Conectar
The Lao People’s Democratic Republic (PDR) faces the significant public health challenges of high cervical cancer incidence and suboptimal human papillomavirus (HPV) vaccine coverage alongside broader adolescent health concerns such as high adolescent pregnancy rates and inadequate sexual and reproductive health (SRH) literacy. This study protocol outlines an approach to address these interconnected issues comprehensively by evaluating an integrated service delivery model.
This study employed a quasi-experimental design with mixed methods to assess the impact of an integrated service package comprising HPV vaccination and improved adolescent health services in two districts of Louangnamtha province in Lao PDR. The study population included girls aged 10–13 years for HPV vaccination and boys and girls aged 10–13 years for other adolescent health services. The intervention district received this integrated service package delivered through school-based, facility-based and outreach approaches. The comparison district continued with its standard HPV vaccination and routine adolescent health service delivery, which does not include the additional refresher training, comprehensive sexuality education or dedicated SRH outreach services provided in the intervention district.
The intervention period was 7 months, from November 2024 to May 2025. Quantitative data on HPV vaccine uptake, SRH knowledge and attitudes and utilisation of adolescent health services were collected at baseline, midline (at 3 months) and endline (at 7 months). Qualitative data on barriers and facilitators to implementation, provider workload and capacity, and stakeholder perceptions were collected through in-depth interviews and focus group discussions with adolescents, caregivers, healthcare providers, educators, community leaders and policymakers at endline.
Ethical approval for the study has been received from the University of Health Sciences Research Ethics Committee in Laos (ID: 833/REC, dated 4 September 2024). Informed consent was obtained from all participants or their legal guardians. Findings will be disseminated through academic publications, policy briefs, workshops and community engagement activities to inform policies and practices in Lao PDR and contribute to the global knowledge base on integrated service delivery models.
Globally, 8 million people experience conditions for which rehabilitation services can be beneficial. These services are considered an essential health service for the attainment of Universal Health Coverage. According to the Nepal Demographic and Health Survey 2022 report, 23% of the population has some type of functional disability, among whom 6% have total functional disability. This study aims to assess the readiness of rehabilitation services, knowledge of health workers, experience of service recipients and policy framework.
A mixed-methods study design will be conducted to assess the readiness for rehabilitation services over a period of 2 years, from July 2024 to 2026. This study protocol will examine the status of rehabilitation services, knowledge and skill gap of health workers, experiences of elderly and persons with disabilities for rehabilitation service utilisation. Similarly, the perception and experience of stakeholders working in the service sector will be assessed through key informant interviews. The participants of the current study will be 23 health facilities, more than 300 health workers in primary healthcare centre in Karnali and a convenience sample of elderly and disabled population. Furthermore, the study will explore (1) facility readiness index by domain; (2) health worker knowledge/practice score; (3) user-reported barriers; and (4) qualitative themes around governance/financing/workforce/WHO health system building blocks. The study team has designed a study protocol and conducted pre-testing in a similar setting.
The present study was approved by Nepal Health Research Council (Ref #49, 21 July 2024). Prior to ethical approval, the study team obtained approval from the Ministry of Social Development, Karnali Province. Informed consent was obtained from all the participants involved in the study. All collected data will be used solely for study purposes. The findings of the study will be published as a report from the Publication of the Ministry of Social Development, and major findings will be published in the Journal.
by Agazhe Aemro, Alebachew Ferede Zegeye, Enyew Getaneh Mekonen, Yilkal Abebaw Wassie, Mequannent Sharew Melaku, Basazinew Chekol Demilew
BackgroundHIV testing is an essential component of HIV prevention and care, yet lifetime testing frequency remains low in sub-Saharan Africa (SSA). This study examines the factors influencing lifetime HIV testing frequency among reproductive-age women in SSA.
