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This study aimed to investigate the association between smoking behaviours during early pregnancy and the risk and severity of gestational diabetes mellitus (GDM), with a particular focus on smoking status, smoking intensity and secondhand smoke exposure.
Secondary analysis of prospectively collected cohort data.
Multi-centre study conducted in South Korea (Korean Pregnancy Outcome Study) between March 2013 and January 2017.
From 4537 pregnant women initially enrolled, 3457 singleton pregnancies were included after excluding cases with transfer, loss to follow-up, twin pregnancies, miscarriages and pre-existing diabetes mellitus. All participants were women of Korean ethnicity.
Primary outcome was GDM and its subtypes (A1GDM: diet-controlled; A2GDM: insulin-requiring). Secondary outcomes were associations with active smoking (before pregnancy and during early pregnancy), smoking intensity dose–response relationships (pack-years) and secondhand smoke exposure among never-smokers.
Among 3457 participants, 231 women (6.7%) were diagnosed with GDM (198 A1GDM, 33 A2GDM). Active smoking before pregnancy (adjusted OR (aOR) 3.98, 95% CI 1.58 to 9.30) and during early pregnancy (aOR 9.90, 95% CI 2.97 to 29.45) were significantly associated with A2GDM, while no significant association was observed with A1GDM. A clear dose-response relationship was observed, with smoking intensity >4 pack-years markedly increasing A2GDM risk (aOR 20.68, 95% CI 6.75 to 59.39). Detailed pack-year analysis showed 4–6 pack-years (aOR 20.57, 95% CI 5.80 to 65.46) and >6 pack-years (aOR 25.98, 95% CI 3.21 to 146.45). Among never-smokers, secondhand smoke exposure showed a borderline association with overall GDM risk (aOR 1.33, 95% CI 0.98 to 1.81).
Maternal active smoking before and during early pregnancy, as well as higher smoking intensity, was associated with an increased risk of pharmacologically treated GDM (A2GDM). Although secondhand smoke exposure did not reach statistical significance, the trend suggested a potential association with GDM risk among never-smokers. These findings provide important evidence for public health strategies for prenatal care, as smoking cessation and environmental smoke avoidance during prenatal and early antenatal care in women reduce the risk of gestational diabetes.
by Ahmed Usama Fahim, Atika Aboni, Shirajoom Munira, Nishat Tasnim Toosty
IntroductionChild discipline, while intended to instill appropriate behavior, often manifests as violent practices in low- and middle-income countries, including Bangladesh. Maternal exposure to violence, attitude towards intimate partner violence (IPV), and disciplinary beliefs serve as key determinants of physical disciplinary practices. These dynamics illustrate how exposure to violence in adulthood can shape parenting behaviors, highlighting the urgency of addressing cultural attitudes that sustain harsh physical discipline.
Materials and methodsThis study analyzed nationally representative cross-sectional data from the 2019 Bangladesh Multiple Indicator Cluster Survey (MICS) which included 30044 mother-child (children aged between 2 and 14 years) pairs. Physical disciplinary practice is analyzed as an ordered outcome, considering maternal experience of physical violence as the primary exposure along with their attitudes toward IPV and disciplinary beliefs as mediators. This study used ordinal logistic regression within a structural equation modeling framework and bootstrapping technique to analyze indirect associations, providing robust inference that accounts for sampling variability and accommodates binary mediators.
ResultsMothers exposed to violence had significantly higher odds of physically disciplining their children (odds ratio, OR=1.77 and 95% confidence interval, CI=[1.60, 1.95]). Three mediators significantly increased the odds of adopting harsh physical disciplinary practice by 2% through maternal positive attitudes toward IPV, by 51% through their disciplinary beliefs, and by 6% through their overall life satisfaction. The total association indicated that maternal exposure to violence nearly tripled the odds (OR = 2.89 and 95% CI= [2.52, 3.31]) of physical disciplinary practices.
ConclusionThis study suggested that supportive environment for children can be fostered by reducing violence against women, promoting mothers’ life satisfaction, and reshaping women’s perceptions of spousal abuse and disciplinary beliefs.
Demographic change is resulting in a growing number of individuals requiring nursing care, while the availability of professional caregivers is simultaneously declining. This imbalance places increasing pressure on care provision, particularly in home settings and rural areas. Primary care services are also under pressure. Digital solutions such as teleconsultations are considered promising strategies to support intersectoral collaboration in long-term care and to mitigate existing gaps in service provision.
