Conectar
by Linda Abou-Abbas, Rima Kashash, Mustapha Khalife, Mohamad Shafic Ramadan
BackgroundEffective preparedness and response to mass casualty incidents (MCI) are essential for hospital safety, operational efficiency, and the delivery of timely, high-quality patient care during emergencies. This study assessed a tertiary government hospital in Lebanon’s Code Orange plan by reviewing documentation for alignment with international guidelines and evaluating staff knowledge, attitudes, and practices (KAP) regarding MCI preparedness.
MethodsDocuments reviewed at Rafik Hariri University Hospital (RHUH) included the current Code Orange plan, relevant policies, and international guidelines. A comprehensive evaluation framework was used, focusing on preparedness, incident command systems, communication, and management. A comparison with established standards was conducted to identify gaps. Complementing this, a cross-sectional study was conducted using a convenient sample of medical and non-medical healthcare workers to evaluate their KAP regarding MCI preparedness.
ResultsThe desk review of the RHUH Code Orange plan identified both strengths and significant gaps in MCI preparedness. While the plan defines staff roles and resources for emergency response, it lacks detailed procedures for activation strategies, surge capacity, continuity of essential services, and triage processes. Additionally, post-event recovery protocols are insufficient or absent, and the importance of regular drills is not adequately emphasized. The KAP study revealed significant differences between medical and non-medical staff in terms of MCI knowledge, involvement, and training engagement, with medical staff reporting higher levels of familiarity and desire for participation.
ConclusionThe findings underscore the need to bridge knowledge and engagement gaps between medical and non-medical staff to enhance MCI response. Key actions include interdisciplinary training to build coordination, clear communication protocols to streamline information flow, and routine drills with defined roles to strengthen preparedness. Additionally, implementing performance monitoring during drills and real MCIs, along with conducting regular evaluations, will allow for continuous refinement of response strategies.
To test a theory-informed, person-centred rehabilitation intervention for older adults following a hospital admission complicated by delirium, developed in line with the Medical Research Council framework for complex interventions, to determine whether: (a) the intervention is acceptable to individuals with delirium and (b) a definitive trial and parallel economic evaluation of the intervention are feasible.
Multicentre, single-arm feasibility study.
19 patient (aged >65 years old) and carer pairs were recruited from six National Health Service acute hospitals across the UK.
Home-based rehabilitation programme designed to support recovery after hospital discharge, addressing cognitive, physical, physiological and psychosocial needs. Delivered by a trained team of occupational therapists, physiotherapists and rehabilitation support workers, the intervention included a comprehensive home assessment, collaborative goal setting, up to 10 personalised sessions over 12 weeks and the use of a recovery record to guide progress, education and psychosocial support.
Examined aspects of feasibility including eligibility, recruitment, data collection, attrition, acceptability of the rehabilitation intervention and potential to calculate cost-effectiveness.
In total, 419 patients were identified as having delirium and 36 met the full eligibility. 19 patient and carer pairs agreed to participate in the study (consent rate 53%; 95% CI 35% to 70%) with 13 participants going on to start the intervention (68%; 95% CI 43% to 87%) and 10 participants completing final follow-up (53%; 95% CI 29% to 76%). Baseline assessments were conducted either during hospitalisation or postdischarge, with initial assessments occurring a mean of 18 days (SD=13.0) postdischarge, and 77% completed within 14 days. Participants completed a mean of eight sessions (SD=2.9). 19 participants completed the primary outcome at baseline, while 10 participants completed it at 6-month follow-up. The economic evaluation indicated a total cost of £1249.29 per participant, covering assessments, intervention sessions and training costs.
The intervention showed feasibility among older adults recovering from delirium, as evidenced by the trial processes for participants who entered the study. However, recruitment challenges indicate a need for better strategies and further research through a definitive randomised controlled trial to demonstrate the effectiveness and cost-effectiveness of the intervention.
