Conectar
The Healthy Lifestyle Index (HLI) integrates key behaviours to assess their cumulative impact on health. While higher HLI adherence is linked to lower disease and mortality risk, its long-term trajectory association remains understudied. This study aims to examine the dose-response relationship and long-term association of HLI on mortality risks.
Systematic review and dose-response meta-analysis using the Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) approach.
PubMed, Scopus and Web of Science were searched until June 2024.
We included observational cohort studies that assessed the relationship of HLI or its trajectories with all-cause, cardiovascular disease (CVD)-cause or cancer-cause of mortality.
Analysis of 13.7 million participants demonstrated that higher adherence to the HLI is linked to lower risk of all-cause (HR: 0.48; 95% CI 0.46 to 0.53; GRADE: moderate), CVD-cause (HR: 0.49; 95% CI 0.44 to 0.51; GRADE: moderate) and cancer-cause mortality (HR: 0.55; 95% CI 0.49 to 0.61; GRADE: low). These associations were further confirmed in a dose-response manner. Moreover, compared with maintaining an unhealthy lifestyle, a decline in HLI adherence was associated with a 14% higher risk of all-cause and a 19% higher risk of cancer-related mortality. In contrast, an improvement in HLI adherence was linked to a 20% lower risk of all-cause and a 13% lower risk of cancer-related mortality.
Adherence to HLI and its long-term patterns are associated with lower mortality risk. These findings emphasise the importance of lifestyle-based prevention and intervention strategies in reducing mortality.
CRD42024500538.
To determine the prevalence of malaria co-infection among patients with irritable bowel syndrome (IBS) in Yemen and to evaluate the association of systemic inflammatory biomarkers (neutrophil-to-lymphocyte ratio (NLR), mean platelet volume (MPV) and platelet-to-lymphocyte ratio (PLR)) with this co-infection.
Multicentre, cross-sectional observational study conducted between April and December 2024.
Primary and secondary healthcare facilities across 21 governorates in Yemen.
142 consecutive adult patients (aged 18–70 years) diagnosed with IBS according to the Rome IV criteria.
The primary outcome was the prevalence of malaria infection, confirmed by a rapid diagnostic test . Secondary outcomes included differences in NLR, MPV and PLR between groups, assessed using independent t-tests, and the diagnostic performance of these biomarkers evaluated by receiver operating characteristic curve analysis with AUC calculation. Multivariate binary logistic regression was used to identify independent predictors of malaria co-infection, adjusting for potential confounders.
The mean age was 42.3 years (SD 11.7) with an equal gender distribution. The prevalence of malaria co-infection was 45.1% (64/142). Patients with malaria positivity had significantly higher NLR (mean difference 0.56, 95% CI 0.40 to 0.72; p
Nearly half of the Yemeni patients with IBS in this study had malaria co-infection, with the highest burden in diarrhoea-predominant and mixed subtypes. Elevated NLR and PLR were strongly associated with co-infection, suggesting these readily available biomarkers could aid targeted screening in resource-limited, endemic settings.
To examine the relationship between moral courage, personality traits and organisational climate among nurses.
A cross-sectional, descriptive-analytical study.
A total of 264 nurses from three hospitals in Semnan, Iran, participated in the study. Stratified random sampling was used, and data were collected in summer and autumn 2024 through the Moral Courage Scale, Organisational Climate Scale and Personality Traits Inventory. Data analysis was conducted using SPSS 26.
Moral courage was positively associated with a supportive organisational climate. A weak inverse relationship was noted with agreeableness, while other personality traits showed no notable influence. Moral courage was more prevalent among married nurses, supervisors and those with permanent contracts.
A positive organisational climate enhances nurses' moral courage, emphasising the need to foster supportive work environments. While agreeableness may slightly inhibit moral courage, other personality traits did not show a significant effect.
Understanding the contributors to moral courage can assist healthcare institutions in developing training and policies that empower nurses to act ethically and confidently in challenging situations, ultimately improving care quality.
