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☐ ☆ ✇ BMJ Open

Knowledge, attitude and practice towards glaucoma among ophthalmic inpatients: a cross-sectional study in Hunan, China

Por: Zhao · Y. · Wu · P. · Liao · L. · Zhang · J. · Zhou · D. · Sun · W. · Dong · F. · Ye · C. · Duan · X. — Enero 16th 2026 at 18:44
Objectives

Glaucoma is an optic neuropathy caused by the gradual degeneration of retinal ganglion cells. This study aimed to investigate the knowledge, attitude and practice (KAP) towards glaucoma among ophthalmic inpatients.

Design

A web-based questionnaire.

Setting

Local hospital.

Participants

Ophthalmic inpatients (n=1238).

Primary and secondary outcome measures

The primary outcome was the patients’ KAP.

Results

Multivariable logistic regression analysis showed that rural residence (OR=0.488, 95% CI 0.313 to 0.762, p=0.002), college education or above (OR=4.996, 95% CI 2.942 to 8.483, p

Conclusions

Ophthalmic inpatients might have moderate knowledge and attitude, but a proactive practice towards glaucoma. A history of glaucoma, previous glaucoma surgery, education level, residency and alcohol consumption were potentially associated with knowledge and attitudes towards glaucoma among ophthalmic inpatients.

☐ ☆ ✇ Journal of Advanced Nursing

Effects of Nursing Workforce and Work Environment on Health System Resilience in Public Health Emergencies: A Multicenter Cross‐Sectional Study

Por: Yun Hu · Aozhou Weng · Xiyi Wang · Yanyan Liu · Xuehong Zhao · Qian Wang · Jing Shao · Ruizhi Cai · Yang Dai — Enero 11th 2026 at 11:46

ABSTRACT

Aim

The study examines the associations between nursing competence, work environment, and health system resilience. It also analyzes how nursing competence and work environment relate to different patterns of health system resilience.

Design

A multiple center cross-sectional study was conducted between December 2023 and January 2024 across 33 hospitals in eastern China, involving 2435 nurses.

Methods

Questionnaires measuring nursing competence, work environment resources, nurse disaster resilience, and organizational commitment to resilience were utilised, along with the collection of additional personal demographic data. Structural equation modelling and cluster analysis were performed to explore the underlying mechanisms within the overall model and across multiple groups. Multivariable regression was conducted to identify variables associated with resilience in different subgroups.

Results

Structural equation modelling demonstrated significant influences of nursing competence and work environment support on system resilience. Cluster analysis identified four resilience patterns: strong, marginal, low, and critical vulnerability. Strong resilience correlated with balanced individual-organizational resources, while vulnerable systems relied heavily on environmental support.

Conclusion

Our findings support policymakers and managers in developing systematic strategies with distinct focal points—targeting nurse workforce investment and optimised work environment—to enhance health system resilience across varying levels of public health emergencies.

Implications for the Profession

This study validated the framework connecting individual and organizational resilience, offering evidence-based insights for nurse training and resource allocation to enhance healthcare systems' adaptability during disasters.

Impact

The study addressed how nursing competence and work environment significantly influenced resilience during public health emergencies, identified four resilience patterns, and provided insights to guide policymakers and healthcare managers in developing targeted, effective strategies.

Reporting Method

Strengthening the Reporting of Observational studies in Epidemiology checklist.

Patient or Public Contribution

No patient or public contribution.

☐ ☆ ✇ Journal of Advanced Nursing

The Relationship Between Organisational Innovation Climate and Nurses' Innovative Behaviour: Roles of Knowledge Sharing and Person‐Organisation Fit

Por: Zhengang Liu · Genqiang Li · Ling Ma · Junqiang Zhao — Enero 10th 2026 at 16:03

ABSTRACT

Aim

The aim of this study was to integrate Social Exchange Theory and the Ability—Motivation—Opportunity (AMO) Theory to examine the influence of organisational innovation climate on nurses' innovative behaviour, considering the mediating role of knowledge sharing and the moderating effect of person-organisation fit, thereby providing a multidimensional theoretical foundation for enhancing nurses' innovative behaviour.

