Conectar
by Mohammad Z. Darabseh, Aseel Aburub, Ragad Alkaraki, Abdullah Saber Alshammari, Yazan Almansi, Ghaith Dalalah, Csaba Melczer, Pongrác Ács
To evaluate pulmonary function and respiratory muscle strength in Mejwez players compared to predicted norms, and to assess the influence of smoking behaviours on these outcomes. A cross-sectional study was conducted involving adult Mejwez players. Spirometric parameters (forced expiratory volume in one second (FEV₁), forced vital capacity (FVC), and FEV₁/FVC) and respiratory pressures (maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP)) were measured and compared to predicted values. Multiple linear regression was used to assess the impact of smoking behaviours on respiratory outcomes. Mejwez players demonstrated significantly higher FEV₁ (+0.38 L, pby Job Kasule, Julius L. Tonzel, Natalie Burns, Tyler Hamby, Roger Ying, Grace Mirembe, Immaculate Nakabuye, Hannah Kibuuka, Margaret Yacovone, Betty Mwesigwa, Trevor A. Crowell, for the Multinational Observational Cohort of HIV and other Infections (MOCHI) Study Group
BackgroundPeople with behavioral vulnerability to HIV face barriers to healthcare engagement that may impede uptake of non-pharmaceutical and other interventions to prevent COVID-19. Understanding COVID-19 knowledge, attitudes, and practices in this population can inform disease prevention efforts during future pandemics.
Materials and methodsFrom October 2022 to September 2024, we enrolled participants aged 14–55 years without HIV who endorsed recent sexually transmitted infection, injection drug use, transactional sex, condomless sex, and/or anal sex with male partners. At enrollment, we collected socio-behavioral data, including assessments of COVID-19 knowledge, attitudes, and practices. Robust Poisson regression with purposeful variable selection was used to estimate prevalence ratios with 95% confidence intervals for factors associated with COVID-19 preventive practices.
ResultsAmong 418 participants, 228 (56.9%) were female, the median age was 21 years (interquartile range 19−24), and 362 (84.9%) reported sex work. Knowledge about SARS-CoV-2 transmission routes was high (95.4%) but lower for the consequences of genetic variants (48.5%−69.7%) and possibility for asymptomatic infection or transmission (66.7%−80.8%). Handwashing was practiced by 90.8% of participants in the preceding month, whereas mask-wearing (76.5%), avoiding symptomatic people (73.7%), and any history of COVID-19 vaccination (46.9%) were less prevalent. Males were more likely to report avoiding symptomatic people (adjusted prevalence ratio 1.16 [95% confidence interval 1.03–1.31]) and COVID-19 vaccination (1.30 [1.05–1.60]). Enrollment during the BQ.1/BQ.1.1 Omicron wave was associated with less mask-wearing (0.81 [0.67–0.99]) but more vaccination (1.59 [1.29–1.95]).
DiscussionWe observed variable COVID-19 knowledge and attitudes among Ugandan adolescents and adults with little impact on COVID-19 preventive practices. Efforts to address suboptimal uptake of disease preventive practices during this and future disease outbreaks will require more than just improving knowledge.
We conducted a feasibility study to evaluate the feasibility of recruiting patients to examine the effect of near vision glasses in young infants at risk of cerebral visual impairment.
A three-arm, parallel-group, open-label randomised feasibility trial.
Tertiary neonatal intensive care in London, UK.
We included babies born before 29 weeks of gestation or at full term with hypoxic ischaemic encephalopathy. Babies who needed ongoing inpatient care, with established eye anomalies or with very high refractive errors at baseline (±8.00D) were not included. Infants with retinopathy of prematurity were not excluded.
At 8 weeks corrected age, we allocated 18 infants to wear glasses (+3.00D over full cycloplegic refraction) immediately (intervention 1), 18 to wear the same glasses at 16 weeks (intervention 2) and 19 infants were allocated to standard treatment (no glasses).
Recruitment and retention of study participants (primary), compliance wearing glasses, preferential-looking visual acuity (with glasses) and visual function as determined using A Test Battery of Child Development for Examining Functional Vision at 3-month and 6-month age post-term.
