Conectar
by Dominika Buni, Áron Botond Kovács, Enikő Wehmann, Dénes Grózner, Krisztián Bányai, Eszter Zsófia Nagy, Janet Bradbury, Marco Bottinelli, Elisabetta Stefani, Salvatore Catania, Inna Lysnyansky, László Kovács, Miklós Gyuranecz, Zsuzsa Kreizinger
Mycoplasma iowae is an economically significant pathogen that causes reduced hatchability, late embryo mortality and leg deformities, chondrodystrophy and skeletal lesions in poults. While prevention is essential in the control of infection, the appropriate administration of antibiotics may reduce economic losses during outbreaks. As a first step in the exploration of antimicrobial resistance mechanisms in M. iowae, target modification and efflux pump activity were examined in the present study. Point mutations were analyzed in previously described antibiotic binding sites in the whole genome sequences of 99 M. iowae strains. Mismatch amplification mutation assays (MAMAs) were designed and validated for the differentiation of mutations corresponding to elevated minimum inhibitory concentration (MIC) values for fluoroquinolones. Broth microdilution assays were performed to evaluate the effect of efflux pump inhibitors. In the presence of orthovanadate (OV), MIC values were significantly lower than in the absence of OV for spiramycin, tilmicosin, tylosin and oxytetracycline, which may indicate the presence of an active efflux system in M. iowae. Putative promoter regions of efflux-related genes were predicted and characterized. Genetic mutations, previously described in other bacteria, were described to be associated with elevated fluoroquinolone, macrolide and lincomycin MICs in M. iowae, although certain resistant phenotypes remained unexplained, promoting future examinations for deeper insights. The developed MAMAs may support rapid identification of M. iowae strains with elevated MIC values for fluoroquinolones. The better understanding of the efflux pump mechanisms enables the development of alternative methods for the support of therapy against this pathogen.by Yaa Abrafi Ankomah, Bright Anneh Awaitey, Moses Monday Omoniyi, Benjamin Asamoah, Obed Kwame Numadzi, Kwofie Robert Amoah, Joel Innocent Goli
BackgroundPregnancy and childbirth increase the risk of pelvic floor muscle damage, leading to conditions such as urinary incontinence, fecal incontinence, and pelvic organ prolapse. This makes it imperative to adopt strategies such as pelvic floor muscle exercises (PFMEs) to ensure positive antenatal and postnatal experiences for women. Hence, the study aimed to assess the awareness, knowledge, practices, and beliefs of PFMEs among pregnant women in a Ghanaian setting.
ObjectiveWe assessed the awareness, knowledge, practices and beliefs of PFMEs among pregnant women in a Ghanaian setting.
DesignA cross-sectional descriptive research was conducted, recruiting 134 pregnant women through convenient sampling in selected antenatal clinics in Kumasi metropolis, Ashanti Region.
MethodsThe study adopted the questionnaire regarding pelvic floor muscle training among pregnant women used by Teerayut Temtanakitpaisan, Suvit Bunyavejchevin, Pranom Buppasiri and Chompilas Chongsomcha. Data on the socio-demographic characteristics of the women, their awareness, knowledge, beliefs and practices about PFMEs were recorded.
ResultsMore than half (64.9%) of the respondents were not aware of PFMEs. Subsequent analysis for this work was therefore done for participants who reported being aware (35.1%). Also, the principal sources of information from which the subjects acquired the knowledge of PFME were health-care providers (42.6%) and media outside the hospital (36.2%). With reference to beliefs 80.3% believed that PFME could reduce vaginal trauma and 83.0% believe PFME aids vaginal birth. In terms of PFME practice, 36.2% of the aware women performed PFME regularly.