Design

A cross-sectional research design was adopted.

Methods

Participants included 380 nurses from two Grade-A tertiary hospitals in Henan Province, China. Data were collected using the Organisational Innovation Climate Scale, Knowledge Sharing Scale, Nurses' Innovative Behaviour Scale and Person-Organisation Fit Scale and analysed via descriptive statistics, correlation analysis, regression analysis and bootstrap testing for mediation and moderation effects.

Results

Organisational innovation climate was positively correlated with nurses' innovative behaviour and knowledge sharing partially mediated this relationship. Person-organisation fit positively moderated both the direct relationship between organisational innovation climate and knowledge sharing and the indirect effect on innovative behaviour.

Conclusion

Under a supportive organisational innovation climate, nurses with high person-organisation fit are more likely to engage in innovative behaviour through knowledge sharing.

Impact

Establishing an organisational innovation climate and improving person-organisation fit can enhance nurses' work engagement and loyalty, advancing innovation and development in nursing.

Implications for the Profession and/or Patient Care

Nursing managers should cultivate an innovation-friendly climate and facilitate knowledge sharing to inspire proactive problem-solving and innovation among nurses, ultimately improving nursing practice and patient care.

Reporting Method

STROBE guidelines were followed.

Patient or Public Contribution

This study clarifies how organisational and individual factors jointly affect nurses' innovative behaviour, providing a theoretical foundation for improving nursing management, service quality and disciplinary innovation.

☐ ☆ ✇ PLOS ONE Medicine&Health

Establishment of an amino acid metabolism related signature for prognostic and therapeutic sensitivity prediction in breast cancer by machine learning

Por: Xinrui Zhao · Jie Li · Nan Hu · Xiaoming Wu · Junbo Duan — Enero 9th 2026 at 15:00

by Xinrui Zhao, Jie Li, Nan Hu, Xiaoming Wu, Junbo Duan

Amino acid metabolism plays a critical role in tumor growth and immune regulation, yet its comprehensive function in breast cancer remains underexplored. We developed an amino acid metabolism–related gene signature (AAMRGS) to predict prognosis and therapeutic response in breast cancer. The AAMRGS was constructed using a machine-learning framework integrating ten algorithms and validated across multiple independent cohorts. It served as an independent prognostic factor and outperformed existing amino acid metabolism–related signatures and clinical variables. Moreover, the prognostic utility of AAMRGS was further validated across pan-cancer datasets, and an AAMRGS-based nomogram was constructed to facilitate clinical application. Functional enrichment and protein–protein interaction analyses revealed that AAMRGS genes were primarily involved in metabolic reprogramming and cell proliferation. Experimental validation confirmed the downregulation of key genes such as SAV1 and IGF2R in breast cancer cells. Integrative analyses revealed that the high-AAMRGS subgroup exhibited a greater copy number variation burden, higher tumor mutation burden (TMB), enrichment of immunosuppressive cell populations, and increased sensitivity to most chemotherapeutic drugs. In contrast, the low-AAMRGS subgroup displayed higher immune scores, stronger immune activation, enrichment of anti-tumor immune cells, and greater responsiveness to immunotherapy. Collectively, our findings establish AAMRGS as a reliable prognostic signature and a potential tool to guide individualized therapeutic strategies for breast cancer patients.
☐ ☆ ✇ BMJ Open

Chinese neuroimmunological disease (NIDBase) cohort study: cohort profile

Por: Zhang · M. · Han · J. · Xia · J. · Lin · M. · Chen · T. · Ruan · S. · Wang · Q. · Men · Y. · Gao · R. · Zheng · H. · Li · J. · Qi · Y. · Chen · S. · Wang · Y. · Tang · Y. · Li · D. · Yang · X. · Qiu · Z. · Liu · Z. · Dong · H. · Zhao · Y. · Hao · J. — Enero 8th 2026 at 13:18
Purpose

The Chinese neuroimmunological disease database (NIDBase) cohort was established to explore genetic and environmental risk factors, clinical features, multi-omics data and prognostic biomarkers. The aim is to enhance our understanding of central nervous system (CNS) demyelinating diseases. Additionally, the establishment of this cohort will address the critical issue of the lack of comprehensive genetic data and biological samples for precision diagnosis and treatment research related to neuroimmunological diseases in China.

