Conectar
To explore intensive care nurses' perceptions of their work environments at the unit and organisational levels according to the American Association of Critical Care Nurses standards, their impact on care quality, national differences, and demographic associations.
Cross-sectional study using a survey design.
Study conducted between January 2021 and April 2022, using a convenience sample of intensive care unit nurses across Cyprus, Spain, Croatia, and Poland, Romania. The Critical Elements of a Healthy Work Environment Scale (CEHWES) developed by the American Association of Critical Care Nurses and cross-culturally adapted by the authors was used, which included four sections, including sociodemographic data and a total of 50 questions. The core section of the tool comprised 16 questions using Likert-type response (1—strongly disagree—4 strongly agree). Perception of fulfilment of healthy work environment standards was calculated using the aforementioned Likert-type scale.
A total of 1183 nurses participated reporting moderate perception of fulfilment of the standards, with mean scores ranging from 2.6 to 2.8. Skilled communication and effective decision making were the highest rated. 56% (n = 662) reported awareness of some standards and while 25.8% (n = 305) reported full or significant implementation in their unit. Significant differences related to the perception of all standards were observed across countries. Implementation of the standards was significantly associated with higher quality of care having better perception when standards were fully implemented.
This study shows moderate perception of healthy work environment standards among intensive care nurses. Country differences highlight the need for more awareness, training, and further implementation of the standards, which is linked to better care quality.
Work environment still need to improve and needs to be prioritised by organisations, considering local and national particularities. Having a measuring tool available in multiple languages facilitates comparisons and getting a global picture.
The questionnaire used is validated in different languages, allowing results to be compared with other countries. Novel data from countries that were poorly investigated is now available. More evidence points out the need to prioritise work environment for maintaining quality in patient care.
The study has been reported following the STROBE checklist.
This study did not include patient or public involvement in its design, conduct, or reporting.
Urgent and emergency care (UEC) systems in England face unprecedented pressures, with record accident and emergency attendances, persistent breaches of ambulance response targets and poorer outcomes for time-sensitive conditions. National UEC recovery plans have introduced multiple innovations—such as same-day emergency care, virtual wards and specialty hubs—to manage these pressures and improve patient flow. Rural coastal areas are particularly vulnerable to excessive demand due to higher levels of deprivation, older populations with complex health needs, seasonal surges that generate unpredictable demand and challenges in attracting and retaining staff. Following the Chief Medical Officer’s 2021 Annual Report, funding research and developing bespoke solutions to manage UEC demand and address geographical disparities has been recognised as a national priority. The Elevate study responds to this priority by identifying and evaluating innovative models of UEC in rural coastal communities in England.
The Elevate study is a 30-month, mixed-methods evaluation that comprises three interlinked work packages: (1) National service mapping—outlining provision of innovative models of UEC in rural coastal areas of England. This will be developed through document review and interviews with regional and national service leaders. (2) Quantitative analysis—quasiexperimental and longitudinal approaches will use National Health Service (NHS) England’s Emergency Care Data Set and linked routine NHS datasets to evaluate the impact of UEC models on health and process outcomes. Standard and bespoke metrics will be developed and used to assess performance. (3) Qualitative case studies—up to 12 case studies of UEC models in rural coastal communities. Interviews with patients and staff and non-participant observation will explore how and why different UEC models influence patient experience, clinical outcomes, resource use and the workforce. Findings will be integrated using the Consolidated Framework for Implementation Research to identify components of UEC models that are effective, scalable and sensitive to local context,
Ethical approval for qualitative components was granted by the North of Scotland Research Ethics Committee (25/NS/0099). Dissemination will include peer-reviewed publications, policy briefs, creative media and community engagement activities to ensure findings are communicated inclusively and effectively to policymakers, health and social care practitioners and the public.
Research Registry (researchregistry11126).
This study investigated perinatal depressive symptoms among pregnant and postpartum Filipino women.
Cross-sectional survey.
The Philippines.
Participants were recruited online and face-to-face from maternal care facilities.
Perinatal depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS) score, with prevalence calculated based on ≥13 cut-off, indicating clinically significant symptoms of depression. Patterns of depressive symptoms were examined by demographics, perinatal time period and other obstetric information using adjusted regression coefficients (ab) and risk ratios (aRR).
