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- Si los dientes dañados se "empastan en bloque" (el material se coloca en una sola capa grande) o con un material de resina compuesta estándar (que se coloca en múltiples capas), es probable que haya poca o ninguna diferencia en el fracaso entre los materiales para empaste (también conocidos como materiales restauradores o para obturación).
- La evidencia más antigua encontró que la amalgama dental (empastes de color plata) podría presentar menos fallos del material que la resina compuesta. Pero este hallazgo se basó en los estudios más antiguos. La resina compuesta moderna es mejor, los dentistas tienen más experiencia en su uso y es probable que haya menos fracasos.
A veces el tejido dental se daña y se pueden formar agujeros (cavidades) en los dientes. Estas cavidades se producen por la caries dental, que es principalmente una enfermedad evitable si las personas mantienen una buena higiene bucodental y reducen el consumo de alimentos y bebidas azucaradas.
Cuando la caries dental provoca un daño permanente, los dentistas pueden rellenar (empastar) la cavidad para restaurar la forma y la función del diente.
Tradicionalmente, las cavidades se llenaban con amalgama. Este material de empaste de color plata (hecho principalmente de estaño, plata y cobre, y mezclado con mercurio líquido) es económico y fácil de usar. Pero ahora se sabe que el mercurio puede ser perjudicial para la salud de las personas y el medio ambiente. En una reunión internacional se acordó reducir (o eliminar) el uso del mercurio, incluso en los empastes dentales. Los materiales de empaste alternativos sin mercurio que se pueden colocar en una única cita dental incluyen:
- resina compuesta: material estándar blanco o del color del diente que se aplica en capas o en bloque.
- cemento de ionoméro de vidrio (GIC): a veces se utiliza como empaste temporal y no es tan resistente en algunas situaciones, por lo que no es adecuado para las superficies de masticación de los dientes.
- GIC modificado con resina (RMGIC): un GIC híbrido, más fuerte que los GIC pero no tan fuerte como el RBC.
- compómeros: alternativa al RMGIC pero más cercano al material de resina compuesta que a los GIC.
La resina compuesta, el RMGIC y los compómeros utilizan un sistema adhesivo para fijar el material a los dientes y necesitan fotocurado para endurecer el material. Con el GIC no son necesarios.
Quisimos averiguar lo siguiente:
- los beneficios de un material de empaste en comparación con otro para reducir la pérdida del diente (porque el empaste ha fallado), el fracaso (cuando el empaste no funciona según lo previsto), el tiempo transcurrido hasta la aparición de problemas y sensibilidad dental tras la intervención.
- si un material de empaste es más rentable que otro.
Buscamos revisiones sistemáticas que analizaran los materiales utilizados para los empastes dentales en las muelas permanentes de las personas. Estas revisiones recopilan toda la evidencia disponible a partir de los estudios publicados y analizan sus resultados. Resumimos los resultados de las revisiones y calificamos la confianza (según factores como los métodos y los tamaños las revisiones o los estudios) en la evidencia que proporcionaron.
También buscamos estudios económicos acerca de la relación entre el coste y la efectividad de estos materiales.
Encontramos 14 revisiones con 57 estudios. Los estudios se realizaron entre 1980 y 2023; 1 estudio tuvo un seguimiento de 10 años, pero en general el seguimiento fue mucho más corto. Algunas revisiones no informaron de los resultados de nuestros desenlaces clave, y a veces se incluyeron los mismos estudios en más de una revisión. Priorizamos la evidencia de 6 revisiones, con 25 estudios únicos.
Encontramos 7 estudios acerca de la relación entre el coste y la efectividad.
No encontramos revisiones con evidencia sobre la pérdida de dientes ni sobre el tiempo transcurrido hasta el fracaso.
- Aunque los empastes de amalgama podrían dar lugar a menos fracasos que los empastes con resina compuesta (8 estudios, 3486 empastes), los estudios comenzaron a finales de los años noventa. Las resinas compuestas y la experiencia de los dentistas al utilizarlas han mejorado desde entonces. Hoy en día la probabilidad de fracaso con la resina compuesta es del 5% (frente al 15% en los estudios más antiguos). Esto significa que la evidencia más antigua que compara la amalgama con la resina compuesta tiene una utilidad limitada en la práctica clínica actual.
- Probablemente no haya diferencias entre resina compuesta en bloque y resina compuesta estándar para reducir los fracasos (7 estudios, 511 empastes). Es probable que la mayoría de las personas no experimenten sensibilidad dental después del uso de cualquiera de los dos tipos de material de resina compuesta (5 estudios, 510 empastes).
- Es posible que no haya diferencias entre la resina compuesta estándar y el GIC en la reducción de los fracasos (1 estudio, 60 empastes) ni en la sensibilidad dental (4 estudios, 311 empastes). El RMGIC podría tener más probabilidades de reducir los fracasos que el GIC (1 estudio, 50 o 38 empastes). Encontramos revisiones que compararon el GIC con la amalgama y el compómero, pero no informaron sobre los fracasos ni la sensibilidad posoperatoria.