Participants

56 hospitals in various regions of China were selected to participate in this study. The patients diagnosed with CNS demyelinating diseases were recruited, including clinically isolated syndrome (CIS), multiple sclerosis (MS), neuromyelitis optica spectrum disease (NMOSD), myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) and autoimmune glial fibrillary acidic protein astrocytopathy (GFAP-A).

Finding to date

At the time of patient enrolment, the clinical information is designated as baseline data. The collected baseline data include demographic information, disease history, clinical features of each demyelinating event, treatment records, standardised scales, questionnaire assessments and laboratory test results. Furthermore, biological samples, MRI and high-density electroencephalography (hd-EEG) data will be collected at baseline. All patients will be followed up at 3 months and 6 months and annually thereafter. As of December 2024, 3866 patients with CNS demyelinating diseases have been enrolled, including 84 CIS, 282 MOGAD, 1405 MS and 2095 NMOSD. Our findings indicate that CNS demyelinating diseases, particularly NMOSD, are more prevalent in women in China, with significant age differences observed among NMOSD patients compared with those with CIS, MS and MOGAD.

Future plans

In future, all patients in our cohort will be followed up at 3 months and 6 months and then annually. By the end of December 2024, the database has been locked and is now being processed and analysed, while our data continue to be updated and expanded for further analysis. Both prospective and retrospective observations will be included in this study. Subsequent publications will emerge from this multicentre cohort, encompassing genomics, clinical cohort studies, hd-EEG biomarkers, imaging-based radiomics and electrical stimulation therapies.

Trail registration number

NCT06443333.

☐ ☆ ✇ BMJ Open

End-of-life knowledge, attitudes and behaviours associated with hospice care preference in community-dwelling older adults: a cross-sectional survey from Mainland China

Por: Zhao · W. · Zhong · J. · Lai · X. — Enero 7th 2026 at 04:50
Objective

To examine end-of-life knowledge, attitudes and behaviours associated with hospice care preference in community-dwelling older adults from Shanghai, China.

Design

This was a cross-sectional study recruiting community-dwelling older adults from Shanghai. Bivariate analysis and multivariate logistic regression models were conducted to identify associated factors.

Setting

Seven community health service centres in Shanghai, China.

Participants

A total of 404 community-dwelling older adults.

Outcome measures

Participants were asked to provide their hospice care preference (‘If you were to become critically ill with limited life expectancy, would you choose hospice care?’) and related reasons. To evaluate knowledge, attitudes and planning behaviours related to end-of-life issues, a structured questionnaire was developed through a multistep process. Demographic and clinical characteristics were also collected.

Results

Nearly two-thirds of participants (65.8%) reported awareness of hospice care. Most of the participants (81.2%) reported they would choose hospice care at the end-of-life stage. Bivariate analyses showed that marital status, living status, education background and disposable personal income were significantly associated with hospice care preference. After controlling for confounding variables, the logistic regression analysis suggested the significant effects of knowledge level of hospice care (β=0.318, 95% CI (1.156 to 1.636), p

Conclusions

The Chinese older adults’ knowledge, attitudes and behaviours towards end-of-life issues in metropolitan areas has been changing. Their preference towards hospice care provides a good foundation for the utilisation of hospice care in the future. Community-based educational interventions should target demographic characteristics such as being unmarried, living alone and having lower levels of education and income among older adults to enhance their knowledge and family communication about hospice care.