ConclusionTo ensure pregnant women are well-informed about PFMEs, physiotherapists should work with antenatal care providers to develop comprehensive courses that include detailed information on PFME’s.
by Ayesha Bibi, Muhammad Hamza Afandi, Azra Mehmood, Usman Ali Ashfaq, Muhammad Shareef Masoud, Mohsin Ahmad Khan, Rashid Bhatti
Hepatocellular carcinoma (HCC) has a very significant mortality rate and is one of the most common cancers worldwide. Jacaranda mimosifolia is reported to have potential antitumor activities against various human cancers. However, the effects of J. mimosifolia on HCC are yet elusive. This study aimed to investigate the anti-HCC potential of methanolic extract of J. mimosifolia leaves using in vitro and in vivo studies and a network pharmacology approach. The effect of J. mimosifolia extract was assessed on Huh-7.5 cells using MTT assay, wound healing assay, and DNA fragmentation assay. These experiments found that J. mimosifolia extract significantly suppressed Huh-7.5 cell proliferation, impaired cell migration, and induced cell apoptosis. The real-time PCR validated the upregulation of p53 and Bax, alongside the downregulation of AFP and GPC3 in Huh-7.5 cells after treatment with J. mimosifolia extract. In vivo experiments confirmed the hepatoprotective effects of J. mimosifolia extract in mice models with CCl4-induced hepatic injury. In addition, through network pharmacological analysis, J. mimosifolia was found to play a critical role against HCC via targeting multiple potential targets and pathways. Docking analysis identified apigenin and kaempferol with the lowest binding energy against PTGS2 and EGFR, respectively, while flavonol glycoside showed the lowest binding energy against MMP9. However, detailed research is needed to isolate the potential phytochemicals from J. mimosifolia against HCC.by Mary Yeboah, Richard Abeiku Bonney, Loretta Adu-Boahemaa Antwi, Pius Amponsah Anane, Obed Kwabena Offe Amponsah, Peter Agyei-Baffour
BackgroundNon-communicable diseases (NCDs) cause 74% of global deaths, disproportionately affecting LMICs like Ghana. Chronic treatment remains hindered by medicine shortages and high costs, consuming over 50% of the minimum wage incomes. Despite Ghana’s NCD policies, supply chain gaps and price inflation persist. This study assesses access to medicine, operationally defined as availability and affordability, in three municipalities to inform reforms for Universal Health Coverage and achieve SDG 3.4 targets.
MethodsThis cross-sectional mixed study assessed the availability and affordability of NCD medicines in three municipalities in Ghana using WHO/HAI methods. Data on 62 medicines were collected from nine health facilities, supplemented by interviews with pharmacy managers.
ResultsThis study assessed access to NCD medicines across three municipalities in Ghana, revealing stark disparities. Availability varied significantly by location (Oforikrom 70% vs. Juaben 48.6%, p Conclusion
This study highlights inequities in access to NCD medicines in Ghana, with stark gaps in availability and affordability, especially in underserved areas. Findings reveal high costs, stock-outs, and geographic disparities as key factors, underscoring the need for supply chain reforms, price regulation, and municipal oversight to advance equitable, sustainable, universal health coverage.
The research investigated the relationship between servant leadership (SL) and innovative work behavior (IWB) among nurses in Pakistan. It also formulates and hypothesizes a serial mediation model, integrating trust-in leadership (TL) and knowledge sharing (KS) as mediated variables.
Nurses' IWBs are critical for improving patient healthcare quality. Despite their significance, scant research has examined how leadership styles, especially SL, can trigger such behavior in nursing. The paper seeks to fill this gap by examining how SL can enhance innovation among nurses, while accounting for the mediating variables of TL and KS within the Pakistani healthcare system.
A quantitative, cross-sectional study was conducted, involving 269 nurses from hospitals in Islamabad and Rawalpindi. A time-lagged approach to data collection was used to reduce common method bias. Confirmatory Factor Analysis (CFA) and Structural Equation Modeling (SEM) were employed to test the proposed hypothesized relationships using SPSS (version 27) and AMOS (version 23).
The hypotheses revealed a significant impact of the constructs. It was discovered that SL has both direct and indirect positive influences on IWB among nurses through TL and KS. Moreover, the findings support high serial mediation, implying that SL has a positive effect on IWB by first building trust, which then leads to knowledge sharing.
The paper contributes to the literature on servant leadership and innovative work behavior by examining mediating mechanisms within nursing teams in Pakistan. The paper also offers practical implications for nurse managers and hospital administrators on fostering a culture of innovation and trust among nurses.