by Nadieh Abdallah, Ahed Almahdi, Diana Shella, Rasha Al-Masri, Iyad Maqboul, Mohammad Jaber, Ramzi Shawahna
This study was conducted to assess the incidence and types of complications and mortality following liver biopsy, and to identify independently associated factors that can inform clinical practice in a resource‑limited healthcare system. A retrospective multicenter study was conducted across six major hospitals between January 2020 and December 2025. Medical records of 218 patients undergoing percutaneous and laparoscopic liver biopsies were reviewed. Demographic, clinical, laboratory, procedural, and outcome variables were extracted using a validated data collection form. Inferential analyses were conducted using chi‑square, Fisher’s exact, and Mann‑Whitney U tests, while multivariate logistic regression models were employed to identify factors independently associated with complications and mortality. The most common types of complications were infection (n = 7, 3.2%) and hemorrhage (n = 6, 2.8%), followed by pulmonary complications (n = 4, 1.8%), metabolic disturbances (n = 3, 1.4%), and acute kidney injury (n = 2, 0.9%). Mortality was recorded in 6 patients (2.8%). Higher pre-operative white blood cell count was independently associated with infections (OR: 1.28, 95% CI: 1.02–1.62, p = 0.036). Older age was independently associated with mortality (OR: 1.07 per year increase, 95% CI: 1.01–1.15, p = 0.035). Hemorrhage and pulmonary complications were more frequent after laparoscopic biopsy and under general anesthesia, although these associations did not remain significant in adjusted models. This study provides the first systematic evidence on liver biopsy safety in Palestine, a resource‑limited healthcare system, thereby filling a critical gap in the regional literature. The study identified pre-operative increases in white blood cell count as a predictor of infection and older age as a predictor of mortality. These simple, pragmatic markers can guide monitoring and risk stratification in constrained environments, offering actionable insights for clinicians and policymakers. Future studies should be conducted to evaluate whether these markers can help reduce complications and mortality.Early-stage mycosis fungoides (MF) is diagnostically challenging due to overlap with inflammatory dermatoses. Age-related immunological and cutaneous changes may modify histopathological presentation. We aimed to compare clinical, histopathological and immunophenotypic features of early-stage MF between geriatric and non-geriatric patients.
Multicentre retrospective cross-sectional study.
Dermatology departments of tertiary centres in Türkiye.
A total of 541 patients diagnosed with early-stage MF were included and stratified into geriatric (≥65 years) and non-geriatric (18–64 years) groups.
The primary outcomes were age-related differences in histopathological and immunohistochemical features. Secondary outcomes included clinical characteristics and quality of life measures. Primary endpoints were prespecified a priori (epidermotropism, basilar lymphocytes, epidermal atrophy, dermal lymphocytic infiltration, papillary dermal fibrosis and CD4-dominant versus CD8(+)/CD4(–) phenotypes); all other comparisons were considered exploratory.
The geriatric group had a higher proportion of males (59.5% vs 47.1%; p=0.004), while lesion type, duration, surface involvement and Dermatology Life Quality Index scores did not differ between groups. Histopathologically, epidermotropism (81.3% vs 63.3%), basilar lymphocytes (57.1% vs 45.7%), epidermal atrophy (26.6% vs 13.8%), dermal lymphocytic infiltration (75.8% vs 58.5%) and papillary dermal fibrosis (55.2% vs 38.4%) were more frequent in geriatric patients (all p
Although clinical characteristics were comparable across age groups, geriatric patients showed differences in reported histopathological and immunophenotypic features; these observations may facilitate clinicopathological recognition of early-stage MF in older individuals. However, some features (particularly epidermal atrophy and superficial/papillary fibrosis) are not MF-specific and may partly reflect background age- and site-related changes.
To evaluate the ‘Countdown to Theatre’ intervention, a co-designed nurse-led approach developed using the COM-B framework to address context-specific barriers and facilitators to preoperative fasting practices.
A prospective mixed-method, pre–post study assessed the intervention's impact on fasting adherence and patient experience.
Participants included children booked for a procedure under general anaesthesia. Adherence was assessed through audited fasting duration, and patient experience was evaluated using caregiver/patient surveys. The intervention was implemented and monitored by nursing staff as a part of a structured quality improvement process. Nurses played a central role in embedding the approach into daily workflows and reinforcing fasting timelines
Over 9 months, 901 observations were undertaken from 774 patients. Fasting duration decreased from 7.6 to 5.7 h (mean difference −1.94; 95% CI −3.04, −0.86). Parent-reported patient experience surveys showed improvement in many areas, including an increase in overall satisfaction (from 44.7% to 68.8%).
The intervention successfully reduced prolonged fasting and improved patient experiences, demonstrating the value of co-designed approaches in addressing evidence–practice gaps in perioperative care.