Seven teleconsultation projects in long-term care are being conducted using a mixed-methods design aligned with the phases of the Medical Research Council framework: with a focus on the feasibility phase. Data on structural conditions, usage patterns and user acceptance will be collected through standardised instruments (including Unified Theory of Acceptance and Use of Technology and Fit between Individuals, Task and Technology). In addition, focus groups and interviews will be carried out. The quantitative analysis will include descriptive and inferential statistical methods and will be complemented by a cost–consequence analysis. The qualitative data will be analysed using structuring content analysis. The aim is to provide a context-informed and theory-informed assessment of the implementation and potential impact of telemedical consultations.
The study has been approved by the Ethics Committee in Tübingen. Participation is voluntary and based on written informed consent. Data protection is ensured in accordance with the GDPR (General Data Protection Regulation); all data are pseudonymised and processed separately. Results will be communicated in a target group-appropriate manner and published in scientific journals. Practice-oriented recommendations will be developed to support the further advancement of telemedical care in nursing.
Type 2 diabetes is a growing global health challenge that requires effective prevention strategies. Public health and community-based approaches play an essential role in reaching vulnerable populations and addressing broader determinants of health. This protocol outlines a scoping review aimed at systematically mapping the existing evidence on lifestyle-based diabetes prevention interventions implemented in public health and community contexts.
A systematic literature search will be conducted to identify relevant studies published in English or German from 1 January 2014 onwards. The following databases will be searched: PubMed, Web of Science Core Collection, CINAHL (via EBSCO), the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews (via OVID) and ClinicalTrials.gov. Relevant websites and grey literature sources will be searched to identify further eligible studies. (Cluster-)randomised controlled trials, non-randomised controlled trials and clinical trials will be included. These must examine nutrition-based, physical activity-based or lifestyle-based interventions aimed at preventing type 2 diabetes in healthy adults or individuals with pre-diabetes, implemented in public health or community settings. Case reports and studies involving medical therapies or pharmacological interventions will be excluded. The literature search started in May 2025 and is expected to be completed by the end of December 2025.
As this scoping review is based on the secondary analysis of publicly available data, no ethical approval is required. Our dissemination strategy includes publication in peer-reviewed journals, presentations at academic conferences and targeted dissemination to relevant interest holders.
This project has been registered at Open Science Framework (https://osf.io/zafg5/), as PROSPERO does not accept registrations for scoping reviews.
Randomised controlled trials (RCTs) are central to generating high-quality evidence in the surgical field but face unique methodological and practical challenges, including recruitment, follow-up, blinding and ensuring patient-centred outcomes. Patient and public involvement (PPI) has emerged as a promising strategy to enhance the relevance, quality and impact of surgical research by actively involving patients throughout the whole research process. Despite growing recognition of its value, the integration and reporting of PPI in surgical RCTs remain inconsistent, and no systematic evaluation has yet addressed its application within general and abdominal surgery.
RCTs in general and abdominal surgery published since 2014 will be identified through systematic searches of the databases MEDLINE, Web of Science and CENTRAL. This systematic review and primary (meta-epidemiological) statistical analysis will assess the reporting prevalence, implementation extent and quality of PPI over time. The Guidance for Reporting Involvement of Patients and the Public 2 (GRIPP2)-SF checklist and Cochrane Risk of Bias V.2.0 tool will be used to evaluate PPI reporting and study quality. To enable a comparison between studies reporting PPI and those that do not, propensity score matching will be performed to identify non-PPI studies with similar population and design characteristics. Subsequently, regression analyses will be employed to investigate potential associations between PPI reporting and various trial characteristics, including patient recruitment and retention, outcome selection and methodological quality. The Patient Advisory Board of the Study Centre of the German Society of Surgery is actively engaged in all phases of the systematic review.
This systematic review does not require ethical approval. Results will be published in an international peer-reviewed scientific journal, as well as distributed in a lay format to the patient community and to the broader public.
CRD42024524426.
by Mengsi Peng, Peng Shen, Kyung-In Joung, Kwang Joon Kim
BackgroundAlthough metformin is the first-line medicine for type 2 diabetes (T2D), its safety profile in adolescents remains poorly understood. This study seeks to investigate the adverse events linked to metformin use in adolescents diagnosed with T2D.
