Conectar
by Haojie Wang, Mengxiang Li, Xiaomeng Liang, Weijian Wang, Pengren Luo, Jiaji Zhang, Yuxuan Du, Tan Liu, Boyu Zhang, Xu Wang, Zhefeng Jin, Yilin Zhu, Tao Han
Background & objectivePrevious biomechanical studies on pediatric flexible flatfoot have treated the subject as a single analytical unit, thus failing to elucidate mechanical transmission within the lower extremity closed kinetic chain. This study investigates the impact of distal arch collapse on macroscopic gait parameters, static joint alignment, and dynamic kinematic deviation by integrating a dual-level analytical strategy at both the subject and individual limb levels.
Methods153 children with pediatric flexible flatfoot (25 unilateral, 128 bilateral) were included, and 3D gait data from 306 lower extremities were analyzed. At the subject level, macroscopic spatiotemporal parameters were compared using the Mann-Whitney U test. At the limb level, linear mixed-effects models (LMMs) compared static 3D joint angles and Gait Variable Scores (GVS) between normal feet and flatfeet, treating subject as a random effect and adjusting for age, body mass index (BMI), and unilateral leg length.
ResultsAt both the subject and limb levels, no significant between-group differences were observed in any core spatiotemporal parameters (e.g., Mean Velocity, Frequency, and Step Width) (P > 0.05). Regarding static joint alignment at the limb level, the static Hip Rotation angle on the flatfoot side exhibited significantly less external rotation (i.e., relative internal rotation) compared to the normal side (−2.11° ± 0.67° vs. −5.79° ± 1.79°, P = 0.043). During dynamic walking, the Hip Abduction/Adduction GVS on the flatfoot side was significantly elevated (P = 0.032). However, comprehensive gait indices, including the GDI and GPS, showed no significant overall between-group differences.
ConclusionPediatric flexible flatfoot was associated with subtle proximal biomechanical alterations despite preserved macroscopic gait characteristics. Changes in static hip alignment and dynamic frontal-plane hip kinematics may therefore provide complementary information beyond conventional gait measures, supporting a broader kinetic-chain assessment in clinical evaluation and follow-up.
This study examines factors associated with deep tissue pressure injury and develops interpretable machine learning models for early risk prediction in adult ICU patients. This retrospective observational cohort study included 336 adult intensive care unit patients, of whom 211 developed deep tissue pressure injury and 125 remained pressure injury-free. For patients who developed deep tissue pressure injury, haemodynamic, laboratory and nursing variables from the 24 h before injury onset were analysed using a physiological time-at-risk framework. For pressure injury-free patients, corresponding variables from the first 24 h after intensive care unit admission were used. Six supervised machine learning classifiers were developed and internally validated using cross-validation and hyperparameter optimization. All models showed good predictive performance. Extreme gradient boosting achieved the highest discriminative ability, with an area under the receiver operating characteristic curve of 0.976. The most influential predictors across feature selection methods were low-molecular-weight heparin use, norepinephrine duration, lower blood pressure values, immobility, nutritional risk, antiplatelet therapy and chronic disease profile. Routinely documented nursing and haemodynamic indicators obtained within a clinically relevant 24-h risk window can support accurate early risk stratification for deep tissue pressure injury in adult intensive care unit patients. A physiology-informed and interpretable machine learning approach may improve recognition of patients at imminent risk.
Osteoporosis is a chronic skeletal condition that significantly affects daily life and may benefit from adequate self-care. The Middle-Range Theory of Self-Care of Chronic Illness conceptualizes self-care as a naturalistic process encompassing maintenance, monitoring, and management, also shaped by contextual and cultural factors. Despite this theoretical framework, limited evidence exists on how people with osteoporosis conceptualize and enact self-care in different cultural contexts. Italy and Spain provide comparable yet distinct settings for exploring cultural influences on self-care practices. This study aims to explore and compare self-care behaviors among Italian and Spanish people with osteoporosis.