Of 70 eligible families, 55 consented and 34 attended baseline assessments, and 28 completed the study. Non-attendance was due mainly to prolonged inpatient stay, infant health and scheduling conflicts. Glasses were worn for similar periods in each group (Intervention 1: median 2 hours/day (95% CI 1 hour to 4 hours); Intervention 2: median 2 hours/day (95% CI 1.5 hours to 3 hours)). Visual acuity improved from baseline to 6 months. Mean (SE) LogMAR (Minimum Angle of Resolution) improvements were standard care: 0.47 (0.45); intervention 1: 0.66 (0.44); intervention 2: 0.37 (0.36). Among the 29 very preterm infants, there were similar findings: standard care: 0.35 (0.35); Intervention 1: 0.67 (0.47); Intervention 2: 0.34 (0.40). As a functional measure, object permanence was present at the following rates by randomised arm: standard care: 29%; whereas intervention 1: 56%; and intervention 2: 44% (OR intervention 1 vs standard care: 3.13 (95% CI 0.38 to 25.57), ie, not statistically significant).
We demonstrate feasibility for a definitive RCT (randomized controlled trial) with good recruitment and retention and observed potential benefits for vision and development following the dispensing of glasses at 8 weeks post-term age compared with untreated controls. We identified methodological modifications to further improve recruitment processes for a future larger study.
To explore the application of Classic Grounded Theory (GT) methodology in nursing research and critically appraise studies employing Classic GT against the validated framework Guideline for Reporting and Evaluating Grounded Theory (GUREGT) research studies.
Systematic review without meta-analysis
The review followed the PRISMA statement and used the Synthesis Without Meta-analysis (SWiM) guideline for data analysis. The quality of included articles was assessed using the CASP qualitative research appraisal tool, and the GUREGT framework was applied to evaluate adherence to Classic GT guiding principles.
Databases were PUBMED, CINAHL, Nursing and Allied Health Database (ProQuest).
Twenty-nine studies from 2010 to 2024 met the inclusion criteria. Findings revealed inconsistencies in the reporting of Classic GT methodology in nursing research, with frequent omissions of key methodological elements. The GUREGT tool, while user-friendly and practical, highlights gaps in areas such as identifying the main concern, philosophical positioning, and engagement with the literature. These omissions can compromise methodological rigour, suggesting that further refinement of the GUREGT tool is necessary.
The GUREGT tool provides a promising framework for improving the reporting and evaluation of Classic GT studies. However, its current version requires enhancement to fully address the unique demands of Classic GT and ensure rigorous application and reporting of the methodology. Development of a dedicated reporting guideline tailored to Classic GT is critical for advancing the quality of nursing research and supporting researchers in generating robust, theory-driven insights.
Few studies critically appraise Classic GT methodology in health research. This review highlights the need for dedicated reporting guidelines to support methodological rigour and transparency in Classic GT studies.
This review adhered to EQUATOR reporting guidelines.
No patient or public contribution.
For adolescents living with higher body weight, changing lifestyle behaviours can be met with challenges due to psychosocial factors, such as mental health and emotional challenges. Few behavioural interventions have included skill development to manage these mental health and emotional challenges.
The feasibility of a dialectical behavioural therapy (DBT)–enhanced lifestyle intervention will be evaluated through a pilot randomised controlled trial. We will recruit 90 adolescents aged 14–17 years with a body mass index Z-score >1.4 and mild-to-moderate depressive symptoms to participate with a caregiver in the trial. Adolescents will be randomised 2:2:1 to one of the three study arms: (A) behavioural lifestyle intervention with DBT skills training, (B) behavioural lifestyle intervention alone (ie, without DBT skills training) or (C) control. The interventions will include two sessions weekly for 16 weeks that include (1) one modified DBT skills training with two facilitators, supervised by a clinical psychologist, combined with one behavioural lifestyle session delivered by a dietitian and/or a kinesiologist and (2) two behavioural lifestyle sessions alone. DBT skills training will consist of teaching mindfulness, emotion regulation, distress tolerance, interpersonal effectiveness and walking the middle path modules. Behavioural sessions will be guided by evidence-based practices for goal setting, dietary counselling, improving sleep, reducing screen time and structured physical activity. The main outcomes are enrolment rates, adherence to the intervention and retention rates for follow-up measurements. The secondary outcome will be changes in the quality of life (Pediatric Quality of Life Inventory) and daily physical activity levels between baseline and immediately post-intervention. Adolescents will participate in a focus group incorporating photo elicitation to explore satisfaction, acceptability and perceived benefits of the study arms.