- La mayoría de los estudios económicos no establecieron conclusiones generales acerca de la relación coste-efectividad de ninguno de los materiales. Un estudio económico encontró que los empastes con amalgama probablemente duraran más y fueran más rentables que los empastes con resina compuesta, aunque esta conclusión se basó en un estudio más antiguo (de finales de los años noventa).
La mayoría de revisiones no cumplieron con los estándares más altos. Consideramos que solo 2 revisiones estaban bien realizadas. Sin embargo, la mayoría de las revisiones presentaron resultados muy similares, incluso cuando incluyeron estudios diferentes.
Tenemos menos confianza en la evidencia sobre el GIC y el RMGIC ya que los estudios fueron, por lo general, de pequeño tamaño y con pocos participantes.
La evidencia está actualizada hasta abril de 2025.
New graduate nurses experience substantial stress during the transition from student to professional practice, which may compromise their well-being and professional practice capabilities. While resilience has been identified as a protective psychological resource, limited longitudinal research has examined how resilience influences professional performance over time or whether well-being functions as a mediating mechanism. Understanding these dynamic relationships is critical for informing evidence-based strategies to support early-career nurses.
This study aimed to (1) examine temporal changes in resilience, well-being, and professional practice capabilities during the first 3 months of employment among new graduate nurses; (2) investigate associations among these variables; and (3) test whether well-being mediates the relationship between resilience and professional practice capabilities.
A three-month longitudinal study was conducted with 72 newly graduated nurses. Measures of resilience, well-being, and five domains of professional practice capabilities (patient-centered care, interdisciplinary teamwork, evidence-based practice, quality improvement, and technology application) were collected at baseline, 2 weeks, and 3 months. Pearson's r correlations, generalized estimating equations (GEEs), and Monte Carlo simulations were performed to examine temporal associations and indirect effects.
Resilience was significantly associated with well-being (B = 1.285, p < 0.001) and all domains of professional practice capabilities. Both resilience and well-being independently predicted patient-centered care, interdisciplinary teamwork, evidence-based practice, quality improvement, and technology application. Monte Carlo simulations confirmed that well-being significantly mediated the relationship between resilience and all five performance domains. Improvements in well-being and several domains of professional practice capabilities were observed at 3 months.
Resilience serves as a foundational psychological resource that supports new graduate nurses' professional practice capabilities. Well-being serves as a key mechanism translating resilience into evidence-based nursing behaviors. Early-career interventions that strengthen resilience and promote well-being may enhance professional practice capabilities and improve workforce retention during the critical transition period.
To explore the challenges and facilitators to consumer engagement in care during hospital attendance, integrating the perspectives of patients, informal carers and care providers.
A qualitative descriptive study using semi-structured interviews.
A total of 102 individual interviews were conducted with patients (n = 43), informal carers (n = 31) and hospital care providers (n = 28) recruited from across Australia using purposive, convenience and snowball sampling. Data were collected between March 2023 and January 2024. Interviews were audio-recorded, transcribed and analysed using thematic analysis.
Eight themes illustrating factors that facilitated or hindered consumer engagement were nested within three overarching domains: relational conditions for engagement; consumer capacity and support; and organisational, system, and safety conditions. Patients, carers and care providers identified many overlapping barriers and facilitators, but differed in how they experienced and emphasised them.
Consumer engagement in hospital care is shaped by individual, interpersonal, organisational, cultural, systemic and ethical factors. Improving engagement therefore requires care environments that actively legitimise patient and carer engagement while providing staff with the time, resources and policy clarity needed to support safe and meaningful participation.
Healthcare organisations could strengthen consumer engagement by improving staff communication practices and cultural sensitivity, supporting patient and carer health literacy, creating structured opportunities for engagement, clarifying confidentiality and safety boundaries, and considering locally feasible support roles or technologies. Such strategies require adaptation to workforce and resource constraints and should be evaluated in future research.
What problem did the study address? ○
Consumer engagement is central to high-quality, patient-centred care, yet the factors that shape it remain incompletely understood, with prior research typically focusing on single perspectives or discrete episodes of hospital care.
What were the main findings? ○
Eight themes were nested within three overarching domains: relational conditions for engagement; consumer capacity and support; and organisational, system, and safety conditions. Although themes were broadly consistent across patients, carers, and care providers, the groups differed in how they experienced and emphasised these factors.
Where and on whom will the research have an impact? ○
The findings will inform care providers, healthcare organisations, and policymakers in developing strategies to improve consumer engagement across hospital settings, with relevance to international contexts where patient-centred care is a priority.
This study adhered to the Consolidated Criteria for Reporting Qualitative Studies (COREQ) guidelines.
Patients and members of the public were involved in the study design, participant recruitment, and interpretation and dissemination of findings. A Patient and Carer Advisory Board provided input from inception to dissemination, ensuring the research addressed patient-relevant priorities.
Not registered.
To develop and internally validate a clinical prediction model estimating the probability of emergency caesarean delivery among low-risk pregnancies using routinely available intrapartum variables. The model is intended to support clinicians in recommending transfer decisions in rural obstetric settings without onsite caesarean capacity.
