Conectar
Cognitive behavioural therapy (CBT) is recommended as a first-line treatment for depression and anxiety disorders, but its utilisation under Japan’s national health insurance remains poorly understood. This study aimed to describe CBT utilisation patterns, quantify regional disparities across prefectures and analyse temporal trends from fiscal year (FY)2015 to FY2023.
This was a nationwide repeated cross-sectional study.
Japan’s National Database of Health Insurance Claims and Specific Health Checkups Open Data (NDB Open Data), FY2015–2023.
All patients who received insurance-covered CBT in FY2023, with a longitudinal comparison across FY2015–2023.
The primary outcomes were annual CBT claims and patient counts. The secondary outcomes included prefecture-level distribution, population-adjusted utilisation rates per 100 000 population, distribution by sex and age, monthly trends and temporal changes over 9 years. Regional variation in physician-delivered CBT was assessed using the coefficient of variation (CV) and extremal quotient (EQ).
In FY2023, the total CBT claims numbered 38 045 with 8299 patients, representing only 0.14% of an estimated 6.03 million psychiatric patients. Physician-delivered CBT accounted for 99.6% (37 886 claims), whereas nurse-delivered CBT introduced in 2016 remained at 0.4% (159 claims). 13 of the 47 prefectures (27.7%) had zero or fewer than 10 claims. The population-adjusted physician-delivered CBT claims ranged from 370.96 per 100 000 in Okayama to 0.99 per 100 000 in Kumamoto, yielding an EQ of 375-fold. The CV among the 34 prefectures with measurable physician-delivered CBT was 174.8%. Despite indication expansions in 2016 and 2018, claims decreased by 9.9% from 42 216 in FY2015 to 38 045 in FY2023.
Insurance-covered CBT in Japan remains severely underused, with significant regional disparities. Incremental policy measures, including indication expansions and nurse-delivered CBT, have failed to improve access. Fundamental system reforms, potentially including dedicated psychological therapy services, are needed to ensure equitable access to evidence-based psychological treatments.
This study aimed to develop a prediction model for the occurrence of medical adhesive-related skin injuries (MARSIs) based on electronic medical records (EMRs) of adult patients who underwent degenerative spine surgery. This study used the EMR data of adult patients who underwent degenerative spine surgery at a university hospital in Seoul between January 2020 and December 2024. Seven machine learning algorithms and the SuperLearner algorithm were used to evaluate the performance of the SuperLearner model. Performance was focused on the area under the curve (AUC), accuracy, sensitivity, specificity, precision and F1 score. Among the machine learning algorithms, the RuleFit algorithm showed the best performance, with an AUC of 0.723, accuracy of 0.689, sensitivity of 0.959, specificity of 0.276, precision of 0.762 and F1 score of 0.789. In contrast, predicting MARSI using the SuperLearner algorithm had an AUC of 0.951, accuracy of 0.834, sensitivity of 0.635, specificity of 0.964, precision of 0.921 and F1 score of 0.752. This study provides practical evidence for the early identification of high-risk patients and establishment of customized nursing plans by presenting a MARSI prediction model using the SuperLearner ensemble. Future research is recommended to verify the external validity of the model through prospective studies and integration of clinical decision support systems.
Trial Registration: ClinicalTrials.gov Identifier KCT0010601.
To investigate the relationship between nurse managers' authentic leadership and staff nurses' organisational citizenship behaviour and to explore the mediating roles of different types of organisational silence in the relationship.
A cross-sectional, correlational, descriptive design.
Survey data from 216 nurses across five hospitals in South Korea were utilised. We used structural equation modelling to examine the relationships between authentic leadership, organisational silence and organisational citizenship behaviour.
Authentic leadership was positively associated with organisational citizenship behaviour and prosocial silence and was negatively associated with acquiescent and defensive silence. Acquiescent silence negatively impacted organisational citizenship behaviour, whereas prosocial silence had a positive effect. Defensive silence showed no significant relationship with organisational citizenship behaviour. Authentic leadership's indirect effects on organisational citizenship behaviour were mediated by acquiescent and prosocial silence.
Nurse managers' authentic leadership enhances organisational citizenship behaviour by reducing acquiescent and defensive silence and fostering prosocial silence. Although prosocial silence promotes harmony and collaboration, nurse managers must also encourage open communication to maintain a positive and professional organisational culture.