The findings offer actionable insights for nursing management by demonstrating that adopting a servant leadership style can directly and indirectly enhance nurses' innovative work behaviors. By prioritizing trust-building and fostering a culture of knowledge sharing, nurse managers can stimulate innovation, which is critical for improving patient care quality and overall healthcare outcomes.
by Saad Al-Lahhaam, Raghad Dweikat, Tala Nazzal, Aman Maraqa, Joud Khalil, Tala Albadawi, Raghad Doufish, Wa'd Amer, Mustafa Ghanim, Mohammad Abuawad, Amer Ghrouz, Samar Alkhaldi, Laith El-lahham, Majdi Dwikat, Maha Rabayaa, Malik Alqub
BackgroundTinnitus is a prevalent condition worldwide, particularly among adolescents, that has a substantial impact on quality of life, yet it remains an understudied issue.
ObjectivesThis study aims to determine the prevalence of tinnitus and its associated risk factors among Palestinian adolescents aged 15–18.
MethodsA cross-sectional study was conducted from January to March 2025. A convenience sample of participants was recruited. The study utilized the European School for the Interdisciplinary Tinnitus Research Screening Questionnaire.
ResultsA total of 1,131 participants were enrolled in the study, with 64.5% being females. The prevalence of tinnitus among the study sample was 532, representing 47% of the population. Females had a higher prevalence of tinnitus, with 370 affected (50.7%) compared to males (40.4%). Significant associations were found between tinnitus and several factors: age, positive family history of tinnitus (threefold increased risk), sensitivity to external sounds (2.7 times higher likelihood), slight hearing difficulty in noisy environments (1.7 times higher risk), pain symptoms (double the risk), and difficulty falling asleep (1.8 times higher risk). Notably, the majority of affected participants (71.5%) had never sought professional care for their tinnitus.
ConclusionAlthough Tinnitus is common among Palestinian adolescents aged 15–18 years, the majority of affected participants did not seek professional care for tinnitus. These findings highlight the importance of conducting further research to shed insight into this prevalent and neglected health priority.
by Obed Kwaku Duah Asumadu, Gilbert Abotisem Abiiro, Joyce Aputere Ndago, David Abatanie Kanligi, Martin Nyaaba Adokiya
IntroductionGlobally, the COVID-19 pandemic significantly impacted the provision of maternal health services, especially facility-based delivery. However, there is little evidence on the proportion of women who delivered at the health facility in various locations and the factors that influenced women’s decision-making in choosing a place of delivery during and amid the COVID-19 restrictions. Therefore, this study assessed the prevalence and factors associated with health facility delivery during the COVID-19 pandemic in the Tamale Metropolis of Ghana.
MethodsAn analytical cross-sectional study design was conducted. A multistage sampling technique was used in selecting the study communities. At the individual level, random sampling technique was applied, and 461 women were recruited from 21st February 2021–21st March 2021. Using a questionnaire, a face-to-face approach was used to conduct the interviews. The questionnaire included questions on socio-demographic characteristics, place of childbirth and factors that led to the choice of delivery place. Using Statistical Package for Social Sciences version 25, descriptive and binary logistic regression analysis were conducted.
ResultsThe results revealed that 64.0% of the women delivered in health facilities during the pandemic. Health facility delivery was more likely to occur among women with higher educational status (AOR: 5.2; 95% CI: 1.40–19.40), married women (AOR:6.3; 95% C.I:1.10–35.80), active National Health Insurance Scheme holders during delivery (AOR: 13.8; 95% C.I: 4.60–41.90), women who received education on birth preparedness and complication readiness (AOR: 7.6; 95% C.I:3.30–17.50) and women with underlying conditions before pregnancy (AOR:3.3; 95% C.I:1.20–9.20). There were reduced odds of health facility delivery among women with a history of home delivery (AOR:0.2; 95% C.I:0.10–0.50), when the mother-in-law decides on the place of delivery (AOR:0.1; 95% C.I:0.03–0.50), longer distance to the place of delivery (AOR:0.3; 95% C.I:0.01–1.00) and when women perceived COVID-19 as a barrier to facility delivery (AOR:0.1; 95% C.I:0.03–0.20).