A total of 856 women participated in the study, comprising 356 pregnant and 500 postpartum women. EPDS scores were, on average, similar between pregnant (14.4) and postpartum women (14.1). Using the locally validated cut-off of ≥13 revealed that 69.1% of pregnant and 62.0% of postpartum women reported clinically significant depressive symptoms. Consistent EPDS scores and prevalence were observed across pregnancy trimesters and within 12 months postpartum and beyond. Women who received adequate prenatal care were less likely to experience antenatal (ab=–1.59, 95% CI –3.13 to –0.05) and postpartum (ab=–1.30, 95% CI –2.48 to –0.12) depressive symptoms. Postpartum EPDS scores and depressive symptom prevalence (EPDS score ≥13) were higher among 18–24-year olds (ab=1.96, 95% CI 0.30 to 3.61; aRR=1.23, 95% CI 1.03 to 1.47) and single mothers (ab=3.46, 95% CI 0.22 to 6.71; aRR=1.42, 95% CI 1.07 to 1.90), compared with older and married mothers, respectively.
At least 60% Filipino mothers experienced clinically significant perinatal depressive symptoms, which exceeds the established global average of 25%. Younger and single postpartum women were at greater risk, while pregnant and postpartum women who attended adequate prenatal visits were less likely to report depressive symptoms. Our study underscores the need for further research to uncover the true burden of poor perinatal mental health and calls for targeted early interventions and integrative public health strategies to support at-risk mothers, particularly those from socially disadvantaged backgrounds.
by Renata dos Santos Guarnieri, Guilherme Sá de Oliveira, Kaylaine Marques Ferreira, Aline Penna-de-Carvalho, Vanessa Souza-Mello, Sandra Barbosa-da-Silva
High-intensity interval training (HIIT) is an effective intervention for improving metabolic health and mitigating metabolic dysfunction-associated steatotic liver disease (MASLD). Nonetheless, the stability of these benefits throughout detraining periods and upon weight regain remains inadequately characterized. This study aimed to evaluate whether hepatic improvements induced by HIIT are sustained during detraining, even after body weight regain. Eighty male C57BL/6 mice were fed either a control (10% fat) or a high-fat (HF) diet (50% fat) for 12 weeks. Following this period, the animals were allocated to groups subjected to continuous HIIT or intermittent training cycles (each lasting 3 weeks). The outcomes assessed included body mass (BM), glucose tolerance, lipid profiles, liver enzyme levels (aspartate aminotransferase and alanine aminotransferase), hepatic steatosis, and the expression profiles of genes associated with lipogenesis (Srebf1, Mlxpl, and Fas), β-oxidation (Ppara and Cpt1a), and endoplasmic reticulum (ER) stress (Atf4, Ddit3, and Gadd45). Compared with the sedentary HF-NT condition, continuous HIIT reduced BM and improved glucose tolerance. Intermittent training (HF-TNT, HF-NTN) preserved metabolic benefits and reduced triglyceride and cholesterol levels. Notably, hepatic steatosis was significantly alleviated in all training groups but persisted even after detraining. Additionally, HIIT downregulated the expression of lipogenic genes and upregulated the expression of genes involved in β-oxidation. The levels of markers indicating ER stress were attenuated by HIIT, with a sustained reduction during periods of detraining. HIIT-induced metabolic and hepatic improvements persist partially during detraining, despite weight regain. These findings underscore the therapeutic value of continued or periodically repeated physical training in mitigating the adverse effects of an HF diet and preventing the progression of metabolic disorders such as MASLD.by Hemant Mahajan, Poppy Alice Carson Mallinson, Judith Lieber, Santhi Bhogadi, Santosh Kumar Banjara, Anoop Shah, Vipin Gupta, Gagandeep Kaur Walia, Bharati Kulkarni, Sanjay Kinra
Background and AimCardiovascular diseases (CVDs) represent a growing public-health challenge in India, where nearly one in four deaths is CVD-related. Accurate risk stratification underpins targeted prevention, yet laboratory-dependent tools are often impractical in resource-limited settings. The World Health Organization (WHO) and GLOBORISK initiatives both offer non-laboratory-based 10-year CVD risk algorithms alongside their laboratory-based counterparts. We aimed to compare laboratory- and non-laboratory-based WHO and GLOBORISK CVD risk scores, assess their concordance, and examine relationships with sub-clinical atherosclerosis in a rural Indian cohort.