Developing authentic leadership in nurse managers can improve nurses' organisational citizenship behaviour by addressing organisational silence, thereby creating a supportive and efficient healthcare environment that benefits staff as well as patients.
No patient or public contribution.
Authentic leaders serve as positive role models who can improve employees' organisational citizenship behaviour by reducing negative forms of organisational silence. However, the mediating effect of organisational silence on the relationship between authentic leadership and organisational citizenship behaviour may vary depending on the type of silence, as different types are induced by distinct underlying motivations. Understanding these dynamics can inform strategies to improve nurses' workplace interactions and patient care outcomes.
Strengthening the Reporting of Observational Studies in Epidemiology guidelines.
by Seong Tak Woo, Sungdae Na
Intraoral palatal plates used in electropalatography (EPG) and tongue-interface systems are designed to monitor articulatory movement with minimal disruption to speech. However, their presence may subtly influence acoustic characteristics by altering tongue mobility and intraoral airflow. This study examines the acoustic effects of a pseudo-palatal plate during the articulation of consonants and vowels. Speech samples from healthy adults were recorded with and without the plate and analyzed using spectral and phonatory measures, including Mel-frequency cepstral coefficients (MFCCs), second formant (F2) slope, jitter, shimmer, harmonics-to-noise ratio (HNR), and quadrilateral vowel space area (qVSA). MFCC-based correlation coefficients and F2 slopes remained highly consistent across conditions, indicating minimal impact on consonant articulation. Shimmer (−0.72%), HNR (+2.5 dB), and qVSA (−24.1%) exhibited directionally consistent changes, with qVSA trending toward reduction; however, overall variation was limited. Vowel formant structures and consonant production were preserved mainly, suggesting that the palatal plate did not significantly impair vocal function. These findings support the interpretation that observed acoustic shifts are more consistent with filter-level effects than with changes at the glottal source. Although palatal plates may introduce minor acoustic variations, their impact on speech production appears minimal, reinforcing their suitability for therapeutic and assistive use, provided that acoustic considerations are addressed during design and clinical implementation.Type 2 diabetes mellitus has been associated with an increased risk of cognitive decline and dementia, with patients being 1.5–2 times more likely to develop these conditions. While both sodium-glucose co-transporter 2 (SGLT2) inhibitors and thiazolidinediones (TZDs) have shown potential neuroprotective effects in previous studies, their comparative effectiveness for preventing neurodegenerative outcomes has not been established. This study aimed to compare the risk of stroke, dementia and Alzheimer’s disease (AD) between patients treated with SGLT2 inhibitors and those treated with TZDs.
Multicentre, retrospective, observational, new-user, active-comparator cohort study.
Electronic health record-based databases from 11 secondary and tertiary institutions in South Korea from 1 January 2014 to 31 July 2025. The study period began in 2014, following the post-marketing surveillance initiation of SGLT2 inhibitors in Korea (November 2013), to ensure adequate drug availability and clinical adoption.
Patients aged 40 years or older who were newly prescribed either SGLT2 inhibitors or TZDs without prior exposure.
Propensity score matching (1:1) was performed using sex as the primary covariate due to data availability constraints in the Observational Medical Outcomes Partnership Common Data Model framework. The HRs with 95% CIs were measured via Cox regression analysis.
The study analysed 24 172 matched pairs for stroke outcomes (40 483 person-years in the SGLT2 inhibitor group and 39 363 person-years in the TZD group), 25 111 matched pairs for dementia (41 924 person-years in the SGLT2 inhibitor group and 40 726 person-years in the TZD group) and 25 237 matched pairs for AD (42 139 person-years in the SGLT2 inhibitor group and 40 895 person-years in the TZD group) across 11 participating hospitals. After a 1:1 propensity score matching, the SGLT2 inhibitors showed no significant difference in stroke risk (HR 1.18, 95% CI 0.62 to 2.23, p=0.62), while having significant reductions in dementia risk (HR 0.66, 95% CI 0.45 to 0.98, p=0.04) and AD risk (HR 0.54, 95% CI 0.35 to 0.83, p=0.005). Moreover, these protective effects for neurodegenerative outcomes were shown to be consistent across multiple hospital sites.
