Work stress is a threat to the well-being of nurses in China and also globally, and many studies have been conducted on the risk factors for stress symptoms. However, research on the process and mechanism between work environment risk factors and perceived stress symptoms among nurses remains limited. This study aimed to examine the direct and indirect relationships between nurse-rated structural empowerment, professional competence, thriving and nurses’ perceived stress symptoms.

This was a cross-sectional correlational study.

This study was conducted between April and October 2023, and 2172 nurses at three general hospitals in a Chinese province were recruited.

A questionnaire that included demographic information, the Conditions of Work Effectiveness Questionnaire, the Nurse Professional Competence Scale, the Thriving at Work Scale and one factor from the Psychosomatic Health Aspects Questionnaire that measured perceived stress symptoms was used. The PROCESS macro (model 4) with a parallel mediation model and bootstrapping tests was conducted to examine the direct and indirect relationships of structural empowerment, professional competence and thriving at work on perceived stress symptoms.

The regression analysis showed that structural empowerment, professional competence and thriving at work were negatively related to stress symptoms (β=–0.42, p

Structural empowerment was related to stress symptoms both directly and indirectly via professional competence and thriving at work. The findings suggest that managers should alleviate nurses’ stress symptoms through measures aimed at providing access to empowering structures, strengthening professional competence and promoting thriving at work.

To examine the effects of 12 weeks group-based peer-led aquatic high-intensity interval training (AHIIT) compared with aquatic moderate continuous training (AMICT) on patient-reported outcome measures (PROMs) and quality-adjusted life-years (QALYs).

A single-blind, parallel-group, randomised trial with a 1:1 allocation ratio.

Community-based setting.

89 participants (mean age 62 (SD 13) years) with rheumatic and musculoskeletal diseases, including hip and knee osteoarthritis, fibromyalgia, rheumatoid arthritis, psoriatic arthritis and axial spondyloarthritis, were randomly allocated to an AHIIT (n=44) or an AMICT (n=45) group.

The intervention consisted of AHIIT (four intervals of 4 min at high intensity, Borg scale 14–18) or AMICT (Borg scale 12–13), conducted twice weekly for 12 weeks.

Outcomes included disease activity (measured by the Patient Global Assessment), fatigue, pain and health-related quality of life (HRQoL), measured by the EQ-5D utility index (five-dimensional health status measure) and EQ VAS (self-rated overall health scale) for overall health, physical and social activities. All outcomes were assessed at baseline, 3 months and 6 months. To compare the overall benefit of these interventions, QALYs were estimated based on HRQoL. Linear mixed models for repeated measures were used to estimate the mean difference (95% CI) in outcomes.

No statistically significant differences between the groups were found in any outcomes at either three or 6 months (p>0.05).

No difference between the groups was found on PROMs and QALYs. Future research should include larger sample sizes and a non-exercising control group to better determine the efficacy of AHIIT and clarify the role of exercise intensity in symptom management.

NCT05209802.

Fathers of preterm infants wish to be actively involved and attentive in caring for their children. The positive impacts of paternal caregiving on preterm infants’ cognitive and social development have been recognised. Awareness of the need to support fathers during early parenthood is increasing, but fathers may feel excluded when their infants are in the neonatal intensive care unit. Here, we present the protocol for a study involving the development and national implementation of a complex intervention supporting first-time fathers of preterm infants in early parenthood.

The study adheres to the Medical Research Council framework for complex interventions. A multicentre, prospective, non-blinded, quasi-experimental design will be applied to evaluate the effect of a clinical and technology-based intervention targeting both nurses and the fathers. Outcomes from participants enrolled during the control (2023–2024) and intervention (2025–2026) periods, comprising 295 fathers and their partners, will be compared. Effects on parental confidence, stress, depression and mood and family and reflective functioning as well as infants’ emotional and social development will be assessed. A comprehensive process evaluation will be applied using both qualitative and quantitative methods.