The principles of co-design, structured implementation and the application of the COM-B framework provide a replicable model for addressing similar challenges in healthcare. The study highlights the pivotal role of nurses in improving perioperative practices, supporting both patient safety and satisfaction. Future research should explore the intervention's applicability across diverse settings and patient populations.
Despite evidence-based guidelines, excessive preoperative fasting remains prevalent in practice. This study demonstrates that a structured, nurse-led intervention can successfully reduce fasting durations and enhance patient experience, reaffirming the nursing profession's capacity to lead meaningful change in perioperative care.
Standards for quality improvement reporting excellence (SQUIRE 2.0).
Patients and caregivers contributed to the co-design of the intervention, ensuring that it addressed practical challenges related to preoperative fasting.
Despite decades of research, we still know surprisingly little about how best to bring about lasting recovery from anorexia nervosa (AN). Furthermore, there is a lack of consensus in the research and treatment communities about what constitutes recovery from AN, or whether “recovery” is even an appropriate term to use in this context. The aim of this study was to analyse the concept of AN recovery from the perspectives of various stakeholders.
Concept analysis.
Walker and Avant's eight-stage concept analysis method.
There continues to be a lack of consensus around the defining criteria for AN recovery. However, there are certain clinical, psychological and quality-of-life attributes that are recurrent in those defined as being in recovery.
Though BMI and rate of weight gain are the primary criteria used to define recovery from AN, in recent years it has become clear that the definition of healthy weight varies and that weight alone is insufficient to fully define recovery. With recent advancements in biomarker and genetics research, there is hope that more objective measures of recovery will be defined. Quality of life as defined by both patients and caregivers is also critical to recovery; however, it is often not adequately assessed in studies of AN. Though the path to recovery is highly individualised, and there are risks in implementing strict criteria for recovery, in research, consensus is needed for adequate comparison of studies evaluating different treatment modalities. Additionally, such criteria are needed to help clinicians with decision-making authority, including advanced practice nurses, provide the most effective treatment options to their patients. Future research should focus on better defining recovery from AN and on facilitating nurse-led system-level advocacy to educate and equip advanced practice nurses in helping those with AN move toward recovery.
This concept analysis provides an overview of recovery from AN from the perspectives of a wide array of stakeholders and the last 20 years of published data.
This study did not include patient or public involvement in its design, conduct, or reporting.
To justify the use of focus group interviews with patients and healthcare professionals within a phenomenological-hermeneutic approach inspired by the theory of the French philosopher Paul Gustave Ricoeur.
Methodological guidance and discussion grounded in Ricoeur's theory on narrative, dialogue, threefold mimesis and interpretation.
This phenomenological-hermeneutical approach to focus group interviews yields significant, in-depth understandings of lived experiences from both patients and healthcare professionals.
Ricoeur-inspired phenomenological-hermeneutical focus group interviews with patients and healthcare professionals offer a promising approach for exploring and generating new, valuable insights into the complexities of clinical nursing practice. Thus, this paper argues for an integration of focus group interviews and a phenomenological-hermeneutical approach within nursing science.
The approach has significant implications for nursing practice. By incorporating Ricoeur-inspired dialogue-based collective voices of patients and healthcare professionals in focus group interviews, nursing practices can be refined, leading to improved patient care and more effective clinical interventions. Thus, this approach advocates for a broader adoption of Ricoeur-inspired focus group interviews in nursing research and in health research in general to enhance the understanding and development of clinical models.
No available EQUATOR guidelines were applicable to this methodological paper, as no new data were created or analysed.
As this is a methodological paper, no new patient or public contributions are included.
To describe patients' and oncology nurses' experiences with symptom management care, and influential barriers and facilitators to enhancing evidence-informed symptom management in an outpatient malignant hematology unit.
A qualitative descriptive study embedded within an experience-based co-design approach.
Patients with hematologic malignancies, registered nurses and nurse practitioners were interviewed. A qualitative content analysis approach was used, informed in part by the Consolidated Framework for Implementation Research (CFIR).
Twenty-seven people participated (15 patients, 12 nurses). Symptom management was focused on medical management, with limited non-pharmacological strategies or patient education provided. The outpatient environment, staff and service model impacted patients' symptoms and experiences. CFIR factors influencing evidence-informed symptom management delivery were mission alignment, the relative priority of symptom management versus procedures and treatment, symptom management guideline compatibility, nursing knowledge and access to information, and symptom management roles.