SGLT2 inhibitors are associated with a reduced risk of dementia and AD compared with TZDs in patients aged 40 years or older with type 2 diabetes and have neutral effects on stroke risk. These findings confirm the potential selective neuroprotective benefits of SGLT2 inhibitors for neurodegenerative outcomes, which may inform therapeutic decision-making for diabetic patients at risk of cognitive decline.
by Chanseo Lee, Jaihyoung Lee, Kimon-Aristotelis Vogt, Muhammad Munshi
BackgroundAccurate intraoperative detection of nociceptive events is essential for optimizing analgesic administration and improving postoperative outcomes. Although deep learning approaches promise improved modeling of complex physiologic dynamics, their added computational and operational complexity may not translate into clinically meaningful benefit, particularly in small, high-resolution perioperative datasets.
MethodsWe performed a head-to-head evaluation of classical supervised models (L1-regularized logistic regression and 50-, 200-tree Random Forests, with and without drug dosing features) against a Temporal Convolutional Network (TCN) transfer-learning framework for intraoperative nociception detection. Using 101 adult surgical cases with 30 physiologic and 18 drug dosing features sampled in 5-second windows, models were assessed under leave-one-surgery-out cross-validation using AUROC and AUPRC. We further examined probability calibration, multiple ensemble strategies, permutation importance features, and computational cost in terms of inference operations and memory footprint.
ResultsDrug-aware Random Forests of various trees (50 trees vs. 200 trees) achieved the highest discrimination (AUROC 0.716; AUPRC 0.399), outperforming the TCN transfer-learning model (AUROC 0.649; AUPRC 0.311). However, increasing personalization windows in the TCN yielded inconsistent and modest gains (p > 0.05). Isotonic calibration substantially improved probability calibration but did not affect discrimination. No ensemble method surpassed the standalone Random Forest; the gated network consistently assigned >84% weight to the classical model. Computational analysis revealed that while the TCN was more compact in total memory footprint, the smaller, 50-tree Random Forest inference required two orders of magnitude fewer operations, with faster training and lower operational complexity.
ConclusionsIn this clinically realistic benchmark, interpretable classical models operating on well-engineered features without personalization matched or exceeded the performance of a personalized deep learning approach while remaining computationally cheaper and simpler to deploy. These findings underscore the importance of rigorously justifying model complexity in perioperative machine learning and suggest that, for intraoperative nociception monitoring, classical approaches may offer a more favorable balance of accuracy, interpretability, and operational efficiency.
(1) To determine the mediating effects of children's transition readiness, which reflects self-management skill acquisition, and family resilience on the relationship between parenting stress and the quality of life (QOL) of parents and children with spina bifida (SB). (2) To conduct an exploratory analysis of the differences in the mediating pathways based on the presence of SB-related clinical characteristics.
A cross-sectional study.
Data were collected from a single centre in South Korea between October 2022 and July 2024. Participants included children aged 7–13 years diagnosed with myelomeningocele, lipomyelomeningocele or tethered cord syndrome, along with their parents. Statistical analysis was conducted using SPSS and the MEDYAD macro for actor–partner interdependence mediation model analysis.
Family resilience significantly mediated the relationship between parenting stress and both child and parent QOL. However, transition readiness was not a significant mediator in the overall sample. Among children with SB-related clinical characteristics, transition readiness significantly mediated the association between parenting stress and child QOL. In contrast, family resilience mediated the relationship between parenting stress and parent QOL. No significant mediators were found in children without SB-related clinical characteristics.
This study highlights the mediating role of family resilience and transition readiness in improving the QOL of children with SB, particularly those with clinical characteristics. The findings suggest that interventions should be tailored to address both family resilience and transition readiness, especially for children with SB-related clinical challenges.
These findings are valuable for nurses supporting children with SB, as the results highlight the importance of transition education tailored to SB-related clinical characteristics. In particular, nurse-led transition education may play a key role in enhancing transition readiness and improving the QOL of children with SB who have clinical characteristics.
None.
STROBE Checklist for cross-sectional studies.
To detail the development of the Canadian National Questionnaire on Overdose Monitoring (CNQOM), a questionnaire aimed at assessing the perspectives of key stakeholders towards elements of overdose prevention interventions—supervised consumption sites (SCSs) and overdose hotlines and applications (ORHAs).
