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Cardiovascular disease (CVD) is the leading cause of death in the USA, with significant disparities affecting racial/ethnic minority populations particularly in Philadelphia. Although effective self-management can improve outcomes for those with CVD risk factors, social and economic barriers often impede implementation of recommended health behaviours in underserved communities. This study aims to (1) determine the effectiveness of the Decision-making Education for Choices in Diabetes Everyday (DECIDE)+ intervention in improving CVD self-management skills among Philadelphia residents with CVD risk factors and unmet social needs compared with standard community health worker (CHW) engagement and (2) assess the reach, adoption, fidelity and maintenance of DECIDE+.
Using a type 1 hybrid effectiveness-implementation design, this quasi-experimental study will compare outcomes between participants who enrol in the DECIDE+ group (n=250) or receive standard CHW services (n=250). DECIDE+ combines a structured nine-session problem-solving programme for chronic disease management with ongoing CHW support addressing social needs. Both groups will be randomly assigned to either monthly or biweekly CHW follow-up to examine the impact of contact frequency on health behaviour outcomes. Primary outcomes include CVD self-management skills measured by the Self-care of Chronic Illness Inventory. Implementation outcomes will be assessed through a mixed-methods approach including structured interviews with CHWs and analysis of programme-level data.
This study was approved by the University of Pennsylvania Institutional Review Board (Protocol #856216). Written informed consent is obtained from all participants prior to enrolment. This pragmatic trial addresses cardiovascular health disparities by simultaneously enhancing problem-solving skills for chronic disease management and addressing social and environmental barriers to effective self-management. The study will provide valuable insights into the effectiveness of multilevel CHW-delivered interventions and optimal implementation strategies in real-world community settings. Findings will be disseminated through peer-reviewed publications and scientific conference presentations.
by Jenny Paola Alfaro-García, Julieta María Ramírez-Mejía, Paola Rojas-Estevez, Diego Alejandro Álvarez-Díaz, Geysson Javier Fernández, Carlos Alberto Orozco-Castaño, Boris Anghelo Rodríguez-Rey, Juan Carlos Gallego-Gómez, Miguel Vicente-Manzanares
Dengue virus (DENV) represents a growing global health challenge with billions of people at risk. Severe Dengue (SD), a complication of DENV infection that involves generalized hemorrhage, is driven, at least in part, by endothelial dysfunction. Endothelial dysfunction refers to increased permeability due to inflammation, mechanical injury and/or modification of the genetic program of endothelial cells. Previous work showed that exposure of endothelial cells to conditioned media from DENV-infected cells (CMDV) increased permeability and cellular stiffness, repressed endothelial markers and induced mesenchymal genes. However, the generality, extent, mechanism and ultimate impact of these events in the onset of SD remain elusive. Here, we integrate analysis from in vitro treatment of endothelial cells with media containing UV-inactivated DENV with computational modeling to investigate the key features of CMDV-induced endothelial alterations and their potential impact on endothelial dysfunction. We found that CMDV increased SNA1 and CDH2 expression, while suppressing endothelial genes OCLN and CDH5. Global transcriptomics analysis revealed that CMDV triggered a transient pro-inflammatory response, followed by induction of selected tissue repair genes and matrix remodeling. A non-directed asynchronous network model (NDAM-CMDV) identified IL6 and FN1 as central nodes of DENV-induced endothelial trans-differentiation, providing new molecular insights that predict the evolution of the disease and identify potential therapeutic targets.To estimate the carbon footprint of a vaccine trial conducted in Uganda and to identify opportunities to reduce greenhouse gas emissions in future trials.
Retrospective carbon footprint assessment of all trial-related activities conducted in Uganda (ClinicalTrials.gov ID NCT02991495), following the Greenhouse Gas Protocol and the guidance provided by the Low Carbon Clinical Trials Group.
The activities related to the yellow fever vaccine fractional dose trial implemented in Mbarara, with contributions from international collaborators.
The study assessed processes; no participants have been included.
Trial activities were retrospectively quantified and converted into a greenhouse gas estimate using publicly available emission factors. The boundaries of the study were defined to cover the set-up, implementation and close-out phases. Emissions were categorised by source, including personnel, travel, medical supply and laboratory.