Retrospective cohort study with multivariable logistic regression and internal validation using bootstrap resampling.
Province-wide birth registry in Ontario, Canada.
Singleton, hospital births from low-risk pregnancies between 1 April 2012 and 31 March 2020, captured in the Better Outcomes Registry and Network Ontario. Exclusions included previous caesarean, major comorbidities and other high-risk conditions.
Emergency caesarean delivery during labour.
Among 611 644 low-risk pregnancies, 66 482 (10.9%) resulted in emergency caesarean delivery. Key predictors included abnormal fetal health surveillance, nulliparity, gestational hypertension, polyhydramnios area under the receiver operating characteristic curve (AUC) and oxytocin augmentation. The optimism-corrected AUC was 0.86, indicating strong discrimination. Calibration was generally good, though the model underestimated caesarean risk in patients first admitted to level I hospitals.
This study presents a proof-of-concept prototype with strong discrimination, though calibration of the full model was suboptimal in level I hospitals, the intended setting for application. While not clinically deployable in its current form, the model lays the groundwork for a translational pathway that will require local recalibration, external validation and contextual adaptation before implementation. Threshold-based clinical utility (eg, positive/negative predictive value or net benefit) was not assessed and will be evaluated during external validation and local recalibration.
Life expectancy for people with type 1 diabetes has increased due to improved treatment of diabetes and its comorbidities, allowing many to reach old age. Still, we lack knowledge of how individuals with type 1 diabetes age. On one hand, those who reach older age can be considered survivors, but on the other hand their long-standing diabetes might still exhibit negative impacts on their health and functional ability. Healthy ageing is the WHO’s priority for this decade. The focus has shifted from chronological age to functional ability, which reflects the ability of individuals to perform meaningful activities. Functional ability is shaped by intrinsic capacity, the environment and their interaction. Intrinsic capacity encompasses five main domains: cognition, vitality, sensory function, locomotion and psychological domain. This observational study aims to assess how this vulnerable group of individuals with type 1 diabetes age and to identify factors that contribute to their healthy ageing, intrinsic capacity and its domains.
The FinnDiane LifeOne Study is a prospective observational cohort study. We aim to recruit a minimum of 300 individuals with type 1 diabetes from the FinnDiane Study, aged >65 and a minimum of 100 matched controls without insulin-dependent diabetes. The cohort will be comprehensively characterised, including clinical assessment, laboratory tests, questionnaires and a geriatric assessment of different aspects of functioning ability, with 5 years intervals. We will compare the individuals with type 1 diabetes to their matched controls. For those with type 1 diabetes, we will further assess which factors from the FinnDiane baseline and trajectories during follow-up predict healthy ageing in above 65-year-olds.
The LifeOne Study protocol is approved by the Ethics Committee of HUS Helsinki University Hospital (HUS/4387/2023) and the study adheres to the Declaration of Helsinki. Written informed consent is obtained from each participant. Findings will be published in international peer-reviewed journals with an open access choice.
Hospital-at-home (HaH) is becoming more widely available to children with cancer, providing care in a familiar environment while upholding medical safety and quality. Little is known, however, about how these children experience their parents' caregiving in the context of HaH, how they perceive and interpret parental roles, what they require in daily care, and how they communicate these needs.
Seven children aged 7 to 12 years undergoing home-based cancer treatment were interviewed using interpretative phenomenological analysis (IPA). These interviews, conducted via telephone, were open-ended and exploratory, allowing the children to express their experiences freely.
One major theme—‘the child's voice’—emerged, encompassing two interrelated sub-themes: (1) parental presence as a condition of care; and (2) the strategies children use to express their voice. Parental presence was described as essential for emotional security, predictability and meaning, serving as both a psychological anchor and a temporal organiser in the child's daily life. The children expressed their voice through multiple forms—verbal, gestural, symptom-focused or silent—revealing their active participation in care and their capacity to preserve relational and emotional continuity within the family setting.
Children with cancer perceive HaH as more than a transfer of hospital treatment; they experience it as a shared relational experience built on parental presence and mutual understanding. Recognising and supporting the child's voice in its various forms is vital for ensuring that HaH becomes not only a site for medical care but also a meaningful space for living.
Our findings highlight the need for healthcare teams to take into account the variety of children's voices and grant them a real place in HaH. They are not simply recipients of care, but also active participants in the care relationship, capable of expressing their needs, emotions, and expectations in their own way.
No patient or public contribution.
To summarize the current evidence on reducing loneliness among informal caregivers of people with dementia, such as family members or friends.
A systematic review.
The methodological quality was evaluated using the revised Cochrane risk-of-bias tool for randomized controlled trials and the revised JBI critical appraisal checklist for quasi-experimental studies. Data were extracted as predefined and synthesized narratively. The Template for Intervention Description and Replication checklist was used to report the intervention characteristics.
Six electronic databases (MEDLINE via PubMed, EMBASE, Cochrane Library, PsycINFO, CINAHL Plus, and Web of Science Core Collection) were searched for studies published in peer-reviewed English journals from the inception of each database until 28 January 2024.