MethodsData from the Food and Drug Administration Adverse Event Reporting System (FAERS), spanning Q1 2004 to Q2 2024, were retrospectively analyzed in this study. Adverse reactions were standardized using the Medical Dictionary for Regulatory Activities, then significant adverse drug reaction signals were identified through disproportionality analysis employing reporting odds ratio (ROR) and information component (IC) methods.
ResultsOf 17,956,653 FAERS reports, 80,187 involved metformin, including 973 in adolescents (10–19 years), with 174 cases were identified with a T2D indication. Analysis at the system organ class level revealed that congenital, familial, and genetic disorders [ROR: 8.8 (4.0, 19.3); IC: 2.2 (1.1, 2.9)] and pregnancy conditions [ROR: 4.9 (2.5, 9.5); IC: 1.8 (0.8, 2.5)] showed the most significant signals. At the preferred term (PT) level, three signals were identified across all sexes and subgroups: treatment noncompliance [ROR: overall 4.14 (2.44, 7.02), male 4.27 (2.00, 9.12), and female 4.65 (2.22, 9.74); IC: overall 1.67 (0.88, 2.22), male 1.60 (0.46, 2.36), and female 1.74 (0.60, 2.50)], lactic acidosis [IC: overall 2.99 (1.91, 3.72), male 2.53 (0.76, 3.61), and female 2.76 (1.34, 3.67)], and gastrointestinal disorder [ROR: overall 13.09 (4.73, 36.23), male 54.33 (6.05, 487.96), female 5.34 (1.10, 25.84)]. Neurological disorders were observed only in males, while pregnancy-related adverse effects and renal disorders occurred exclusively in females. Additionally, the study identified potential new signals not documented in metformin labeling, including areflexia, muscle weakness, ataxia, decreased vibratory sense, rhabdomyolysis, substance use, and axillary pain.
ConclusionThe study reveals a complex safety profile of metformin in adolescents with T2D, warranting further research to confirm risks.
by Sang Ah Lee, Jin-Myung Kim, Hye Eun Kwon, Youngmin Ko, Joo Hee Jung, Sung Shin, Young Hoon Kim, Sung-Han Kim, Hyunwook Kwon
PurposeOptimal perioperative antibiotic prophylaxis in kidney transplantation remains undefined despite routine antibiotic administration to prevent infections. In this retrospective observational cohort study with historical comparison, we compared the clinical efficacy of 6 days of ampicillin/sulbactam vs. a single dose of cefazolin.
Materials and methodsWe retrospectively analyzed 2322 kidney transplantation recipients at a single center, with the evaluation period spanning from 2015 through 2021. Patients were divided into 2 groups based on the perioperative antibiotic regimen received: 971 patients received ampicillin/sulbactam, and 1351 received cefazolin. This study focused on evaluating the impact of these regimens on postoperative infection incidence and the 6-month acute rejection (AR) rates.
ResultsThe cefazolin group exhibited a tendency toward higher urinary tract infection rates within 1 month after transplantation (3.4% vs. 2.2%, p= = 0.078). There were no significant differences in surgical site infections between the groups. The 6-month AR rates were significantly lower in the cefazolin group than in the ampicillin/sulbactam group (5.1% vs. 7.9%, p= = 0.009). Cefazolin was also confirmed to be significantly associated with reduced 6-month AR rates in the multivariable logistic regression analysis (odds ratio 0.63, 95% confidence interval [0.45-0.89], p= = 0.009).
ConclusionIn this study, we observed that a single dose of cefazolin as perioperative antibiotic prophylaxis may lead to higher rates of postoperative urinary tract infections, but it could potentially lower the incidence of acute rejection within six months.
by Soha Albeitawi, Mohammad Talal Al-zubi, Anas Aljaiuossi, Murad Shatnawi, Ahlam Al-Kharabsheh, Fadi Sawaqed, Emad Aborajooh, Walid I. Wadi, Randa Mahasneh, Benjamin Rowland Colton, Mohammad AlQudah, Tamara Kufoof, Fida Asali, Ahmed Sheyyab, Monther A. Gharaibeh, Motasem Al-latayfeh, Enas Al-Zayadneh, Eman Badran, Yaser M. Rayyan, Kais Al Balbissi, Raed Al-Taher, Asma Basha, Rola Saqan, Ashraf Omar Oweis, Wafa Taher, Shadi Hamouri
BackgroundClinical preceptors serve as vital educators, so it is essential to enhance their effectiveness by developing a competency-based development program. In this study, we explored the challenges faced by preceptors and students, and measured the educational needs of preceptors, to inform the design of a syllabus for a preceptor development program.