The vaccine trial produced an estimated 224.66 tonnes of carbon dioxide equivalent (tCO2e). The largest emission category was related to the research centres, accounting for 78.80 tCO2e (35.07%), with the Mbarara research centre representing 75.74 tCO2e (32.38%), including commuting (21.01 tCO2e), waste disposal (19.31 tCO2e), goods and services (18.66 tCO2e) and energy (13.75 tCO2e). International travel, including air, non-air travel and accommodation accounted for 59.37 tonnes CO2e (26.43%), with the majority attributed to air travel (53.60 CO2e). Additional contributors included road travel by trial team and participants’ travel to attend trial’s visits. The storage of samples at –80°C in ultra-dry freezers was not a significant contributor due to the low volume of samples stored. However, important differences were observed in sample storage emissions between settings that relied more heavily on oil-based electricity and those with greater dependence on hydroelectric power.
This study highlights multiple opportunities to reduce the carbon emissions of clinical trials. These include already recognised actions such as higher use of solar energy and reduction of international travel. Nevertheless, to improve sustainability of trials, attention should be given to all controllable processes across the trial lifecycle and not solely to the main drivers of emissions. For this, environmental considerations should be present from the initial trial conception phase, involving for instance decisions about the number of trial visits and where these are conducted and taking rational decisions about the long-term storage of samples.
Care provided in people’s own homes (domiciliary care) is an increasingly important part of long-term care. There are various services, including home visits, live-in care and housing with care. Some people directly employ care staff, called personal assistants. Services vary in quality, price and availability, and there is currently little evidence of the value these services provide to the public purse and individuals. This study protocol presents planned research to fill this important gap.
This will be a cross-sectional study based on surveys of care recipients, their unpaid carers as well as formal care providers. In the first half of 2026, we will survey 1850 people accessing domiciliary care either through a homecare agency, a housing with care scheme or by directly employing personal assistants and 400 unpaid carers, all based in England. We will conduct a cost-effectiveness analysis taking a ‘production function’ approach and use quality of life as measured by the Adult Social Care Outcomes Toolkit as the main outcome of interest.
The study received ethical approval from the School of Social Sciences Staff Review Committee at the University of Kent on 20 May 2025 (reference 1195) and the Health Research Authority, London—Camberwell St Giles Research Ethics Committee on 28 October 2025 (reference 25/LO/0652). Implications around consent, data protection and confidentiality, risk and participant payment are discussed. In addition to academic outputs (eg, academic articles, conference presentations), we aim to coproduce news items and blogs with people with lived experience of accessing long-term care and jointly present findings at events aimed at the care sector. Moreover, we will offer participating care providers benchmarking briefs based on our findings.
by Esther Ortega-Martin, Javier Alvarez-Galvez
ObjectiveTo characterize the heterogeneity of Long COVID (LC) by identifying distinct patient profiles based on symptoms and quality of life (QoL), and to examine the sociodemographic and clinical predictors associated with these profiles.
Study designA cross-sectional observational study was conducted.
MethodsWe recruited 363 patients with LC in Spain via an online survey. Symptom patterns were identified through latent class analysis of 15 binary symptoms. QoL was assessed with the patient-derived LC-6D-QoL across six dimensions, and cluster analysis defined QoL subgroups. Logistic regression was applied to examine clinical and sociodemographic predictors of QoL profiles.
ResultsTwo symptom profiles emerged: a low-burden profile, dominated by fatigue and cognitive problems, and a high-burden profile with multisystem involvement. QoL clustered into three profiles—high, middle, and low QoL—with more than half of participants in the low QoL group. Symptom burden and employment status were the strongest predictors of poor QoL, whereas age, sex, education, and income showed limited associations. Social support was more frequently reported among participants with low QoL.
ConclusionsLC is characterized by distinct clinical and QoL profiles, with strong interactions between multisystem symptom burden and social determinants. Identifying patients at greatest risk of poor QoL can inform stratified interventions and integrated policies that combine medical care, psychosocial support, and workplace reintegration.