Eight studies were included in this review, published between 2002 and 2023, with three being randomized controlled trials. All included interventions were psychosocial. Only one study reported significant improvements in loneliness. Five studies utilized remote and online interventions, such as social networking, psychotherapy, and online social support. Interventions varied in their impact on secondary outcomes, including stress, depressive symptoms, anxiety, and caregiver burden. Four studies demonstrated a positive effect on caregiver stress levels. One pilot trial reported a positive impact on depressive symptoms, and another study noted potential improvements in anxiety. One pilot study reported an average improvement in caregiver burden.
While the evidence is insufficient for conclusive statements, this systematic review suggests potential benefits of interventions to reduce loneliness and improve mental health among these caregivers. It highlights the promise of remote interventions in addressing loneliness among dementia caregivers.
The findings suggest that tailored interventions, especially those delivered remotely, can enhance the support provided to caregivers, potentially improving their mental health and overall well-being.
This systematic review adhered to the PRISMA statement.
No patient or public contribution.
by Emily R. Spencer, Rachel L. Winer, Selly Ba, Marie Pierre Sy, John Lin, Qinghua Feng, Geoffrey S. Gottlieb, Papa Salif Sow, Nancy B. Kiviat, Stephen E. Hawes
Hormonal and immunologic changes related to menopause may play a role in human papillomavirus (HPV) and cervical neoplasia detection, yet this relationship has not been examined in West African populations, where cervical cancer remains a leading cause of cancer-related death. The purpose of this study was to assess whether menopausal status is associated with HPV and cervical neoplasia detection in Senegalese women aged 40–60. We conducted a secondary analysis of three prospective cervical cancer studies in Dakar, Senegal (1998–2011). Participants with known menopausal status and a satisfactory HPV test (N = 3,118) and/or Pap smear (N = 2,907) were included, excluding those with cervical cancer or pregnancy; participants without known HIV status were additionally excluded from the cervical neoplasia analysis. Multivariable logistic regression and generalized estimating equations were used to estimate adjusted odds ratios and 95% confidence intervals, adjusting for age, gravidity, and HIV status. Compared with premenopausal women, postmenopausal women had significantly higher odds of HPV detection (OR = 1.48; 95% CI: 1.18, 1.85), including both high-risk (OR = 1.55; 95% CI: 1.25, 1.93) and low-risk types (OR = 1.64; 95% CI: 1.30, 2.08). Odds of cervical neoplasia were elevated, but non-significant, among postmenopausal women (OR = 1.36; 95% CI: 0.97, 1.90), with increased odds for both high-grade (OR = 1.43; 95% CI: 0.90, 2.28) and low-grade lesions (OR = 1.30; 95% CI: 0.84, 2.02). However, in a sensitivity analysis restricted to participants with known HIV status, these cervical neoplasia odds were attenuated, suggesting caution in interpreting the magnitude of these findings. These findings suggest menopause may contribute to HPV persistence or reactivation, and development of cervical neoplasia. Our results highlight the importance of continued surveillance for HPV and cervical neoplasia among older women, particularly in low-resource settings with disproportionately high cervical cancer burden.by Ya-Ling Hsieh, Chia-Jung Chiang, Tsung Yu
BackgroundAs cancer survival improves, increasing numbers of women diagnosed during their reproductive years face potential fertility impairment. However, population-based evidence on post-cancer childbearing remains limited in Asian settings.
MethodsWe conducted a nationwide cohort study in Taiwan by linking the Cancer Registry, Birth Reporting Registry, and Death Registry. A total of 72,929 females diagnosed with cancer at age ≤ 39 years were followed to identify subsequent livebirths. The cumulative incidence of first post-diagnosis livebirth was estimated using competing-risk methods. Predictors were evaluated using cause-specific Cox models. Standardized birth ratios (SBRs) were calculated by comparing observed births with expected births in the general population, standardized by age and calendar year.
ResultsOverall, 9.8% of female cancer survivors had at least one livebirth after diagnosis. The 5-, 10-, and 15-year cumulative incidences were 6.4%, 10.7%, and 13.9%, respectively. Compared with the general population, survivors had approximately half the expected number of births (SBR = 0.50; 95% CI, 0.49–0.51). Substantial heterogeneity was observed across cancer types: childbirth was most preserved among survivors of thyroid and skin cancers, whereas those with cervical, uterine, breast, leukemia, and central nervous system cancers had markedly reduced childbirth. Older age at diagnosis and receipt of chemotherapy were strongly associated with lower likelihood of childbirth.
ConclusionsIn this large, nationwide study, female cancer survivors in Taiwan experienced substantially reduced childbirth rates, with pronounced variation by cancer type, age at diagnosis, and treatment. These findings provide robust population-level evidence from an Asian context and highlight the need for early fertility counseling and improved access to oncofertility care.
Physical restraint is still common in intensive care units (ICUs) despite well-documented adverse effects. ICU nurses' knowledge, attitudes and practices (KAP) directly affect how restraints are used.
To synthesize the evidence on physical restraint related KAP among ICU nurses in China and to identify gaps between knowledge and practice.
