Conectar
Older adults face growing risks of depression and anxiety, yet stigma, comorbidities, cost, and limited access impede receipt of conventional care. Digital mental health interventions (DMHIs), including immersive virtual reality (VR), exergaming, and mobile apps, may reduce these barriers.
To evaluate the efficacy of DMHIs in reducing depressive and anxiety symptoms among adults aged ≥ 50 years.
We conducted a PRISMA adherent systematic review and meta-analysis of randomized controlled trials. Interventions included immersive VR, exergaming/physical digital platforms, mobile applications, and digital cognitive training. Standardized mean differences (SMDs) were pooled with random effects models; heterogeneity was assessed with I 2.
Nineteen RCTs (n = 718; mean ages 50.9–84.7 years) met inclusion criteria. Across studies, DMHIs significantly reduced depressive symptoms (SMD = −0.656, 95% CI = −0.932 to −0.380; p < 0.001) and anxiety symptoms (SMD = −0.559, 95% CI = −0.740 to −0.380; p < 0.0001). Immersive and physically engaging modalities (e.g., VR, exergaming) outperformed app-based approaches. Heterogeneity ranged from moderate to high (I 2 ≈ 69.6%–97%).
Offer DMHIs: especially VR or exergaming when access to in-person therapy is limited or as an adjunct to usual care. Provide brief onboarding and, when feasible, caregiver support to boost adherence and confidence with technology. Select or configure age-friendly interfaces (e.g., large fonts, simple navigation) to address common usability barriers. Integrate DMHIs into stepped-care or rehabilitation pathways and monitor outcomes with validated tools (e.g., GDS, STAI). Address equity by supplying devices/connectivity solutions and consider cost-effectiveness and long-term engagement in implementation plans.
Trial Registration: PROSPERO ID: CRD420250655153
To identify the drivers of changes in modern contraceptive use (MCU) among women of reproductive age in three selected sub-Saharan African countries.
This is a secondary analysis of cross-sectional Demographic and Health Survey (DHS) data using a multivariable Blinder-Oaxaca decomposition approach.
The sample consisted of 73 777 women aged 15–49 years from the two most recent DHSs conducted in Gabon (2012, 2019–2021), Senegal (2018, 2023), and Tanzania (2015, 2022). Pregnant women were excluded from the sample.
We assessed the change in MCU over the two most recent DHS waves for the three countries.
MCU declined in Gabon from 26.5% to 18.4%, in Senegal from 20.5% to 18.5% and in Tanzania from 29.7% to 27.6%. Across the three countries, the contributions of compositional changes to trends in MCU varied significantly. In Senegal, characteristics explained 181% of the change, driven by reduced exposure to family planning information (157%), high parity (147%) and employment (9%), while education, urbanisation, union type and lower parity mitigated the decline. In Gabon, the overall characteristics included led to an increase in MCU (–44%), rather than a decline, reflecting the effect of favourable changes toward higher education (–19%) and urban residence (–10%). However, the behavioural effect was predominant (144%). This suggests that modifications in individual attitudes, practices and preferences regarding contraception outweighed structural changes, leading to the overall downward trend observed in Gabon. In Tanzania, neither characteristics nor coefficients significantly explained observed changes. Results for Tanzania indicate that none of the factors included in the model made a significant contribution to the change in MCU. Conversely, increases in educational attainment and urbanisation contributed to an increase in MCU in both Senegal and Gabon.
Interventions promoting MCU should consider the role of receiving family planning information at a health facility, parity, work status, educational attainment and urbanisation in informing changes in the use of modern contraceptive methods.
Perinatal depression poses substantial risks to both mothers and their offspring. Given its chronic and recurrent nature, developing effective prevention strategies is crucial. Internet-based cognitive–behavioural therapy (iCBT) has shown promise. However, the efficacy of specific CBT skills and the influence of individual differences remain unclear.
This protocol describes two harmonised multicentre, open-label, six-arm randomised controlled trials. Across both trials, a total of 2400 pregnant women between 10 and 20 weeks of gestation will be enrolled. After completing psychoeducation (PE), participants will be randomised to either the control condition (PE only) or one of five CBT programmes: behavioural activation (BA), assertion training, BA+cognitive restructuring, BA + problem solving or BA + behaviour therapy for insomnia. The objectives of the study are: (1) to ascertain that the iCBT approach is effective in perinatal depression, (2) to identify active CBT skills for perinatal women and (3) to examine interactions between these CBT skills and individuals’ baseline characteristics to find personalised and optimised therapy for individual women. The primary outcome is the point prevalence of depression at 1 month postpartum, defined as scoring of 9 or higher on the Edinburgh Postnatal Depression Scale.