A cross-national qualitative study was conducted using an Automatic Analysis of Textual Data approach within the Exploratory Multidimensional Data Analysis framework.
Forty people with osteoporosis (38 women and 2 men; mean age 68.6 years, SD = 5.74) were recruited, equally distributed between Italy (n = 20) and Spain (n = 20). Data were analyzed using Labbé's intertextual distance and correspondence analysis to examine lexical similarities, differences, and semantic structures of self-care narratives.
Although moderate intra-national lexical similarity was observed within each national group, substantial inter-national differences emerged between Italian and Spanish participants in the discursive construction of self-care. Italian participants described self-care as a medically mediated and system-oriented process, closely linked to professional guidance, diagnostic procedures, and prescribed treatments. In contrast, Spanish participants framed self-care as embodied, routine-based, and emotionally expressive, grounded in daily practices and bodily awareness. These findings indicate that participants relied on distinct cultural and epistemic models when interpreting and organizing self-care experiences.
This study highlights clear cross-cultural differences in how people with osteoporosis narrate and conceptualize self-care. Methodologically, it illustrates the potential of multidimensional analysis to support systematic and transparent comparison of qualitative datasets. The findings are consistent with the Middle-Range Theory of Self-Care and suggest that greater attention to cultural contexts may inform the development of self-care interventions that are more responsive to individuals' lived experiences.
Recognizing how cultural contexts influence how people with osteoporosis understand and practise self-care may help nurses tailor communication and educational support to individuals' everyday experiences, supporting more responsive and culturally sensitive care.
Due to the increased survival and stable prevalence rates of preterm birth, every clinician, regardless of the patient population or practice setting, has cared for someone born preterm. Unfortunately, most healthcare teams fail to consider preterm birth as a risk factor to adult health, missing a critical opportunity to mitigate risk in this vulnerable population. The purpose of the study was to explore the health status and health experience of adults born preterm with comparisons between birth year cohorts and gestational age categories.
The study utilized a cross-sectional, quantitative descriptive comparative design, augmented by qualitative analysis of open-ended questions.
The health status and health experience survey was developed in collaboration with leaders of an advocacy group for adults born preterm and based on the available research. Convenience, snowball sampling among members of the advocacy network and other preterm birth groups provided an international sample of participants (N = 80).
Chronic conditions or symptoms, representing health status, were reported by 85.7% of participants, with 75% of those participants taking medications for the condition. Participants born less than 32 weeks of gestation reported experiencing health conditions significantly more than those born at later gestations (91.8% vs. 62.5%, p = 0.008); there was no difference in birth year cohort. The most commonly reported conditions were respiratory, mental health, neurodevelopmental, and musculoskeletal. Two-thirds of participants reported never being asked about preterm birth history by healthcare teams. Healthcare experiences were described as ambivalent or dismissive among those who chose to disclose preterm birth status to providers.
Chronic and comorbid conditions associated with preterm birth are common among adults born preterm. These conditions are responsive to prevention and mitigation strategies and, as such, failure to identify adults born preterm as a population susceptible to chronic health conditions results in unidentified, unmanaged risk.
To examine the association between compassion fatigue and spiritual care competence amongst palliative care nurses, investigate the mediating role of palliative care quality and determine the moderating effect of job satisfaction.
Palliative care nurses face intense emotional demands and end-of-life stressors, increasing their risk of compassion fatigue and potentially affecting care delivery. Spiritual care competence is central to holistic palliative nursing; however, its association with compassion fatigue and the organisational factors shaping this relationship remain unclear.
A cross-sectional, correlational study.
Using a convenience sampling approach, 141 nurses working in palliative care units across hospitals in different regions of Türkiye were recruited. Data were collected between April and August 2024 via an online questionnaire including demographic variables and validated instruments measuring compassion fatigue, palliative care quality, spiritual care competence and job satisfaction. Data were analysed using SPSS and PROCESS macro.