MethodsWe analyzed the most recent Demographic and Health Survey (DHS) data from nine sub-Saharan African countries, with an overall weighted sample of 158,722 women aged 15–49. The dependent variable was the lifetime number of HIV tests, and Zero-Inflated Negative Binomial (ZINB) regression was used. Model selection was based on Akaike Information Criterion (AIC) or Bayesian Information Criterion (BIC) and Vuong’s test, favoring the ZINB model over other count models. Adjusted incidence rate ratios (aIRRs) for the count and aOR for the inflation part with 95% confidence intervals (CIs) were reported, with statistical significance set at p Results
The mean number of lifetime HIV tests was 2.49 (SD = 7.67), with a median of 0 (IQR = 0–3). Key predictors of lifetime HIV testing included: age (30–39 years: aIRR = 2.94; 40–49 years: aIRR = 3.14), rural residence (aIRR = 1.10), current or former union (aIRR = 1.37 and 1.30, respectively), education (primary: aIRR = 1.19; secondary: aIRR = 1.35; higher: aIRR = 1.81), wealth (richer: aIRR = 1.30; richest: aIRR = 1.34), and employment (manual labor: aIRR = 1.21; skilled work: aIRR = 1.18). Other significant factors included: comprehensive HIV knowledge (aIRR = 1.37), STI awareness (aIRR = 2.21), media exposure (aIRR = 1.25), access to health facilities (aIRR = 1.26), number of sexual partners (1 partner: aIRR = 4.82; 2–3 partners: aIRR = 5.67; 4 or more partners: aIRR = 6.13), early sexual debut (aIRR = 0.61), and region (East Africa: aIRR = 2.82; Southern Africa: aIRR = 7.25). The inflation model showed very low odds of never testing among women with primary and secondary education, lower odds with media exposure (OR=0.40), but higher odds with higher education (OR=5.26) and rural residence (OR=1.93).
ConclusionsThis study indicated that over half of women of reproductive age in SSA have never tested for HIV. Addressing socio-economic, structural, and regional disparities, particularly in West Africa, is crucial, highlighting the need for targeted, equitable, and community-based strategies to expand testing coverage and promote repeat uptake.
Although solid organ transplantation is a life-saving procedure, it is also associated with numerous challenges for patients. Creative writing has been described as a therapeutic tool for patients with chronic disease. Between 2020 and 2022, we held creative writing workshops with patients and professional writers. During these workshops, patients were invited to explore different aspects of their transplantation journey through different literary styles.
The aim of this study is to understand lung, liver and heart transplant patients’ perspectives on the role of patient self-narratives and creative writing workshops during their transplantation journey, and collect testimonies on their experiences in the workshops.
Focus groups and individual interviews.
The Centre hospitalier de l’Université de Montréal (CHUM) lung and liver transplant programmes and the Montreal Heart Institute (MHI) heart transplant programme.
Lung, liver and heart transplant recipients attending the CHUM and the MHI transplant clinic between September 2020 and August 2022.
Before the creative writing workshop, we conducted two focus groups and individual interviews with 22 lung recipients, five liver transplant recipients and four heart transplant patients. After their participation in the creative workshop, we conducted 17 semi-structured interviews with nine lung transplant recipients, four liver transplant recipients and one heart transplant recipient (three participants participated twice in interviews). Interviews were transcribed for subsequent qualitative description analyses.
Most participants had previous experiences of sharing their transplant stories and considered that a web-based platform where transplant patients share their stories could be highly beneficial for future transplant patients and the public. The creative workshops were described as ‘therapeutic’ since they let participants express their emotions and realities. Peer support and connection to other people contributed to normalise their transplant journey and helped participants put their experiences into perspective.
Creative writing workshops and peer support through the sharing of self-narratives are a feasible approach that participants have described as beneficial. Future studies are needed to assess the benefits of patients’ creative writings on other patients and on caregivers.
by Nesreen Alqaissi, Mohammad Qtait, Khalaf Awwad, Zeenat Mesk, Fuad Farajalla, Yasmeen Ziad, Farah Abu-Salameh, Amani Hmedat, Rawan Halayka, Maysam Ajlouni, Yasmeen Shareef
BackgroundArtificial intelligence (AI) is increasingly integrated into healthcare education and clinical practice. Understanding health sciences students’ knowledge, attitudes, and practices (KAP) toward AI is important for informing curriculum development, particularly in resource-limited educational settings.