Patients with hematologic malignancies receiving outpatient care experience a high symptom burden. Opportunities exist to enhance symptom management through evidence-informed oncology nursing practice.
Organizational and unit-based strategies are needed to empower oncology nurses to work to their full scope when providing symptom management care. Implementing guideline-informed symptom management protocols may optimize the range of interventions offered and reduce suffering.
A local Steering Group will use these findings to collaboratively identify the top priorities and strategies for improving symptom management.
Reported in line with the Standards for Reporting Qualitative Research and Guidance for Reporting Involvement of Patients and the Public.
A Steering Group of patients, caregivers, oncology clinicians and organizational leaders informed all study phases. Their contributions included reviewing protocols and data collection tools, supporting recruitment and interpreting findings to ensure the research addressed relevant issues and could be meaningfully used to inform improvement priorities through experience-based co-design.
Obstructive sleep apnoea syndrome (OSAS) is a prevalent sleep disorder caused by recurrent upper airway collapse during sleep. Continuous positive airway pressure (CPAP) therapy is the most commonly prescribed treatment; however, adherence remains suboptimal, with non-compliance rates reported between 46% and 83%. Exercise-based interventions have demonstrated beneficial effects on respiratory muscle strength, upper airway function and sleep quality. This study aims to develop an interactive, web-based, game exercise platform (ApneaTheraPlay (ATP)) integrating respiratory, aerobic, strengthening and oropharyngeal exercises as an adjunct to CPAP therapy for individuals with OSAS, and to evaluate its effectiveness compared with a structured presleep exercise programme and a control condition.
This study is designed as a single-blinded, three-arm, parallel-group randomised controlled trial. Individuals diagnosed with OSAS who use CPAP will be randomly allocated to the ATP group, the structured presleep exercise group (SPEG) or the control group (CG). Participants in the ATP and SPEG groups will perform exercise sessions three times per week for 12 weeks (36 sessions in total). The ATP group will use a web-based, interactive, game-based exercise system, whereas the SPEG group will follow a conventional video-based exercise programme delivered in a non-interactive format. Participants in the CG will continue their usual activities and record daily physical activity using an activity diary. The primary outcome measures will be the Apnoea–Hypopnoea Index and nocturnal oxygen saturation parameters. Secondary outcomes will include sleep quality, daytime functioning, fatigue, muscle strength and function, CPAP adherence, psychological status and technology usability.
This study was approved by the Istanbul Medipol University Non-Interventional Clinical Research Ethics Committee (E-10840098-202.3.02-6266; 17 September 2025). The study will comply with the guidelines established by the International Committee of Medical Journal Editors (ICMJE) for clinical trial registration and reporting. The results of this trial will be disseminated through publication in peer-reviewed scientific journals and presentation at national and international scientific meetings. No individual participant data will be shared publicly. This study is supported by The Scientific and Technological Research Council of Turkey (TÜBITAK) under project number 225S257.
This study aimed to comprehensively examine social and clinical factors contributing to postpartum depression among women in Nepal and identify their perspectives/experiences regarding postpartum mental health.
The explanatory sequential mixed-method study was conducted in two phases. In the quantitative phase, data were collected via survey of 200 postpartum women at immunisation clinics of two hospitals in Kathmandu Nepal. Measures included sociodemographic and perinatal factors and the Edinburgh Postpartum Depression Scale. Regression models were conducted to analyse data. In the qualitative phase, in-depth interviews were conducted with 15 participants having depression scores ≥ 10. Data were analysed using the thematic content analysis method. Qualitative and quantitative findings were integrated using the joint display and the narrative weaving approach to generate results.
Findings show that 28% of postpartum women screened positive for depressive symptoms, requiring referral for further evaluation. Integrated findings indicate that prenatal mental health problems, low birth weight or medical conditions among infants, intimate partner violence, partner substance abuse, and a lack of postpartum social support were major contributors to postpartum depression.
Depression is highly prevalent among women 6–12 months postpartum in Nepal and is associated with several clinical and social factors.
These findings have important implications, emphasising the need for routine screening using validated tools for early identification, timely treatment and referral of women at-risk for postpartum depression. Evidence-based clinical and community initiatives are needed to promote positive outcomes for women and their families.
External experts were consulted for survey questions and qualitative interview guide, then refined those instruments based on their feedback to improve construct validity. The immunisation clinic staff provided input during study design, for participant recruitment and data collection. Key findings were presented to stakeholders to validate the interpretation of findings.