The mean spiritual care competence score was 107.9 ± 14.7. Compassion fatigue was negatively associated with palliative care quality and spiritual care competence, whereas palliative care quality was positively associated with spiritual care competence. Mediation analysis indicated a significant indirect association between compassion fatigue and spiritual care competence through palliative care quality. Moderated mediation analysis indicated that this indirect effect was significant only amongst nurses reporting higher job satisfaction.
Compassion fatigue was negatively associated with palliative care nurses' spiritual care competence. Mediation analysis suggested that this association was statistically explained by palliative care quality, whilst job satisfaction moderated the relationship between compassion fatigue and care quality.
Addressing compassion fatigue as a critical occupational risk in palliative care nursing is essential. Organisational strategies that enhance job satisfaction and support high-quality care delivery may help sustain nurses' spiritual care competence and promote high-quality palliative nursing practise.
No patients or members of the public were involved in this study. Palliative care nurses participated by completing online questionnaires.
This cross-sectional study was reported in accordance with the STROBE Statement.
To evaluate the artificial intelligence-assisted lymphedema education material in patients undergoing breast cancer surgery.
A comprehensive, successful methodological design was used to evaluate the portability of the expandable, AI-supported lymphedema education material for breast cancer. The study was reported in accordance with the STROBE statement (see Data S1 for the completed STROBE [Strengthening the Reporting of Observational Studies in Epidemiology] checklist). When preparing the AI-supported lymphedema education material managed with breast cancer treatment, it is first determined in the education of patients. Then, the commands of the Chat GBT-4 program are included in the scope of the transferred education content. For the created education content, readability was first evaluated and expert opinion was taken for the final version of the draft.
While preparing the AI-assisted lymphedema education material in the study, expert opinions were obtained, and the educational needs of the patients were determined by scanning the literature. Then, 12 commands were given in the ChatGPT-4 program to create the educational content. Formulas were used to evaluate the readability of the created educational content in Turkish and the readability of the health literature. The validity of the lymphedema education material was presented to 10 experts. The experts evaluated the understandability and actionability of the educational material using the Patient Education Materials Evaluation Tool and the Global Quality Scale, which evaluates the quality of the educational material.
It was concluded that the readability index of the lymphedema education material for Turkish was 67.3, and the Turkish readability level was ‘easily understandable’. The readability index of health literature was found to be 11.28, 9.68, 10.58, 39.0, and 11.26, respectively. When the internal consistency coefficient between the experts was examined, it was found to be 0.74. It was determined that the Patient Education Materials Evaluation Tool understandability score average was 92.10 ± 9.03, and the actionability score average was 81.60 ± 18.47. The Global Quality Scale score average, which evaluates the suitability and quality of the content of the AI-supported educational material, was found to be 4.10 ± 0.87.
At the end of the study, it was determined that the educational material was reasonable regarding understandability and actionability. The Turkish readability level was also reasonable and easily understandable.
This study is one of the proactive attempts to use AI in preparing educational materials for nurses and healthcare professionals.
No patient or public contribution.
This study examined the anxiety levels of nurses and nurse candidates regarding humanoid nurse robots and artificial intelligence health technologies in perioperative patient care.
Descriptive and cross-sectional study.
The research was conducted with 158 intern students and 167 surgical nurses. Socio-demographic characteristics form, Questions Form Regarding Humanoid Nurse Robots and Artificial Intelligence Health Technologies, Artificial Intelligence Anxiety Scale and The Medical Artificial Intelligence Preparedness Scale were used. The independent t-test and one-way analysis of variance (ANOVA) were used. This study complied with Appendix S1.
The total scores on the Artificial Intelligence Anxiety Scale for nurses and nursing students are 73.089 ± 31.667 and 73.624 ± 28.029, respectively. The total scores on the Artificial Intelligence Readiness Scale for nurses and nursing students are 71.736 ± 15.064 and 72.183 ± 13.714, respectively. When comparing the sociodemographic characteristics and scale scores of nurses, a statistically significant difference was found between age and the Artificial Intelligence Anxiety Scale scores (p < 0.05). There was also a statistically significant difference between age, gender and work duration and the Artificial Intelligence Readiness Scale scores for nurses (p < 0.05).