ConclusionOur findings show that health facility delivery declined during COVID-19. Factors that affected health facility delivery were educational status, marriage, having an active National Health Insurance Scheme, education on birth preparedness and complication readiness, underlying conditions before pregnancy, history of home delivery, mother-in-law decision on place of delivery, distance to place of delivery and perceiving COVID-19 as a barrier to facility delivery. These contributed to low facility delivery. Thus, maternal health services need to be brought to the doorsteps of communities, including proper implementation of the Focused Antenatal Care and community-based pregnancy school programmes, especially during future pandemics.
by Zoya Waqas, Aisha Irum, Muhammad Ibrahim, Maheen Sughra, Sanaa Khan, Ayesha Khan, Adnan Ahmad Khan
IntroductionUnintended pregnancies remain a major public health concern globally and in Pakistan, where family planning (FP) uptake continues to be hindered by entrenched social and behavioral barriers. This study applies the Theory of Planned Behavior (TPB) to examine how attitudes, subjective norms, and perceived behavioral control (PBC) shape women’s contraceptive intentions in Pakistan.
MethodsWe analyzed data from 13,335 non-pregnant women aged 15–49 using the Pakistan Demographic and Health Survey (PDHS) 2017–18. Partial Least Squares Structural Equation Modeling (PLS-SEM) was used to test TPB pathways. Model reliability, validity, and fit were assessed using Composite Reliability, Average Variance Extracted, discriminant validity indices, and bootstrapped estimates to ensure analytical rigor.
ResultsOver half of respondents lacked formal education, and most (84%) were unemployed. Only 23% had FP knowledge, and 96% were unaware of contraceptive side effects. Subjective norms negatively influenced contraceptive intentions (β = −0.056, p Conclusion
The study demonstrates the applicability of TPB for understanding contraceptive intentions in a collectivist, patriarchal context. Subjective norms and PBC emerge as critical determinants, underscoring the need for interventions that engage families, strengthen women’s autonomy, and improve access to FP services. The findings offer a theoretically grounded and policy-relevant framework for designing behaviorally informed family planning programs in Pakistan.
by Shamal Ali Othman, Dalshad Kakasor Ismael Jaff, Ahmet Öztaş
Construction projects are exposed to numerous risks that may adversely affect project cost and duration. The purpose of this study is to identify and prioritize key construction risks by combining a Work Breakdown Structure (WBS) with a Risk Breakdown Structure (RBS) and analyzing these risks using two-dimensional (2D) and three-dimensional (3D) risk matrices. In total, 63 risk factors were identified and categorized into five main areas of the work breakdown structure: earthwork, concrete, finishing, mechanical, and electrical. The questionnaire was designed based on each risk category and then sent to engineers, who were asked to estimate the risk probability and its impact. In total, 378 engineers responded. The respondents data were analyzed by using the risk matrix method. Two separate 3D risk matrices were made: one was based on multiplying all three data points, and the other was based on combining both impacts. The results clearly show that the 3D matrix, which combines cost and time impact, yields more accurate results than the matrix that multiplies cost impact and time impact.Chronic kidney disease (CKD) is a significant public health problem that requires effective preventive and conservative methods to limit morbidity and death.
This study aims to give clinical practice an evidence-based basis for the clinical practice of healthcare professionals by methodically looking for the best available data on conservative strategies and CKD prevention in high-risk and early-stage patients.
The 6S evidence resource model was followed and states that evidence retrieval was done top-down, gathering necessary studies from January 2014 to July 30, 2024. Databases searched included BMJ Best Practice, DynaMed, NICE, GIN, SIGN, JBI Evidence Synthesis, JBI Evidence Implementation, Cochrane Library, and PubMed. Following the JBI grade of evidence and recommendation methodology, two reviewers independently examined and assessed the literature, extracting and summarizing evidence.
Seventy-nine publications were identified: 18 guidelines, 1 randomized controlled trial, 2 expert consensus statements, 36 evidence summaries, and 22 systematic reviews and meta-analyses. Key findings were summarized across eight aspects: risk assessment and early detection, risk factors and prevention of genetic factors, management of diabetic nephrology, impact of bariatric surgery on preventing CKD, screening and diagnosis, treatment and prevention strategies, lifestyle modifications, and CKD prevention.