This scoping review explores the environmental impact of nursing interventions in acute care settings, focusing on waste reduction, energy consumption, and carbon emissions, while identifying nurse-led sustainability practices, assessment frameworks, and implementation barriers/enablers.
Guided by Arksey and O'Malley's framework and reported per PRISMA-ScR guidelines.
Data Sources: PubMed, CINAHL, Scopus, and Google Scholar were searched for peer-reviewed, English-language studies published between 2020 and 2025. Review Methods: A five-stage process was employed: (1) research question formulation, (2) comprehensive literature search, (3) study selection using the Population–Phenomenon–Context (PPC) framework, (4) data charting via a structured extraction form, and (5) thematic synthesis. Methodological quality was appraised using Joanna Briggs Institute (JBI) tools.
Of 400 identified records, 25 met inclusion criteria. Findings show nurses reduce environmental impact through reusable linen use (e.g., 496 kg/year ICU waste reduction), energy-efficient equipment, and improved waste segregation. However, time constraints, limited resources, and inadequate sustainability training impede consistent implementation. Awareness among nurses and students is moderate but rarely translates into practice.
Nursing interventions hold significant potential to reduce healthcare's environmental footprint. Embedding sustainability competencies into curricula and reinforcing them with institutional policies and leadership support are essential.
This review informs nurses and clinical leaders that sustainable practices—such as switching to reusable linens and optimizing energy use—are both feasible and impactful in acute care. It provides actionable evidence for reducing waste and carbon emissions while maintaining patient safety, supporting the integration of environmental stewardship into daily nursing practice. Findings from this review highlight the measurable environmental benefits of nurse-led sustainability interventions, such as waste reduction and energy conservation in ICUs. The evidence supports updating nursing curricula, clinical guidelines, and hospital policies to equip nurses with the knowledge and tools needed to lead sustainability efforts, thereby reducing healthcare's carbon footprint without compromising care quality.
by Víctor Herrera, María Consuelo Miranda, Anyela Lozano-Parra, Diana Niño, Luis Ángel Villar, Rosa Margarita Gélvez Ramírez, Thomas Jaenisch, Laura Pezzi, Claudia Acevedo, Jürg Niederbacher
BackgroundZika virus (ZIKV) infection has been inconsistently associated with neurodevelopmental delay (ND). We aimed to compare the incidence of ND between ZIKV-exposed and ZIKV-unexposed children within the ZIKAlliance (ZA) cohort, in Colombia, assessed 2 years after birth (2018–2021).
MethodsWe performed a neurodevelopmental evaluation on normocephalic children (aged 40–72 months) from the ZIKAlliance cohort. Children were classified as ZIKV-exposed (maternal positive RT-qPCR or virus neutralization test – VNT) or unexposed (maternal negative IgG ELISA or VNT in paired antenatal samples). A trained psychologist, blinded to exposure status, administered the Denver Developmental Screening Test II (DDST-II). Children were considered at ND risk if they presented ≥1 delay or ≥2 cautions in one or more areas, within their age range in the DDST-II scale. Inconclusive initial tests were re-evaluated. Adjusted odds ratios were estimated using logistic regression.
ResultsWe analyzed conclusive DDST-II results from 153 children (mean age: 4.7 years; 53.8% male). Overall, 57.2% (n = 83) were classified as cases of ND. Children with ND were more likely to be male (61.4% versus 43.5%) and less likely to attend daycare or school (42.2% versus 11.3%) than children with normal development. After adjusting for child age, sex, household size, and education, the association between in utero ZIKV exposure and ND was not statistically significant (OR = 0.71; 95% CI: 0.32–1.59, p = 0.320). However, children attending daycare or school had a significantly lower risk of ND compared to those who stayed at home.
ConclusionsPrenatal ZIKV exposure was not associated with ND in this cohort of normocephalic preschool children. Instead, attending a community daycare or school emerged as a significant protective factor against developmental delays.
The primary barrier to maximizing the benefits of intermittently scanned continuous glucose monitoring (isCGM) is low scan frequency. Higher daily scan frequency correlates with better glycemic control.
To evaluate the effect of a nurse-led educational intervention on scan frequency and behavioral change in adults with type 1 diabetes (T1D) showing low scanning frequency.