ObjectiveTo assess knowledge, attitudes, and practices toward artificial intelligence among health sciences students at a Palestinian university.
MethodsA cross-sectional study was conducted during the 2024–2025 academic year among 666 undergraduate students from nursing, medicine and health sciences, and dentistry programs. Data were collected using a structured questionnaire assessing AI knowledge (7 items), attitudes (10 items), and practices (7 items). Descriptive statistics were calculated. Independent-samples t-tests and one-way analysis of variance (ANOVA) were used to examine group differences. Effect sizes were reported using Cohen’s d and eta squared (η²). Statistical significance was set at p Results
The overall AI knowledge accuracy rate was 42.9% (mean 3.00 ± 1.61), indicating limited foundational understanding, particularly regarding machine learning and deep learning concepts. Attitudes toward AI were generally positive (mean 3.60 ± 0.44), with high endorsement of ethical awareness. AI practice levels were moderate (mean 3.32 ± 0.70), with frequent use for assignments and research activities. Formal AI training was associated with higher knowledge scores (t(664)=7.45, p Conclusion
Health sciences students demonstrated positive attitudes and regular academic use of AI tools despite limited foundational knowledge. These findings suggest the potential benefit of structured AI literacy integration within health sciences curricula.
The literature on sustainability performance frameworks for healthcare organisations varies in its applicability to different types of organisations and settings, functions and activities, and definitions and dimensions of sustainability. This fragmentation creates implementation barriers which may be overcome by consolidating existing evidence in a format that can be linked directly to organisations’ business models. This protocol proposes a scoping review to assess the extent of the literature on frameworks for monitoring and evaluating the multidimensional sustainability performance of healthcare organisations and to assemble a consolidated framework in an operationally relevant format to support progress towards sustainable healthcare organisations.
The search strategy will be applied across Semantic Scholar, Google Scholar, Web of Science, MEDLINE, Embase, Academic Search Premier, CINAHL and Business Source Premier databases. Search results from 2009, coinciding with the publication of the WHO’s ‘Healthy Hospitals, Healthy Planet, Healthy People’ report, will be considered. The scoping review will include studies reporting on multidimensional sustainability monitoring or evaluation frameworks applied or developed for use at the level of healthcare delivery organisations. Studies relating to operational units within organisations or to healthcare systems will be excluded. The review’s context will be restricted to operational sustainability and will not consider the literature on sustainable design planning and construction of new facilities. No specific exclusion criteria will be applied to the types of healthcare delivery organisations nor participants implicated in the frameworks. Title and abstract screening against the inclusion and exclusion criteria, followed by full-text assessment of remaining articles, will be performed by two reviewers. Data from included studies will be extracted using a custom-designed extraction tool, analysed using topic or thematic analysis to consolidate themes and presented within the triple-layered business model canvas.
Only publicly available sources will be used; research ethics approval is not required. Findings will be submitted to a peer-reviewed journal and presented at scientific meetings.
Aboriginal women in the remote Northern Territory (NT) experience high rates of adverse pregnancy outcomes related to hyperglycaemia in pregnancy. Oral glucose tolerance test (OGTT) screening was recommended in early pregnancy but barriers to uptake exist.
To examine uptake of screening for hyperglycaemia in pregnancy among Aboriginal women in remote NT communities and explore adverse pregnancy outcome rates among women who did not have early OGTT screening compared with women who did undergo screening in early pregnancy and those with pre-existing diabetes.