We searched 11 databases (CNKI, WanFang, CBM, VIP, Chaoxing, PubMed, Cochrane Library, Web of Science, MEDLINE via Ovid, CINAHL via EBSCO, Scopus) from inception to October 2025. The protocol was registered in PROSPERO (CRD420251154455). Methodological quality was assessed using Joanna Briggs Institute tools. We used a convergent segregated approach to integrate quantitative and qualitative findings.
Twenty studies were included (13 quantitative, 6 qualitative, 1 mixed methods). Knowledge scores ranged from 50.43% to 93.73% (median 63.37%), attitude scores from 38.92% to 70.98% (median 64.28%), and practice scores from 50.51% to 94.36% (median 73.64%). Systematic training, years of ICU experience, and critical care certification were significant influencing factors. The qualitative synthesis produced three themes: a knowledge-practice gap, attitudinal conflict between safety principles and emotional burden and a disconnect between standardized protocols and real-world practice.
The linear KAP model does not fully explain restraint practices in Chinese ICUs. Environmental and systemic factors such as staffing levels, workflow design and safety metrics mediate the relationship between knowledge and practice. Improving practice calls for unit-level interventions (a two-tiered assessment process integrated into workflow, daily multidisciplinary review) and nurse-level training (alternatives, ethical decision making). Future research should use validated instruments, include secondary hospitals and test interventions with controlled designs.
This study is a systematic review of previously published literature and did not involve direct participation of patients, service users, caregivers or members of the public in its design, conduct, analysis, interpretation or manuscript preparation.
Parkinson’s disease (PD) is the second most common neurodegenerative disorder, its principal symptom being deterioration of motor function. Current treatment options are limited to symptom management but there is evidence that physical activity can provide motor benefits. More recently there is evidence to suggest that rhythmic auditory stimulation may improve gait and balance in PD. Sparky Samba is a community initiative in South Wales, UK, founded by a person living with PD. Sessions incorporate the following samba rhythms from a trained facilitator and are held weekly in a community setting.
The Sparky Samba trial is a multi-site, non-blinded, randomised controlled feasibility trial of Sparky Samba compared with activity as usual. A total of 60 people with PD will be randomised 1:1 to take part in a local Sparky Samba group for 12 weeks or continue their normal activities for the same length of time. The primary outcome is feasibility defined by recruitment, retention, data completeness and intervention adherence. Secondary outcomes relating to motor function, cognition, well-being and self-efficacy will also be assessed at baseline and at 12 weeks. Additionally, we will conduct a process evaluation to understand contextual mechanisms surrounding Sparky Samba. This will be achieved through qualitative interviews and structured participant questionnaires following individual trial completion and through structured questionnaires with intervention delivery staff, supplemented with qualitative interviews.
Feasibility outcomes will be assessed according to pre-defined criteria. For secondary outcomes, means and standard deviations (or medians and IQRs) will be calculated by arm, alongside 95% CIs for change from baseline to 12-week follow-up. Qualitative data will be subject to thematic analysis using NVivo software.
This study received a favourable ethical opinion from the North of Scotland Research Ethics Committee in April 2025 (REC reference 25/NS/0037). Study results will be disseminated through the peer-review literature, the ISRCTN registry and directly to participants, which will be facilitated by the study’s public and patient involvement steering group.
Chronic pain affects around 28 million adults in the UK and is associated with impaired work ability, reduced productivity and increased sickness absence. Access to work-focused support within healthcare services is limited, and most employers do not routinely provide structured assistance for employees living with chronic pain. The Pain-at-Work Toolkit is a co-created, web-based intervention designed to improve work ability, self-management, and workplace experiences for employees living with chronic pain. A feasibility trial demonstrated strong acceptability, exceptional recruitment and potential improvements in work ability, providing clear justification for progression to a fully powered evaluation. This paper describes the protocol for a definitive cluster randomised controlled trial to evaluate the effectiveness, cost-effectiveness and implementation of the Pain-at-Work Toolkit.
This two-arm, open-label cluster-randomised controlled trial will recruit at least 70 organisations (minimum 35 clusters per arm) and at least 685 participants. Organisations will be randomised 1:1 to (a) support-as-usual (SAU) or (b) SAU plus the Pain-at-Work Toolkit, and Pain-at-Work Manager’s Toolkit as an implementation-support component. The primary outcome is work ability at 3 months, measured using the Work Ability Index (three-item version). Secondary outcomes include work self-efficacy, sickness absence, presenteeism, productivity loss, job satisfaction, job stressfulness, turnover intentions, anxiety, depression and health-related quality of life. A mixed-methods process and implementation evaluation will assess fidelity, contextual influences and mechanisms of impact. A health economic evaluation will estimate cost-effectiveness from employer and societal perspectives. Analyses will follow intention-to-treat principles using multilevel modelling.
Ethical approval was granted by the University of Nottingham Faculty of Medicine and Health Sciences Research Ethics Committee (Ref: FMHS 1200226) and the UK Health Research Authority and Health and Care Wales (IRAS 367449). Findings will be disseminated through peer-reviewed publications, conference presentations, stakeholder reports and public summaries.