In this 12-week quasi-experimental study, adults with T1D using isCGM and low scan frequency participated in a single, individualized, direct education session led by a diabetes nurse educator. The intervention focused on increasing daily scan frequency and supporting patient engagement in self-management.
Thirty-four patients using isCGM participated. Mean daily scan frequency increased from 3.1 to 6.1 scans/day following the intervention. This rise was associated with an 8.0% improvement in TIR. A positive correlation was observed between scan frequency and TIR, with each additional daily scan associated with a 0.51% increase in TIR.
A single, targeted educational session can significantly improve isCGM adherence and glycemic control in adults with T1D and low adherence, supporting its value as a practical strategy in routine clinical care.
The protocol was publicly registered at ClinicalTrials.gov (NCT05570162)
Patient and Observer Scar Assessment Scale Version 3.0 (POSAS 3.0) is a robust instrument for scar evaluation. Currently, no validated POSAS 3.0 in the Malay language is available. This study aimed to translate, culturally adapt, and psychometrically evaluate POSAS 3.0 for Malay-speaking populations in Malaysia. Malaysian patients were recruited between 31 October 2023, to 31 December 2024. Translation was conducted using a forward and backward translation approach. Reliability was assessed using internal consistency (Cronbach's alpha) and test–retest. Face validity was addressed with 10 patients, and content validity was evaluated by four clinical specialists. Content validity was evaluated using the item-content validity index (I-CVI) and content validity ratio (CVR). Construct validity was assessed using exploratory factor analysis (EFA). Seventy-eight participants with facial (n = 39, 50.0%) and non-facial (n = 39, 50.0%) soft tissue scars were recruited for the EFA. The Malay POSAS-O demonstrated acceptable internal consistency (α = 0.75) and excellent inter-rater reliability, with item-level intraclass correlation coefficient (ICCs) ranging from 0.91 to 1.00 and total score ICC of 0.99. Agreement for categorical scar severity ratings was almost perfect (κ = 0.89). The Malay POSAS-P showed excellent internal consistency (α = 0.89), and test–retest reliability for the total score was good to excellent (ICC = 0.89). Intermittent symptom items (painful, shooting, burning and fragile) exhibited lower stability, reflecting natural symptom variability. Content validity was excellent, with all items achieving I-CVI and CVR values of 1.00. EFA supported construct validity, with adequate Kaiser-Meyer-Olkin (KMO) values (POSAS-O: 0.88; POSAS-P: 0.85), significant Bartlett's tests, strong communalities and factor loadings. The cumulative variance explained was 79.05% for POSAS-O and 68.19% for POSAS-P. The Malay version of the POSAS 3.0 is a reliable, valid, and culturally appropriate instrument for scar assessment. Its strong psychometric properties support its application in clinical practice and research involving Malay-speaking populations.
To develop and evaluate an explainable machine learning framework enhanced with synthetic data generation to predict unplanned 30-day hospital readmissions among patients with chronic obstructive pulmonary disease (COPD), heart failure (HF) and type 2 diabetes mellitus (T2DM), and to identify key clinical and social predictors of readmission.
A retrospective cohort study using electronic health record data incorporating both structured variables and information extracted from unstructured clinical notes. Synthetic data were generated using advanced resampling and deep learning-based techniques to address outcome imbalance and improve model training.
Intensive care unit and general ward admissions at a single tertiary academic medical centre included in the MIMIC-IV (Medical Information Mart for Intensive Care IV) database.
Adult patients (≥18 years) were admitted with a primary diagnosis of COPD (n=14 050), HF (n=7097) or T2DM (n=12 735) between 2008 and 2019, with complete 30-day follow-up and no in-hospital mortality during the index admission.
The primary outcome was unplanned all-cause hospital readmission within 30-days of discharge. Predictors were drawn from six domains, including demographics, comorbidities, clinical acuity, therapies, behavioural factors and care continuity. Predictive performance was evaluated using multiple machine learning methods and fivefold cross-validation, with model interpretability assessed using established goal and local explanation approaches.
Ensemble-based machine learning models demonstrated the strongest predictive performance across all three disease cohorts. Key predictors of readmission included higher illness severity, greater comorbidity burden, medication non-adherence, gaps in preventive care and limited social support. Models incorporating synthetic data augmentation showed improved discrimination compared with models trained on original data alone.