The study has been approved by the Kyoto University Graduate School of Medicine Ethics Committee (C1710) and Nagoya City University Certified Review Board (2024A007). Anonymised study results will be presented at conferences and published by the investigators in peer-reviewed journals.
jRCTs042240162 (hospital-based, on-site trial) and jRCT1050250074 (nationwide online trial).
In this paper, the development of an evidence-informed, data-driven strategy for implementation of the HIRAID emergency nursing framework in Thailand is reported. HIRAID stands for H istory including I nfection risk, R ed flags, A ssessment, I nterventions, D iagnostics, reassessment and communication.
This exploratory descriptive study was underpinned by the Knowledge-to-Action framework.
The study was conducted in Chiangrai Prachanukroh Hospital (CRH) in Northern Thailand. The identified problem was no standardised approach to patient assessment and management. Adaptation of knowledge to local context occurred by feasibility assessments and experience-based co-design. Surveys designed and analysed using the Behaviour Change Wheel and Theoretical Domains Framework were used to understand the barriers to knowledge use. Selecting, tailoring and implementing the intervention was guided by the Behaviour Change Wheel.
Practice environment and behavioural diagnostics surveys were completed by 49 nurses (response rate 100%) who identified 19 enablers and 33 barriers to HIRAID implementation at CRH. Enablers and barriers were mapped to seven intervention functions (education, modelling, persuasion, enablement, training, environment restructuring, incentivisation) and 19 behaviour change techniques most likely to be effective. The study methods and results culminated in an evidence-informed, data-driven HIRAID Thailand Implementation Strategy.
In-depth understanding of context-specific enablers and barriers, active engagement of end-users was critical to maximising likelihood of successful implementation. Development of an evidence-informed implementation strategy for a limited resource setting was achievable with robust application of theory, key stakeholder and end-user engagement and multi-agency collaboration.
Implementation of clinical interventions in emergency care settings is challenging, even in well-resourced settings. For end-users, knowledge that an intervention would improve patient care was a powerful enabler coupled with meaningful organisational support is critical to sustained implementation in complex nursing environments.
This study addresses the lack of standardised approach to patient assessment and management in the emergency department in a resource-limited setting. Application of robust theory is possible in middle-resource settings, and this study identified 19 behaviour change techniques that were distilled to develop a sustainable, context specific implementation strategy. Development of an evidence-informed implementation strategy for a limited resource setting with robust application of theory is possible with key stakeholder and end-user engagement and multi-agency collaboration.
There is no EQUATOR guideline available for this study.
This study did not include patient or public involvement in its design, conduct or reporting.
To assess health-related quality of life (HRQoL), treatment satisfaction and associated factors among older adults with acute heart failure in Northwest Ethiopia.
Prospective, multicentre observational study.
Three tertiary hospitals in Northwest Ethiopia provide secondary and tertiary care services.
A total of 422 patients aged ≥60 years with a confirmed diagnosis of acute heart failure were consecutively enrolled between December 2024 and April 2025. Patients with unstable psychiatric conditions or advanced kidney disease were excluded.
HRQoL was assessed using the WHO Quality of Life – Brief Version questionnaire, and treatment satisfaction was measured using the Treatment Satisfaction Questionnaire for Medication (TSQM). Multiple linear regression identified factors associated with HRQoL and treatment satisfaction.
95% of participants reported moderate HRQoL, and 3% reported poor HRQoL. Weight loss was positively associated with HRQoL (β=1.52; 95% CI 0.04 to 3.07; p=0.021), whereas asthma was negatively associated with HRQoL (β = –3.28; 95% CI 6.94 to 0.37; p=0.001). Regarding treatment satisfaction, 65% of patients were moderately satisfied, with notable concerns regarding medication safety and overall experience. Rural residents reported lower satisfaction than urban residents (β = –0.20; 95% CI 0.34 to 0.05; p=0.007). Patients with New York Heart Association (NYHA) class III had higher satisfaction (β=0.25; 95% CI 0.05 to 0.45; p=0.016). Effective hypertension management was linked to increased satisfaction (β=0.20; 95% CI 0.02 to 0.37; p=0.026), whereas coronary heart disease was associated with lower satisfaction (β = –0.40; 95% CI 0.64 to 0.88; p=0.012).
