons with early-onset dementia may differ from caregiving for persons with other dementias.
To explain the caregiving trajectory for new family caregivers of persons with early-onset dementia before and after diagnosis of the disease.
This qualitative study was conducted from a grounded theory perspective.
Family caregivers of persons recently diagnosed with early-onset dementia were recruited from two medical centres in northern Taiwan by a combination of purposive and theoretical sampling to inform the theory explaining the caregiving trajectory. Data were collected with face-to-face semi-structured interviews. Interview data were analysed with constant comparative analysis; data collection and analysis ceased when theoretical saturation was reached. A total of 15 family caregivers were interviewed.
The core theme describing the trajectory of the caregiving process for new family caregivers of persons recently diagnosed with early-onset dementia was maintaining a dynamic balance, which involved three interacting elements: (1) emotional reactions, (2) multitasking and facing conflicts, and (3) continual adjustments. A diagnosis helped caregivers find a temporary balance, but when disease progression increased, new adjustments were required.
Maintaining dynamic balance allowed caregivers to cope with their emotions, juggle the responsibilities associated with their new role, and adjust to the progression of dementia.
The findings describe the process of maintaining a dynamic balance for family caregivers of a spouse or parent with early-onset dementia. The elements used to achieve caregiving balance could help mental healthcare nurses educate family caregivers on how to adjust communication and provide them with information on when more practical support is needed.
No Patient or public contribution.
COREQ (COnsolidated criteria for REporting Qualitative research).
by Ya-Chun Feng, Bo-Cheng Kuo, Wen-Yau Hsu
Previous studies have demonstrated that emotional facial expressions influence attention and perception in individuals with social anxiety. However, the relative influence of positive versus negative expressions on distinct subprocesses of attention and perception remains unclear. This event-related potential (ERP) study investigates the temporal dynamics of electrophysiological responses to emotional faces in high (HSA; N = 56) or low (LSA; N = 47) social anxiety individuals using a dot-probe task. Four face pairs (angry-neutral, happy-neutral, angry-happy, and neutral-neutral) were presented to probe the influence of positive and negative expressions. While behavioural results showed no significant group differences in attention bias, ERP results showed a reduced N170 amplitude for the HSA vs. LSA group in angry-neutral, happy-neutral, and angry-happy face pairs. Furthermore, enhanced N2pc effects to emotional expressions were found only in the HSA group when angry-neutral and happy-neutral face pairs were presented. No N2pc effect emerged when both positive and negative expressions were presented simultaneously. Finally, no significant P1 effect was found. Together, both positive and negative expressions influenced attentional deployment and face-specific processing in relation to social anxiety. Socially anxious individuals perceived less emotional facial information, yet their attention was biased by both negative and positive expressions.The financial impact on trauma patients can be devastating. Although Taiwan has universal health insurance coverage, medical bill reimbursement cannot compensate for the damage to a person’s ability to work. The aim of this study was to investigate personal financial outcomes after major trauma.
A retrospective cohort study.
Nationwide data from Taiwan’s National Health Insurance Research Database.
This study included all patients with major trauma (injury severity score ≥16) in Taiwan from 2003 to 2007, and a 10-year follow-up was conducted. Patients aged 18–70 were enrolled. Patients who returned to work after trauma (RTW) and those who did not return to work (non-RTW) were compared. Basic demographics and short-term outcomes were analysed, and the 10-year trend of income variation was calculated.
The primary outcomes are the ratio of non-RTW after major trauma, and the independent risk factors for non-RTW. The secondary outcome is the 10-year trend of income variation of major trauma patients.
5965 patients were included, with 4741 (79.5%) in the RTW group and 1224 (20.5%) in the non-RTW group. Hospital-acquired pneumonia, urinary tract infection, prolonged intensive care unit length of stay (LOS) and prolonged hospital LOS were identified as independent risk factors for future non-RTW. The mean monthly income of all patients declined in the three consecutive years postinjury and slowly returned to the preinjury level 9 years after the injury.