Both groups exhibited moderate levels of anxiety and readiness regarding artificial intelligence. Comprehensive research is needed to elucidate the impact of artificial intelligence technologies on nursing professionals.
The proper use of Artificial Intelligence technologies can enhance the quality of patient care, alleviate the workload, increase patient and staff satisfaction and foster new perspectives on acceptance. With their integration into clinics, a patient-centred care environment will emerge, improving patient safety, outcomes and overall well-being. Thus, the anxieties of nurses and students towards artificial intelligence technologies will decrease, and their readiness will increase.
No Patient or Public Contribution.
Standardised triage systems have been in place for decades with minor modifications, while nurses' skills and knowledge have significantly advanced.
To determine whether nurses' clinical expertise outperforms triage systems in simulated clinical cases.
A multicenter simulated observational study.
The study was conducted from January 1, 2024 to March 31, 2024, in four Italian emergency departments, enrolling triage-performing nurses. Thirty clinical cases, based on real patients representing daily emergency department influx, were reconstructed. The primary outcome was the agreement between the triage code assigned by the Manchester Triage System and the code assigned based on clinical expertise. The secondary outcome compared the predictive ability of the codes assigned by nurses regarding clinical outcomes, such as death within 72 h, the need for hospitalisation, and the need for life-saving intervention. The study was reported in accordance with the STROBE statement.
Seventy-seven triage nurses completed the 30 vignettes. The agreement between the MTS-assigned code and the clinical expertise triage reported a Cohen's kappa of 0.576 (95% CI: 0.564–0.598). For death within 72 h, the clinical expertise code reported better results than the Manchester Triage System. For life-saving interventions, the Manchester Triage System reported a lower performance than clinical expertise. The variability in triage code assignment was higher for clinical expertise compared to the Manchester Triage System.
Triage codes assigned by nurses based on clinical expertise perform better in terms of clinical outcomes, suggesting a need to update triage systems to incorporate nurses' knowledge and skills. However, standardised triage systems should be maintained to reduce variability and ensure consistent patient classification.
The study was conducted and reported according to the STROBE statement.
No patient or public contribution.
To understand the role of simulation in ensuring the development of the competencies expected by newly graduated register nurses (NGRNs) from the work initiation up to 5 months of transition.
Mixed-method study design. A longitudinal phase employing the Nurse Competence Scale (NCS, from 0 to 100, excellent) to assess the perceived competencies among NGRNs (N = 151) at three time points (first day of work up to fifth month); followed by a qualitative phase involving four focus groups of preceptors (N = 16) to explore the potential role of simulation in the NGRNs' working transition. Integration was performed at findings level, using the building procedures and joint displaying the results.
During the different time periods, variations emerged in the NCS scores from 64.41 out of 100 in the first day of work to 61.82 after 15 days, reaching 69.25 and 73.21 at 3 and 5 months. Nine potentialities have been identified as having simulation supporting NGRNs during their transition to independent practice. Simulation may contribute to develop competencies in some competence domains (diagnostic function, managing situation, therapeutic intervention, quality assurance and working role) while not in others (helping role and teaching–coaching).
Early interventions, through integration of simulation sessions into strategies offered at the unit's level may be useful to ensure an effective working transition.
Problem the study addresses: Challenges in transition from education to working settings are increasing given the difficulties of the units in providing time and support to NGRNs. Main findings: Competencies of NGRNs' are fluctuant in the five first months of work, and sub-optimal in certain domains. Simulation may support the full development of most competencies. Impact on research: Healthcare organisations can support NGRNs to ensure smoother transitions by integrating simulations in their strategy.
This study was conducted following the Good Reporting of a Mixed-Methods Study.
Only healthcare professionals were involved.