Retrospective observational cohort study of pregnancies among Aboriginal women in remote NT clinics from January 2017 to December 2019. Screening for hyperglycaemia in pregnancy included having an early OGTT (
Among 1191 pregnancies in 52 remote communities, pre-existing type 2 diabetes (T2D) was diagnosed in 6.4% (n=76) and gestational diabetes mellitus (GDM) was diagnosed in 13% (154/1191). Excluding women with pre-existing diabetes, 226 (20%) had an early OGTT. Guideline-directed screening (with either (a) an early OGTT diagnosing GDM or (b) a negative early OGTT followed by a routine OGTT) occurred in 14% of pregnancies (n=158). Compared with women who had an early pregnancy OGTT, the combined adverse pregnancy outcome was more common among women with pre-existing T2D (89% vs 54%, adjusted OR 6.06 (95% CI 2.75 to 13.35)) and similar among women who did not undergo early OGTT (50%, adjusted OR 0.97 (95% CI 0.71 to 1.32)).
Uptake of guideline-directed screening in Aboriginal women in remote NT was low, although there was no difference in pregnancy outcomes for women who were and were not screened with an early OGTT. Rates of adverse pregnancy outcomes were concerningly high in women with pre-existing T2D, highlighting a need to strengthen diabetes care for these women.
Medical device-related pressure injuries (MDRPIs) are a patient safety concern in acute and critical care settings. Registered nurses must implement preventive strategies, yet gaps remain in their knowledge, attitudes, and clinical practices related to MDRPI prevention. This study aimed to evaluate the effectiveness of a structured educational intervention in improving registered nurses' knowledge, attitudes, and practices related to MDRPI prevention. A quasi-experimental pre–post intervention study was conducted in a tertiary care hospital in Saudi Arabia, with 311 registered nurses participating. Data were collected using a questionnaire assessing knowledge, attitudes, and practices related to MDRPI prevention. Participants received a one-day structured educational program based on the knowledge, attitude, practice (KAP) framework and the evidence-based SKINCARE bundle. The educational intervention resulted in significant improvements. Mean scores increased from 14.17 (SD = 2.38) pre-intervention to 16.25 (SD = 1.97) post-intervention (t = −11.81, p < 0.001). The intervention demonstrated a moderate-to-large effect size (Cohen's d = 0.67), indicating meaningful improvement in nurses' preventive competencies. Structured educational programs can enhance registered nurses' knowledge and practices in MDRPI prevention. Integrating evidence-based training programs into routine hospital education may strengthen pressure injury prevention guidelines and improve patient safety outcomes.
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 Xiangxiang Kong, Lujie Karen Chen, Sancharee Hom Chowdhurry, Ryan B. Felix, Shiming Yang, Peter Hu, Neeraj Badjatia, Jamie Erin Podell
Paroxysmal sympathetic hyperactivity (PSH) is a syndrome that occurs in a large subset of critically ill traumatic brain injury (TBI) patients and is associated with complications and poor recovery. PSH is defined by recurrent episodic vital sign elevations in the appropriate clinical context. However, standard diagnostic criteria rely heavily on subjective judgment, leading to challenges and delays in recognition, monitoring, and management. The objective of this study was to develop automated PSH detection and quantification tools that exclusively utilize objective bedside continuous vital sign data. Using a cohort of 221 critically ill acute TBI patients with at least 14 days of continuous physiologic data (of which 107 were clinically diagnosed with PSH) we developed a high-resolution clinical feature scale based on established PSH-Assessment Measure criteria and two artificial intelligence-based episode detection models including an expert system approach and a machine learning model approach, using a clinician-annotated case example as ground truth. For the episode detection methods, PSH was quantified as the number, duration, and overall temporal burden of detected episodes. To evaluate performance, we compared quantifications across PSH cases and controls and explored precision and recall. All three methods demonstrated initial face validity to delineate PSH cases from non-PSH TBI controls. Future optimization and implementation of the described computational frameworks with real-time patient data could improve the standard monitoring and management of this challenging clinical syndrome.To report on the unique perspectives of senior nursing leaders on the value proposition of the Clinical Nurse Specialist (CNS) role, their organisational experience and the barriers and facilitators to optimise and promote the long-term sustainability.
A qualitative sub-study of a larger multi-method study focused on informing policy recommendations to optimise the CNS workforce, informed by integrated knowledge translation.