Cross-sectional survey.
Canadian health system.
English or French speaking adults from four key informant groups: people who use substances (PWUS), health professionals, emergency responders and the general public.
Test–retest reliability of CNQOM items.
A novel questionnaire was developed. Item development followed a standard approach, with face validity verified by representatives from the four informant groups. Input from experts in harm reduction and addiction medicine enhanced content and face validity of the questionnaire. A rigorous response validation approach was undertaken to ensure respondents were human and from Canada. Test–retest reliability items were assessed using Spearman’s rank correlation, Wilcoxon rank-sum test and Cohen’s kappa.
After data cleaning and response validation, 4445 valid responses were obtained from the four key informant groups. Respondents represented a range of sociodemographic backgrounds and housing scenarios from all provinces and territories in Canada. Test–retest reliability was assessed using a small subsample of 142 participants (primarily from general public informants). Questionnaire items demonstrated slight to substantial stability in responses (kappa coefficients: 0.15–0.58; Spearman’s r: 0.08–0.66).
The CNQOM is the first online questionnaire in Canada designed to capture perspectives and attitudes towards specific elements of SCSs and ORHAs among diverse key informant groups. Our questionnaire was administered to a large, geographically diverse sample and designed to capture the perspectives of four key informant groups. Lower than expected test–retest reliability may be explained by lack of participant familiarity with SCS and especially ORHAs and the impersonal nature of the instrument content among some respondents. Future work will elucidate key informant perspectives on these services based on the data.
To investigate factors affecting the quality of life of parents of children with spina bifida and examine how family resilience mediates between parental depression and quality of life.
Cross–sectional study.
Secondary data analysis was performed using first-year data from a five-year spina bifida cohort project (2022–2026) in South Korea. The study included 162 parents of children aged 4–12 years with spina bifida. Data were collected using the Korean version of the Family Resiliency Scale, the Center for Epidemiologic Studies Depression Scale, and the WHO Quality of Life Scale.
Factors were found to have a statistically significant influence on the quality of life of parents of children with spina bifida: the child's need for enemas, parental stress, parental depression, and family resilience. Baron & Kenny's mediation analysis and bootstrap analysis in SPSS further confirmed that family resilience plays a mediating role between parental depression and quality of life. The indirect effect of parental depression on quality of life through family resilience was statistically significant, with a 95% confidence interval of [−0.2615, −0.0516].
The quality of life of parents with children with spina bifida is significantly influenced by both their child's daily symptom management and their psychological health. Family resilience plays a positive mediating role between parental depression and quality of life.
These findings support a two-track approach to family resilience building programs and the development of core intervention strategies to enhance the quality of life in spina bifida families.
This study adhered to Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.
There was no direct patient involvement in the study design, data collection, or analysis.
To evaluate the association between cumulative radiation dose and haematological parameters among radiation workers and compare the prevalences of abnormalities in blood counts with those in the general population.
Retrospective cohort study.
Nationwide radiation dose registry in Korea, linked with occupational health examination data. Cumulative doses were estimated using annual personal dose equivalent (Hp(10)) records from 1984 onward.
The study included 20 414 radiation workers, comprising 17 651 men (86.5%) and 2763 women (13.5%), with baseline survey data, dosimetry records and at least one complete blood count (CBC) record between 2014 and 2019.
The primary outcome was the continuous haematological parameters, including white blood cell (WBC), platelet (PLT) and haemoglobin (Hb) counts, in relation to cumulative radiation dose. Associations were evaluated using linear mixed-effects models incorporating repeated measurements and adjusting for age, smoking status and body mass index. The secondary outcome was the prevalence of abnormal blood counts among radiation workers.
Most haematological parameters among radiation workers were within normal ranges. In male workers, cumulative radiation dose was associated with increased Hb levels (β=0.5 mg/dL per 1 mSv; 95% CI 0.006 to 0.9) after adjusting for age, smoking status and body mass index. No significant associations were observed between cumulative dose and WBC or PLT counts in either sex. Overall, compared with the general population, radiation workers had significantly lower standardised prevalence ratios for abnormal WBC and PLT counts.