This study has received ethical approval from the University of Manitoba’s Biomedical Research Ethics Committee (HS24295-H2020:427), Hamilton Health Sciences & McMaster University (HiREB 18159) and The Conjoint Health Research Ethics Board (CHREB), University of Calgary (REB24-1084). Results will be disseminated through publication in peer-reviewed journals and be relevant to researchers and clinicians involved in paediatrics and paediatric weight management.
The Infant Gut Bacterial Study in Nigeria (INBUGS-NG) investigates how delivery mode, antibiotic exposure, feeding practices and environmental factors shape gut microbiome development and acquisition of antibiotic resistance genes (ARGs) during the first year of life in northern Nigeria.
Between February and July 2024, 90 mother–infant dyads were enrolled at a tertiary hospital in Kano city, Nigeria. This was a prospective longitudinal cohort with follow-ups at 10 scheduled time points: days 0, 1, 3, 5, 7, 14, 28, 90, 180 and 365. We also intensified stool sampling after infant antibiotic administration, enabling dense early-life sampling. To date, the cohort has contributed 480 infant stool samples, 232 maternal rectal swabs, 254 breast milk samples and 806 environmental samples (total 1772). In parallel, socio-demographic, clinical and cultural data were collected using Research Electronic Data Capture (REDCap) and household visit diaries.
Baseline data show that 84/90 mothers (93.3%) received postpartum antibiotics, and 26/90 infants (28.9%) received antibiotics within the first 3 months of life. Only 8% of infants were exclusively breastfed, with early water supplementation common. Caesarean deliveries accounted for 25% of births, and the mean gestational age was 38.5 weeks. Across the cohort, high retention was achieved, and the study has generated a unique long-read metagenomic resource from an African infant population, with analyses ongoing.
Shotgun long-read metagenomic sequencing (Oxford Nanopore) will enable strain-level and plasmid-level profiling of microbial communities and ARGs. Planned analyses include associations between early-life exposures and resistome dynamics, as well as cross-cohort comparisons with a parallel study in Pakistan. Follow-up will continue through 12 months.
by Ralph Kwakye, Grace Boakye, Bright Yaw Vigbedor, Albert Aniagyei, Bernard Owusu Asimeng, Boniface Yeboah Antwi, David Neglo, Salifu Nanga
Zeolite X was synthesized from kaolin and then modified using (Azadirachta indica) neem together with silver nitrate solution by ion exchange. X-ray diffraction confirmed a highly crystalline FAU framework characterised by a low angle reflection, which showed that silver incorporation did not alter the zeolite structure. Scanning Electron Microscopy (SEM) revealed a well-defined polyhedral crystal for zeolite X, whiles the Ag-zeolite X exhibited increased surface heterogeneity and agglomeration. Fourier Transform Infrared (FT-IR) and Raman Spectroscopy further confirmed framework retention, with band broadening attributed to the partial substitution of Na⁺ by Ag+ within the zeolite lattice. The antimicrobial activity of zeolite X, Ag-zeolite X, were evaluated against Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae, Enterococcus faecalis, Candida albicans, Aspergillus niger strains by Minimum Inhibition Concentration (MIC) and Minimum Bacterial/fungal Concentration (MBC/MFC) Assays. The antioxidant properties were evaluated using 2,2-Diphenyl-1-picrylhydrazyl (DPPH) and 2,2’-Azino-bis (3-ethylbenzothialine-6-sulfonic acid (ABTS) radical scavenging assays. The unmodified zeolite X showed weak activity (MIC, MBC, MFC > 1 mg/mL, R > 4) whilst the Ag-zeolite X showed strong antimicrobial activity (MIC = 0.5–1.0 mg/mL, MBC, MFC = 0.5–2 mg/mL, R ≤ 4) across all tested strains. Antioxidant activity assessed using DPPH and ABTS radical scavenging assays showed significantly enhanced antioxidant performance for Ag-zeolite X compared to unmodified zeolite X, particularly in the ABTS assay. These findings demonstrate that neem-assisted silver modification enhances the bioactivity of kaolin-derived zeolite X while preserving its crystalline framework, supporting its potential application in biomedical, food packaging, and water treatment systems.More than 300 million major surgical procedures are carried out under general anaesthesia each year worldwide, and advanced airway management remains one of the leading daily challenges for clinicians. Data from large international prospective cohort studies on adverse events such as cardiovascular collapse, cardiac arrest and severe hypoxaemia during advanced airway management to facilitate anaesthesia are lacking.