Materials and MethodsWe conducted a cross-sectional analysis of 2,465 adults (1,184 men, 1,281 women) aged 40−74 years from the third wave (2010−12) of the Andhra Pradesh Children and Parents Study (APCAPS). Participants with prior CVD were excluded. Ten-year CVD risk was calculated using sex-specific WHO (South Asia) and India-calibrated GLOBORISK models, both laboratory-based (age, sex, smoking, systolic blood pressure, diabetes, total cholesterol) and non-laboratory-based (age, sex, smoking, systolic blood pressure, BMI) algorithms. Categorical agreement was quantified via percentage agreement and quadratic weighted kappa (κ); continuous agreement by Bland-Altman analysis. We also evaluated linear associations between each risk score (categorical and continuous) and three sub-clinical atherosclerosis markers: carotid intima-media thickness (CIMT), pulse-wave velocity (PWV), and augmentation index (AIx), through sex-stratified multi-level linear regression with random intercept at the household level, adjusting for multiple testing (p Results
Median WHO-CVD-risk was 6.0% (IQR 4% − 9%) in men and 3.0% (2% − 4%) in women for both lab and non-lab models; median GLOBORISK-CVD-risk was 12.0% (9% − 16%) for lab-model vs. 15.0% (10% − 16%) for non-lab-model in men and 5.0% (3% − 9%) for lab-model vs. 5.0% (3% − 9%) for non-lab-model in women. Categorical agreement was substantial to almost perfect: WHO κ = 0.82 (overall), GLOBORISK κ = 0.72. Bland-Altman analyses demonstrated mean differences Conclusion
Non-laboratory-based WHO and GLOBORISK CVD risk scores exhibit high overall agreement with laboratory-based models and correlate strongly with subclinical atherosclerosis in rural India. However, modest underestimation in high-risk subgroups (diabetics, hypercholesterolemia) warrants cautious interpretation. These findings support the feasibility of non-lab risk assessment in resource-constrained settings, while underscoring the need for prospective validation against hard cardiovascular outcomes prior to large-scale implementation.
This study assessed the feasibility of implementing a phase 3 field-based clinical trial protocol to evaluate paediatric praziquantel (PED-PZQ) for the treatment of Schistosoma mansoni infection in children aged 3 months to 6 years in endemic areas of Brazil, focusing on operational aspects such as recruitment logistics, documentation management, investigational product handling and protocol adherence.
Pilot and feasibility study for a phase 3 clinical trial, comprising two components: a randomised, open-label, parallel-group, two-arm trial and a single-arm trial.
Conde, Bahia, Brazil, from December 2024 to January 2025.
Two trials aim to screen 5774 participants from three rural areas in Bahia and three in Sergipe, states in northeastern Brazil, and enrol 403 children eligible for either randomisation or allocation. Trial 1 will randomise (1:1 ratio) 240 children aged 4–6 years into the PED-PZQ treatment arm or the standard praziquantel (PZQ) 1. Trial 2 will enrol 163 children aged 3 months to 3 years, all receiving PED-PZQ. Both trials are open label. Eligible participants shall meet age criteria, test positive for S. mansoni and fulfil other inclusion criteria. In the first recruiting centre, Conde (Bahia), it was estimated that 650 participants would need to be screened for trial 1 and 552 for trial 2, assuming schistosomiasis prevalence of 5% and 4%, respectively. This pilot study reports on the first 60 participants enrolled.
The primary outcome of this pilot study is the feasibility of implementing the research protocol in a real-world field setting, focusing on key aspects such as study documentation challenges, participant safety, investigational medicinal product custody chain and protocol adherence. In addition to providing preliminary data on the parasitological cure rate, secondary outcomes include the prevalence of S. mansoni infection and the reduction in S. mansoni egg count (Kato-Katz method). Furthermore, the occurrence and severity of drug-related adverse events are monitored from drug administration to day 21 post-treatment, alongside changes in renal, hepatic and cardiac functions assessed through biochemical markers.
A total of 60 participants were recruited, and 55 provided stool samples for screening. The pilot phase demonstrated the feasibility of implementing the clinical protocol under field conditions, with successful completion of all planned procedures and minimal protocol deviations. Operational challenges were identified mainly in documentation processes, participant recruitment and investigational product management and were addressed through preventive and corrective quality assurance actions. The experience also highlighted logistical and infrastructural barriers typical of field-based trials in remote endemic areas, which informed adjustments for the subsequent phase 3 study. Preliminary parasitological results indicated an overall S. mansoni prevalence of 9.1% (5/55), with 21% in trial 1 and 2.8% in trial 2. All infected participants met the eligibility criteria, received treatment and completed follow-up. Four achieved a parasitological cure, and one case of treatment failure was observed (trial 1, PZQ group). Two mild adverse events (diarrhoea) were reported, with no serious complications or clinically significant changes in biochemical parameters.
This pilot study demonstrated the feasibility of implementing a field-based phase 3 clinical trial protocol for PED-PZQ in endemic areas of Brazil. The findings confirm that the protocol can be successfully applied in primary care settings, despite operational challenges related to recruitment, logistics and documentation. The study also provided preliminary evidence supporting the safety and effectiveness of the paediatric formulation and highlighted the need to revise prevalence assumptions to improve future screening strategies. Overall, the experience offers valuable insights to guide the large-scale phase 3 trial and supports the incorporation of PED-PZQ into national schistosomiasis control policies.
Brazilian Clinical Trials Registry; RBR-86kcy37.