☐ ☆ ✇ PLOS ONE Medicine&Health

A simulation study of the cost of cerebral vasospasm treatments with clazosentan: A mathematical model using time-driven activity-based costing

Por: Jieyu Zhao · Kota Kurisu · Kazuki Ohashi · Toshiya Osanai · Katsuhiko Ogasawara · Miki Fujimura — Enero 2nd 2026 at 15:00

by Jieyu Zhao, Kota Kurisu, Kazuki Ohashi, Toshiya Osanai, Katsuhiko Ogasawara, Miki Fujimura

In this work, we aimed to assess the impact of clazosentan on clinical labour time costs within Japan’s value-based healthcare system using time-driven activity-based costing. Time-driven activity-based costing was employed to analyse the labour time costs associated with preventing cerebral vasospasm following aneurysmal subarachnoid haemorrhage. Time-driven activity-based costing simplifies cost analysis by utilising time as the primary cost driver. We compared two treatment approaches: conventional therapy with fasudil hydrochloride and postoperative therapy with clazosentan. Scenario and sensitivity analyses were performed to assess the impact of physicians’ costs on the results. The use of clazosentan for the prevention of cerebral vasospasm significantly reduced human resource costs, particularly in cases where symptomatic vasospasm did not occur, yielding savings of approximately 51,343 yen. The greatest cost reductions were observed among nursing staff, with a 30% decrease in the absence of symptomatic vasospasm and a 15% reduction when symptomatic vasospasm was present. The cost reductions for physicians were comparatively smaller, particularly in cases where symptomatic vasospasm occurred. Sensitivity analyses indicated that clazosentan reduced overall costs by approximately 35,000–50,000 yen; however, costs increased in the presence of symptomatic vasospasm. Clazosentan for subarachnoid haemorrhage treatment significantly reduces human resource costs, especially in nursing staff. These findings support the potential of clazosentan for broader clinical use, given its cost-savings and clinical benefits in reducing cerebral vasospasm following aneurysmal subarachnoid haemorrhage.
☐ ☆ ✇ BMJ Open

School-based and animation-based comprehensive sexuality education in Kenya: protocol for a quasiexperimental study

Por: Gao · Y. · Zhao · S. · Okenyoru · D. · Lu · Y. · Zhang · R. — Diciembre 31st 2025 at 11:30
Introduction

Adolescents in Kenya face a high burden of sexual and reproductive health (SRH) challenges, including early pregnancy, sexually transmitted infections and limited access to accurate sexuality education. While school-based comprehensive sexuality education (SBCSE) has shown promise globally, its implementation in Kenya has faced significant barriers, including cultural resistance and lack of trained personnel. To address these gaps, the Afya Kesho (‘Health for Tomorrow’) programme introduces an innovative, animation-based, school-integrated and community-integrated comprehensive sexuality education curriculum aimed at enhancing adolescent SRH knowledge, attitudes and behaviours in rural and periurban Kenya. This manuscript presents the protocol of the Afya Kesho programme.

Methods and analysis

This quasiexperimental study will employ a preintervention and postintervention design to evaluate the effectiveness of the Afya Kesho programme. The intervention, delivered in three schools across Nairobi and Kiambu counties, includes 17 animated episodes structured into eight interactive SBCSE sessions facilitated by trained school health teachers and community health promoters. A total of 422 adolescents aged 10–19 will be recruited using multistage sampling. Quantitative data will be collected at baseline and endline using a structured questionnaire adapted from the Global School-based Student Health Survey and the Global Diet Quality Score. Primary outcomes include SRH knowledge, gender norms and intimacy, while secondary outcomes include physical and mental health, dietary behaviours and healthcare utilisation. Statistical analysis using STATA V.17 will include descriptive, inferential and multivariate regression analyses. The final protocol is available on Open Science Forum (https://osf.io/fx38c).

Ethics and dissemination

Ethical approval has been granted by the Kenyatta National Hospital-University of Nairobi Ethics and Research Committee (P854/12/2024). Informed consent will be obtained from all participants and their guardians. The study prioritises minimal disruption and adheres to ethical standards of adolescent research. Findings will be disseminated through open-access publications, infographics, school-based brochures and digital platforms. Anonymised datasets will be made publicly available on the Innovation for Health Equity in Africa website on completion.