Motor skills are integral to numerous developmental domains throughout infancy and childhood. In autism, motor impairments are prevalent and pervasive, often appearing before core symptoms. These motor difficulties have a cascading effect on a child’s broader physical and psychological health, including social, cognitive, emotional and behavioural functioning. Accordingly, researchers are increasingly interested in interventions that improve motor functioning, as these may have a downstream effect on broader developmental domains. One intervention that could address motor difficulties is the AllPlay Dance programme, which provides inclusive dance classes to children in community settings, with pilot data demonstrating acceptability and feasibility among parents and their children with autism and cerebral palsy. This pragmatic randomised controlled trial (pRCT) is thus designed to evaluate whether the AllPlay Dance programme creates the conditions for motor, cognitive and social abilities to thrive in children with autism.
This pRCT intends to enrol 70 families of children with autism, aged 7–12 years, living in Victoria, Australia. We will also enrol up to 60 participants with previous dance experience, called buddies, to support the participation of our dancers with autism. We will use our clinical, research, university and community networks to recruit participants. Interested families will complete an online screening survey, followed by questionnaires that parents complete and assessments of the motor functioning in the children. Interested buddies will also complete an online screening survey followed by a baseline questionnaire. Families will be randomly allocated to the intervention group or the treatment-as-usual waitlist control group. The intervention group will attend 9 weeks of community-based dance classes led by disability and dance experts and supported by buddies. The primary outcome is change in motor functioning, as assessed through performance-based measures, with parent reports providing complementary information about everyday motor functioning. Secondary outcomes include improvements in the executive, social, emotional and behavioural functioning of the children, as well as decreases in the stress of parents. We will also evaluate the acceptability and feasibility of this programme, as well as whether families decide to enrol and engage with other dance programmes in the community following the intervention.
The study has received approval from the Monash University Human Research Ethics Committee and the Deakin University Human Research Ethics Committee. Findings will be disseminated through a PhD thesis, peer-reviewed publications, presentations at scientific conferences and reports to participants, community organisations and the wider community.
Australian New Zealand Clinical Trials Registry (ANZCTR); ACTRN12625000600448; registered on 11 June 2025; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=389672.
Skeletal fractures are a leading cause of death and disability and a growing global public health concern. Internal fixation is a common surgical treatment indicated for several fractures, yet there are few comprehensive epidemiological studies describing mortality following the procedure.
Data were extracted from an England-wide administrative database (Hospital Episode Statistics, HES) and linked to mortality records from the Office for National Statistics (ONS). All records from patients aged 18 years or older who were admitted due to a non-polytrauma single fracture and underwent internal fixation between 2013 and 2023 were included. Crude and adjusted mortality rates were calculated as well as the restricted mean time lost.
A total of 630 758 admissions were included in the primary analysis. Of these, 55% were female, and the mean±SD age was 59±23 years. Primary open reduction internal fixation was the most common procedure (54% of cases), followed by closed reduction internal fixation (35%). Overall, mortality rates following internal fixation were 2% within 30 days, 5% within 90 days and 10% within 365 days. Mortality rates were described by fracture region and reduction procedure. Variation in mortality rates across fracture regions and procedures was attenuated in the case-mix-adjusted estimates.
This study described national crude and adjusted mortality rates following internal fixation for the treatment of skeletal fractures. These findings provide population-level descriptive benchmarks for clinical and epidemiological interpretation and may inform decision-making by clinicians and patients as well as the design of randomised controlled trials and other research studies.
by Isabela Oliveira Sousa, João Lucas Pinheiro Leite, Amanda Oliveira dos Santos Melo, Adriano Souza Santos Monteiro, Carolina Ferreira Cavalcanti Xavier, Valmira de Jesus Santos, Ana Paula Silva de Lemos, Samanta Cristine Grassi Almeida, Ana Paula de Oliveira Menezes, Soraia Machado Cordeiro, Joice Neves Reis
BackgroundMonitoring the prevalence and serotype distribution of Streptococcus pneumoniae nasopharyngeal carriage is essential for understanding transmission dynamics and assessing the impact of pneumococcal conjugate vaccines (PCVs). In Brazil, PCV10-GSK is routinely administered at 2 and 4 months of age with a booster at 12 months. This study aimed to determine the nasopharyngeal carriage rate, serotype distribution, antimicrobial susceptibility, and factors associated with carriage among healthy children aged 2–5 years vaccinated with PCV10-GSK under the Brazilian routine immunization program.
MethodsA cross-sectional study was conducted from August to November 2023 among children aged two to five years from 10 randomly selected schools in Salvador, Brazil. Within each school, all eligible children whose parents or legal guardians provided written informed consent were enrolled. Nasopharyngeal swabs were collected, and demographic, vaccination, and risk factor data were recorded. S. pneumoniae isolates were serotyped using multiplex polymerase chain reaction and/or the Quellung reaction. Antimicrobial susceptibility was evaluated using disk diffusion and gradient strip minimum inhibitory concentration methods. Risk factors for carriage were assessed using univariate and multivariable logistic regression analysis.