Among older adults with heart failure in Northwest Ethiopia, 98% reported moderate to low HRQoL. Asthma and polypharmacy negatively affected HRQoL, whereas weight loss was positively associated with HRQoL. An NYHA class III status and well-managed hypertension improved treatment satisfaction, whereas rural residency and coronary heart disease were associated with lower satisfaction. These findings underscore the need for targeted interventions to enhance outcomes and QoL in this vulnerable population.
To provide a nationwide epidemiological assessment of upper limb amputations (ULAs) in Germany, including incidence trends, underlying aetiologies, amputation levels and revision patterns, with a comparative analysis between 2019 and 2023.
Nationwide retrospective cross-sectional analysis of routinely collected inpatient hospital data.
All acute-care hospitals in Germany reporting to the national Diagnosis-Related Groups and Operation and Procedure Classification System (OPS) from 2019 to 2023.
All patients undergoing ULA procedures (OPS 5-862 and 5-863) or revision procedures (OPS 5-866) within the study period. No exclusion criteria were applied.
Primary measures were annual incidence of ULAs, the distribution of amputation levels and underlying medical aetiologies. Secondary measures included the incidence of revision procedures and revision aetiologies stratified by anatomical level.
A total of 5427 ULAs were performed in 2023, representing a 7.3% decrease compared with 2019 (5,852). Distal amputations remained most frequent, though proximal amputations increased proportionally over time. Above-wrist amputations were predominantly associated with malignancy (40.3%) and vascular disease (23.7%), whereas distal amputations were mainly trauma-related (43.6%). Infection-related distal amputations increased from 23.4% in 2019 to 30.4% in 2023. Revision procedures occurred in 32.4% of proximal amputations and 6.1% of distal amputations in 2023. Infection was the most common indication for distal revisions (53.3%), while infection and neuroma formation each accounted for 29.4% of proximal revisions.
This nationwide analysis provides a comprehensive epidemiological overview of ULAs in Germany, demonstrating stable overall incidence but clear level-specific differences in underlying aetiologies. Proximal amputations were mainly associated with malignant and vascular disease, whereas trauma predominated at distal levels. High rates of infection-related and neuroma-related revisions, particularly after proximal amputations, highlight the complexity of surgical management and the need for level-specific perioperative and follow-up strategies.
With the rapid increase in the ageing population, the use of procedural sedation and analgesia (PSA) for diagnostic procedures such as prostate biopsy in older adults is increasing. However, elderly patients are particularly susceptible to respiratory depression during PSA testing and have a significantly higher risk of hypoxaemia during procedures requiring deep sedation. Although propofol combined with fentanyl is commonly used, it frequently causes hypoxaemia and apnoea. Remimazolam, a novel ultrashort-acting benzodiazepine, may be a safer alternative with less respiratory compromise; however, the supporting evidence remains limited. This study aims to assess whether remimazolam combined with fentanyl reduces the incidence of respiratory depression compared with propofol combined with fentanyl in elderly patients undergoing prostate biopsy under deep sedation requiring immobility.
This is a single-centre, participant and assessor-blinded (with pragmatic blinding of participants), parallel-group, superiority randomised controlled trial conducted at the Jichi Medical University Saitama Medical Centre, Japan. Eligible participants are men aged ≥70 years who are scheduled to undergo prostate biopsy under intravenous sedation. Participants will be randomised in a 1:1 ratio to receive either remimazolam or propofol, each administered in combination with fentanyl at a fixed effect-site concentration. The primary outcome is the incidence of severe apnoea (≥1 min). The primary analysis will follow the intention-to-treat principle, implemented practically as a full analysis set analysed using a complete case approach. Sensitivity analyses will include a per-protocol analysis and multiple imputations of missing data. A subgroup analysis of patients aged ≥75 years was performed.
This study was approved by the Jichi Medical University Central Clinical Research Ethics Committee (approval number: 24JMU001S-2) and was registered with the Japan Registry of Clinical Trials on 11 November 2024. Written informed consent was obtained from all participants before enrolment. These findings will be disseminated through publications in peer-reviewed journals and presentations at scientific conferences.
jRCTs031240478.
Clinical nurses face notable chronic stress due to work-related stressors, exacerbated by the COVID-19 pandemic, leading to somatic symptoms and low-grade inflammation. Mindfulness meditation has shown promise in reducing stress and improving health outcomes, but its effects on somatic symptoms and inflammatory biomarkers in nurses remain underexplored.
To assess the impact of mindfulness meditation on somatic symptoms and inflammatory biomarkers such as leptin, interleukin-6, and tumor necrosis factor-α among nurses. To explore the secondary effects on perceived stress and trait mindfulness because of the complex interlinked association with the primary outcomes of interest.