Frailty is a multidimensional syndrome of reduced physiological reserve and heightened vulnerability to stressors. Frailty is common among older adults and linked to adverse outcomes including disability, hospitalisation and death. Infections are common in older populations and remain a major cause of morbidity and death. Although it has been suggested that infections influence frailty development and progression (via inflammatory and functional mechanisms), evidence from longitudinal studies is inconsistent. Therefore, we aim to assess longitudinal associations between infections and frailty in adults.
We will conduct a systematic review of observational cohort and case-control studies examining associations between infections and frailty in adults. We will search MEDLINE, Embase and Global Health from 2001 to February 2026 without language restrictions. Two reviewers will independently screen titles and abstracts and subsequently assess full texts for eligibility. Data will be extracted using a standardised data extraction form. Risk of bias will be assessed using a customised domain-based tool based on the Risk Of Bias In Non-randomised Studies of Exposures (ROBINS-E) framework. We will initially narratively synthesise our findings. Where studies are sufficiently homogeneous, we will undertake random effects meta-analysis. We will assess the certainty of the evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.
Ethical approval is not required for a systematic review. Results of the review will be published in a peer-reviewed journal and disseminated through conferences.
CRD420261299590.
There are currently no colorectal cancer (CRC) screening recommendations specifically outlined for people with HIV (PWH). Screening measures used for people without HIV (PWoH) have been previously discussed as sufficient for use among PWH, despite observations of higher CRC prevalence and CRC reportedly appearing at earlier ages among PWH in comparison to PWoH. Machine learning (ML) methods are regarded as robust approaches that may enhance predictive performance, particularly in the context of complex or high-dimensional data. This study aims to develop an ensemble ML model to predict CRC risk in PWH using comprehensive nationwide datasets. The model’s predictive performance will be evaluated and compared with a baseline Cox proportional regression model. The better-performing method will be implemented to develop a CRC risk prediction model with the aim of personalising screening recommendations for PWH.
The study population will include all PWH and PWoH born between 1940 and 2008, aged 18 or older and living in Sweden sometime between 1983 and 2024. The study population will be linked to six nationwide demographic and healthcare registers. Follow-up will continue until the first incident of CRC, emigration or death. The outcome of interest is CRC. PWH will be matched to negative controls 1:10. A Cox regression analysis will be completed first, and the results will be used as a baseline comparison to the ensemble ML results. A range of ML methods will be used to develop the ensemble model using stacking.
This study has ethical approval from the Regional Ethical Committee in Sweden (Dnr: 2024-04185-02, 2024-06783-02, 2023-00191-01, 2022-02897-02, 2022-05624-01, 2018/11-31/2). Given that the study is retrospective and register-based, using only pseudonymised data, there are minimal physical, psychological or privacy risks to included individuals. All results will be presented at the population level with no possibility of identification. The results of this study will be submitted for publication in a peer-reviewed journal.
by Anirudh Bhatia, Justin Elser, Steven J. Carrell, Brent Kronmiller, Melissa Sutton, Christine Kelly, Tyler S. Radniecki
BackgroundWastewater surveillance is a valuable tool for monitoring SARS-CoV-2 at the community level. As the virus diversified into many variants and subvariants that share overlapping mutations, resolving them accurately from wastewater becomes a key bioinformatic challenge.
Objectives and aimsThis study evaluated two distinct bioinformatic approaches, multilocus sequence typing (MLST) and Freyja, for identifying SARS-CoV-2 variants and subvariants in Oregon wastewater samples collected from February 2021 to February 2022.
MethodsThe MLST approach identified SARS-CoV-2 variants using unique mutations curated from clinical samples. In contrast, the Freyja approach resolved variant and subvariant abundances using genome wide mutation profiles weighted by sequencing depth. In this study, the variant and subvariants relative abundances produced by both approaches were compared against those observed in clinical surveillance data.