This study summarized the best evidence for preventing CKD from eight aspects, which can help clinical or community medical professionals develop and apply CKD preventive strategies for high-risk groups and early-stage patients. By using these evidence-based strategies, healthcare professionals can reduce the incidence and progression of CKD, leading to fewer hospitalizations, improved kidney function preservation, and enhanced long-term survival and quality of life for patients. Future research should address identified gaps and explore the implementation of these strategies in diverse clinical settings.
by Md. Masud Reza, Hasibul Hasan Shanto, Samira Dishti Irfan, A. K. M. Masud Rana, Mohammad Niaz Morshed Khan, Golam Sarwar, Mohammad Sha Al Imran, Mahbubur Rahman, Md. Safiullah Sarker, Muntasir Alam, Md. Abu Hena Chowdhury, Mustafizur Rahman, Sharful Islam Khan
BackgroundUnintended pregnancy among female sex workers (FSW) is a pressing reproductive health concern attributable to risky sexual behaviors, healthcare inequities and poor negotiation powers with male sex partners. However, evidence is scarce on the prevalence and determinants of unintended pregnancies among FSW, which is crucial for enhancing reproductive healthcare. This analysis aims to measure the prevalence of lifetime unintended pregnancies and their associated factors.
MethodsA cross-sectional study was conducted on 327 FSW in Jashore (a border belt district of Bangladesh) from September 2022 to March 2023. Participants were recruited through take-all sampling. Data were collected on the lifetime history of unintended pregnancies and other relevant variables through face-to-face interviews. Chi-square statistic was used to compare the characteristics of FSW reporting unintended pregnancies. To assess the net association of factors associated with unintended pregnancy, multiple logistic regression was applied.
ResultThe lifetime prevalence of unintended pregnancies was reported at 75.8% (95%CI: 71.0–80.1). Among those who reported unintended pregnancies, 37.1% (95%CI: 30.8–43.8) had no education, 39.9% (95%CI: 32.8–47.5) were 25–34 years old, 49.6% (95%CI: 39.3–59.9) were currently married and 62.9% (95%CI: 49.7–74.4) earned ≤10,000 BDT per month compared to those who did not report lifetime unintended pregnancies. The likelihood of unintended pregnancies was significantly higher among those who reported having sex with non-transactional male sex partners (AOR: 2.4, 95%CI: 1.1–5.3, p = 0.036) than those who never had sex with any non-transactional male sex partner. The likelihood was also higher among those who reported rape in their lifetime (AOR: 2.0, 95%CI: 1.0–3.8, p = 0.037) and who self-reported mental health problems (AOR: 2.1, 95%CI: 1.0–4.2, p = 0.045) within the past year, compared to their counterparts.
ConclusionThis study highlights the considerable prevalence and associated determinants of unintended pregnancies among FSW in Jashore. These determinants need to be considered to strengthen reproductive healthcare interventions and policies for FSW. Reproductive health of FSW cannot be improved unless these factors are addressed in the ongoing interventions.
by David A. Green, Jesse M. Maestas, Jessica N. Sanchez, Nathan C. Nieto, Andrew S. Bridges, David K. Garcelon
The San Clemente Island fox (Urocyon littoralis clementae) is classified as a focal species for conservation management by the US Navy. They are considered vulnerable to a variety of vector-borne diseases due to their relatively high population density and low genetic diversity. During the dry (July–November) and wet (December–February) seasons of 2017–2018 we live-trapped 95 foxes and collected ectoparasites to test for the presence of pathogens. We found a significant difference in ectoparasite abundance on foxes between seasons, but no differences associated with sex or age. We found that foxes carried two species of flea (Echidnophaga gallinacea and Orchopeas howardi) and two tick species (Ixodes pacificus and Ixodes jellisoni). No evidence of Borrelia burgdorferi, Anaplasma phagocytophilum, or Borrelia miyamotoi bacteria were found. This paper is the first account of ectoparasite species identification, quantification, and pathogen testing for the San Clemente Island fox subspecies.To explore how public health nurses at child and family health clinics work to prevent maltreatment and the experiences of public health nurses in the maltreatment prevention efforts.
Child maltreatment is a serious societal issue with major consequences. Preventive efforts are increasing and have broad political support. A key objective of the child and family health clinic services is to prevent, identify, and stop maltreatment, abuse, and neglect. National clinical guidelines outline, in general terms, how such work should be conducted. However, limited research exists on how public health nurses prevent maltreatment and the effectiveness of their methods.
A qualitative and explorative design was used, based on semi-structured interviews with 14 public health nurses conducted as part of the project ‘Public Health Nurses in Child and Family Clinics' Role in Preventing and Detecting Child Maltreatment’ at Oslo Metropolitan University. The interviews were carried out between August and November 2021. We used qualitative content analysis with an inductive approach to analyse the data.