A randomized controlled trial was conducted with 102 nurses randomly assigned to a meditation group (8-week mindfulness meditation program) or a non-meditation group. Data were collected using self-report questionnaires (Mindfulness Attention Awareness Scale, Perceived Stress Scale, Patient Health Questionnaire-15) and blood samples for biomarker analysis at baseline and post-intervention.
The meditation group demonstrated notable reductions in perceived stress (p < 0.001), somatic symptoms (p < 0.001), IL-6 (p < 0.001), and leptin levels (p < 0.001) compared to the non-meditation group. Trait mindfulness increased markedly in the meditation group (p = 0.003), while TNF-α levels did not show notable changes.
Mindfulness meditation efficiently reduces perceived stress, somatic symptoms, and inflammatory biomarkers in nurses, highlighting its potential as a holistic intervention to improve both psychological and physical well-being in high-stress healthcare environments.
ClinicalTrail.gove, NCT06635278
by Ryosuke Segawa, Makiko Yagisawa, Chihiro Miyata, Noriyasu Hirasawa
Thymic stromal lymphopoietin (TSLP) is an epithelial-derived cytokine that induces type 2 immune responses through dendritic cell activation, and its aberrant regulation is implicated in TSLP-associated inflammatory disorders including atopic dermatitis. We previously demonstrated that hypoxia-inducible factor (HIF) suppresses TSLP expression in human keratinocyte cells; however, the underlying mechanism remained unclear. In this study, we aimed to explore the suppressive mechanism of enarodustat, an HIF-prolyl hydroxylase inhibitor. Enarodustat selectively suppressed TSLP expression induced by the fibroblast-stimulating lipopeptide (FSL-1), a toll like receptor 2/6 agonist in HaCaT, a human keratinocyte cell line. Although both the nuclear factor-κB (NF-κB) and activator protein (AP)-1 contributed to FSL-1-induced TSLP induction, enarodustat preferentially attenuated AP-1 signaling by reducing c-Jun N-terminal kinase (JNK) phosphorylation. This JNK dephosphorylation required both HIF1α and HIF2α and was accompanied by increased expression of dual-specificity phosphatases (DUSPs), which target JNK for dephosphorylation. Collectively, our findings identify a previously uncharacterized HIF–DUSP–JNK axis that negatively regulates TSLP expression. This study provides mechanistic insight into how HIF activation shapes epithelial cytokine responses, offering a basis for understanding the pathogenesis of TSLP-associated diseases such as atopic dermatitis.This paper aims to describe the development of an inventory of chronic ambulatory care sensitive conditions (ACSCs) relevant to the Malaysian context and identify potentially preventable hospitalisations in the Malaysian Ministry of Health (MOH) facilities based on the developed list.
Consultative panel discussion, multi-panel modified Delphi and secondary health data analysis.
Setting: Malaysian MOH healthcare facilities.
42 experts from the family medicine and internal medicine specialties (modified Delphi), and 2022 inpatient data from MOH hospitals (secondary health data analysis).
A list of chronic ACSCs tailored to the Malaysian context and the proportion of potentially preventable hospitalisation in MOH hospitals.
10 conditions were identified as chronic ACSCs for Malaysia, namely angina, asthma, chronic kidney disease, convulsions and epilepsy, chronic obstructive pulmonary disease, diabetes mellitus, heart failure, hypertension, iron deficiency anaemia and ischaemic heart disease. In 2022, these conditions accounted for 8.6% of potentially preventable hospitalisations among the total hospitalisations in MOH hospitals.
This study provides a base list of chronic ACSCs tailored to the Malaysian context, which enables monitoring of potentially preventable hospitalisations due to chronic conditions. The findings underscore a proportion of hospital admissions that could potentially be avoided through interventions that enhance outpatient care. The conditions identified as ambulatory care sensitive provide specific targets for policy action and resource allocation to optimise outpatient health services and thus reduce the burden of hospitalisations in the country.
Malaysian National Medical Research Register, NMRR ID-23–02149-TBZ (https://nmrr.gov.my/research-directory/45c901d6-f121-4e79-9f38-dd7d283ec9a6).
by Halid Worku Jemil, Sonia Worku Semayneh, Altaseb Beyene Kassaw, Kassahun Dessie Gashu
IntroductionSevere stunting is one of the primary public health challenges in LMIC including Eastern African Countries, which affects millions of children. In addition, it was a major contributor for mortality and related complication of children aged under five. However, there is limited study conducted severe form of stunting by employing Machine learning (ML) in Eastern African Countries. Therefore, our study was demonstrated to predict and identify its major determinants using ML algorithms, furthermore, to improve model explainablity. Our study used Shapley Additive explanations (SHAP) and ARM to identify the determinants of severe stunting among under-five.