Loss of working ability was noted in 20.5% of major trauma patients, and the income level for all patients did not recover to the preinjury level until 9 years after the injury. Further welfare planning beyond the extent of the National Health Insurance programme should be made to protect the financial shortcomings experienced by these patients.
Children with medical complexity (CMC) are a subset of children with special healthcare needs, defined by high healthcare utilisation, severe single or multisystem organ dysfunction, and in many cases, reliance on medical technology. In the emergency care setting, known challenges for this population include poor quality of care, avoidable admissions and high caregiver and provider burden. While experts and professional societies recommend emergency care planning tools to address these concerns, evidence to support effectiveness and implementation of such tools is lacking. Through a human-centred design approach, we recently engaged key partners to create and optimise an emergency care action plan (ECAP) for infants with medical complexity. Here, we describe the protocol for a pilot type 1 hybrid effectiveness-implementation randomised controlled trial (RCT) for infants with medical complexity aimed to evaluate ECAP effectiveness and implementation.
Infants with medical complexity and their caregivers will be randomly assigned to the intervention group (ECAP) or control group (standard care) in a pilot type 1 hybrid effectiveness-implementation RCT. The primary outcome is number of inpatient hospital days for infant participants. Additional effectiveness outcomes include perceived avoidance of emergency department (ED) visits, healthcare costs, caregiver stress and self-efficacy. Preliminary implementation outcomes include acceptability, feasibility, appropriateness and usability, as well as contextual barriers and facilitators to reach, adoption and implementation. Key partners, including caregivers of CMC and healthcare providers, will be engaged throughout the implementation of the ECAP and execution of the trial.
This study was approved by the University of Vermont Institutional Review Board (STUDY00002937). Findings will be disseminated through peer-reviewed publications, conference presentations, and focus groups and interviews with key stakeholders.
The evidence for the optimal duration of psychotherapy for borderline personality disorder (BPD) is scarce. Two previous trials have compared different durations of psychotherapy. The first compared 6 months versus 12 months of dialectical behaviour therapy for BPD (the FASTER trial). The second compared 5 months versus 14 months of mentalisation-based therapy for BPD (the MBT-RCT trial). The primary objective of the present study will be to provide an individual patient data pooled analysis of two randomised clinical trials by combining the two short-term groups and the two long-term groups from the FASTER and MBT-RCT trials, thereby providing greater statistical power than the individual trials. Accordingly, we will evaluate the overall evidence on the effects of short-term versus long-term psychotherapy for BPD and investigate whether certain subgroups might benefit from short-term versus long-term psychotherapy.
An individual patient data pooled analysis of the FASTER trial and the MBT-RCT trial will be conducted. The primary outcome will be a composite of the proportion of participants with a suicide, a suicide attempt or a psychiatric hospitalisation. The secondary outcome will be the proportion of participants with self-harm. Exploratory outcomes will be BPD symptoms, symptom distress, level of functioning and quality of life. We will primarily assess outcomes at 15 months after randomisation for the FASTER trial and at 16 months after randomisation for the MBT-RCT trial. Predefined subgroups based on the design variables in the original trials will be tested for interaction with the intervention as follows: trial, sex (male compared with female), age (below or at 30 years compared with above 30 years) and baseline level of functioning (Global Assessment of Functioning baseline score at 0–49 compared with 50–100).
The statistical analyses will be performed on anonymised trial data that have already been approved by the respective ethical committees that originally assessed the included trials. The final analysis will be published in a peer-reviewed scientific journal and the results will be presented at national seminars and international conferences.
CRD42024612840.
The mental health of people living with HIV (PLWH) is a growing concern globally, particularly in sub-Saharan Africa (SSA), where there is limited access to mental healthcare, with evidence showing high levels of depression, anxiety and neurocognitive disorders among this population. While Mental Health Disorders (MHDs) can impede HIV care and promote adverse health outcomes, there is limited literature on MHDs among PLWH. This scoping review will explore the existing literature on the burden and factors associated with MHDs among adults living with HIV in SSA.