Chief Nursing Officers (CNOs) and other senior leaders in all health authorities in British Columbia, Canada, were invited to participate in semi-structured interviews via video call between August–December 2023. We recruited 13 participants from diverse health regions, including 5 CNOs.
Leaders collectively conveyed a renewed interest in the CNS role to support nursing and multidisciplinary teams to better meet patient and system needs, and a sense of urgency to optimise the role in diverse settings. The overarching theme of “success by design” was supported by three thematic priorities: (1) understanding the CNS role, (2) a role that needs protection and connections and (3) moving forward together. Views were aligned to co-construct implementation-ready policy recommendations to guide provincial strategies.
Senior leaders reported a common understanding of the value-add of the CNS workforce and had a shared experience of barriers to optimisation. Contemporary policy guidance is needed to equip health systems to address this gap.
Across international regions, the role of CNSs is not fully optimised. This is a wasted opportunity to address the pressing need for nursing practice leaders to transform health systems and improve outcomes. This study provides new knowledge about the perspectives of Chief Nursing Officers and other nursing leaders to shape comprehensive and targeted policy recommendations and address enduring and new challenges to realise the full impact of the CNS workforce.
We have adhered to COREQ reporting guidelines (See supplemental file).
This study did not include patient or public involvement in its design, conduct, or reporting.
by Riham M. Hamadouk, Esra D. Albashair, Einass M. Alshareif, Ali Awadallah Saeed, Bashir A. Yousef
BackgroundToday, community pharmacists’ responsibilities have expanded beyond the traditional role to include the management of minor ailments. Acute uncomplicated cystitis is one of the most prevalent medical conditions seen in primary healthcare and can be managed by community pharmacists (CPs).
ObjectivesTo evaluate community pharmacists’ history-taking practice when responding to patients with acute uncomplicated cystitis.
MethodsA cross-sectional simulated patient study was conducted from November 2022 to January 2023 in Khartoum locality targeting only pharmacists. Six trained female students played the simulation in which they pretended to have the clinical symptoms of acute uncomplicated cystitis and requested treatment for their condition. The Interactions during the simulation were documented immediately in a data collection form after each visit. Descriptive statistics were used to report the study outcomes.
ResultsA total of 238 community pharmacies were visited. The majority of the pharmacists were female. The mean of the number of questions that were asked by the pharmacists was 1 (SD = 1.6) questions. Among the studied pharmacists, 45.4% asked at least one question during patient assessment. The most asked question was if the patient has a fever, representing 61 (25.6%) CPs, followed by if there is vaginal discharge, representing 38 (16%) CPs. In response to scenario 47 (19.7%) CPs decided to refer the patient to a physician, and 45 (18.9%) of the CPs advised the patient to increase water intake.
ConclusionsThe study has revealed a poor history-taking practice towards acute uncomplicated cystitis during patient assessment. Further studies exploring pharmacists’ involvement in patient assessment are required. Strategies to improve community pharmacists’ practice, like continuing pharmacy education and providing a national guideline regarding patient assessment should be considered seriously.
Diabetes is a leading cause of morbidity and mortality, contributing to complications such as cardiovascular disease, kidney failure and lower-limb amputations. Diabetic foot complications, such as structural deformities, ulceration and infection, present significant risks, necessitating early detection and intervention. This study explores the development and validation of artificial intelligence (AI) image analysis for diabetic foot screening, focusing on structural deformity identification which includes callus, hallux valgus and hammer toes, because they represent the earliest detectable visual risk markers for ulceration, preceding wound formation. Leveraging datasets comprising over 1000 healthy foot images and 215 diabetic foot deformity images, the model employed YOLOv5 for object detection, a convolutional autoencoder for anomaly detection, and DenseNet201 for anomaly classification. Initial internal validation yielded 91.1% anomaly detection accuracy, while anomaly classification accuracy improved to 88.57% following refinement. External validation using 27 participants achieved an overall accuracy of 85.2% and anomaly classification accuracy of 66.7%. Final evaluation on 35 unlabelled images demonstrated promising performance, with 88.57% accuracy, 90.47% precision and an F1 score of 86.11%. Integrated into the ‘Foot at Risk’ (FAR) mobile application, this AI-driven solution offers a scalable tool for early diabetic foot deformity detection. With larger dataset input for training and development, it can be utilised as an early screening tool for diabetic foot and integrated into existing community diabetic care model, facilitating timely intervention and improving patient outcomes.