ResultsAmong the 400 children enrolled, the overall S. pneumoniae carriage rate was 39.5%. White race was independently associated with lower odds of carriage compared with mixed race, whereas none of the evaluated factors was significantly associated with carriage of non-PCV20 serotypes among colonized children. The most frequent serotypes were 6C (17.9%), 19A (13.0%), 11A (9.3%), 15B (8.6%), 23A (8.6%), and 15A (7.4%). Estimated vaccine serotype carriage was 3.2% for PCV10-GSK, 17.3% for PCV13/PCV15/PCV10-SII, and 39.5% for PCV20. Penicillin non-susceptibility was observed in 21.8% of isolates, with the highest rates among serotypes 19A (71.4%), 23A (35.7%), and 6C (20.7%).
ConclusionsA high pneumococcal carriage rate, predominantly involving non-PCV10-GSK serotypes, was observed among children vaccinated under the Brazilian PCV10-GSK program. The limited serotype coverage of PCV10-GSK, together with antimicrobial resistance among circulating serotypes, underscores the need for ongoing surveillance to guide vaccine policy and antimicrobial stewardship in Brazil.
by Tianyu Zhang, Yu Yuan, Chunli Lin, Chao Song, Tianrong Liao, Yuewen Sun, Hongzhen Tang
BackgroundPerfluorooctanoic acid (PFOA), a pervasive environmental pollutant, has been implicated in hepatic injury and metabolic dysfunction. However, its role as an environmental risk factor in the pathogenesis of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) remains incompletely understood, particularly from a systems biology perspective.
MethodsThis study employed an integrative approach combining computational toxicology, multi-omics data analysis, and machine learning. Public databases were utilized to identify PFOA-related targets and MASLD-associated genes. A comprehensive machine learning framework comprising 113 model combinations was applied to transcriptomic datasets (GSE66676, GSE89632, GSE164760) to identify hub genes. Single-cell RNA sequencing (scRNA-seq) analysis delineated cell type-specific expression patterns. Molecular docking and dynamics simulations assessed the binding stability between PFOA and core targets, which was further validated in vitro using an FFA-induced MASLD HepG2 cell model.
ResultsWe identified 17 shared targets between PFOA and NAFLD. Machine learning pinpointed six hub genes (NR4A2, BCL6, CASP1, SHBG, FABP4, IL10) with high diagnostic accuracy (AUC up to 0.996). scRNA-seq revealed distinct expression patterns of these genes across liver cell subtypes in MASLD. Molecular docking and dynamics simulations demonstrated stable binding of PFOA to SHBG and FABP4. In vitro experiments confirmed that PFOA exposure significantly altered the mRNA and protein expression levels of these core genes in the MASLD model.
ConclusionOur findings suggest a potential mechanistic association between PFOA exposure and MASLD pathogenesis, characterized by disruption of lipid metabolism, inflammatory responses, and immune homeostasis. While these results identify biologically plausible pathways, they do not establish epidemiological causation, and further prospective studies with quantified PFOA exposure are required to confirm causality in humans.
Burnout and mental distress among nurses are global public health epidemics that adversely affect nurse well-being and healthcare quality. Evidence-based, scalable mental health interventions are urgently needed.
To evaluate the 3- and 6-month outcomes of a randomized controlled trial (RCT) comparing a psychologically safe, digital mental health screening and referral program alone versus the same screening and referral program combined with the video-based online MINDBODYSTRONG (MBS) cognitive behavioral therapy (CBT)-based skills-building program among nurses at risk for mental distress.
501 nurses were recruited from professional organizations and healthcare systems across the United States by email and randomized to either mental health screening and referral (standard care) or standard care plus the MBS cognitive behavioral skills-building intervention (the intervention). All study activities were conducted remotely. Follow-up surveys administered at 3- and 6-months assessed anxiety, depression, suicidal ideation, burnout, healthy lifestyle beliefs, and healthy lifestyle behaviors using valid and reliable scales.
Compared with the screening and referral only group, participants in the intervention group had greater reductions in anxiety and depression and significantly greater increases in healthy lifestyle beliefs and behaviors at 3 and 6 months post-intervention. After controlling baseline risk, the intervention group had a lower risk of suicidal ideation than the screening and referral group at 3 months (relative risk ratio [RRR] = 0.717; 95% CI: 0.320–1.606) and 6 months (RRR = 0.329; 95% CI: 0.101–1.072). The intervention group also had a significantly lower risk of burnout at 6 months (RRR: 0.698, 95% CI: 0.528, 0.929, p = 0.012). Nurses who completed more MBS sessions had less suicidal ideation at 6 months and those who completed more MBS skills-building activities had less burnout at 3 and 6 months.
Integrating psychologically safe mental health screening combined with the scalable online CBT-based intervention, MBS, can produce sustained improvements in burnout, mental health symptoms, including suicidality, and healthy lifestyle beliefs and behaviors among nurses experiencing mental distress.
Missed nursing care threatens quality and safety, but patient counts may not capture shift-level demands. We examined associations of patient-count and perceived workload indicators with missed care, separating within- and between-nurse effects.
A multicenter observational study using repeated shift-level measurements.