An explainable synthetic-data driven framework incorporating clinical, behavioural and social data can support prediction of 30-day readmissions among patients with common chronic conditions using routinely available electronic health record data.
by Meshack Achore, Martine Hackett, Tatiana Ramirez
IntroductionCommunity health workers (CHWs) play a critical role in advancing health equity by bridging underserved communities with health and social services. However, expanding responsibilities, emotional labor, and fragmented service systems contribute to burnout. While prior research has examined CHW burnout in urban, rural, and crisis contexts, little is known about how burnout is experienced and mitigated in suburban settings characterized by geographic dispersion and administrative fragmentation. This study explored how CHWs in suburban Long Island, New York, experience emotional labor overload and the strategies they use, individually and organizationally, to prevent burnout.
MethodsWe conducted a qualitative descriptive study using purposive and snowball sampling and recruited 10 CHWs from Nassau and Suffolk counties in New York. Data were collected through ten semi-structured interviews and five participant observations. Participants were primarily women aged 35–44 years, most of whom (86%) worked in Nassau County and reported 2–5 years of experience. Transcripts were analyzed thematically using Braun and Clarke’s six-step framework in ATLAS.ti.
ResultsTwo overarching themes emerged: (1) Creating a healthy work-life balance, in which CHWs managed burnout by setting boundaries and practicing self-care; and (2) Building support structures in the workplace, where organizational supports such as supervision, peer collaboration, and ongoing training promoted resilience. Participants emphasized the importance of self-care rituals, spiritual grounding, and collegial networks as protective factors against emotional exhaustion.
ConclusionsBurnout among suburban CHWs is shaped by the interaction of individual coping practices and organizational conditions within fragmented service systems. Strengthening supervision, peer support infrastructure, and professional development opportunities may enhance workforce resilience and sustainability. Investments in organizational support structures are critical to sustaining CHWs’ capacity to promote health equity.
To explore the meaning older Asian immigrants attribute to social isolation and loneliness, their management strategies, utilisation of resources and impact on health.
Systematic review of qualitative studies.
AgeLine, CINAHL, MEDLINE, ProQuest, PsycINFO, Scopus, and Web of Science databases were searched in September 2024.
Inclusion criteria: participants were Asian immigrants to Western countries aged 65 and over, community-living and experiencing social isolation and loneliness. Antonovsky's Sense of Coherence was used to frame the thematic analysis.
Ten papers were included and analysed deductively using elements of the sense of coherence framework: • Comprehensibility: Social isolation and loneliness are viewed as multifaceted, influenced by cultural and environmental dislocation, language barriers, intergenerational conflicts, deteriorating health and mobility, and socioeconomic challenges. • Manageability: included engaging in culture-specific community programs, family and ethnic community support and living within ethnic enclaves mitigated isolation and loneliness. • Meaningfulness: Strong family ties, active community involvement, spirituality, volunteerism, and cultural practices fostered resilience. However, accepting the changing values of their new world, living independently, and carving their own niche provided meaning to their transformed reality.
Older Asian immigrants experience social isolation and loneliness through a cultural lens, shaped by migration experiences, language barriers, and shifting family dynamics. Cultural roots, family ties, spirituality, community, acceptance, and independence enhance sense of coherence. Recognising the dynamic interplay between cultural identity, resilience, and adaptation is key to understanding their lived experience.
This review informs culturally sensitive interventions, guiding healthcare, community services, and policy to support social participation, mitigate loneliness through ethno-specific activities, and improve the quality of life for aging immigrant populations in Western countries.
The review was undertaken and reported using the PRISMA guidelines.
None.