Methodscross-sectional study was conducted using DHS data from 2012–2022 in East Africa. 136,074 children were the source populations, and 76,019 children were the study population. Data were analyzed using Python version 3.7 and R version 4.3.3 for data preprocessing, modeling, and statistical analysis. Model performance was evaluated using accuracy and AUC. Furthermore, the SHAP analysis and ARM was used to further explain and interpret the determinants of severe stunting among children under five.
ResultsThe Random Forest performed the best in this analysis, with an accuracy of 87% and an AUC score of 0.83. The analysis indicated that women’s who do not practicing exclusive breastfeeding (SHAP value = +0.41), being from Burundi (SHAP value = +0.04), children being underweight (SHAP value = +0.25), lived in poor household (SHAP value = +0.40), child gender being male(SHAP value = +0.23), mothers height being short (SHAP value = +0.03), mothers being underweight (SHAP value = +0.18), child size at birth being small (SHAP value = +0.21), women’s being delivered in home(SHAP value = +0.07), mothers education being primary (SHAP value = +0.20), unimproved toilet (SHAP value = +0.06), distance to health facility being a big problem (SHAP value = +0.02), were associated with increase the risk of severe stunting among under five.
ConclusionThe Random Forest was the best-performing model for predicting severe stunting in Eastern African countries. To decrease the effects of severe stunting, integrated interventions should provide support for mothers with lower socioeconomic conditions, strengthen maternal education, empower women to practice exclusive breastfeeding, encourage facility deliveries, increase access for households to sanitary facilities, provide education on personal and environmental hygiene, provide mothers with information on the importance of complementary feeding for children as well as for the mothers, and provide near health facilities for mothers and essential care services.
by Jieyu Zhao, Kota Kurisu, Kazuki Ohashi, Toshiya Osanai, Katsuhiko Ogasawara, Miki Fujimura
In this work, we aimed to assess the impact of clazosentan on clinical labour time costs within Japan’s value-based healthcare system using time-driven activity-based costing. Time-driven activity-based costing was employed to analyse the labour time costs associated with preventing cerebral vasospasm following aneurysmal subarachnoid haemorrhage. Time-driven activity-based costing simplifies cost analysis by utilising time as the primary cost driver. We compared two treatment approaches: conventional therapy with fasudil hydrochloride and postoperative therapy with clazosentan. Scenario and sensitivity analyses were performed to assess the impact of physicians’ costs on the results. The use of clazosentan for the prevention of cerebral vasospasm significantly reduced human resource costs, particularly in cases where symptomatic vasospasm did not occur, yielding savings of approximately 51,343 yen. The greatest cost reductions were observed among nursing staff, with a 30% decrease in the absence of symptomatic vasospasm and a 15% reduction when symptomatic vasospasm was present. The cost reductions for physicians were comparatively smaller, particularly in cases where symptomatic vasospasm occurred. Sensitivity analyses indicated that clazosentan reduced overall costs by approximately 35,000–50,000 yen; however, costs increased in the presence of symptomatic vasospasm. Clazosentan for subarachnoid haemorrhage treatment significantly reduces human resource costs, especially in nursing staff. These findings support the potential of clazosentan for broader clinical use, given its cost-savings and clinical benefits in reducing cerebral vasospasm following aneurysmal subarachnoid haemorrhage.To explore public perceptions of COVID-19 vaccine acceptance and hesitancy in India, and to identify underlying factors influencing attitudes toward vaccination during the second wave of the pandemic.
A cross-sectional qualitative study based on a grounded theory approach.
Community-based interviews conducted in Mumbai, a densely populated metropolitan city in India, during the second COVID-19 wave (April–June 2021).
Twenty purposively selected adults (men and women aged 22–87 years) from varied educational and occupational backgrounds. Inclusion criteria were willingness to participate and the ability to provide informed consent; individuals directly involved in COVID-19 vaccine policy or administration were excluded.
In-depth semi-structured interviews were conducted using an interview guide exploring perceptions of COVID-19 vaccination. Interviews were audio-recorded, transcribed verbatim and analysed inductively following grounded theory principles. Reflexivity was maintained throughout data collection and analysis.
Key emergent themes relating to vaccine acceptance, hesitancy and influencing factors such as safety concerns, efficacy perceptions, media influence and social determinants of vaccine choice.