Yoga has been shown to improve pain and function compared with no exercise in people with chronic low back pain (LBP), but treatment effects are small. Given that yoga is a mind–body intervention that addresses physical as well as psychological factors, it may be more effective for patients with chronic LBP who are at high risk of poor prognosis. The study aims to investigate the efficacy of a 12-week yoga programme combined with education in reducing pain and disability for individuals with chronic LBP at high risk of poor prognosis at short (12 weeks) and intermediate (24 weeks) terms, compared with a control group receiving education only.
A randomised controlled trial will include 110 adults with chronic non-specific LBP reporting an average pain intensity of 3 points or more on a 0–10 scale over the past week and classified as high risk of poor prognosis (ie, scoring 50 points or above) on the Orebro Musculoskeletal Pain Questionnaire short-form. Participants in the control group will receive an educational booklet and attend three face-to-face lectures over a 3-month period. In the intervention group, in addition to the booklet and lectures, participants will attend group yoga sessions twice a week for 12 weeks, totalling 24 yoga sessions. The primary outcome is disability assessed at 12 weeks, measured using the Roland-Morris Disability Questionnaire.
The study was approved by the Human Research Ethics Committee of Universidade Federal de Minas Gerais (Protocol number CAAE: 57028022.0.0000.5149). Findings will be disseminated to trial participants, clinicians and the broader public and scientific community.
To explore and map the landscape of doctoral nursing research across eight countries.
A scoping review.
This review followed the Joanna Briggs Institute methodology for scoping reviews and included doctoral theses in nursing defended between 2020 and 2023 in Austria, Italy, Israel, the Netherlands, Poland, Portugal, Slovakia and the United Kingdom.
Searches were conducted across 15 national and university repositories (4 national, 11 university) in the eight participating countries.
This review included 431 doctoral nursing theses, the majority of which employed quantitative methodologies and focused on patient populations and healthcare professionals. Key topics included clinical nursing care, quality of care, quality of life, home care, perinatal care and the work environments.
Nursing doctoral research shows progress in healthcare delivery, patient care and education via digital tools, holistic approaches and professional development. Yet gaps persist in mental health, paediatrics and marginalised groups. Limited qualitative/mixed-methods research and weak interdisciplinary collaboration reveal further opportunities.
This review underscores that nursing doctoral research is addressing major healthcare and professional challenges. Nonetheless, the identified gaps emphasise the need for more comprehensive and inclusive research to enhance equity and guide future nursing practices and policies.
This review provides an overview of the scope of doctoral nursing research across eight countries, identifying key trends and research gaps. The findings are expected to inform nursing academia, policymakers, and healthcare professionals by guiding future research priorities, fostering interdisciplinary collaboration, and promoting equitable, patient-centred care practices.
No direct involvement in data collection; one lay reviewer gave feedback on readability and practice implications, informing minor refinements.
Da Parteira à Enfermeira Especialista em Enfermagem Obstétrica: evolução da formação entre 1836 e 1988
Resumo
Contexto: Em Portugal, a escolarização das Parteiras teve início no século XIX, a partir de 1836, altura em que os cursos de partos começaram a ser ministrados nas Faculdades de Medicina, pelos professores da “arte obstétrica”. Desde essa altura e até 1988, ano em que o Ensino de Enfermagem foi integrado no Sistema Nacional do Ensino Superior, esta formação foi palco de uma enorme evolução que importa explorar, realçando os marcos e os contextos que mais a caracterizaram: a partir de 1943 os cursos decorreram nas Maternidades Alfredo da Costa, Júlio Dinis e Bissaya Barreto, onde estavam sediadas as delegações do Instituto Maternal, cuja extinção, em 1967, motivou a transição desta formação para as escolas de enfermagem, Calouste Gulbenkian em Lisboa, S. João no Porto e Bissaya Barreto em Coimbra; em 1983 os cursos transitaram para as Escolas de Enfermagem pós-básicas até 1988.
Objetivo: Descrever a evolução da formação das enfermeiras parteiras entre 1836 e 1988 no contexto português, e em especial na cidade do Porto, desde a altura em que se designavam por “Parteiras” até ao momento em que passam a titular-se como “Enfermeiras Especialistas em Enfermagem Obstétrica.
Metodologia: Método histórico, através da revisão da literatura e da análise documental de fontes primárias e da produção legislativa.
Resultados: Entre 1836 e 1988, a formação das parteiras passou por várias mudanças institucionais e identitárias. Inicialmente, os cursos eram ministrados por médicos nas faculdades de medicina. A partir de 1943, a formação começou a integrar monitoras Enfermeiras Puericultoras ou Enfermeiras Obstetras, na docência. No total formaram-se 892 profissionais no Porto, incluindo cinco homens.