To determine the proportion of postpartum depression (PPD), explore associated risk factors with PPD, and examine changes in PPD, social support and quality of life (QOL) among adolescent and adult mothers in the first 6 months postpartum during the COVID-19 pandemic.
A longitudinal comparative study was conducted using an online questionnaire from January to August 2021.
The study recruited 65 adolescent and 65 adult mothers who attended postpartum checkups at 6 weeks postpartum in primary hospitals across Ayutthaya, Chachoengsao and Phetchaburi provinces in Thailand. Data were collected by the Edinburgh Postnatal Depression Scale, Postpartum Support Questionnaire, and the World Health Organisation Quality of Life Brief at 6 weeks, 4 months and 6 months postpartum.
Finally, 60 adolescent and 60 adult mothers were included for analysis. Adolescent mothers experienced lower social support and QOL compared to adult mothers over the 6-month postpartum period. Notably, both adolescent and adult mothers had significantly increased PPD proportions from 6 weeks to 6 months postpartum (31.7%–48.3% and 23.3%–43.3%, respectively). However, there was no significant difference in the PPD proportions between groups. In adjusted models, significant risk factors for PPD during the first 6 months postpartum included educational level, unintended pregnancy, mode of delivery and social support.
Significant changes in PPD, social support and QOL were observed in both adolescent and adult mothers during the first 6 months postpartum. Adolescent mothers consistently demonstrated lower levels of social support and QOL at 6 weeks, 4 months and 6 months postpartum compared to adult mothers. Additionally, mothers with lower educational attainment, unintended pregnancies, caesarean deliveries and low social support were more likely to experience PPD.
Midwives/nurses should provide routine PPD screenings throughout the first six months postpartum for all mothers, particularly for at-risk mothers such as adolescent mothers or those with lower education, unintended pregnancies, caesarean deliveries and limited social support.
We have followed the STROBE guidelines.
No patient or public contribution.
The way communication is conducted directly influences the professional–patient relationship, how patients cope with their diagnosis, and their sense of hope throughout treatment. This study aims to map the literature on strategies that healthcare professionals can use to promote hope in communication with pediatric patients and their families in the context of chronic illness. Based on this objective, the study highlights an algorithm to assist healthcare professionals in instilling hope in this population through communication.
Scoping review.
This systematized review was conducted using the databases PubMed, LILACS, PsycInfo, Embase, CINAHL, and Scopus, employing the PCC framework and the Boolean operators AND and OR. The time frame was limited to the last 20 years (2004–2024). A total of 734 studies were identified across the databases, with an additional four retrieved through manual citation searches, resulting in 19 articles included in the final sample.
The findings highlight three key pillars for promoting hope in communication: (1) careful preparation for information delivery, which involves identifying the diverse needs of families and creating a physically comfortable and emotionally supportive environment; (2) providing information and emphasizing how it is presented—considering content, clarity, honesty, empathy, and adaptation to the recipient's specific needs; and (3) follow-up after information delivery, ensuring emotional support and active, skilled listening.
Interpersonal communication between the healthcare professional, the patient, and the family was mainly focused on the transmission of information about the disease and treatment in a clear and empathetic manner, considering who is receiving the information and how the information is interpreted.
This review provides guidance for healthcare professionals in implementing communication strategies that foster hope in the context of pediatric chronic illness. Additionally, this guide may serve as a model for training students and healthcare professionals. Further research is needed to implement and explore additional effective communication strategies for this population across diverse cultural settings.
FreshRSS 