Three main categories were developed: 1. Structure and system: weaving prevention into daily practice; 2. To dare and endure: a negotiation of courage and understanding, and 3. To empower and uphold: the goal of strengthening and supporting parents. The results show the importance of early intervention, barriers to discussing maltreatment with parents, and the importance of building trust and empowering parents.
Preventing maltreatment is a key part of public health nurses' clinical work, focusing on early risk identification and parental guidance. While building trust with families is prioritised, structural, resource, and guideline-related challenges persist.
This study provides knowledge about Norwegian public health nurses clinical work with child maltreatment at the child and family health clinics, which can serve as a valuable foundation for further research as well as for collaborating services.
EQUATOR guidelines were followed, using the COREQ checklist.
No patient or public contribution.
by Yeahyea Ahmed, Md Abdullah Saeed Khan, Laila Afroz, Mohammad Nurunnabi, Md Golam Abbas
BackgroundStreet adolescents often engage in early sexual activity, have multiple partners, and are at high risk of sexual abuse and exploitation. Despite the significance of this issue, there is a critical gap in understanding the sexual and reproductive health (SRH) needs, practices, and challenges of this marginalized population in Bangladesh, which this study aimed to explore.
MethodsA cross-sectional study was conducted from August to December 2023, involving 311 street adolescents aged 16–19 years in Sylhet City Corporation, Bangladesh. Data were collected through face-to-face interviews using a semi-structured questionnaire. The questionnaire covered sociodemographic characteristics, pubertal changes, SRH status, and SRH-seeking behaviors.
ResultsOf all participants, 62.8% were males and 37.2% were females, with a mean age of approximately 17.3 years for both sexes. Sexual intercourse was reported by 32.56% of participants, with a significant gender disparity (76.79% females vs. 6.35% males, p Conclusion
Street adolescents in Sylhet City face severe SRH challenges, including high rates of sexual abuse, low contraceptive use, and limited STD knowledge, with significant gender disparities, which should be addressed through appropriate and urgent interventions.
by Nurin Yasmin Mohd Khairudin, Awla Mohd Azraai, Rosfaiizah Siran, Nasibah Azme
Genistein is an isoflavone phytoestrogen that is considered a nutraceutical compound found in soybean. The mimicking of estrogen effects includes the ability to bind to the intracellular and cell membrane receptors of estrogen and exert biological functions like antitumor, anti-inflammatory, anti-oxidative, and antiproliferative properties. With more studies focusing on the therapeutic effect of genistein, both in vitro and in vivo, it is evident that genistein acts through multiple pathways including anti-apoptotic, anti-inflammatory, and anti-oxidative. As the effects of stroke are affecting more people and causing devastating repercussions, this warrants genistein to be utilized as a therapeutic drug. Therefore, further studies are due on the effects of genistein on humans so that clinical trials can be carried out for long-term benefits. This review encompasses various studies regarding the potential neuroprotective effects of genistein on cerebral stroke, examining both in vitro and in vivo experimental models. Four database searches: Web of Science (WoS), Scopus, PUBMED and Science Direct were searched from 1st January 1999 until 31st October 2025. The initial datasets identified through the database search yielded a total of 549 publications and 341 publications were finalized after removing duplicates. In the initial screening, a total of 293 studies were excluded due to their irrelevance to the main objective of this study. After assessing the suitability of the studies and following the PRISMA guidelines, a total of 31 articles were found to be suitable and systematically reviewed. Findings demonstrated the major mechanistic pathways involved in the therapeutic action of genistein are anti-apoptotic, anti-inflammatory, and anti-oxidative. Each of these mechanisms is governed by specific pathways, which will be thoroughly discussed, indicating that genistein can be effective as a therapeutic drug in ischemic stroke.To reflect on ethnography as a qualitative research methodology in nursing, examining its conceptual, theoretical and practical applications. It offers insights into its effective adoption in nursing research, particularly in culturally diverse healthcare settings, emphasising the integration of ethnonursing and critical ethnography.
This methodological reflection draws on the author's research experience and extensive review of ethnography's principles and practices.
This paper examines key components of ethnography, including participant observation, semi-structured interviews and field notes. Ethical considerations, data analysis processes and strategies to ensure trustworthiness and reflexivity are discussed. Special attention is given to the application of ethnonursing in culturally specific care and the use of critical ethnography to analyse power dynamics and institutional structures.