The International obServational sTudy on AiRway manaGement in operAting room and non-operaTing room anaEsthesia (STARGATE) study will be an international prospective observational cohort study describing the incidence of major adverse events associated with advanced airway management (tracheal intubation or supraglottic airway device placement) for general anaesthesia in the operating and non-operating room for surgery and medical procedures. The secondary aim will be to describe the practice of airway management in a large international cohort. Critically ill patients will be excluded from this study. Data on patients’ characteristics, type of procedure and the adopted airway management strategy, post-procedure adverse events, operator characteristics and in-hospital mortality will be prospectively collected. The study aims to enrol 10 500 patients.
The study has been approved by the Ethics Committee of the coordinating centre (Comitato Etico Interaziendale AOU San Luigi Gonzaga, N° 25/2023). Each of the participating centres will then seek approval of their local Ethics Committee before enrolment. Data will be disseminated to the scientific community by original articles submitted to international peer-reviewed journals.
This article investigates school vaccination for adolescents with intellectual and developmental disability through the lens of person-centred care principles.
This is a theoretical framework analysis in which qualitative interview data were mapped to the principles of a Person-Centred Practice Framework.
Data were drawn from Vax4Health, an empirical study that aims to improve vaccination uptake and experiences for adolescents with disabilities.
Our four-step process included: identifying elements of the school vaccination programme that relate to the Framework domains; mapping programme capacities and challenges by each domain; identifying key factors influencing person-centredness; and synthesising these key influencing factors into three themes.
We extrapolated three themes: (1) Parents and students expressed strong support for the programme, but there is potential to enhance their participation in vaccination decision-making processes. (2) Nurses bring high levels of motivation, clinical experience, empathy and creativity to vaccinate students, but opportunities remain to enhance disability-specific training and knowledge of individual students' needs. (3) Special schools are committed to supporting families and facilitating the programme, but limited resourcing and unclear responsibilities present challenges that need addressing. We discuss how these themes relate to the five domains of the Framework. Key considerations for vaccination programme improvement towards a more person-centred approach are highlighted.
Applying the Framework to the findings of the Vax4Health study identified a range of opportunities to improve person-centred school-based vaccination for adolescents with IDD. Future research could involve engagement with all stakeholders to co-design interventions aimed at applying person-centred care principles to vaccinating students with IDD.
The findings from this analysis could be used to inform future implementation research into person-centred approaches to school vaccination aiming for positive outcomes for adolescents with IDD, their families and schools and health professionals.
Nursing students experience heightened stress and emotional burden during clinical training, but opportunities for structured resilience skill development remain limited.
To explore undergraduate nursing students' lived experiences of participation in a resilience-enhancement program.
Qualitative descriptive phenomenology.
Undergraduate students participated in a resilience-enhancement pilot program adapted from Japan for American nursing students. Upon program completion, four semi-structured focus groups were conducted. Sessions were audio-recorded, transcribed and analysed inductively.
Three themes were identified: (1) Intrapersonal Resilience Strategies; (2) Interpersonal & Accountability Supports; and (3) Intervention Design & Delivery Factors. Students described increased emotional insight, stronger coping tools and the value of social accountability.