☐ ☆ ✇ BMJ Open

Epidemiological characteristics of major respiratory infectious diseases in Baiyin, China, from 2014 to 2023: a descriptive epidemiological study

Por: Zhan · Z. · Xie · T. · Zhao · T. · Zhang · X. · Zhang · S. · Wang · M. · Xu · Q. · Cheng · Y. · Liu · Y. · Yang · S. · Cui · F. — Diciembre 30th 2025 at 15:31
Objective

To analyse temporal trends of respiratory infectious diseases (RIDs) in Baiyin City from 2014 to 2023, aiming to explore the epidemiological patterns of these diseases (tuberculosis, scarlet fever, pertussis, measles, influenza, mumps, varicella and rubella) and provide evidence for developing effective prevention and control strategies.

Design and setting

A descriptive epidemiological study was conducted to analyse the incidence of tuberculosis, scarlet fever, pertussis, measles, influenza, mumps, varicella and rubella in Baiyin City, China, from 2014 to 2023, using data from the national notifiable disease reporting system.

Participants

All reported cases of eight notifiable RIDs in Baiyin City between 2014 and 2023 were included in the analysis. Data were categorised by age and sex.

Methods

Joinpoint Regression Software was employed to estimate both the annual percentage change in incidence and the average annual percentage change, facilitating a phased comparison of incidence trends.

Results

Between 2014 and 2023, the annual incidence of major bacterial RIDs (tuberculosis, scarlet fever and pertussis) in Baiyin City fluctuated between 52.69 and 87.94 per 100 000 population, demonstrating an overall declining trend. Specifically, the annual decrease rates for the age groups of 0–14 years, 15–59 years and ≥60 years were 11.62% (95% CI –20.26% to –2.16%), 6.44% (95% CI –10.37% to –2.46%) and 5.15% (95% CI –9.12% to –1.07%), respectively. The annual incidence of major viral RIDs (measles, influenza, mumps, varicella and rubella) fluctuated between 111.70 per 100 000 and 541.12 per 100 000. No significant temporal trend was observed for major viral RIDs in Baiyin City. With the exception of pertussis, measles and rubella, the overall incidence rate was significantly higher in males than in females (p

Conclusion

From 2014 to 2023, the annual incidence of major bacterial RIDs in Baiyin City showed an overall decline, mainly due to a reduction in tuberculosis incidence, whereas the annual incidence of major viral RIDs fluctuated and rose sharply in 2023. The overall incidence of both major bacterial and viral RIDs was consistently higher in males, with major viral RIDs occurring predominantly in children aged 0–14 years and major bacterial RIDs being more common in older adults aged ≥60 years. Further efforts are needed to monitor the epidemiological patterns and develop strategies to reduce the incidence of major viral RIDs, particularly among children aged 0–14 years.

☐ ☆ ✇ BMJ Open

Use of continuous temperature data from wearable devices for fever or infection management in acute hospital settings: a scoping review protocol

Por: Liu · Y. · Zhao · Q. · Li · K. · Dowding · D. — Diciembre 30th 2025 at 05:33
Introduction

Despite the increasing interest in wearable devices for monitoring body temperature in acute hospital settings, their integration into routine clinical workflows remains limited. There is a growing need to map the existing evidence on the use of temperature data generated by wearable devices to enhance our understanding of how these data are monitored, presented and used in clinical practice.

Methods and analysis

A scoping review of relevant literature from January 2013 to February 2025 will be conducted following the Joanna Briggs Institute scoping review methodology. A search of Medline, Embase, Web of Science, CINAHL and IEEE Xplore Databases will be undertaken using the Population, Concept, Context framework to identify studies that use wearable devices to monitor patients’ body temperature in acute hospital settings to support the management of fever or infections. A pilot search has been conducted to identify key search terms and specific types of wearable devices, followed by analysis of retrieved literature. We will use a two-step screening process to identify eligible articles, starting with title/abstract screening, followed by full-text screening. A hand search of the reference lists and citation lists of eligible articles and identified reviews will be conducted for additional publications that meet the inclusion criteria. Primary studies published in English and Chinese will be included regardless of their design and type of publication. Information on the characteristics of wearable devices, clinical contexts of device usage, strategies of presenting and analysing temperature data, and their integration into clinical workflows will be extracted. In the article presenting the results of the scoping review, we will provide a descriptive synthesis of the findings, supported by visual representations, such as charts, tables and images to describe the current evidence base.