Conclusão: Entre 1836 e 1988, a formação de Parteiras e Enfermeiras Especializadas na área da saúde materno-infantil na cidade do Porto, decorreu em diferentes instituições e sob a influência de reformas sucessivas. Estas reformas elevaram o nível técnico e científico da profissão, contribuindo para fortalecer o reconhecimento social e a valorização profissional das Enfermeiras Especialistas em Enfermagem Obstétrica.
Palavras-chave:
Ensino, Parteira, Enfermeira Parteira, Enfermeira Obstetra, Enfermagem Obstétrica.
This scoping review aimed to explore what is known about Indigenous peoples' experiences with palliative and end-of-life care in Canada.
A scoping review.
A systematic search was performed from database inception to May 2022: CINAHL, Academic Search Complete, ERIC, Cochrane, Medline, PsychINFO, Indigenous Collections, Indigenous Peoples of North America and EMBASE. No date limitations were applied. Unpublished and grey literature was searched using the Google search engine. A search update was conducted in April 2024.
This scoping review was conducted in accordance with the Joanna Briggs Institute methodology for scoping reviews. Titles, abstracts and full text were screened for inclusion by two reviewers. Mapping and thematic analysis were used to analyse, collate and summarise extracted data.
Fifty-three sources were included in the review. While the methods, locations and context vary across the literature, common themes emerged: Disparities in Indigenous representation in palliative and end-of-life care literature, challenges in accessing palliative and end-of-life care, priorities related to palliative and end-of-life care and experiences specific to end of life.
This scoping review revealed several key insights into Indigenous peoples' experiences with palliative and end-of-life care.
Findings identify the need to enhance cultural safety in palliative and end-of-life care and support community capacity to develop and lead palliative and end-of-life care research and initiatives. Furthermore, findings suggest the need for palliative and end-of-life care initiatives that are Indigenous-led, grounded in Indigenous research methods and distinctions-based.
We have adhered to relevant EQUATOR guidelines. We followed the PRISMA-Scr in the reporting of this scoping review.
No patient or public contribution. This study did not include patient or public involvement in its design, conduct or reporting.
To verify the efficacy of virtual reality compared to tablet games for pain and anxiety management in children undergoing percutaneous bone pin and/or suture removal procedures.
Randomised clinical trial using two parallel groups: (1) virtual reality or (2) tablet game.
Three-center, randomised pragmatic clinical trial, using a parallel design with two groups (experimental group: immersive virtual reality; active comparator: tablet games). Children aged 6–17 requiring percutaneous pins and/or sutures were recruited between 2020 and 2022 from three outpatient orthopaedic clinics in paediatric hospitals. Pain was measured with the Numerical Rating Scale and anxiety with the Child Fear Scale before and immediately after the procedure.
A total of 188 participants were assigned to either the virtual reality group (96 participants) or the tablet group (92 participants). At the first assessment, there was no noticeable difference between the two groups in terms of pain or anxiety levels. However, further analysis revealed that participants aged 13 and older in the virtual reality group experienced significantly lower anxiety.
Virtual reality was not more efficacious than games on a tablet for pain and anxiety of children undergoing removal of bone pins or sutures. However, virtual reality demonstrated a benefit in reducing anxiety for teenagers, particularly those aged 13-older.
Virtual reality games provide an immersive, non-pharmacological alternative of for anxiety management of teenagers during pins and/or sutures removal.
This study showed that a virtual reality game may help reduce anxiety during pins and/or sutures removal procedures in patients aged 13 years and older.
We adhered to the CONSORT checklist for reporting results.
A patient partner reviewed the study design, methods and final manuscript.
NCT03680625
This scoping review aims to map evidence or literature on improvement strategies used by health leaders and professionals to strengthen the safety climate in the operating room.
A scoping review was performed on the basis of the method proposed by the Joanna Briggs Institute and applied to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR) extension.
16 academic and grey literature data sources were searched using search terms on 17 January 2025, namely, Medical Literature Analysis and Retrieval System Online via Pubmed, Latin American and Caribbean Literature on Health Sciences via the Virtual Health Library, Cumulative Index to Nursing and Allied Health Literature, Scopus, Web of Science, Embase, PsycINFO, Cochrane Library, WorldCat, Digital Library of Theses and Dissertations, Brazilian Association of Surgical Center Nurses, Center for Material and Sterilization and Anesthetic Recovery, Association of Portuguese Operating Room Nurses, Association of PeriOperative Registered Nurses, Institute for Healthcare Improvement, WHO and Agency for Healthcare Research and Quality.
Study selection, data extraction and synthesis were based on the following eligibility criteria based on the acronym PCC (participants, concept, context): participants (health leaders and professionals), concept (strategies to improve the safety climate) and context (operating room). This scoping review considered studies published from 2009 onwards.
Information on the objective, method and findings addressing improvement strategies employed to strengthen the safety climate in the surgical centre was retrieved. The findings are presented in tables and in a qualitative thematic summary.