This study demonstrates that an undergraduate resilience-enhancement program grounded in mindfulness, journaling and peer support is both feasible and meaningful for nursing students. Integrating brief, scalable resilience interventions into nursing curricula may help prepare the next generation of nurses to care effectively for patients and navigate the emotional, ethical and interpersonal demands of a rapidly evolving global healthcare landscape.
This study addresses the global challenge of preparing nursing students for the emotional and relational demands of contemporary healthcare. The program's scalability and alignment with global workforce priorities highlight its potential relevance for nursing education internationally.
This study adhered to the SRQR guidelines.
None.
To explore challenges parents of children with cancer encounter while providing complex medical care at home.
Design: Cross-sectional convergent mixed-methods study. Instruments: Questionnaire and open interviews that mirrored and complemented each other.
Parents (n = 32), with no prior medical training, were expected to remain constantly vigilant as they monitored and managed rapidly changing situations. Regardless of time from diagnosis, they detected a mean of 3.3 ± 1.4 (0–6) symptoms, reported administering up to 22 daily medications, including cytotoxics, narcotics and injections, and dealt with many related challenges. Parents described needing responsive communication channels, especially when dealing with bleeding and infection emergency situations during off-hours.
Findings highlight the constantly shifting demands when managing a child with cancer at home. Educational programmes that address parental needs throughout treatment, tailored to protocol changes and individual circumstances, should be expanded and further developed.
Parents need continual education regarding home management throughout their children's illness and treatment.
This study addresses challenges parents of children with cancer encounter while providing complex medical care at home. The findings demonstrated that parents, responsible for administering numerous medications via various routes and managing symptoms and side effects, did not feel confident performing these tasks regardless of time from diagnosis. Nurses should adapt ongoing parental education regarding complex medical tasks, symptoms, side effects, emergency detection and management for children with cancer at home. The study adhered to the Mixed Methods Appraisal Tool (MMAT) and STROBE reporting method.
Parents of children with cancer participated in the design and questionnaire validation.
To (1) examine the attitudes of community-dwelling adults towards death and their ability to cope with death, as well as (2) understand the influence of advance care planning on community-dwelling adults' death attitudes and coping with death.
A sequential explanatory mixed-methods study was conducted in Singapore.
In Phase I, a case–control study was conducted to examine the differences in death attitudes and coping with death ability between community-dwelling adults who have completed advance care planning and those who have not. A univariate general linear model was used to compute the mean difference in death attitudes and coping with death scores. In Phase II, a descriptive qualitative study was conducted to provide an in-depth understanding of the influence of advance care planning among community-dwelling adults. Thematic analysis was used for qualitative analysis. Mixed-methods analysis was conducted to integrate the quantitative and qualitative data.
In Phase I, 80 community-dwelling adults who had completed advance care planning and 81 community-dwelling adults who did not have advance care planning were included. Adults who had completed advance care planning had significantly higher coping with death scores (t = 4.14, p < 0.01). In Phase II, a purposive sample of 24 adults who had completed advance care planning was selected for individual semi-structured interviews. From the thematic analysis, three themes were developed: (1) Advance care planning enables coping with death, (2) overcoming fear of death with advance care planning and (3) confronting death with advance care planning.
Advance care planning may influence death attitudes and coping with death. Further work on longitudinal designs and among individuals from different age groups should be used to gain further in-depth understanding of the impacts of advance care planning.
Strategies to enhance one's coping abilities with death and death attitudes should be developed to stimulate the uptake of advance care planning.
This paper was reported according to the Good Reporting of A Mixed Methods Study framework.
Community-dwelling adults participated in the survey and interviews.
by Taylor E. Gin, Charlotte O. Moore, Trey Tomlinson, Grace Wilson, Amiah Gray, Cameron Sutherland, Kamilyah Miller, Krista Li, Michael Canfield, Brian Herrin, Erin Lashnits, Benjamin Callahan
BackgroundCtenocephalides felis is a common ectoparasite of dogs and cats and can transmit a variety of pathogens including Bartonella and Rickettsia species. These bacteria, along with the known endosymbiont Wolbachia, are well-documented members of the C. felis microbiome, but species-level information is limited. Additionally, little is known about the variation in the C. felis microbiome in fleas from different sources and when different sequencing methods are applied to the same samples.