Ethics and dissemination

As this is a scoping review, ethical approval is not required. The results will be presented in a peer-reviewed journal article and at healthcare or medical informatics conferences. The findings will provide insights into the interpretation of temperature data generated by wearable devices to support clinical decision-making and inform strategies to facilitate their incorporation into clinical practice.

PROSPERO registration number

This scoping review protocol is registered on Open Science Framework (https://osf.io/v6sp8).

☐ ☆ ✇ BMJ Open

Examining the associations between the food environment and dietary intake in British Columbia: a cross-sectional study

Por: Zhao · B. · Cohen · T. R. · Sutherland · J. · Meza · R. · Bhatti · P. · Murphy · R. A. — Diciembre 26th 2025 at 04:45
Objectives

To characterise neighbourhood food environments in British Columbia (BC) and determine whether food environment characteristics are associated with fruit and vegetable (FV) intake.

Design

A cross-sectional study using geospatial linkage of food environment measures within 1 km residential buffers, analysed with mixed-effects models

Setting

Urban neighbourhoods in BC, Canada.

Participants

Approximately 25 000 adults aged 35–69 years from the BC Generations Project cohort.

Outcome measures

FV intake as a continuous variable (servings/day) and as a binary measure (

Results

Approximately 50% of participants lived in neighbourhoods without chain grocery stores, fast-food outlets or convenience stores within walking distance. Neighbourhoods in the highest density category for fast-food outlets were associated with lower odds of consuming ≥5 servings of FV per day (OR=0.89, 95% CI 0.80 to 0.98). Associations between chain grocery stores, convenience stores and FV intake were attenuated after adjusting for neighbourhood characteristics including walkability, and material and social deprivation.

Conclusions

The findings suggest limited neighbourhood access to retail food outlets across urban areas in BC. Participants living in neighbourhoods with greater density of fast-food restaurants were less likely to consume >5 servings of FV per day. Further studies are needed to better understand the null findings and additional factors that may be associated with dietary intake.

☐ ☆ ✇ BMJ Open

Tobacco-free cities: a qualitative evaluation of the tobacco control programmes in Chinese cities, 2009-2018

Por: Zhao · Y. · Qian · C. · Fang · L. · Zheng · P. · Duan · Z. · Koplan · J. · Redmon · P. · Eriksen · M. — Diciembre 25th 2025 at 05:45
Objective

During 2009–2018, the Emory Global Health Institute conducted the Tobacco-Free Cities (TFC) programme in 22 cities in mainland China. This study aims to assess the sustained impact of the TFC programme.

Design

A qualitative study using semi-structured interviews was adopted, which focused on the leadership and capacity building, city-level smoke-free policies, tobacco control activities, outcomes of tobacco control, sustainability post TFC programme and the accomplishments of tobacco control. The thematic analysis was employed for qualitative data analysis.

Setting

Online in-depth personal interviews.

Participants

This qualitative study recruited 17 participants from 10 cities which participated in the TFC programme (five with comprehensive and five with partial smoke-free policies). Interview participants included TFC programme leaders, TFC staff and current tobacco control staff.

Results

First, TFC members reported enhanced competencies in smoke-free policy effort and leadership. Five cities with comprehensive smoke-free policies had a high degree of public support, while cities with partial bans faced barriers such as lack of leadership support and experiencing tobacco industry influence. Tobacco control activities, including media campaigns, policy enforcement, cessation programmes and monitoring activities, were sustained in almost all cities. Enhancement in smoke-free social norms, decrease in smoking rate and second-hand smoking exposure were perceived. Challenges to sustainability included reduced financial and personnel resources and weakened policy enforcement.