Introducción. Los síntomas prostáticos abarcan alteraciones en el vaciado, llenado, posmicción y volumen urinario, su aparición está influida por factores de riesgo como la edad, la raza, la predisposición genética y los hábitos dietéticos. Objetivo. Analizar la severidad de los síntomas prostáticos con los factores epidemiológicos y clínicos de los residentes del del Hogar de Ancianos “San José de las Canoas”, del cantón Catamayo. Metodología. Se realizó un estudio descriptivo, cuantitativo, no experimental, y corte transversal, con una muestra de 30 participantes. Para la recolección de datos se utilizó el cuestionario “International Prostate Symptom Score” (IPSS) destacándose por su alta confiabilidad y validez. El estudio contó con la aprobación de un Comité de Ética en Investigación en Seres Humanos y se llevó a cabo respetando los principios bioéticos establecidos. Resultados. 18 de los pacientes estudiados presentaban síntomas moderados. Se obtuvo una asociación estadística entre la severidad de los síntomas síntomas prostáticos y la edad (p= 0,007) y el grado de instrucción (p= 0,046). En cuanto a la presencia de comorbilidad (diabetes, hipertensión arterial/cardiopatía), se observó una relación significativa en la muestra (p= 0,043) en términos generales. Discusión. Los datos revelan que los síntomas prostáticos moderados se asocian con factores sociales y clínicos críticos, como el aislamiento, la falta de educación y enfermedades relacionadas con el estilo de vida, este panorama exige acciones integrales para mejorar la salud y calidad de vida de esta población vulnerable.
ABSTRACT
Introduction. Prostatic symptoms include alterations in voiding, filling, postvoiding and urinary volume, their appearance is influenced by risk factors such as age, race, genetic predisposition and dietary habits. Objective. To analyze the severity of prostatic symptoms with epidemiological and clinical factors in the residents of the “San José de las Canoas” Elderly Home in Catamayo. Methodology. A descriptive, quantitative, non-experimental, cross-sectional study was carried out with a sample of 30 participants. The “International Prostate Symptom Score” (IPSS) questionnaire was used for data collection, standing out for its high reliability and validity. The study had the approval of a Human Research Ethics Committee and was carried out respecting the established bioethical principles. Results. 18 of the patients studied had moderate symptoms. Statistical association was obtained between severity of prostatic symptoms and age (p= 0,007) and education degree (p= 0,046). Regarding the presence of comorbidity (diabetes, arterial hypertension/cardiopathy), a significative association was observed in the sample (p= 0,043). Discussion. Data reveal that moderate prostatic symptoms are associated with critical social and clinical factors, such as isolation, lack of education and lifestyle-related diseases, this scenario calls for comprehensive actions to improve the health and quality of life of this vulnerable population.
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.To explore the views of health care professionals involved in initiatives that have led to successful research-related roles for nurses and midwives working in community settings.
A sequential mixed-methods study.
Between December 2022 and January 2023 a survey was completed by health care professionals with relevant experience of successful research-related initiatives for nurses and midwives in community settings. Survey responses were categorised into low, medium or high-priority examples of productive practice. Nineteen of the twenty responders who provided high-priority examples were interviewed between May and July 2023. The research capacity development for impact framework underpinned data collection and analysis. Data were thematically analysed using the framework method.
The seven themes of the research capacity development for impact framework: leadership and sustainability, skills and confidence building, infrastructures, linkages and collaborations, ownership and responsibilities, actionable dissemination and co-production were identified as important features of successful research-related roles in community settings. A new cross-cutting theme of trust and relationships was generated. The initiation, continued growth and ambition continuum guided the development of the planning change and features of success template.
This study highlighted the key features that matter when planning change and developing research-related roles for nurses and midwives in community settings.
Study findings have the potential to inform policy and practice for organisations focused on developing research capacity and capability in community settings.
This study adhered to the COREQ reporting guidelines.
No patient or public involvement.
Communicating a clear, authentic and socially coherent image among nurses and their associations is essential because it helps shape an accurate perception of their role in society. Thus, although each nurse plays a crucial role individually, real transformation in the public perception of the profession requires coordinated and strategic actions by the organisations representing them.
This study explored existing knowledge on how nursing colleges, professional associations and unions communicate with their stakeholders.
A scoping review was performed following the methodological framework proposed by Arksey and O'Malley and the Joanna Briggs Institute. Eight electronic databases were searched, including CINAHL, Cochrane, Dialnet, Scopus, Scielo, PsycINFO, PubMed and Web of Science for both peer-reviewed articles and grey literature (e.g., reports, policy documents), using both MeSH terms and keywords. Data were collected using the Covidence platform, and articles published in English, Spanish, Portuguese and Italian were included. No limitations were applied regarding the publication year of the articles. They were then independently analysed based on their titles, abstracts and full text according to predefined inclusion and exclusion criteria. Conflicts were resolved via discussions with a third reviewer.