PROSPERO (CRD42023425752)
by Claudia Jaramillo-Mazo, Daniel Bravo, Diego Fernando Villanueva-Mejía, Javier Correa-Alvarez
Cadmium (Cd), a toxic heavy metal found in agricultural landscapes worldwide, has been pointed out in cropped soils with Theobroma cacao L., as one of the main contaminants that translocate into plant tissues. Among the factors linked to cadmium translocation into plants, the role of soil bacterial communities in chemical transformation in soils has been poorly investigated. Overall, soil bacterial communities are shaped by diverse environmental and anthropogenic factors that influence crop yield and health. Cadmium alters soil microbial communities and increases the risk to human health through plant uptake. Although the impacts of cadmium on soil bacteria have been studied in other crops, there is limited information on cacao. Thus, this study aimed to assess the responses of soil bacterial communities in cacao farms to cadmium exposure, both natural and spiked. A total of 225 rhizosphere soil samples were collected from 16 plots across five cacao farms in two Colombian departments. The complementary approaches used were: (i) 16S rDNA amplicon sequencing to assess the composition of the bacterial community in soils with natural Cd concentrations, and (ii) isothermal microcalorimetry (IMC) to measure the temporal metabolic responses of bacteria to Cd in closed systems for 80 hours at 25 °C. The findings suggest that nearly 28% of the bacterial community responds to high cadmium concentrations in soils, both in natural and experimental conditions. Field-based observations revealed that Cd-responsive taxa detected under natural soil conditions included several unculturable bacterial groups, whereas laboratory experiments with Cd spiking predominantly selected for previously characterized cadmium-tolerant bacteria (CdtB). Significant variation in natural Cd-bacterial community composition and Cd-related metabolic activity was observed across the farms. Moreover, Cd-responsive bacterial taxa exhibited increased abundance during Cd spikes. As expected, contrasting patterns were revealed by the activity-response measured by IMC and taxonomic analyses of 16S rRNA gene sequences.by Maria Grazia De Iorio, Michele Polli, Sara Ghilardi, Stefano Frattini, Mara Bagardi, Alessandra Paganelli, Maria Cristina Cozzi, Kenza Seghrouchni, Paola Giuseppina Brambilla, Giulietta Minozzi
Non-epidermolytic ichthyosis (NEI) is a hereditary skin disorder affecting several dog breeds, most notably the Golden Retriever. It is primarily caused by a loss-of-function variant in the PNPLA1 gene, while a second, less common form is associated with a deletion in the ABHD5 gene. This retrospective study aimed to assess the prevalence and temporal trends of both mutations in Golden Retrievers tested in Italy between 2017 and September 2025. A total of 508 genetic tests were analyzed, including 463 dogs tested for the PNPLA1 mutation, 42 for the ABHD5 deletion, and 3 for both variants. DNA was extracted from blood or buccal samples and analyzed by real-time PCR followed by confirmatory Sanger sequencing. Among the PNPLA1 tested dogs, 42% were clears (wt/wt), 37% carriers (wt/mut), and 21% affected (mut/mut), with calculated allele frequencies of 60% wild-type and 40% mutant. A significant temporal decline in mutant allele frequency was observed, accompanied by an increasing number of animals tested over time, suggesting growing interest in genetic screening and its impact on selective breeding. Conversely, all dogs tested for the ABHD5 deletion were wild-type, supporting its rarity in the breed. Overall, these findings confirm that PNPLA1-related ichthyosis remains one of the most prevalent hereditary disorders in Golden Retrievers, although its frequency is decreasing. The results emphasize the effectiveness of genetic testing in disease prevention and highlight the importance of continued monitoring to maintain genetic health within the breed.In all countries, some population groups experience barriers to accessing eye health services, contributing to health inequities. Outreach is a common strategy used to deliver healthcare services to populations experiencing inequities. This scoping review aims to summarise the nature and extent of the existing literature describing outreach as a service delivery model to improve access to eye health services, particularly among populations experiencing inequities.
An information specialist will search academic databases (Medline, Embase and Global Health) without language restrictions to find peer-reviewed articles describing outreach eye health services, published in any country between 1 January 2010 and the search date. Grey literature sources will also be searched. In Covidence, two reviewers will independently screen titles and abstracts and subsequently relevant full texts against the inclusion criteria. Data extraction will also be performed independently by two reviewers in Covidence. This scoping review will summarise the characteristics of the included outreach eye health services, including the type of eye health service delivered, personnel involved, mode of transport, source of funding and whether the service targeted any specific PROGRESS-Plus group (Place of residence, Race/ethnicity/culture/language, Occupation, Gender/sex, Religion, Education, Socioeconomic status, Social capital, Plus). We will present our findings quantitatively using diagrams, tables and graphs.
Ethics approval was not sought, as this scoping review will use only publicly available reports. The results of this review will be disseminated through publication in a peer-reviewed journal and will be presented at eye health conferences. It will offer valuable insights for eye health providers, health and social service providers and policymakers who are interested in improving access to eye health services for populations experiencing inequities. This scoping review will inform a project in New Zealand which aims to develop outreach eye health services to populations experiencing inequities, such as unhoused people and refugees.
This protocol was registered on the Open Science Framework on 11 November 2025 (https://osf.io/vyz32).
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