ResultsBoth approaches identified SARS-CoV-2 variants at relative abundances that agreed closely with those observed in clinical surveillance data. However, only the Freyja approach identified over 200 Delta subvariants, divided into three clades (21A, 21I and 21J) and two levels (Level 1 and 2) based on Pango subvariants. Delta subvariants showed strong agreement at Level 1 subvariants (rs = 0.892–0.944), while agreement at Level 2 subvariants was inconsistent (rs = 0.324–0.903).
ConclusionsThe Freyja approach provided enhanced resolution of SARS-CoV-2 variants and subvariants in wastewater, at abundances that agreed with clinical surveillance. This added resolution is a critical advantage for public health surveillance as SARS-CoV-2 continues to evolve and share mutations across variants and subvariants.
by Melissa Lagger, Hugo Najberg, Almir Miftaroski, Lucien Widmer, Sara Di Renzo, Pouya Iranmanesh, Maxime Matter, Boran Tekdogan, Stéphanie Perrodin, Beat Gloor, Christian Toso, Jean-Louis Frossard, Michel Adamina, Leo Buhler
Aim of the studyIntraductal papillary mucinous neoplasms (IPMNs) are among the most common cystic pancreatic neoplasms, with a potential to progress to malignancy. The increasing prevalence of IPMNs, coupled with the widespread use of GLP-1 receptor agonists (GLP-1 RAs) for diabetes and obesity management, raises concerns about the safety of these medications in patients with preexisting pancreatic conditions. Despite their proven metabolic benefits, questions remain about their impact on pancreatic pathology. This study investigates the association between GLP-1 RA use and IPMN progression to address this critical gap in the current literature.
MethodsThis retrospective multicentric cohort study will analyse data from January 2010 to July 2026 across three Swiss tertiary institutions. Patients with a radiological diagnosis of IPMN and/or treated with GLP-1 RAs will be included. Patients will be stratified into four groups according to a 2 × 2 design based on GLP-1 RAs exposure and IPMN status. The primary objective is to evaluate the impact of GLP-1 RAs on IPMN progression using radiological criteria from the Kyoto 2023 Consensus. Secondary objectives include assessing changes in tumour markers (CA19−9, CEA), the incidence of acute pancreatitis, the progression of IPMNs to high-grade dysplasia or invasive carcinoma, and the need for surgical intervention or altered surveillance protocols associated with GLP1 RAs use.
DiscussionThis study aims to explore potential associations between GLP-1 RA use and changes in IPMN characteristics, tumour markers, and disease progression. Given the retrospective design and expected small sample size (estimated at 30–60 patients in total), the study may not be powered to establish definitive correlations. Nonetheless, it will generate preliminary data to help inform hypotheses and guide future research. Any observed trends could provide valuable insights into the safety of GLP-1 RAs in patients with IPMNs and contribute to more informed clinical decision-making regarding the use of these agents in a population at risk for pancreatic disease progression.
Trial registrationClinicalTrials.gov NCT07014709
To critically analyse how the integration of artificial intelligence into clinical nursing practice reconfigures the foundations of person-centred care, in light of the Fundamentals of Care Framework.
This is a theoretical-reflective study using the relational, integrative and contextual dimensions of the Fundamentals of Care Framework as analytical axes.
The analysis argues that the integration of artificial intelligence modifies the conditions under which person-centred care is delivered. In the relational dimension, technological mediation redistributes professional attention and influences clinical decision-making. In the integrative dimension, the expansion of monitoring and coordination does not, by itself, ensure coherent articulation among physical, psychosocial and relational needs. In the contextual dimension, the adoption of this technology is conditioned by organizational, political and regulatory factors that shape care priorities and quality criteria.
Artificial intelligence does not replace care but transforms the structural conditions under which person-centred fundamental care is delivered. The quality of care remains dependent on the nurse's professional mediation, responsible for integrating digital data with lived experience and sustaining the relational, integrative and ethical commitment that underpins nursing practice.