Ethnography, particularly ethnonursing and critical ethnography, provides an invaluable framework for understanding healthcare's cultural and social dynamics. The paper presents reflections on methodological challenges encountered during an ethnographic study of neonatal intensive care units in Jordan, offering practical insights for nursing researchers.
Ethnography enables nursing researchers to explore the complexities of human experiences within cultural contexts, contributing to the advancement of culturally informed and evidence-based nursing practices. The combination of ethnonursing and critical ethnography enhances the ability to uncover both cultural influences on care and the structural factors shaping healthcare experiences.
This paper provides methodological insights that can guide nursing researchers to adopt ethnography effectively, promote culturally sensitive care that aligns with patients' social and cultural needs, and contribute to healthcare equity and improved patient outcomes.
This paper follows the COREQ (Consolidated Criteria for Reporting Qualitative Research) guidelines.
No patient or public contribution.
by Saleh A. Alqahtani, Shadan AlMuhaidib, Dimitri A. Raptis, Waleed K. Al-Hamoudi, K. Rajender Reddy, Dieter C. Broering, Saad A. Alghamdi, The OTCE Collaborative
BackgroundLiver transplantation (LT) represents the life-saving treatment for advanced liver disease. We aim to investigate LT indication trends and outcomes in Saudi Arabia, following the evolution of effective therapies for hepatitis C virus (HCV) and the rising fatty liver disease prevalence.
MethodsWe retrospectively analyzed data from adult patients who underwent LT from 2011 to 2023 at a tertiary referral center in Saudi Arabia. We assessed demographics, LT indication trends, Model for End-stage Liver Disease (MELD) scores, donor type, and survival outcomes.
ResultsA total of 1,419 patients were included. The median age was 56.9 years, with 37.4% female. Living donor LT (LDLT) represented 79.8% of all transplants, and 22.0% of recipients had hepatocellular carcinoma (HCC). Metabolic dysfunction-associated steatohepatitis (MASH) was the predominant indication for LT (33.2%), followed by HCV (18.0%) and hepatitis B virus (HBV) (17.1%). Overall survival rates at 1-, 2-, 3-, 5-, and 10-years post-transplantation were 87.9%, 85.0%, 82.4%, 77.7%, and 71.3%, respectively. Hazard ratios (HR) for mortality were lower in patients with HBV compared to MASH (HR: 0.44, 95% CI: 0.28–0.69, p Conclusions
MASH represents the leading indication for LT in this large cohort, necessitating preventive strategies and early detection efforts.
by Mohajit Arneja, Swetharajan Gunasekar, Dharaneswari Hari Narayanan, Joshma Joseph, Harilalith Kovvuri, Sharath Shanmugam, Pavitraa Saravana Kumar, Asuwin Anandaram, Vinod Kumar Balakrishnan, Jayanty Venkata Balasubramaniyan, Sadhanandham Shanmugasundaram, Sankaran Ramesh, Nagendra Boopathy Senguttuvan
BackgroundFaster time to reperfusion can be achieved by minimizing various patient and system-level delays that contribute to total ischemic time. Procedural delays within the catheterization laboratory represent a non-negligible and modifiable component in the chain of reperfusion, but remain unquantified by conventional metrics such as door-to-ballon (D2B) time. Universal catheter approaches have rapidly gained traction as an alternative to the traditional two catheter approach for transradial coronary interventions. However, their utility for both diagnostic angiography and subsequent angioplasty is limited, and the impact of this strategy on reperfusion outcomes has remained unexplored. We utilized a procedural metric termed fluoroscopy-to-device (FluTD) time to quantify the efficiency of a single catheter strategy, and assessed its impact on epicardial and myocardial perfusion.