Attitudes toward vaccination ranged from strong acceptance to hesitancy driven by concerns about safety, side effects and the speed of vaccine development. Media coverage, peer and healthcare professional opinions, and personal experiences shaped the decision of the participants. Cost considerations and lack of vaccine choice influenced uptake. Many participants favoured vaccination being voluntary rather than mandatory for the general population.
Trust in authorities, transparent risk communication and culturally sensitive engagement are critical to improving vaccine confidence. Public health strategies should address safety concerns, ensure equitable access and promote consistent messaging to enhance vaccine acceptance in current and future pandemic contexts.
To determine the proportion of postpartum depression (PPD), explore associated risk factors with PPD, and examine changes in PPD, social support and quality of life (QOL) among adolescent and adult mothers in the first 6 months postpartum during the COVID-19 pandemic.
A longitudinal comparative study was conducted using an online questionnaire from January to August 2021.
The study recruited 65 adolescent and 65 adult mothers who attended postpartum checkups at 6 weeks postpartum in primary hospitals across Ayutthaya, Chachoengsao and Phetchaburi provinces in Thailand. Data were collected by the Edinburgh Postnatal Depression Scale, Postpartum Support Questionnaire, and the World Health Organisation Quality of Life Brief at 6 weeks, 4 months and 6 months postpartum.
Finally, 60 adolescent and 60 adult mothers were included for analysis. Adolescent mothers experienced lower social support and QOL compared to adult mothers over the 6-month postpartum period. Notably, both adolescent and adult mothers had significantly increased PPD proportions from 6 weeks to 6 months postpartum (31.7%–48.3% and 23.3%–43.3%, respectively). However, there was no significant difference in the PPD proportions between groups. In adjusted models, significant risk factors for PPD during the first 6 months postpartum included educational level, unintended pregnancy, mode of delivery and social support.
Significant changes in PPD, social support and QOL were observed in both adolescent and adult mothers during the first 6 months postpartum. Adolescent mothers consistently demonstrated lower levels of social support and QOL at 6 weeks, 4 months and 6 months postpartum compared to adult mothers. Additionally, mothers with lower educational attainment, unintended pregnancies, caesarean deliveries and low social support were more likely to experience PPD.
Midwives/nurses should provide routine PPD screenings throughout the first six months postpartum for all mothers, particularly for at-risk mothers such as adolescent mothers or those with lower education, unintended pregnancies, caesarean deliveries and limited social support.
We have followed the STROBE guidelines.
No patient or public contribution.
The objective of this study was to generate evidence for strengthening the local food system to contribute to improved dietary diversity among children in Ethiopia.
A community-based cross-sectional survey.
The study was conducted in the Amhara, Oromia and Somali regions of Ethiopia.
A total of 1475 children aged 6–23 months were included. Children requiring special care or not permanently residing in the study areas were excluded.
The primary outcome measure was the adequate Minimum Dietary Diversity, defined as the consumption of at least five of the eight defined food groups in the previous 24 hours.
Only 25.6% of children met the adequate minimum dietary diversity requirement. Children from households with backyard gardening (Adjusted odds ratio (AOR)=1.43, 95% CI 1.08 to 1.88), access to communication devices (AOR=1.99, 95% CI 1.51 to 2.64), attendance at cooking demonstrations (AOR=1.99, 95% CI 1.44 to 2.74), use of labour-saving and time-saving technologies (AOR=1.55, 95% CI 1.15 to 2.09) and irrigation use for crop production (AOR=1.78, 95% CI 1.26 to 2.52) had higher odds of meeting adequate minimum dietary diversity. Residence was strongly associated with dietary outcomes: children in Amhara had more than seven times the odds of achieving adequate minimum dietary diversity of children compared with Somali (AOR=7.56, 95% CI 4.92 to 11.62), while those in Oromia had nearly twice the odds (AOR=1.74, 95% CI 1.17 to 2.60).
Dietary diversity among children was low in the study areas. Strengthening local food systems through promotion of backyard gardening, cooking demonstrations, irrigation use, communication access and appropriate technologies could improve children’s dietary diversity. Regional disparities highlight the need for context-specific strategies, particularly to address the low dietary diversity in children.