The integration of artificial intelligence requires relational competence, critical judgement and the ability to calibrate trust in algorithmic recommendations in light of the person's circumstances. Nursing organizations and leadership must ensure that digital transformation remains aligned with the principles of person-centred care, incorporating ethical governance, data protection and evaluation sensitive to patient experience. Professional education should prepare nurses to compare algorithmic outputs with patient narratives and their own clinical assessments, and to sustain the care relationship across varying levels of cognition, communication and cultural reference.
by Perseverence Savieri, Lara Stas, Kurt Barbé
Interaction effects in ANOVA provide crucial insights into how the effect of one independent variable depends on the level of another. However, interpreting these interactions, especially three-way interactions, remains a challenge. Firstly, visualisation techniques typically rely on multiple separate two-dimensional plots conditioned on the levels of a third factor; as the number of levels of the third factor increases, so does the number of plots, complicating interpretation. Secondly, routinely applying uncorrected post-hoc pairwise comparisons oversimplifies interaction effects and, by ignoring the multiplicity of tests, inflates Type I error rates, potentially leading to misleading conclusions. Advanced methods, such as partial dependence plots and interaction decomposition models, have partially addressed these limitations; however, they typically require substantial statistical or computational expertise, which limits their accessibility. To address these challenges, this manuscript introduces EXCITE (Enhanced eXploration of Complex Interactions in ANOVA using Trees), an interactive web application developed using the Shiny package within the R statistical environment. EXCITE integrates traditional two- and three-way ANOVA models with decision tree-based visualisations. Decision trees detect interaction patterns via recursive data partitioning and present conditional subgroup relationships through an interpretable tree structure. The advantages of EXCITE include presenting two- and three-way interactions intuitively, enhancing accessibility, and facilitating accurate interpretation of complex statistical interactions. This integration provides researchers and educators across various scientific disciplines with a user-friendly tool for interpreting and visualising ANOVA interactions. We illustrate the capabilities of EXCITE using both simulated examples and a real dataset to demonstrate its practical applicability. The web application is freely available online, requiring no installation or coding expertise, at https://zq9mvv-vub0square.shinyapps.io/EXCITE-research-tool/.Chronic pain is a public health priority that affects 18% of Dutch and 16% of German adults, representing a major societal burden. The Ems Dollart Region (EDR), which forms the northern part of the Dutch–German border area, is particularly characterised by lower incomes, more physically demanding jobs and lower health literacy, which are associated with higher pain prevalence. Individuals with lower socioeconomic status face greater pain-related disability and reduced quality of life. Public health campaigns underpinned by pain science education provide a strategy to improve understanding of pain among the wider public by addressing common misconceptions about its causes and management. However, large-scale population-level interventions and evaluations of such campaigns remain limited.
This protocol describes the design and implementation of a cross-border public health campaign in the EDR, aimed at improving public understanding of pain, changing attitudes and beliefs and promoting healthy behaviours. We will conduct a quasi-experimental before–after study in the EDR with a control group in Flanders (Belgium). The intervention is guided by behaviour change and biopsychosocial models. The campaign will deliver tailored content via social media, broadcast, print and online advertisements over a 24-month period. Two independent cross-sectional samples will be surveyed at baseline and at 2-year follow-up, comprising 3200 participants per measurement wave from three regions: the Netherlands and Germany as intervention regions, and Flanders, Belgium, as the control region. The primary outcome is the prespecified Pain Concepts Questionnaire ratio score, assessing pain-related knowledge, attitudes and beliefs. The primary analysis will use an adjusted difference-in-differences framework to estimate whether change in the primary outcome differs between the combined intervention regions and the control region. Secondary analyses will examine the Netherlands and Germany separately and will evaluate healthcare utilisation, medication use, health-related quality of life and work absenteeism.
This study protocol was reviewed by the Medical Ethics Review Board of the University Medical Center Groningen and the University of Oldenburg. The study was considered not subject to the Medical Research Involving Human Subjects Act (non-WMO declaration; reference number M24.345555, issued on 31 December 2024) and was approved by the University of Oldenburg Ethics Committee (reference number 2025–056, issued on 07 March 2025). Informed consent was obtained electronically by the research agency at the time of participants’ registration with the research panel. Study findings, regardless of outcome, will be disseminated through peer-reviewed publications and presentations at national and international conferences.