The study has been registered at Clinicaltrials.org [no. NCT0 6 116 747 (The SUPPORTED study – First-time Fathers of Preterm Infants), approved on 3 November 2023]. The Danish Data Protection Agency has approved the study (P-2022–792). The findings will be disseminated through peer-reviewed publications.

NCT06116747.

To evaluate the reliability and validity of screening tools designed to identify child maltreatment by parents or caregivers in paediatric healthcare settings, particularly for use in early childhood or neonatal care.

Systematic literature review.

The Cochrane Library, Embase, Cinahl and Ovid Medline were searched for studies published up to June 2025. Eligibility criteria for selecting studies: studies evaluating screening tools intended for use by caregivers or healthcare professionals to identify child maltreatment in paediatric healthcare settings. Included tools targeted children under 18 years of age.

Key characteristics of included tools were extracted, including type of maltreatment assessed, number of items, tool format and the age range of the child population. Data on reliability and validity were synthesised narratively due to heterogeneity in methods and outcomes.

Risk of bias and the quality of Patient Reported Outcome Measure development were assessed using the Consensus-based Standards for the Selection of Health Measurement Instruments checklist, which also guided the grading of evidence strength.

In total, 1874 abstracts and 84 full-text articles were reviewed. 14 articles featuring 13 distinct screening tools were identified, most of which were used to detect physical abuse in emergency room settings. Only the Escape tool was evaluated in two studies, both of very good quality; the study evaluating the Pediatric Hurt-Insult-Threaten-Scream-Sex tool also demonstrated very good quality. The remaining studies varied in methodological quality and evidence strength. No tools were identified for children in neonatal care settings, and few were validated for children aged 0–3 years, none for neonatal care.

This review highlights the limited number of validated tools suitable for identifying maltreatment in very young children and across different contexts, particularly neonatal care. Future research should address these critical gaps to better support the early identification of child abuse within diverse clinical settings.

PROSPERO (2023), registration number CRD42023483966.

To describe the prevalence of cardiovascular disease (CVD) at the time of diagnosis of adult-onset type 1 (T1D) and type 2 (T2D) diabetes, in a recent cohort and compare to a previous cohort from the same region. Further, to explore factors influencing the prevalence of pre-existing CVD, including age, sex, body mass index (BMI) and C-peptide; in the later cohort also heart failure, hyperlipidaemia, tobacco use and physical activity.

Two prospective cross-sectional cohort studies compared.

All primary health care centres and hospitals in Kalmar and Kronoberg counties in Southeastern Sweden.

Adults with newly diagnosed T1D or T2D (classified by combination of islet antibodies and C-peptide) in 1998–2001 and 2016–2017.

Prevalence of hypertension and CVD at diagnosis of diabetes, and associations with beta-cell function, in two cohorts collected 15 years apart. Further, to explore factors influencing the prevalence of hypertension and CVD, and level of C-peptide.

In patients with newly diagnosed T2D, mean age-at-onset had decreased (66±14.1 years vs 63±12.6, p≤0.001) and mean BMI had increased (29.0±5.4 vs 31.4±5.8 kg/m², p≤0.001). Prevalence of pre-existing myocardial infarction had decreased in both T1D (18% vs 7%, p=0.03) and T2D (25% vs 11%, p≤0.001). Pre-existing hypertension had increased in both T1D (23% vs 40%, p=0.01) and T2D (44% vs 61%, p≤0.001). C-peptide level was lower and was associated with several cardiovascular conditions in newly diagnosed T2D in 2016–2017 (p=0.048 p≤0.001).

Patients with newly diagnosed T2D were younger, with higher BMI, compared with 15 years earlier, a challenge for diabetes care. Prevalence of pre-existing myocardial infarction had decreased notably, in line with, but still less than in the general population; while pre-existing hypertension had increased, in both diabetes types. C-peptide was associated with several cardiovascular conditions in newly diagnosed T2D in the recent cohort, which warrants further investigation.