MethodsThis was a sequential multi method study utilizing a structured questionnaire survey and focus group discussions among a representative sample of medical students in their fourth, fifth, and sixth years in addition to preceptors from the six public medical schools in Jordan.
ResultsThematic analysis of focus group discussions revealed six themes: admission policy, training environment, curriculum gaps, trainers and mentorship, learners, and dissemination. The most important training needs documented by preceptors were teaching in the clinical setting, mentoring skills, simulation, assessment in the clinical setting, and providing feedback. Accordingly, a competency-based preliminary syllabus was developed.
ConclusionIt is essential to enrich the skills of preceptors regularly based on a needs assessment. Further long term studies are required to investigate the effectiveness of the proposed syllabus after implementation.
The integration of artificial intelligence such as ChatGPT into educational frameworks marks a pivotal transformation in teaching. This quasi-experimental study, conducted in September 2023, aimed to evaluate the effects of artificial intelligence–assisted learning on nursing students' ethical decision-making and clinical reasoning. A total of 99 nursing students enrolled in a pediatric nursing course were randomly divided into two groups: an experimental group that utilized ChatGPT and a control group that used traditional textbooks. The Mann-Whitney U test was employed to assess differences between the groups in two primary outcomes: (a) ethical standards, focusing on the understanding and applying ethical principles, and (b) nursing processes, emphasizing critical thinking skills and integrating evidence-based knowledge. The control group outperformed the experimental group in ethical standards and demonstrated better clinical reasoning in nursing processes. Reflective essays revealed that the experimental group reported lower reliability but higher time efficiency. Despite artificial intelligence's ability to offer diverse perspectives, the findings highlight that educators must supplement artificial intelligence technology with strategies that enhance critical thinking, careful data selection, and source verification. This study suggests a hybrid educational approach combining artificial intelligence with traditional learning methods to bolster nursing students' decision-making processes and clinical reasoning skills. This study aimed to examine the effectiveness of an infection control simulation using mixed reality, comparing simulation fidelity with a high-fidelity mannequin (MN) group and problem-based learning with written cases group. This study used a three-group pretest-posttest quasi-experimental design. Two universities with similar curricula were conveniently selected, and a total of 72 nursing students were recruited. Participants were randomly assigned to three groups of 24 each. In the final analysis, there were 22 participants in the mixed reality groups, 21 in the mannequin groups, and 23 in the problem-based learning with written cases groups. Data were analyzed using descriptive statistics and the χ2, Kruskal-Wallis, and Wilcoxon signed rank tests. The mixed reality groups had a significantly positive effect on clinical reasoning ability and clinical competence than the problem-based learning with written cases groups, whereas the mannequin groups had a significantly positive effect on clinical competence than the problem-based learning with written cases groups. Mixed reality simulation is an appropriate simulation method that enhances learning immersion, satisfaction, and self-confidence in simulation. Additionally, it can substitute for mannequin simulation in terms of clinical reasoning ability and clinical competence. This study suggests that it is important to the various approaches in simulation fidelity to diversely enhance the competency of nursing students in simulation outcomes. Esta narrativa pretende describir el trabajo realizado en una unidad hospitalaria de nueva creación (Unidad de Innovación), en la que Enfermería, además de realizar una función asistencial con cuidados altamente individualizados como elemento humanizador, desempeña una función investigadora mediante la realización de programas y proyectos propios. La narrativa propiamente dicha enlaza la experiencia de una enfermera, que se enfrenta al cambio desde su antiguo lugar de trabajo a la nueva unidad, con el caso clínico de uno de los primeros pacientes ingresados en la misma, tomándolo como muestra de la aplicación de cuidados integrales e individualizados.
¡Cámbiate de sexo!, es el consejo que me dio una buena amiga no hace mucho; y me hizo reflexionar, tenía claro que una afirmación de ese calibre no se correspondía con una lascivia, así que tras unos pocos segundos de desenredo mental, llegué a la conclusión que mi faceta profesional estaba involucrada en tal afirmación [Fragmento de texto].
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