Conclusions

The TFC programme was regarded by participants as an effective model that provided the necessary training and technical support to develop and enforce effective and sustainable tobacco control policies and initiatives at the city level in China. Future tobacco control training should focus more on developing concrete solutions for sustainability challenges.

☐ ☆ ✇ BMJ Open

Randomised trial protocol to assess efficacy of modified olfactory training method for patients with postinfectious olfactory dysfunction

Por: Xie · J. · Li · Y. · He · H. · Liu · Y. · Chen · L. · Liu · X. · Zhao · D. · Wu · D. — Diciembre 23rd 2025 at 10:35
Introduction

This article outlines the research protocol for a multicentre, randomised, controlled study designed to evaluate the therapeutic effect of a modified olfactory training (MOT) based on bi-directional nasal drug delivery system for patients with postinfectious olfactory dysfunction (PIOD), and to compare its efficacy with conventional olfactory training (COT).

Methods and analysis

This is a multicentre study in which patients will be recruited from several participating hospitals. Patients will be divided into three groups: COT group using COT device, MOT group using MOT device, Control group without any intervention other than follow-up. The olfactory training (OT) intervention will last for 12 months. The primary outcome will be the improvement in olfactory ability from baseline measurement to the end of intervention or control period, evaluated through the total Threshold, Discrimination, Identification (TDI) score of the Sniffin’ Stick test. Secondary outcomes will be changes in olfactory bulb volume and shape, olfactory-related brain area volume, olfactory and trigeminal nerve-related potentials, and subjective assessments.

Ethics and dissemination

This study protocol has been registered with ClinicalTrials.gov. The Peking University Third Hospital Medical Science Research Ethics Committee reviewed and approved this study protocol. The results will be published in BMJ Open.

Trial registration number

NCT06829706.

☐ ☆ ✇ BMJ Open

Association of cognitive impairment with adverse cardiovascular outcomes: the mediating role of modifiable risk factors in a prospective cohort study

Por: Zhou · L. · Yang · Z. · Ren · L. · Hu · G. · Wang · J. · Li · S. · Peng · X. · Zhao · M. · Li · Q. · Zhao · Z. · Li · M. · Zhao · M. · Shen · T. · Wang · Z. · Li · E. · Zhao · Y. · Zhou · N. · Sang · C. · Ma · C.-S. · Dong · J. · Lai · Y. · He · L. · Zhang · J. · Wang · W.-Y. · Du · X. · Tang · R. · Long — Diciembre 21st 2025 at 18:45
Objectives

To investigate, in a prospective cohort study, the association between cognitive impairment and cardiovascular disease (CVD), to quantify the extent to which uncontrolled risk factors mediate this association, and to explore whether the mediation effect varies across sex and age groups.

Design

Prospective cohort study.

Setting

UK Biobank, a large population-based cohort study in the UK.

Participants

A total of 152 155 participants without prevalent CVD or dementia at baseline were included. The mean age was 56.3±8.2 years, and 44.0% were male.

Primary outcomes

Cardiovascular death and composite cardiovascular outcomes, assessed using Cox proportional-hazards models and mediation analyses.

Results

During a median follow-up of 13.03–13.87 years, 1474 cardiovascular deaths and 21 518 composite cardiovascular outcomes were recorded. Participants with cognitive impairment (n=23 146; 15.2%) exhibited higher proportions of lifestyle, metabolic and psychological risks (p

Conclusions

Cognitive impairment is associated with increased risks of cardiovascular death and composite cardiovascular outcomes. Uncontrolled lifestyle, cardiometabolic and psychological risk factors partially mediate this association, highlighting the importance of comprehensive management to improve cardiovascular prognosis in this population.