ObjectiveThis study aimed to characterize the flea microbiome using both short-read (V3/V4) and long-read (full-length) 16S rRNA gene sequencing, determine whether long-read sequencing improves species-level identification especially in known pathogenic genera, and evaluate differences in microbial composition between fleas collected from cats, dogs, and environmental traps.
MethodsFleas were collected from cats, dogs, and traps in flea-infested homes in Florida, pooled by source, and sequenced using short- (V3/V4) and long-read (full-length) 16S rRNA gene sequencing. Microbial prevalence and abundance were compared across sequencing approaches. Community composition was evaluated for differences between sources and houses. Candidate members of the flea microbiome were identified based on a combination of prevalence, abundance, and statistical signatures of potential contaminant origin. For Rickettsia and Bartonella, species-level taxonomic assignments were refined using a phylogenetic approach.
ResultsWolbachia, Rickettsia, and Bartonella were the most prevalent and abundant taxa. Spiroplasma was identified as a fourth core member of the flea microbiome. Long-read sequencing enabled better, but not perfect, species-level classification of Bartonella and Rickettsia compared to short-read sequencing. Important relationships between specific ASVs and flea sources were identified, for example fleas from cats harbored higher abundances of B. clarridgeiae and B. henselae than fleas from traps.
The Novara Cohort Study (NCS) was established to investigate the biological, psychological and social factors that influence ageing in the general population. The study aims to identify early risk factors for frailty, allostatic load and cognitive decline, and to uncover molecular and functional markers of accelerated biological ageing. NCS addresses the need for detailed life-course data from Southern Europe to support personalised prevention and early diagnosis, and to promote healthy longevity.
NCS is a population-based, longitudinal cohort in the Novara province (Northern Italy), originally enrolling adults aged 35 and older. The inclusion criteria were later expanded to encompass all residents aged 18 and over, facilitating the study of ageing trajectories from early adulthood onward. As of mid-2025, about 1000 participants have been enrolled, and recruitment is ongoing. The cohort’s diversity in age, employment status and health conditions enhances its value for life-course analysis.
Following a pilot phase in 2022–2023, the whole study protocol now includes detailed demographic, clinical, behavioural, cognitive and psychosocial data, along with biological samples stored in the UPO Biobank. The protocol incorporates validated tools, comprehensive physical and cognitive assessments, and over 90 laboratory biomarkers covering inflammation, metabolism, hormonal function and coagulation. Additionally, a subset of participants underwent advanced inflammatory profiling by simultaneous measurement of 92 immune-related proteins and comprehensive genomic profiling using Illumina Single Nucleotide Polymorphism (SNP) arrays, capturing common genetic variation across multiple biological domains. Preliminary results demonstrate the feasibility of integrating deep phenotyping, reveal the roles of frailty in ageing and show initial evidence of age-related changes in inflammatory proteins.
NCS plans to enrol at least 10 000 participants and will conduct long-term follow-up using both passive methods, such as linking with clinical records and administrative health databases, and active in-person reassessments. Future phases will integrate clinical, behavioural and cognitive data with large-scale omics analyses, including genomics, proteomics, metabolomics and transcriptomics. Machine learning techniques will be employed to model biological age, identify early signs of age-related decline and develop personalised prevention strategies. By combining high-resolution phenotyping with multidimensional data, NCS aims to find modifiable risk factors and molecular signatures of ageing, supporting national and European research efforts and encouraging collaborative studies through open data-sharing frameworks.
Population ageing is a global phenomenon that has resulted in an increase in the number of patients with chronic diseases and geriatric syndromes. Frailty, sarcopenia and neurocognitive disorders are among the most prevalent conditions affecting older adults and have a direct effect on their quality of life, and can impact the burden and budgets of health systems. Recently, the oral microbiome has gained attention as it may be a factor that potentially influences the onset and progression of these syndromes. However, this is still a new line of research that has not been deeply explored. This scoping review protocol aims to explore how the oral microbiome may be associated with the onset of prevalent geriatric syndromes, frailty, sarcopenia and neurocognitive disorders, providing a picture of the current evidence and potential gaps for future research.