by Moe Thi Thi Han, Tay Zar Myo Oo, Busayamas Chewaskulyong, Sakorn Pornprasert, Kanyamas Choocheep, Khanittha Punturee, Warunee Kumsaiyai, Yupanun Wuttiin, Sawitree Chiampanichayakul, Ratchada Cressey
Non-smoking-related lung cancer is increasingly associated with environmental factors such as particulate matter (PM) exposure. Using deep small RNA sequencing, we identified distinct miRNA expression patterns in lung cancer patients compared to non-cancer controls, stratified by smoking status. Notably, hsa-miR-125b-5p and hsa-miR-100-5p were significantly downregulated in non-smoking lung cancer patients. Pathway enrichment analysis revealed smoking amplifies pathways related to glycan biosynthesis, signal transduction, and transcriptional regulation, while non-smoking lung cancer is characterized by immune dysfunction and metabolic alterations, including oxidative phosphorylation and natural killer cell cytotoxicity. Validation in a larger cohort using quantitative RT-PCR confirmed the suppression of miR-125b-5p and miR-100-5p in non-smoking lung cancer patients. Additionally, miR-203a and miR-199a-3p were identified as potential biomarkers for lung cancer, independent of smoking status. Chronic PM exposure in primary bronchial/tracheal epithelial cells initially elevated miR-125b-5p and miR-100-5p expression, but prolonged exposure suppressed these miRNAs while increasing their target genes, TXNRD1 and HOXA1, suggesting stress-induced dysregulation. Functional studies using miRNA mimics demonstrated that miR-125b-5p and miR-100-5p suppress PM-induced cancer cell mobility and colony formation, with miR-125b-5p exhibiting broader effects. These findings underscore the critical roles of miR-125b-5p and miR-100-5p in PM-associated lung cancer progression and their potential as biomarkers and therapeutic targets. This study highlights distinct mechanisms of lung carcinogenesis in smokers and non-smokers, providing a foundation for targeted interventions in PM-associated lung cancer.by Soha Albeitawi, Mohammad Talal Al-zubi, Anas Aljaiuossi, Murad Shatnawi, Ahlam Al-Kharabsheh, Fadi Sawaqed, Emad Aborajooh, Walid I. Wadi, Randa Mahasneh, Benjamin Rowland Colton, Mohammad AlQudah, Tamara Kufoof, Fida Asali, Ahmed Sheyyab, Monther A. Gharaibeh, Motasem Al-latayfeh, Enas Al-Zayadneh, Eman Badran, Yaser M. Rayyan, Kais Al Balbissi, Raed Al-Taher, Asma Basha, Rola Saqan, Ashraf Omar Oweis, Wafa Taher, Shadi Hamouri
BackgroundClinical preceptors serve as vital educators, so it is essential to enhance their effectiveness by developing a competency-based development program. In this study, we explored the challenges faced by preceptors and students, and measured the educational needs of preceptors, to inform the design of a syllabus for a preceptor development program.
MethodsThis was a sequential multi method study utilizing a structured questionnaire survey and focus group discussions among a representative sample of medical students in their fourth, fifth, and sixth years in addition to preceptors from the six public medical schools in Jordan.
ResultsThematic analysis of focus group discussions revealed six themes: admission policy, training environment, curriculum gaps, trainers and mentorship, learners, and dissemination. The most important training needs documented by preceptors were teaching in the clinical setting, mentoring skills, simulation, assessment in the clinical setting, and providing feedback. Accordingly, a competency-based preliminary syllabus was developed.
ConclusionIt is essential to enrich the skills of preceptors regularly based on a needs assessment. Further long term studies are required to investigate the effectiveness of the proposed syllabus after implementation.
Optimal nutrition during early childhood is crucial for psychosomatic development and for preventing diet-related diseases. However, evidence from Poland highlights significant deviations from recommended dietary practices. The previous Polish Infants and Toddler Nutritional Study conducted in 2016 (PITNUTS 2016) revealed imbalances in nutrient intake among children aged 5–36 months. The aim of this study (PITNUTS 2024) is to assess the diet and nutritional status of infants and children aged 5–72 months, providing a broader understanding of eating behaviours across critical stages of growth and development and allowing evaluation of how dietary practices changed in recent years.
This cross-sectional study will recruit a nationally representative sample of Polish infants and children aged 5 to 72 months using stratified random sampling. Survey interviews will be conducted with parents or legal guardians as proxy reporters for the children. Dietary practices will be evaluated through validated qualitative and quantitative dietary assessments, ensuring a comprehensive evaluation of food consumption and energy and nutrient intake. Dietary data will be collected using the 3 day food record and the survey questionnaire, including a food frequency questionnaire (FFQ). Daily energy and nutrient intake will be compared with national dietary standards and WHO guidelines. Dietary patterns will be derived based on the FFQ data. Nutritional status will be assessed based on measured anthropometric parameters. Energy, macro- and micronutrient intake as well as dietary patterns identified among children will be associated with nutritional status, including body mass index z-score and body weight status.