☐ ☆ ✇ PLOS ONE Medicine&Health

Concentration-dependent effects of fermented spent coffee grounds and contrasting effects of earthworms on growth and phytochemicals in medicinal plant <i>Glechoma longituba</i>

Por: Bing-Nan Zhao · Zi-Yang Xie · Jia-Ning Liu · Xiao-Ran Chen · Xin-Xin Wang · Jia-Yi Li · Rui Zhang · Chao Si — Diciembre 17th 2025 at 15:00

by Bing-Nan Zhao, Zi-Yang Xie, Jia-Ning Liu, Xiao-Ran Chen, Xin-Xin Wang, Jia-Yi Li, Rui Zhang, Chao Si

Fermented spent coffee grounds (FSCG) serve as a valuable soil amendment to improve soil structure and fertility, while earthworms play a well-established role in enhancing soil processes and plant growth. However, their combined effects on bioactive compound accumulation in medicinal plants remain unclear. This study investigated the individual and interactive effects of FSCG (0%, 10%, and 20%, v/v) and earthworms (with and without Pheretima guillelmi) on the growth and phytochemical content of Glechoma longituba, a common medicinal herb, under greenhouse conditions. Results showed that 10% FSCG generally promoted plant growth, whereas 20% FSCG generally enhanced the accumulation of total flavonoids, chlorogenic acid, and soluble protein. Earthworms enhanced aboveground biomass and node number but significantly reduced chlorogenic acid content. These findings highlight the potential of FSCG as a sustainable soil amendment in medicinal plant cultivation and underscore the need to consider earthworm activity when optimizing both plant biomass and phytochemical quality.
☐ ☆ ✇ PLOS ONE Medicine&Health

Biopsychosocial factors associated with symptom severity in the overlap of non-erosive reflux disease and epigastric pain syndrome: A multicenter cross-sectional study

Por: Mi Lv · Hui Che · Jiayan Hu · Wenxi Yu · Zhaoxia Liu · Xiaolin Zhou · Binduo Zhou · Jinyi Xie · Fengyun Wang — Diciembre 15th 2025 at 15:00

by Mi Lv, Hui Che, Jiayan Hu, Wenxi Yu, Zhaoxia Liu, Xiaolin Zhou, Binduo Zhou, Jinyi Xie, Fengyun Wang

Background

The overlap between non-erosive reflux disease (NERD) and epigastric pain syndrome (EPS, a subtype of functional dyspepsia) is common, yet its associated factors remain poorly defined. We aimed to identify factors associated with symptom severity in NERD-EPS overlap, focusing on psychosocial and somatic factors.

Methods

In this multicenter cross-sectional study, 800 patients meeting Rome IV criteria for NERD-EPS overlap were enrolled. Standardized questionnaires assessed gastrointestinal symptoms (GSRS), somatic symptoms (PHQ-15), anxiety/depression (PHQ-4), and sleep quality (SRSS). Multivariable regression models identified factors independently associated with GSRS scores, adjusted for demographics and clinical covariates. Interaction terms were tested to assess whether the association between one factor and GSRS scores varied across different levels of another factor.

Results

Of the 800 patients, 67% were female, and the mean age was (44.50 ± 14.43) years. 67% had mild or more sleep problems, and 47% had anxiety or depression. Somatic symptoms (PHQ-15) showed the strongest association with GSRS scores (β = 0.617, P P P = 0.026). Urban residence (β = 0.071) and mixed labor type (β = −0.066) were also independently associated with symptom burden.

Conclusion

Somatic symptoms, psychological distress, and sleep disturbances were the factors most strongly associated with symptom severity in NERD-EPS overlap, with additional contributions from younger age, male sex, and urban residence. Our findings advocate for integrated biopsychosocial interventions to alleviate symptom burden in this population.

☐ ☆ ✇ PLOS ONE Medicine&Health

Comparison of outcomes between minimally invasive percutaneous bunnell suture and traditional open modified Kessler technique for acute closed achilles tendon rupture: A single-center cohort study

Por: Zihang Zhao · Xiang Zhang · Xi Hou · Zihan Liu · Zhiyong Hou · Lianxin Song · Ruipeng Zhang — Diciembre 15th 2025 at 15:00

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; P 
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