In total, 2033 articles were analysed from databases, of which 47 met the inclusion criteria. Eighteen studies used a structured methodology, while 29 were categorised as grey literature. The findings were organised into five key themes: (1) what organisations communicate (e.g., labour conditions, political content, health information); (2) with whom they communicate (e.g., nurses, journalists, political actors, the public); (3) for what purpose (e.g., advocacy, education, recruitment); (4) through what media (e.g., social media, websites, professional journals) and (5) how communication is evaluated (limited but promising insights on effectiveness).
This review provides the first diagnosis of communication management in professional nursing organisations. The lack of communication structures, trained professionals and effective strategies limits the effectiveness of communication among the entities. Studies are necessary to diagnose these shortcomings and design plans to improve the visibility and impact of their messages, positioning nurses as qualified and respected professionals.
A review protocol was developed and registered in the Open Science Framework platform.
Because the research is a scoping review.
To assess the potential for microbial contamination of open-but-unused portions of wound dressings stored under real-life conditions in healthcare facilities, to inform safer and evidence-based wound care practices. Observational, descriptive, longitudinal, prospective study. Eleven types of non-adhesive wound dressings were sampled after opening and storage under usual clinical conditions in a hospital inpatient unit and a primary care centre in Andalusia, Spain. Samples were collected on six predefined sampling days (Days 0, 2, 3, 4, 5 and 6 after opening), cultured under standardised laboratory conditions and microorganisms were identified using mass spectrometry. Differences in contamination were examined by dressing type, healthcare setting, storage time and handling conditions. Microbial growth was frequently detected in open-but-unused dressings from the first day after opening, particularly after enrichment culture and increased with handling and time. The most frequent microorganisms were coagulase-negative staphylococci and Staphylococcus aureus. Contamination patterns were similar across settings, although microbial diversity was higher in the hospital. Silver-containing dressings showed slightly lower contamination, but not enough to indicate protection. Scissors used for cutting dressings had high microbial loads, suggesting a potential source of cross-contamination. Open-but-unused dressings may become contaminated shortly after opening under routine clinical practice conditions, across different healthcare settings and dressing types.
Introducción. Se conoce como “síndrome post cuidados intensivos” a un conjunto de problemas de salud que persisten tras una enfermedad crítica, pudiendo durar incluso años tras el alta, y que incluyen síntomas cognitivos, físicos y mentales. El paquete de medidas ABCDEF ha demostrado mejorar los efectos indeseados del síndrome, como el delirium, los datos de mortalidad, los días de estancia en la unidad, y sobre todo, siendo útil en el destete de la ventilación mecánica. Objetivo. Describir si los pacientes que ingresan en unidades de cuidados intensivos con una enfermedad crítica, obtienen mejoras en las diferentes áreas del síndrome post cuidados intensivos tras el empleo del paquete de medidas ABCDEF. Método: Se llevó a cabo una revisión sistemática de la literatura disponible entre 2018 y 2023, en las bases de datos PubMed, Scopus y Web of Science (WOS). Resultados. Finalmente se incluyeron 11 artículos para formar parte de este trabajo. Gran parte de los estudios analizados coinciden en que el paquete ABCDEF es útil para minimizar determinados componentes del síndrome post cuidados intensivos, y otros aspectos del proceso de enfermedad del paciente ingresado en UCI. Discusión. El paquete de medidas ABCDEF representa una ayuda a la hora de promover una recuperación más rápida y completa de los pacientes críticos. Los resultados mejoran de manera exponencial al uso del paquete, según varios autores. También ha sido asociado a mejoras en otros aspectos secundarios como la reducción del tiempo de ventilación mecánica, tiempo de estancia en el hospital o mortalidad.