The study has been approved by the ethics board of the Institute of Mother and Child. Written informed consent was obtained from all participants’ parents or legal guardians before the interviews began. The results from this study will be presented at scientific conferences and published in peer-reviewed journals, contributing to nutrition policies in Poland and informing educational materials and dietary consultation services.
NCT06417151, results.
Stillbirth remains a major global health challenge, with India bearing a substantial share of the burden. Despite the availability of evidence-based interventions, stillbirth rates (SBRs) remain high due to gaps in healthcare access, quality and the effective delivery of maternal and neonatal care. This study aims to develop and implement an optimised, context-specific model to reduce SBRs in Sangrur district, Punjab.
This mixed-methods implementation research will adopt a sequential explanatory design. The study will be conducted over 3 years in four blocks of Sangrur. Data will be collected through baseline and endline surveys, verbal autopsies of stillbirths, direct observations of antenatal and intrapartum care, and qualitative interviews with community members and healthcare providers. The intervention package will focus on preconception and antepartum care, intrapartum care and strengthening health systems. The study will use the plan-do-check-act model for continuous improvement, and real-time data collection through electronic systems will support timely decision-making.
The study expects to achieve a 25% reduction in SBRs through the optimised delivery of high-quality antenatal and intrapartum care services. Additionally, the research will provide critical evidence on the barriers and facilitators to optimise service delivery, as well as insights into the health system and community factors influencing stillbirth outcomes. This study aims to create a scalable and adaptable intervention model to reduce SBRs in low-resource settings like Sangrur and Punjab. The findings will inform future maternal and neonatal health policies and provide a framework for the broader implementation of similar interventions in other regions of India.
The study protocol has been approved by the International Institute of Health Management Research, Delhi (IIHMR) Institutional Ethics Committee (IRB/2024-2025/01). The study is funded through a competitive call for proposals on stillbirths by the Indian Council of Medical Research (ICMR) under the National Health Research Priority Projects (5/7BMIPR/2022-RBMCH). The research has been awarded by ICMR (project ID NHRP05586) to IIHMR under grant number 5/7/BMIPR/2022-RCN.
To ascertain the clinical impact, prevalence and associated determinants of delayed treatment intensification, defined as delaying the escalation of treatment plans for individuals with type 2 diabetes mellitus who fail to attain ideal glycaemic control, at the University of Gondar Comprehensive Specialised Hospital in Northwest Ethiopia.
A mixed-methods study.
University of Gondar Comprehensive Specialised Hospital.
420 patients with type 2 diabetes mellitus with poor glycaemic control after the index date were included in this study. A simple random sampling technique was employed to select the required sample size. Data were collected retrospectively and entered into EpiData V.4.6 and exported to Stata V.14.2 for analysis.
Multivariable logistic regression was used to identify factors associated with delayed treatment intensification. A p value of 0.05 in the multivariable analysis was considered statistically significant. Qualitative data were collected through in-depth interviews with eight selected healthcare providers, and thematic analysis was undertaken to identify the underlying barriers to timely treatment intensification.
Delayed treatment intensification.
The prevalence of delayed treatment intensification was 51.4% (95% CI 46.6% to 56.2%), with a median delay of 14 months (IQR: 7.5–42 months) from the index date. Among those experiencing delayed treatment intensification, 43.1% developed new chronic diabetic complications, including retinopathy (18.1%), neuropathy (14.4%) and nephropathy (6.0%). Other complications (hypertension, stroke, heart failure and diabetic foot ulcer) accounted for 4.64% of the cases. Significant predictors of delayed treatment intensification included longer duration of diabetes (adjusted ORs (AOR) 1.68; 95% CI 1.13 to 2.5), presence of comorbidities (AOR 1.83; 95% CI 1.04 to 3.2) and use of cardioprotective medications (AOR 1.59; 95% CI: 1.04 to 2.43). The qualitative findings revealed additional barriers contributing to delayed treatment intensification, including financial limitations, insufficient patient awareness and non-adherence among patients. Additionally, healthcare provider-related factors, including professional fatigue and knowledge gaps, as well as health institution-related factors such as inadequate healthcare infrastructure.
This study found a high prevalence of delayed treatment intensification (51.4%), associated with comorbidities, longer disease duration, low patient awareness, cardioprotective drug use and barriers related to the system and providers. To address these gaps, priorities should include strengthening patient education, scheduling regular reviews for high-risk patients and improving clinical decision support tools for timely treatment intensification. Enhancing healthcare infrastructure, such as medication supply and diagnostic services, and offering refresher training to reduce provider fatigue, are also crucial for improving the delivery of diabetes care.
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