The scoping review will follow the Johanna Briggs Institute (JBI) methodology and will be reported accordit to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines (PRISMA-ScR). Searches will be conducted in Medline, Embase, Cochrane Central, CINAHL, LILACS and Epistemonikos from inception to December 2025. Independent reviewers will perform the study selection and data extraction. A descriptive analysis of information will be conducted, highlighting oral microorganisms associated with these syndromes and emerging trends in the evidence. Original research studies in any language will be included. We will include randomised controlled trials, cohort studies, case–control studies and other relevant designs if they investigate the oral microbiome and its relation to geriatric syndromes in adults aged 65 or older, regardless of geographic location or setting.
Ethics approval is not required.
by Nitchawan Jongrakthanakij, Thanavadee Prachason, Nida Limsuwan, Komsan Kiatrungrit, Masatha Thongpan, Passaporn Lorterapong, Pattarabhorn Wisajun, Sudawan Jullagate
BackgroundRaising a child with Attention-Deficit/Hyperactivity Disorder (ADHD) is associated with significant parental stress. However, the complex relationships between factors in the child and family in shaping this stress are not well understood. This study aimed to elucidate these interrelationships and identify the key determinants of parental stress.
MethodsA cross-sectional study included 127 children and adolescents with ADHD (70.9% males; mean age 9.6 ± 3.3 years) and their caregivers, recruited from the ADHD Registry at Ramathibodi Hospital, Bangkok (2019–2023). Caregivers completed standardized measures of parental stress, child ADHD symptoms, child functional impairment, family functioning, and parental ADHD symptoms. Structural equation modeling was used to examine pathways from child and parental ADHD symptoms to parental stress, with functional impairment and family functioning specified as mediators.
ResultsExamining child- and family-related factors separately, child ADHD symptoms indirectly influenced parental stress via functional impairment, whereas parental ADHD symptoms significantly influenced parental stress both directly and indirectly via family functioning. In the integrated model examining both child- and family-related factors concurrently, the direct and indirect pathways from parental ADHD symptoms to parental stress via family functioning remained significant, but not the pathway from child ADHD symptoms to parental stress via functional impairment.
ConclusionsFunctional impairment, parental ADHD, and family functioning, rather than child ADHD symptoms, are key determinants of parental stress in families of children with ADHD. These factors should be routinely assessed and targeted to alleviate parental stress more effectively than focusing on child ADHD symptoms alone.
Identify and describe patient engagement interventions used to improve medication management in older adults during transitions of care.
A mixed-methods systematic review.
A comprehensive search of all study designs was conducted. Studies were categorised using the ladder of patient and family engagement, a framework that positions engagement from low (passive) to high (active partnership) patient engagement.
Six databases were searched from inception to April 2024.
The search yielded 29 reports, with 25 classified as studies. Most interventions (n = 19, 76%) were low-level interventions that comprised informing patients in a passive manner. Interventions that facilitated high-level engagement (n = 6, 24%) where patients were integrated in the decision-making process were associated with consistently improved patient and healthcare long-term outcomes.
While low and high-level engagement interventions were associated with significantly decreased hospital readmission rates, high-level interventions consistently demonstrated positive patient outcomes. Interventions supporting older adults beyond discharge achieved meaningful and lasting patient and healthcare outcomes for older adults.
Findings provide clinical reference for designing engagement interventions, highlighting long-term benefits of partnership-based approaches and continuity beyond discharge.
Engagement in medication management during transitions of care varied significantly. High-level engagement was consistently linked to improved patient and healthcare outcomes but was often resource intensive. This review identifies the need to design balanced interventions that align with the preferences of older adults and real-world contextual healthcare settings.
PRISMA guidelines.
No patient or public contribution.
PROSPERO (registration number CRD42024557385).
Patient mental state deterioration presents significant challenges in acute hospital settings, affecting outcomes, increasing reliance on restrictive interventions, and placing additional strain on healthcare staff. Despite its prevalence, consensus on best practice remains limited. The De-escalation, Intervention, Early Response Team (DIvERT) is a pilot rapid response system introduced to improve early identification, enable timely interventions, reduce crisis incidents, and support ward staff in caring for patients with mental state deterioration.