The study included 502 shift records from 213 nurses in 16 medical–surgical units across six Italian hospitals; the primary analysis included 480 records from 196 nurses. Patient-count indicators were nurse-reported numbers of assigned, isolated, and specialist-care patients; perceived workload included work rhythm/quantity, mental workload, emotional workload, and work organization. Grouped-binomial generalized estimating equations modeled the proportion of applicable activities missed, with nurse clustering, robust standard errors, exchangeable correlation, and hospital fixed effects. Workloads were decomposed into within- and between-nurse components, and four missed-care domains were examined.
Nurses reported a mean of 6.5 missed activities per shift; 29.9% of shifts had no missed care. The seven workload indicators were jointly associated with missed care (robust Wald χ 2[7] = 22.95, p = 0.002). Work rhythm/quantity was the only individual indicator with a nominal p-value below 0.05 (OR 1.24 per SD, 95% CI 1.03–1.49; p = 0.023), but it did not remain significant after Benjamini–Hochberg correction (q = 0.159). Assigned patient count was not clearly associated (OR 1.14, 95% CI 0.94–1.40; p = 0.192). In exploratory within–between analyses, the between-nurse work rhythm/quantity component was associated with missed care (OR 1.42, 95% CI 1.11–1.82; p = 0.005), whereas the within-nurse component was not (OR 1.03, 95% CI 0.90–1.17; p = 0.649). Domain-specific associations did not remain significant after multiplicity adjustment.
The workload indicators were jointly associated with missed nursing care, with secondary analyses indicating that the global signal was evident in the perceived-workload block. However, no individual workload indicator remained statistically significant after multiplicity adjustment. Work rhythm/quantity and its between-nurse component should therefore be regarded as exploratory signals requiring confirmation in studies with denser repeated measurements.
Workload surveillance research should evaluate patient-count and multidimensional perceived-workload indicators together. The present coefficient-specific findings are insufficient to support the operational use of work rhythm/quantity as a stand-alone workload indicator.
The treatment of bladder cancer often involves radical cystectomy and urostomy, which increase survival rates but cause significant physical, psychological and social distress. While existing evidence emphasizes treatment and interventions to improve the quality of life, few studies have explored the continuous health management experience and needs of urostomy patients from diagnosis through recovery.
To construct a journey map of the healthcare management needs of urostomy patients to explore key pain points in their rehabilitation process and provide a reference for continuous health management.
A descriptive qualitative study was conducted. Using purposive sampling, 25 participants who underwent urostomies were recruited from a tertiary hospital in Tianjin, China. Data were collected through semi-structured face-to-face in-depth interviews. Conventional content analysis was used to analyse the data, extract themes and visualize dynamic changes in patient needs via a patient journey map.
The patient journey map delineated four phases and extracted 12 themes. During the screening and diagnosis phases, participants experience symptom distress, information overload and fear of recurrence. The perioperative phase was marked by challenges in symptom management, frustration in learning stoma skills and abrupt transitions in caregiving models. During the transitional adaptation and continuing treatment phases, participants experience survival fatigue due to the dual burden of early complications, chemotherapy reactions and financial pressure. In the long-term self-management phase, participants struggle with cumbersome self-management routines, anxiety about recurrence and barriers to psychosexual and social reintegration. Fortunately, some participants show posttraumatic growth and resilience after urostomy.
The rehabilitation of urostomy patients is a complex process accompanied by information overload, shifts in caregiving and the superimposition of physical and psychological symptoms. Healthcare professionals should prioritize these multidimensional needs across stages, establish an intelligent continuous care platform led by ostomy specialist nurses and be supported by multidisciplinary collaboration.
Healthcare professionals should establish an intelligent, continuous care platform led by ostomy specialist nurses to monitor home-based rehabilitation. The implementation of staged multimodal health education across all disease phases is crucial. Furthermore, clinical practice must actively provide psychosexual counselling, support social reintegration and deliver targeted interventions to alleviate the immense psychological burden on family caregivers.
This study followed the COREQ guidelines for reporting qualitative studies.
No patient or public contribution.
by Carla Treloar, Emily Lenton, Amy Kirwan, Caitlin Douglass, Gemma Nourse, Adrian Farrugia, Kate Seear, Caroline Watts, Mark Stoove, Elena Cama
The impacts of stigma on health are well-known. Most interventions to reduce stigma focus on education or skills building of health workers and less on organisational or structural approaches. Responding to ongoing efforts to increase the quality of health care, we explore data from semi-structured interviews with 20 key stakeholders to identify and examine stigma reduction opportunities that align with existing practices, policies and structures for strengthening quality in the Australian healthcare system. Analysis focused on the “outer setting” constructs of the Consolidated Framework for Implementation Research to identify and categorise mechanisms that linked to or were determined by governing processes of the (“outer setting”). The necessity to be accredited against national standards was positioned as an over-arching driver of what health systems do and what gets the attention of leaders and executives, and can subsequently impact allocation of resources, including for stigma reduction. Participants’ accounts also raise the possibility of using other more general industrial relations laws to bring greater attention to stigma reduction. Innovative approaches to stigma reduction using macro, structural tools provide a promising opportunity to trial.
FreshRSS 