Arksey and O’Malley’s methodological framework will guide the search of this scoping review. Relevant original research articles published in English from 1 January 2000 to 31 May 2025 on MHDs among PLWH in SSA will be identified through searches in the African Index Medicus, African Journal Online, PubMed and Embase databases. Four independent reviewers, working in pairs (one reviewer and one verifier), will screen the titles, abstracts and later the full texts, adopting the population, concept and context framework. Other coauthors will serve as tiebreakers whenever there is disagreement on the eligibility. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews flowchart will be presented. We will perform a narrative synthesis to report our findings.
This scoping review protocol does not require ethical approval, as it relies solely on publicly available existing data and does not involve human participants. We will disseminate the findings from this review through peer-reviewed publications and presentations at local and international conferences.
The protocol was registered in the Open Science Framework (https://osf.io/8ymqu).
Traumatic brain injury (TBI) often causes permanent neurological dysfunction. Although no medication has been validated yet to prevent secondary injury of brain tissue, recent animal studies have reported that perampanel, a glutamine receptor antagonist, could improve the neurological functions of animals with TBI by mitigating the abnormal calcium influx and cell death around the site of primary injury. The present study aims to elucidate the efficacy of perampanel administration in improving the neurological function of patients with TBI.
The perampanel for alleviation of secondary injury in TBI trial is a multicentre, phase-II, open-label randomised controlled trial targeting patients with mild-to-moderate TBI. This trial will include adult TBI patients with a Glasgow Coma Scale score of 9–14 from five tertiary centres. Patients with epilepsy as a comorbidity, delayed presentation of symptoms (>24 hours after injury) or Injury Severity Score of ≥25 will be excluded. The study participants will be randomly assigned to either the perampanel group (2 mg/day) or the control group (fosphenytoin administered at a dose of 15–18 mg/kg/day, followed by 5–7.5 mg/kg/day of fosphenytoin). In both groups, the medication will be initiated within 12 hours of the TBI diagnosis and continued for 7 days. The antiepileptic drugs can be increased, changed or added as necessary if early post-traumatic seizures are observed. The primary outcome is favourable neurological outcome, defined as a Glasgow Outcome Scale Extended score of ≥5 at 90 days after the TBI diagnosis, which will then be compared between the groups through an intention-to-treat analysis.
The present study has been approved by the Certified Review Board of Keio at the principal institution (approval number: N20240004). Written informed consent will be obtained from all participants or their legal representatives. The results will be disseminated via publications and presentations.
Japan Registry of Clinical Trials (jRCTs031250067).
To investigate the relationship between demographic characteristics and extracurricular achievements among UK medical students.
National, cross-sectional survey.
All 44 UK medical schools recognised by the General Medical Council.
8,395 medical students.
Binary indicators of extracurricular engagement, including PubMed-indexed authorship, academic presentations, quality improvement projects, leadership roles and academic prizes. Logistic regression models were used to explore associations with demographic and extracurricular achievement predictors.
Logistic regression analysis showed that students from private schools (OR 1.35, CI 1.20 to 1.53, p
Significant disparities in extracurricular achievement exist among UK medical students, principally associated with gender, private schooling and familial links to medicine. Apparent ethnic differences were largely attenuated after adjustment for other variables, indicating socioeconomic factors as stronger predictors of engagement. Given the role of these achievements in postgraduate selection, targeted interventions by medical schools and professional bodies to widen access to funding, mentorship and structured guidance for all students, regardless of perceived advantage, may support equitable opportunity without undermining merit-based standards.
To explore factors influencing UK medical students’ specialty choices and examine variations in these influences across demographic groups and stages of training.
National, cross-sectional online survey.
All 44 UK medical schools recognised by the General Medical Council.
8,395 medical students.