A total of 26 studies were analysed, published between 2009 and 2024, with the USA as the country of origin of the publications with the highest number (11 studies). As for the methodological approach, intervention and quasi-experimental studies stand out. When the studies in this review were mapped, strategies that strengthened the safety climate in the operating room were identified and grouped into two main axes that are interrelated: communication tools and training programmes.
It is evident that the implementation of tools that promote communication and training programmes enhances safe surgical care, as they contribute substantially to the domains of the safety culture. The use of communication protocols in the operating room is recommended as a perioperative safety tool.
This scoping review adhered to a protocol previously published in this journal and that is registered on the Open Science Framework website (https://osf.io/zg8nu/).
To develop and validate a concise, physician-specific quality-of-life scale (Afya MedQol) Index, and to examine sociodemographic and occupational correlates of physician well-being in Brazil.
Nation-wide, cross-sectional, web-based survey employing split-sample psychometric validation: exploratory factor analysis, confirmatory factor analysis (CFA), multidimensional graded-response item-response theory calibration and post-stratification weighting to the 2025 Brazilian medical demographic census.
Physicians practising in all five Brazilian macro-regions and 27 state medical councils (2 July 2024–6 August 2024).
A total of 2005 fully responding physicians (56% women; mean age 38.5±12.6 years).
Domain scores—F1: Quality of Life, F2: Institutional Support, F3: Perceived Stress—and a Fisher-information-weighted global score. Convergent validity with WHOQOL-Bref; subgroup differences (Cohen’s d, partial ²).
CFA supported a three-factor, 13-item solution (Comparative Fit Index=0.987; Root Mean Square Error of Approximation=0.050) with strict invariance across sex and graduation-year quartiles. Item-response modelling showed marginal reliability =0.82. Convergent validity with WHOQOL-Bref domains was strong (r=0.55–0.73). Weighted mean (95% CI) scores were: Global 67.2 (66.5–67.9), F1 69.5 (68.9–70.2), F2 64.1 (63.4–64.8) and F3 62.5 (61.8–63.2).Women scored higher on Perceived Stress (F3) than men by 5.6 points (weighted mean difference 5.6, 95% CI 4.0 to 7.2; Cohen’s d 0.28). Physicians working ≥60 hours/week scored higher on Perceived Stress than those working ≤44 hours/week by 8.8 points (weighted mean difference 8.8, 95% CI 6.7 to 10.9; Cohen’s d 0.40). Well-being increased with income up to ~BRL 25 000 per month and plateaued thereafter.
Afya MedQoL Index is a psychometrically robust, 13-item instrument capturing personal, organisational and stress dimensions of physician well-being. Perceived Stress—shaped by workload, institutional climate and gender—was the most discriminative domain, while additional income beyond an upper-middle-class threshold conferred negligible benefit. Findings support policies aimed at capping duty hours, fostering ‘just-culture’ environments and expanding flexible work models.
Achieving physical activity recommendations for health as part of mental healthcare for adults with severe mental illness (SMI) could enhance clinical, functional and quality of life outcomes. We have co-designed a protocol to evaluate the impact of an intervention which combines High Intensity Interval Training (HIIT) and Vigorous Intermittent Lifestyle Physical Activity (VILPA) on clinical, functional and quality of life outcomes in people who have SMI.
Pragmatic clinical trial with an intervention and control arms. Participants will be recruited from two mental health services in two different cities in the same geographical area. Participants who meet the inclusion criteria (>18 years, SMI diagnosis, not at medical risk to practise vigorous physical activity, living in the community) will be included. Those from one service will be assigned to the intervention group and those from the other to the control group. The intervention will take place in the mental healthcare centre and will comprise 16 weeks of group-based HIIT, with transition to an individual lifestyle intervention VILPA over the next 12 weeks—for a total intervention period of 28 weeks. Primary outcome (clinical and functional and quality of life) measures and secondary (self-perception and device-measured fitness, physical activity and sedentary behaviour, and experience) measures will be assessed at baseline and at 16-week, 28-week and 40-week follow-ups. Group differences in change scores will be assessed using linear mixed-effects models with time, group and their interaction as fixed effects, accounting for within-subject correlations.
The study was approved by the Human Ethics Committee of the Institute for Research and Innovation in Life and Health Sciences in Central Catalonia (Spain, CEIm code: 24/007). Data will be shared following publication of results with no end date. Results will be disseminated in peer-reviewed journals and at national and international conferences and will inform the development of recovery protocols for people with SMI.
ClinicalTrials.gov NCT06338917.
To provide an overview of doctoral programs in nursing offered in Ibero-American countries to inform regional collaboration and academic development.
This study was a descriptive, document analysis.