ABSTRACT
Introduction: “Post-intensive care syndrome” is a set of health problems that persist after a critical illness, and can last even months or years after discharge, and that include cognitive, physical, and mental symptoms. The ABCDEF bundle has been shown to improve the unwanted effects of the syndrome, improving delirium, mortality data, length of stay in ICU, and above all, being useful in weaning from mechanical ventilation. Objective: Describing whether critically ill patients admitted to intensive care units show signs of improvements in the different components of post-intensive care syndrome after implementing the ABCDEF bundle. Methods: A systematic review of the available literature between 2018 and 2023 was conducted, in the PubMed, Scopus and Web of Science (WOS) databases. Results: Finally, 11 articles were included to be part of this work. Most of the studies analyzed agree that the ABCDEF bundle is useful for minimizing certain components of the post-intensive care syndrome, and other aspects of the disease process of the patient admitted to the ICU. Discussion. The ABCDEF bundle represents an aid in promoting a faster and more complete recovery of critically ill patients. The results improve exponentially with the use of the bundle, according to several authors. It has also been associated with improvements in other secondary aspects such as reducing mechanical ventilation time, length of hospital stay or mortality
by Annyi Tatiana Belalcazar, Valeria Monroy Lasso, José Darío Álvarez Herazo, Ana Clarete, Roger Figueroa-Paz, Duban Maya-Portillo, Julio Diez-Sepúlveda
BackgroundThe Shock Index (SI) is a validated prognostic tool in conditions such as severe trauma and obstetric hemorrhage. During the COVID-19 pandemic, it was used to identify patients at higher risk of clinical deterioration, but results have been inconsistent. This study aimed to evaluate the prognostic value of the SI and its variants in predicting mortality, need for mechanical ventilation, and hospital length of stay in patients with moderate COVID-19.
Methods and findingsThis longitudinal analytical observational study was conducted at a high-complexity hospital in southwestern Colombia and included adults over 18 years of age with moderate COVID-19 treated between 2020 and 2022, using data from the institutional RECOVID registry. A total of 283 patients were analyzed (median age: 61 years; 58.7% male), with cardiovascular and renal comorbidities being predominant. On admission, vital signs were stable (NEWS2: 3.0; shock index: 0.7). ICU admission was required in 29.3% of cases, and overall mortality was 12%. ROC curves and diagnostic accuracy parameters were used to assess the discriminatory ability of the SI and its variants. Most SI variants showed low discriminatory power (AUC Conclusions
Early identification of patients at risk for complications in moderate COVID-19 is essential for optimizing hospital resources. The shock index and its variants showed limited utility as standalone predictors for mortality, ICU admission, and hospital length of stay. Combining SI with other clinical parameters may offer some benefit, but heterogeneity limits generalizability. Future studies should develop and prospectively validate multivariable models integrating clinical, laboratory, and imaging biomarkers.
Objetivo: Interpretar las experiencias vividas del mundo subjetivo en mujeres violentadas por su pareja. Metodología: Estudio cualitativo en base a la Teoría de la Acción Comunicativa, realizado con 14 mujeres que acudieron al Taller de Relaciones Saludables implementado por la Secretaria de Salud de Aguascalientes. Se aplicó una entrevista semi-estructurada conformada por 7 preguntas sobre el mundo subjetivo. Resultados: Se obtuvieron 20 códigos que permitieron definir el siguiente fenómeno: La aceptación de la violencia como un estilo de vida, sin comprender el por qué permitir el abuso, lo cual origina sentimientos de autodestrucción física, emocional y familiar. Conclusiones: La sociedad ha construido una falsa igualdad cultural entre el hombre y la mujer; sin embargo, la ideología de la unión familiar le ha impedido a la mujer que se empodere y decida su forma de vida, esto lo transmiten a sus familias y éstas a su vez educan de tal forma a las mujeres, para que acepten “la vida que les tocó vivir”.
To systematically examine how structural vulnerability has been defined and operationalised in United States-based health research, identify conceptual consistencies and methodological gaps, and propose core dimensions of structural vulnerability along with implications for future application in health research.
A systematic mixed-studies review using a parallel-results convergent synthesis design.
PubMed, Embase, Scopus and CINAHL were searched from first publication through 2024 using the terms ‘structural* vulnerab*’ AND health.
Peer-reviewed English-language empirical studies conducted in the United States that applied the concept of structural vulnerability were identified. The Mixed Methods Appraisal Tool was used to assess study quality. Study content was analysed to identify how structural vulnerability was defined and operationalised.