The primary outcome was the specialty preferences of UK medical students. The secondary outcomes were factors behind these preferences and how these factors vary across demographic groups and different stages of training.
General Practice (15.3%), Paediatrics (10.6%) and Anaesthetics (9.9%) were the most preferred specialties among final-year students. Work-life balance (84.1%), compatibility with family life (78.2%), positive training experiences (85.2%) and future specialty outlook (74.9%) were key factors influencing specialty choice. Only 23.1% of students felt confident about securing a specialty training post, with confidence higher among males (OR 1.36, 95% CI 1.21 to 1.52, p
This study highlights disparities in specialty preferences and influencing factors among UK medical students. A focus on improving career guidance, exposure to various specialties and supporting equitable access to training opportunities is essential for fostering a motivated and sustainable medical workforce.
This study aimed to estimate the prevalence of depression and anxiety and associated risk factors among non-communicable diseases (NCD) clinic attendees in rural Rwanda.
Cross-sectional.
44 health centres in three rural districts in Rwanda.
Adults aged 18 years and older with a clinical diagnosis of diabetes, hypertension and/or asthma, who were attending a follow-up appointment during the study period (n=595).
Primary outcome measures were depression (measured by Patient Health Questionnaire-9) and anxiety (measured by Generalised Anxiety Disorder-7). Explanatory measures included sociodemographic and behavioural risk factors associated with depression and anxiety.
Of 595 participants, 265 (44.5%) had depression (95% CI: 40.5% to 48.6%) and 202 (33.9%) had anxiety (95% CI: 30.1% to 37.9%). Comorbidity of depression and anxiety was found in 137 participants (23%). Participants with no formal education had significantly higher odds of reporting depression and anxiety compared with those with primary and secondary/higher education (adjusted OR (aOR)=2.08; 95% CI=1.27 to 3.33, p=0.004, aOR=5.00; 95% CI=1.12 to 25.00, p=0.035, respectively). In addition, participants who were unemployed were more likely to report depression and anxiety (aOR=3.03; 95% CI=1.62 to 5.67, p
The overall prevalence of depression and anxiety was found to be significantly high among the study participants. The risk factors that were associated with depression and anxiety included level of education, district of residence, employment status and past trauma exposure. The findings emphasise the need for integrating mental health screening into NCD care, district-specific interventions, employment support services and trauma-focused care.
Background
The wear and tear from chronic stress exposure has been linked to premature aging through allostatic load; however, it is unclear how chronic stress exposure affects physical functioning and physical activity in older adults.
Objectives
The study aims were to examine the behavioral and functional adaptation to chronic stress in older adults and its mediational pathways.
Methods
Data from the Health and Retirement Study 2016 and 2020 (N = 3075, mean age 66 years) were analyzed. Chronic and perceived stress exposure was quantified using Troxel’s Chronic Stressors Scale and Cohen’s Perceived Stress Scale. Physical activity was quantified using self-reported questionnaires, including light, moderate, and vigorous physical activity. Physical functioning was operated as a latent construct with four perceived physical limitations (i.e., difficulty in movement, hand strength, shortness of breath, and balance). The cross-sectional data were analyzed using latent regression analysis. The longitudinal data were analyzed using serial mediation based on MacKinnon’s bias-corrected bootstrap confidence intervals.
Results
Cross-sectionally, psychological stress, as a latent construct indicated by stress exposure and stress perception, explained more variances in perceived physical limitation than physical activity. Longitudinally, perceived stress and physical activity mediated the relationship between chronic stress exposure and perceived physical limitation with significant indirect effects. Furthermore, perceived physical limitation suppressed the effect of chronic stress exposure on physical activity levels. The effects of mediation and suppression remained significant after the adjustment for age, gender, years of education, race, number of comorbidities, working status, and marital status.
Discussion
The promotion of physical activity and physical functioning in older adults might not achieve the optimal outcome if the program design overlooks the target population’s chronic stress process and functional limitations. 
FreshRSS 