Methods and resultsIn this retrospective study, consecutive STEMI patients undergoing transradial primary PCI (pPCI) at a tertiary care center in India between May 2022 to October 2024 were analyzed. Patients were divided into two groups: 51 underwent PCI using a single universal guiding catheter (UGC), and 51 underwent the conventional two-catheter (CTC) approach. The primary outcome of the study was a comparison of the FluTD time between the two procedural strategies. Secondary outcomes included myocardial blush grade (MBG), Thrombolysis in Myocardial Infarction (TIMI) flow grade, total fluoroscopy time, radiation dose, device safety and efficacy, and procedural success.The median FluTD time was significantly shorter in the UGC compared to the CTC group (3 minutes [IQR 3–4] vs. 10 minutes [IQR 8–17], p Conclusion
A single catheter strategy for both angiography and pPCI in STEMI patients was associated with a significant reduction in FluTD time and improved microvascular perfusion, without compromising device safety or efficacy. In low- and middle-income countries (LMICs), where intra- and extra-procedural delays are often more pronounced, inclusion of the single catheter strategy can optimize catheterization workflows and yield substantial cost-savings.
Spiritual well-being (SpWB) is a critical yet often underexplored component of holistic care for patients with advanced cancer. This study aimed to assess the SpWB and quality of life (QOL) levels and examine their correlation among patients receiving palliative care at a tertiary cancer centre in Kerala, India.
Institution-based cross-sectional observational study among patients with advanced cancer conducted between August 2023 and December 2024.
The outpatient department of a major tertiary-level, autonomous cancer centre under the Government of Kerala, India.
398 patients with advanced cancer aged 18 and above.
SpWB and QOL were measured using validated Malayalam versions of the Functional Assessment of Chronic Illness Therapy–Spiritual well-being Expanded Version and European Organisation for Research and Treatment of Cancer, Quality of Life Core 30 questionnaires, respectively. Data collection included patient self-reports or assistance by a medical social worker.
The median (IQR) age of participants was 59 (51–65) years; most were married (94.5%) and from an upper-lower socioeconomic background (55%). Hinduism was the predominant religion (67.1%). Almost all patients (99%) were aware of their diagnosis, but only 62.3% knew their prognosis. The median (IQR) SpWB score was 67.5 (57–76), significantly higher in females (p=0.02). The median (IQR) QOL score was 50 (41.7–66.7). SpWB was positively correlated with QOL (r=0.766, p
SpWB showed a strong positive correlation with QOL among patients with advanced cancer. Enhancing SpWB may play a pivotal role in improving overall QOL in palliative care settings.
by Bwambale Jonani, Emmanuel Charles Kasule, Bwire Roman Herman, Joel Fredrick Arturo, Mwesigwa Calvin Mugambwa, Ssebulime Stephen, John Bosco Mundaka, Richard Kwizera, Gerald Mboowa, Felix Bongomin
IntroductionSickle Cell Anemia (SCA) is a significant genetic disorder in Africa; however, comprehensive data on its prevalence and geographic distribution remain limited. We aimed to estimate the pooled prevalence of SCA (HbSS) in African populations and examine regional, demographic, and temporal variations from 1994–2024.
MethodsWe systematically searched PubMed, Scopus, Google Scholar, and BASE databases for studies reporting SCA prevalence in African populations. Screening and quality assessments were performed using JBI tools. A random-effects meta-analysis with logit transformation was performed, with subgroup analyses by region, age, sex, and study design. Meta-regression explored heterogeneity sources, including geographic region, age category, diagnostic method, study design, and publication year.
ResultsFrom 115 studies with 1,203,839 participants and 17,458 confirmed HbSS cases, the pooled prevalence was 1.43% (95% CI: 1.08%–1.88%), with substantial heterogeneity (I2 = 99.1%) and a prediction interval of 0.21%–8.91%. Central Africa showed the highest prevalence (1.99%), and Southern Africa showed the lowest (0.59%). Children exhibited a higher prevalence (1.65%) than adults (0.45%), while sex differences were non-significant (males 2.71%, females 1.74%; p = 0.694). The prevalence has remained stable over three decades despite a six-fold increase in research output, although wide prediction intervals indicated substantial between-study variability. Electrophoretic techniques predominated (86.4% of cases). Diagnostic method (χ² = 16.73, p = 0.033) and age category (χ² = 33.66, p 2 = 98.6%). Leave-one-out sensitivity analysis showed that no single study significantly impacted the pooled estimates.
ConclusionSCA represents a substantial and geographically variable public health challenge across Africa. These findings highlight the need for region-specific interventions, expanded newborn screening programs, improved diagnostic accessibility with quality assurance for point-of-care technologies, and continued surveillance to address geographic gaps.
FreshRSS 