A realist evaluation approach was used to test, validate, and refine program theories explaining DIvERT's mechanisms. Data collection included a cross-sectional survey, semi-structured interviews, field observations, a medical record audit, and incident report analysis. Analysis was guided by the Context-Mechanism-Outcome framework to explain DIvERT's effective functioning in responding to patient deterioration.
DIvERT facilitated early intervention through multidisciplinary collaboration, though organisational factors such as staffing constraints, workload pressures, and inconsistent assessment practices influenced effectiveness. Key mechanisms included structured escalation pathways, clinical skills, staff training, and interprofessional collaboration. Challenges included limited after-hours availability, reflecting the constraints of a pilot initiative, underreporting of incidents, and hierarchical decision-making. While causation cannot be directly established, trends indicate DIvERT was associated with fewer Code Grey responses, particularly during initial episodes of mental state deterioration.
This realist evaluation highlights the value of structured escalation pathways, multidisciplinary collaboration, organisational support, and tailored training in managing mental state deterioration. Preliminary trends suggest DIvERT may enable more proactive and timely early intervention, whereas traditional reactive hospital emergency response for aggression (Code Grey) was more often linked to repeat incidents. Workforce constraints and inconsistent assessment limited effective functioning, underscoring the need for strengthened training, integration into workflows, and improved after-hours coverage to support scalability and long-term success.
This study demonstrates that a proactive rapid response model (DIvERT) can strengthen the recognition and management of mental state deterioration in acute hospital settings. By formalising escalation pathways, improving interdisciplinary collaboration, and tailoring training to staff needs, the model supports safer and more timely responses to patient deterioration. Embedding such approaches into organisational workflows has implications for patient safety, staff confidence, and system efficiency.
The study addressed the challenge of inconsistent and reactive responses to patient mental state deterioration, which are often reliant on crisis interventions such as Code Grey. DIvERT facilitated early intervention through structured escalation processes, improved interdisciplinary collaboration, and enhanced staff skills. However, organisational barriers such as workforce constraints, after-hours gaps, and inconsistent use of mental state deterioration assessment tools limited its effective functioning. Findings are directly relevant to clinicians in acute hospital settings (particularly nursing and allied health staff), hospital administrators responsible for patient safety and workforce planning, and policymakers overseeing standards for recognising and responding to acute deterioration. The results highlight where investment in training, structured escalation systems, and organisational support can reduce reliance on restrictive interventions and improve both patient and staff safety.
This evaluation adhered to the Realist And Meta-narrative Evidence Synthesis: Evolving Standards (RAMESES) II reporting standards for realist evaluations, as outlined in the EQUATOR Network guidelines.
This study did not include patient or public involvement in its design, conduct, or reporting.
To explore whether a delay from referral to first contact with nurse-led community health services is associated with the likelihood of subsequent emergency department attendance.
We use individual linked administrative data on use of community health and hospital services. We identify a cohort of 343,721 individuals referred to community health services in England by their primary care provider in 2019. We then track their subsequent community healthcare contacts and emergency department attendances.
We exploit variation in the time to contact caused by weekend delays, which create longer times to first contact for people referred later in the working week. The main analysis compares patients referred on Thursday with those referred on Tuesday.
We show that 6.7% of patients referred on Thursday wait an extra two days for their first community contact relative to those referred on Tuesday. Despite this delay, we find no evidence that people referred on Thursday are more likely to have a subsequent emergency department attendance compared to those referred on Tuesday.
We do not find delayed community health services contact to be associated with an increased risk of emergency attendance amongst patients referred to community services by their primary care provider. This suggests that short delays in contact time are not detrimental for this group.
Shifting care from hospital to community settings is a key priority for health systems internationally. In England, community health services face significant staffing shortages, limiting the extent to which services can be responsive and support the desired strategic shift. Our findings suggest that these constrained community providers could use their limited capacity to prioritise responding quickly to other patients without harming those referred via primary care.
STROBE guidelines.
This study did not include patient or public involvement in its design, conduct, or reporting.
FreshRSS 