To describe all nursing home staff members' confidence in engaging in complex clinical communication with residents and family carers, and to explore factors affecting their attitudes.
A convergent mixed-methods study used questionnaires (n = 288) and 15 group-based discussions involving 278 professionals across nine nursing homes between April and May 2025. Quantitative data were analysed descriptively, and qualitative data underwent inductive thematic analysis. Findings from the two strands were compared and integrated to develop mixed-methods inferences, with qualitative data given priority to confirm, expand or contrast the survey results.
Staff members reported limited confidence in sustaining complex clinical communication, mainly because of uncertainty in responding to family carers' questions, difficulty managing emotional reactions, lack of training and unclear role responsibility. Qualitative findings identified barriers at the facility (chronic understaffing, limited physician presence, structural limitations), team (hierarchical asymmetries, limited information sharing, intraprofessional conflicts) and resident/family levels (sensory/cognitive impairments, unrealistic expectations, distrust, role confusion, intra-family conflict). Integrated findings showed convergent and divergent patterns. Qualitative data added information on communicative and relational challenges with residents/families, understaffing-driven system barriers and structural limitations. Questionnaires suggested good leadership relationship and group cohesiveness, but group discussions revealed interprofessional and intraprofessional conflicts.
Limited confidence in complex clinical communication was linked to interacting barriers at the organizational, team and resident/family levels. Effective improvement requires combining education that builds communication skills and strategies for emotionally intense conversation, protected time and spaces, team and organizational initiatives that strengthen wellbeing and collaboration, and strategies that support residents' involvement, foster family trust, and reduce unrealistic expectations and role confusion.
Findings highlight the factors that undermine professionals' confidence in sustaining complex clinical communication in nursing homes, and offer targets that policymakers, nursing home managers and educators should consider to strengthen staff-resident/family interactions.
Mixed methods reporting checklist.
None.
by Rena Hidaka, Akiko Kojo, Yuji Masuda, Shintaro Hata, Misaki Tanaka, Tona Watanabe, Koichiro Matsuo
BackgroundDental and oral health activities that promote awareness of oral health are essential in children’s nutrition education. We aimed to evaluate the effects of the Comprehensive Awareness Modification of Mouth, Chewing And Meal (CAMCAM) program for kids, in which participants gather monthly to learn about oral health and nutrition while consuming a textured meal at community children’s cafeterias.
MethodsThis single-group pre–post pilot intervention without a control group included 52 children and 32 parents/guardians who regularly attended two community children’s cafeterias in Tokyo, Japan. They participated monthly in six sessions in which they were provided a “munchy” textured meal and a 10-minute lecture on chewing, oral health, and food and nutrition. Participants completed questionnaires assessing their awareness of the subject and food intake frequency, before and after the intervention. Changes in awareness and behaviors following participation in the program were analyzed.
ResultsThe median ages of the children and parents were 8.5 (6–16) and 43.0 (36–50) years, respectively. The frequency of self-observation of the oral cavity among children increased. Daily fluoride use frequency increased from 61.5% to 76.9% (p = 0.020). The number of children who reported not considering nutritional balance decreased from 63.5% to 38.5% (p = 0.022). The number of parents/guardians who actively practiced a nutritionally balanced diet non-significantly increased from 56.2% to 75.0%. Food intake frequencies for meat, dairy products, and tubers, among caregivers, and that for rice, tubers, and fruits among children increased post-intervention. The number of participants who did not consider the number of chewing cycles decreased.
ConclusionParticipation in CAMCAM-P for kids was associated with favorable changes in oral health awareness and attitudes toward nutritional balance among children and parents/guardians. As a pilot study without a control group, these findings should be considered preliminary. Larger controlled studies are warranted to confirm effectiveness.
FreshRSS 