Problem addressed: The study explores the relationship between moral courage, personality traits, and organisational climate among nurses in clinical settings. Main findings: Organisational climate significantly impacts moral courage, while most personality traits do not play a major role. Where and on whom will the research have an impact? These findings can inform hospital leaders, educators, and policymakers in shaping ethics-centred strategies to support nurses in clinical settings.
This study adheres to EQUATOR guidelines for cross-sectional studies.
This study did not include patient or public involvement in its design, conduct or reporting.
To examine the impact of delays in intensive care unit (ICU) admission on patient outcomes, specifically clinical deterioration and mortality among patients transferred from the emergency department (ED) or general wards following acute deterioration in an Australian public hospital.
This prospective cohort study was conducted over a 12-month period (15 April 2022–14 April 2023) in a 209-bed regional hospital. It included adult patients (aged ≥ 18 years) admitted to the ICU from ED or general wards following acute deterioration. Primary outcomes measured were duration of delay in ICU admission, ICU and hospital mortality and changes in Sequential Organ Failure Assessment (SOFA) scores over time to assess organ dysfunction and progression.
A total of 403 patients were included. Of these, 276 (68.5%) experienced delays in ICU admission, ranging from 25 min to 347.25 h (median: 7.13 h). Delayed ICU admission was associated with increased mortality. Each one-point increase in the highest recorded SOFA score was linked to a 7.5% rise in mortality odds, while each one-point increase in the initial or 24-h SOFA score corresponded to a 6.8% increase.
Delayed ICU admission was significantly associated with increased mortality, particularly in patients with elevated SOFA scores, indicating worsening organ dysfunction and clinical instability.
These findings highlight the urgent need for improved triage systems, early warning protocols and streamlined escalation pathways to expedite ICU transfers for deteriorating patients. Timely intervention is essential to reduce harm and improve outcomes.
This study reinforces the clinical risks of delayed ICU admission and supports timely escalation of care in emergency and ward settings across Australian public hospitals.
Conducted in accordance with STROBE guidelines.
No direct patient or public involvement. The study used routinely collected clinical data to evaluate systemic and clinical outcomes.
Skin tears (ST) are common traumatic wounds, particularly among older adults, that can lead to complications if not accurately assessed and classified. The International Skin Tear Advisory Panel (ISTAP) classification system is widely used internationally; however, no validated Persian version currently exists. To culturally adapt, and evaluate the clinimetric properties of the Persian version of the ISTAP Classification System. This methodological study was conducted from February to May 2025 in multiple phases. After forward–backward translation and expert review, face and content validity were assessed. Criterion validity was assessed by comparing nurses' classifications with expert consensus using weighted Cohen's kappa coefficient. Construct validity was examined using the known-groups method, comparing skin tear frequency and severity between 30 elderly patients with impaired mobility and 30 younger adults without impaired mobility. Reliability was evaluated using Fleiss' kappa coefficient for multiple raters, and weighted Cohen's kappa coefficient for inter-rater and intra-rater agreement. Diagnostic accuracy indices, including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+), negative likelihood ratio (LR–), odds ratio (OR) and the area under the receiver operating characteristic curve (AUC), were calculated for each skin tear type. Content validity was excellent (content validity ratio (CVR): 0.82–1.00; item-level content validity index (I-CVI): 0.91–1.00; scale-level content validity index (S-CVI/Ave): 0.94). Criterion validity showed almost perfect agreement with experts (weighted κ = 0.902, p < 0.001). Construct validity was supported by significant group differences in skin tear frequency (Fisher's exact p = 0.001) and severity (t(58) = 2.12, p = 0.039). Reliability was substantial to almost perfect across analyses (Fleiss' κ = 0.8447; inter-rater weighted κ = 0.66; intra-rater weighted κ = 0.86). Diagnostic accuracy was excellent for all types (AUC = 0.99), with sensitivity 97.5%–99.2%, specificity 98.4%–99.6%, PPV 97.5%–99.3%, NPV 98.1%–99.6% and very high OR and LR values. The Persian version of the ISTAP Classification System demonstrated excellent validity, reliability and diagnostic accuracy, supporting its use as a standardised tool for assessing ST in Persian-speaking healthcare settings.