Thirty-seven predominantly high-quality studies published between 2011 and 2024 met inclusion criteria. Structural vulnerability was consistently defined through two interrelated dimensions: as a social positionality (characterised by constrained resilience, limited agency and imposed risks rooted in systemic discrimination and social hierarchies) and as a critical analytic framework for examining structural determinants of health. Quantitative studies predominantly used individual-level indicators (e.g., income, housing) and cross-sectional designs. Qualitative studies focused on experiences of structural vulnerability in relation to health outcomes and infrequently translated findings into structural interventions. The most frequently studied outcomes were infectious disease, substance use and mental health.
Structural vulnerability, as a conceptual and empirical lens, reveals how systems produce—and can potentially reduce—health risks. Findings underscore the need for geographically diverse and longitudinal studies, as well as multidimensional measures. Advancing health equity demands critiquing systemic causes of inequities and pursuing justice-oriented interventions.
Nursing, positioned at the intersection of public health, social sciences and policy, is uniquely equipped to engage structural vulnerability as a critical analytic tool to address health inequities, design interventions and advocate for policy reform.
What problem did the study address? This study addressed a lack of clarity in the definition and operationalization of structural vulnerability in health research.
What were the main findings? The definition of structural vulnerability is consistent across quantitative and qualitative studies, but there are marked variations in its operationalization. Quantitative studies predominantly rely on individual-level indicators, while qualitative studies use it as a theoretical framework to guide analysis, interpret findings and examine structural determinants of health.
Where and on whom will the research have an impact? This review offers a clear framing for integrating structural vulnerability in health research in efforts to advance health equity.
PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting guideline.
This study did not include patient or public involvement in its design, conduct or reporting.
by Nadeen Ibrahim, Shaifer Jones, Katherine Rich, Lisandra Alvarez, Carolina Price, Natalie Kil, Frederick L. Altice, Jaimie P. Meyer
BackgroundPeople who inject drugs (PWID) experience high risk for HIV and HCV infection, which can be mitigated by harm reduction strategies, including syringe service programs (SSP). Understanding individuals’ patterns of substance use and SSP utilization is important for optimizing harm reduction strategies and disease prevention for PWID.
MethodsWe evaluated demographic characteristics and service utilization from the New Haven Syringe Services Program (NHSSP), a low-threshold service delivery site in New Haven, Connecticut that provides fully integrated harm reduction and primary healthcare services to PWID. Site-specific data were extracted from the e2ctprevention database, managed by the Connecticut Department of Public Health, and EvaluationWeb from January 2017 to October 2023. We conducted a descriptive analysis of basic demographic and social characteristics of SSP clients, transaction characteristics, and service utilization. Statistical analyses were conducted using STATA v 16.1 and IBM SPSS Statistics (v 29.0.2.0).
ResultsAmong 1,189 unique individuals utilizing SSP during the observation period, most (65.2%) identified as men and white (73.3%), consistent with SSP clients regionally and nationally. The mean age of clients was 41 years (SD = 9.8); approximately half of participants were unstably housed and 80% were unemployed at intake. From June 2020 to October 2023, there were 7,238 transactions, which increased throughout the COVID-19 pandemic period. During this period, the program dispensed 1,860,621 syringes, in addition to other materials, including overdose education and naloxone distribution (OEND), and provided patient education on safer injecting techniques and wound care.
ConclusionIn this first comprehensive analysis of a large SSP since its inception and through the COVID-19 pandemic, we described important client characteristics and utilization of an array of syringe services from an integrated SSP. Findings suggest the SSP attracts a high volume of clients, provides on-demand services, and reaches a wide range of clients. Future research is needed to evaluate the impact of the program’s home-delivery service and increased outreach efforts. Despite limitations, the program’s success demonstrates the SSP can serve as a model for other harm reduction programs nationally.
Climate change has serious consequences for the morbidity and mortality of older adults.
To identify the effects of climate change on older people's health.
A scoping review was conducted following the Joanna Briggs Institute guidelines and the PRISMA-ScR checklist. Quantitative research and reports from organizations describing the effects of climate change on older people were selected.
Sixty-three full-text documents were selected. Heat and air pollution were the two factors that had the most negative effects on cardiovascular and respiratory morbidity and mortality in older people. Mental health and cognitive function were also affected.
Climate change affects several health problems in older individuals, especially high temperatures and air pollution. Nursing professionals must have the necessary skills to respond to the climate risks in older adults. More instruments are required to determine nursing competencies on climate change and the health of this population group.
No patient or public contribution.
FreshRSS 