A systematic mapping was conducted using data obtained from official university and program websites, national postgraduate databases, and academic documents. The variables analysed included country, institution, year of implementation, number of faculty and students, course duration, delivery modality, costs, scholarship availability, internationalisation activities, and research lines.
A total of 94 active nursing doctoral programs were identified. Brazil emerged as the pioneer, launching the first doctoral program in 1982, and remains the regional leader, accounting for 43 programs. Most programs are offered by public institutions (76.6%), delivered primarily in face-to-face format (64.1%), and emphasise research (90.4%). There has been a consistent upward trend in the establishment of programs since 2000, with notable expansion between 2011 and 2025. Despite this progress, regional disparities persist, along with a lack of data standardisation and a limited presence of professional doctorates. While 69.1% of programs reported international activities, few offer joint or dual degrees. The most common thematic axis, “Health Care and Nursing,” proved to be broad and non-specific.
The study reveals the expanding landscape of nursing doctoral education in Ibero-America, while also exposing persistent challenges regarding access, curricular clarity and regional articulation.
Doctoral programs are essential for developing research capacity, academic leadership and evidence-based care. Strengthening these programs could enhance nursing responses to local health needs and promote scientific progress in care delivery.
This study provides the first comprehensive mapping of nursing doctoral programs in Ibero-America, highlighting regional disparities and areas for academic collaboration, with potential impact on policy-making, curriculum development, and the strengthening of research capacity in nursing education.
STROBE (Strengthening the Reporting of Observational Studies in Epidemiology).
No patient or public contribution.
Since 2018, WHO has endorsed the use of whole-genome sequencing (WGS) of Mycobacterium tuberculosis complex isolates to detect drug-resistant tuberculosis (DR-TB). This endorsement was based on the assumption that a faster and more detailed description of the resistance profile would improve treatment prescription for DR-TB by healthcare providers, and hence the treatment outcomes of patients. Nonetheless, this assumption has not been tested in routine clinical practice and different scenarios. In Brazil, WGS is not routinely used for the diagnosis of DR-TB, having been carried out in only a few centres for research purposes. With this trial, we will evaluate whether a WGS-based drug-resistance report improves treatment adequacy in patients with pulmonary DR-TB, compared with the current standard-of-care diagnostic methods used in the state of São Paulo, Brazil.
We will conduct a non-randomised controlled clinical trial with two arms to compare the intervention group (ie, individuals receiving a WGS-based report) with a historical control group (i.e., individuals who received resistance diagnostics based on the standard of care of conventional genotyping and phenotyping techniques). The primary outcome will be the proportion of patients whose treatment scheme was adequate based on complete resistance profile determined by WGS and/or phenotypic drug-susceptibility testing (pDST). Other secondary outcomes will also be considered. The target sample size is 88 eligible patients per group. The intervention group will be prospectively recruited over 18 months and the control group will be composed of patients diagnosed with pulmonary DR-TB up to 2 years before the start of the trial. To ensure comparability, isolates from the control group will undergo WGS retrospectively, and pDST will be performed retrospectively in both groups. This clinical trial will take place in six medical centres for the treatment of DR-TB in the state of São Paulo. This study is intended to support the implementation of the WGS in the routine diagnosis of DR-TB in the state of São Paulo.
Ethical approval was obtained from the Human Research Committee of the Institute of Biomedical Sciences, University of São Paulo, Brazil (CAAE: 79497924.1.1001.5467). Study results will be published in peer-reviewed journals and disseminated to policymakers and stakeholders.
U1111-1308-4669.
Stroke is a leading cause of death and disability in the Caribbean, yet there is limited published information on the availability and utilisation of diagnostic imaging and treatment methods. Inequities in healthcare infrastructure, access to neuroimaging and acute treatment options may contribute to poorer outcomes following stroke, particularly in the low-resource settings that characterise most of the Caribbean region. The objective of this review is to map the literature on access to diagnostic and therapeutic modalities for adult stroke care in the Caribbean to identify potential limitations in acute treatment and examine how restricted access may impact outcomes. The resulting data can help inform strategies for improving access to stroke care in resource-limited communities.
We will apply a three-step strategy based on the Joanna Briggs Institute methodological framework: first, a limited search to identify relevant articles; second, selection of key search terms; third, implementation into a comprehensive search strategy. The query will range from 1 January 1995 to 1 June 2025 (date of final search). Search results will be extracted and screened by two independent reviewers, and findings will be presented in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. We will consider studies focusing on ischaemic and haemorrhagic stroke in the Caribbean, emphasising access to diagnostic imaging, stroke centres, prehospital management and emergent treatment. Studies examining acute stroke management capacity within the region will be considered. Studies will be excluded if they: focus exclusively on primary stroke prevention, postacute care, longitudinal care pathways for stroke victims or paediatric populations; are unrelated to stroke diagnosis or treatment or are conducted outside the Caribbean.