Prehospital notification by emergency medical services (EMS) can activate hospital resources before the patient arrives, which has been shown to improve in-hospital care for stroke patients. Optimising prehospital and handover processes in stroke care requires considering end-user perspectives to enhance acceptance and effectiveness of the developed solutions. The aim of this study was to identify current barriers in the preclinical-clinical phase of stroke care.
Within the investigator-initiated CAEHR project (CArdiovascular diseases—Enhancing Healthcare through cross-sectoral Routine data integration), an interface for transferring data from the electronic prenotification system to the hospital information system is implemented. A mixed-methods approach with semi-structured interviews as well as a cross-sectional online survey was used to gather feedback from healthcare professionals at a single stroke centre in Germany as well as from the participating EMS personnel. Data collection for the interviews was conducted between January and August 2023 and for the online survey between May and September 2023.
Interviews were conducted with 10 healthcare professionals, including seven from the neurological clinic and three from EMS. Additionally, 39 EMS employees took part in a cross-sectional online survey.
Challenges identified were educational and training aspects affecting preclinical processes and patient handover procedures, along with the opportunity for establishing more uniform protocols. Participants emphasised the importance of detailed patient information. Electronic prenotification was seen as an important step regarding structured information transmission, reducing the risk of information loss in stroke care.
The study highlights the importance of addressing organisational processes in addition to technical interfaces for implementing effective stroke care processes.
German Clinical Trials Register, DRKS00029103.
Glecaprevir/pibrentasvir (GLE/PIB), despite being a highly costly medication, is considered a cost-effective approach compared with sofosbuvir/velpatasvir (SOF/VEL) and sofosbuvir/daclatasvir (SOF/DCV) in the treatment of hepatitis C virus (HCV) infection. No study has evaluated the effect of GLE/PIB’s introduction into Iran’s drug list from a health policy perspective and estimated the budgetary impact change. Therefore, this study was conducted to analyse the fiscal effect of the introduction of GLE/PIB into Iran’s drug list.
Budget impact analysis. The assumptions and costs of including GLE/PIB in Iran’s drug list for the treatment of patients with hepatitis C were derived from a conducted cost-effectiveness analysis.
National level. In this study, the budgetary changes in Iran’s pharmaceutical market and health system, from the Ministry of Health’s perspective, have been estimated for a 5-year time horizon following the introduction of GLE/PIB in the country.
Based on the results obtained from the budget impact model, currently, 4112 patients are receiving SOF/DCV and SOF/VEL therapeutic regimens, which is expected to decrease to 1093 in 2029 owing to the affordability of medications and a 50% estimated market share for GLE/PIB. According to the results, with the introduction of GLE/PIB into the market and assuming a market share of 10% in the first year, growing to 50% by the fifth year, the healthcare system costs will increase by approximately $0.61, $1.77, $3.86, $7.45 and $13.51 million over the next 5 years, respectively. Additionally, based on the drug’s selling price, there will be a 468% increase in hepatitis C drug market costs after 5 years, resulting in an overall budget increase of approximately 0.13% for Iran’s pharmaceutical market. According to the sensitivity analysis, a 20% reduction in chronic hepatitis C (CHC) costs could decrease the projected increase in health sector costs from $13.51 million (an 18.84% increase) to $10.52 million (an 18.16% increase). Conversely, a 20% rise in CHC costs would raise those costs to $16.49 million (a 19.31% increase).
Considering the high price of the GLE/PIB compared with the available options in Iran, with the introduction of GLE/PIB into Iran’s drug list, insurance coverage and appropriate allocation of necessary resources, a reduction in the cost burden because of hepatitis C treatment is expected for individuals and households. Additionally, with a well-regulated market share of existing medications, the optimal treatment choice for patients will be feasible.
FreshRSS 