This protocol aims to perform secondary analysis of previously published literature; therefore, ethical approval is not required. The results of this review will be disseminated through academic conferences and peer-reviewed publication.
by Jaime Carballedo-Pulido, Mariona Farrés-Tarafa, Juan Roldán-Merino, Marta Berenguer-Poblet, Montserrat Girabent-Farrés, Carla Otero-Arús, Susana Santos-Ruiz
BackgroundAlthough the SBAR framework is widely used in clinical and educational settings, there is a lack of validated Spanish-language tools that objectively assess its use by students in simulation. The adaptation and validation of the SBAR-LA rubric address this gap and provide a resource for training and evaluating structured communication.
ObjectiveTo conduct the cross-cultural adaptation and psychometric validation of the SBAR-LA rubric in Spanish for assessing structured communication skills in undergraduate nursing students during clinical simulation.
MethodsA two-phase cross-sectional psychometric validation study was conducted. Phase one involved cross-cultural adaptation, including forward and backward translation, expert panel review, and cognitive debriefing with nursing students. Phase two assessed inter-rater reliability using Krippendorff’s alpha based on 97 performance evaluations obtained in different simulation scenarios. The SBAR-LA-Sp rubric contains 10 dichotomous items across the four SBAR dimensions.
ResultsThe Spanish version of the SBAR-LA rubric demonstrated excellent inter-rater reliability, with a Krippendorff’s alpha of 0.933 (95% CI: 0.905–0.956). Internal consistency and agreement between raters were also high, confirming the instrument’s robustness.
ConclusionsThe Spanish version of the SBAR-LA rubric provides an objective measure of structured communication in nursing simulation. The findings support its use in academic training. Further research is needed to examine its effect on learning outcomes.
Continuous Glucose Monitoring (CGM) supports Type 2 Diabetes (T2D) management, but healthcare professionals (HCPs) often face challenges interpreting data. E-learning platforms can enhance knowledge, skills and confidence. This systematic review identified enablers and barriers to e-learning for CGM interpretation.
Systematic review conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
PubMed, Ovid MEDLINE, Ovid Embase, Cochrane Library, Scopus, Web of Science and CINAHL were searched on 7 February 2024.
Studies of HCPs using e-learning for T2D management were included, both comparative and non-comparative. Outcomes included enablers and barriers. Eligible designs were randomised, quasi-experimental, controlled before-and-after and observational studies. No restrictions on setting or language; conference abstracts included if full text was available
Two reviewers independently screened and extracted data using a predefined form; disagreements were resolved by a third reviewer. Thematic analysis identified key enablers and barriers. Methodological quality was assessed using the Downs and Black checklist, and findings were synthesised narratively.
Four studies met inclusion criteria, including 6790 participants (physicians, nurses, midwives and medical residents). E-learning improved knowledge and skills. Emami et al reported increased knowledge of T2D diagnosis and treatment (p=0.001), while Okuroğlu and Alpar found improvements in diabetes care knowledge and skills (pet al noted enhanced self-reported performance (p=0.03) and 84% satisfaction. Enablers included flexibility and accessibility, while barriers involved time constraints, resistance to change and methodological limitations (self-selection bias, lack of blinding). Study quality ranged from fair (three studies) to poor (one study).
Based on current evidence, it is unclear if e-learning can significantly enhance HCPs’ knowledge, skills and confidence in T2D management. Barriers such as time constraints and resistance to change remain, and the limited number and quality of studies restrict the generalisability of these findings. E-learning may offer potential benefits, but further robust randomised controlled trials are needed to evaluate long-term outcomes and strategies to overcome these challenges.
CRD42023455156.
by Véronique Gille, Flore Gubert, Camille Saint-Macary, Stéphanie Dos Santos, Franck Houffoué, Hugues Kouadio, Epiphane Marahoua, Petanki Soro, Alexander van Geen
Lead (Pb) exposure is a major global health concern, particularly for young children, yet awareness of the risks is low. Pb-based paint remains a significant source of exposure in many low- and middle-income countries, despite existing regulations. We investigate whether personalized information on lead in paint can increase awareness and encourage preventive behaviors. As part of a pilot study in Abidjan, Ivory Coast, painted surfaces in pregnant women’s homes were tested using a low-cost Pb detection kit, followed by confirmatory testing with an X-ray fluorescence (XRF) device. Among the final sample of 153 women, those living in homes that tested positive for Pb were 33-35 percentage points more likely to acknowledge their exposure risk. This increased awareness led to self-reported behavioral changes among mothers of young children, including a higher likelihood of preventing children from ingesting paint chips and washing their hands more frequently. We find no impact on self-reported home-cleaning or renovation behaviors. Our findings highlight the potential of personalized information to drive behavioral change in environmental health.
FreshRSS 