No substantial adverse changes in haematological parameters were found among radiation workers exposed to prolonged low-dose radiation. The findings suggest that cumulative doses at occupational levels may not substantially affect CBC profiles, although continued monitoring and follow-up are warranted.
Considering that suicide has remained a public health challenge in South Korea since 2009, the development of a real-time monitoring system for suicide risk is urgently needed, especially for those living in the community. The aims of this study were to explore the 28-day longitudinal pattern of suicidal ideation, compare momentary depression, anxiety and stress between different risk groups, and identify the association of suicidal ideation with momentary indicators in community-dwelling outpatients at risk of suicide.
Observational and longitudinal investigation.
A total of 50 community-dwelling psychiatric outpatients were included herein. Those with a history of suicide attempts were classified into the high-risk group (n = 40, 80%), whereas the rest were classified into the low-risk group (n = 10, 20%). Real-time data on depression, anxiety, stress and suicidal ideation were collected from May 2021 to July 2023 based on ecological momentary assessment. Each participant provided reports at least three times a day for 4 weeks. A total of 3195 ecological momentary assessment responses were collected, among which 1345 with the highest mood intensity per day were selected for analysis. Panel mixed-effect linear regression models examined differences in ecological momentary assessment responses between high- and low-risk groups and elucidated the separate effects of depression, anxiety and stress on suicidal ideation in each risk group.
Momentary depression, anxiety and stress were positively associated with momentary suicidal ideation in both risk groups, with these associations being higher among the high-risk group. In both risk groups, momentary suicidal ideation was more strongly associated with momentary depression than with momentary anxiety and stress.
Psychosocial stress indicators were associated with momentary suicidal ideation. Moreover, a strong association was observed between momentary depression and suicide attempts. Further research with larger samples should be conducted to evaluate whether depression interventions could reduce momentary suicidal ideation.
No Patient or Public Contribution.
To determine the clinical characteristics and identify not only the Korean Triage and Acuity Scale levels of older patients with pneumonia in the emergency department but also the factors associated with their survival.
This study employed a retrospective observational design.
This study was conducted at the emergency department of a university hospital in Seoul, South Korea. It utilised medical data from January 1 to December 31, 2023. The study sample comprised 327 patients aged 65 years or older who received a pneumonia diagnosis (International Classification of Diseases: J10–J18). Binary logistic regression analysis was performed to identify independent factors associated with their survival.
Survival was significantly associated with and influenced by sex (specifically, male sex), initial Korean Triage and Acuity Scale level, oxygen supplementation in the emergency department, consciousness level (specifically, painful response), body temperature (> 37.5°C) and a diagnosis of solid or hematologic malignancies.
The findings highlight the need for improved triage protocols, emphasising consciousness level, body temperature and malignancies. Incorporating geriatric-specific age thresholds and oncologic status into Korean Triage and Acuity Scale classifications may enhance risk stratification, timely intervention and resource allocation in emergency department settings.
This study provides insight into triage accuracy for older pneumonia patients, emphasising early recognition of high-risk individuals and strengthening nursing assessment protocols. Improved Korean Triage and Acuity Scale classifications can optimise resource allocation and emergency care strategies, ultimately reducing mortality rates.
The study provides actionable insights for emergency nurses, triage clinicians and policymakers. The findings support the refinement of KTAS protocols to enhance risk stratification and guide resource allocation for older pneumonia patients, ultimately aiming to reduce mortality rates.
Adhered to STROBE guidelines for observational studies.
Although patients did not directly participate, the findings advocate for patient-centred triage improvements, enhancing early identification of high-risk older patients with pneumonia.
by Yong Seok Jo, Seung Jae Lee, Hyun Jin Lee, Jeon Mi Lee
ObjectivesThis study aimed to determine the preferred timing and measurement sites for electroneuronography (ENoG) to predict early recovery from acute peripheral facial paralysis.
MethodsWe retrospectively evaluated 42 patients with acute peripheral facial paralysis who received standard treatment with oral corticosteroids. The severity of facial paralysis was assessed at the initial visit and after 1 month using the House–Brackmann grading system. Patients were classified into recovery and non-recovery groups according to changes in the grade. ENoG was performed at the initial visit and after 2 weeks. ENoG amplitudes of four facial muscles (frontalis, nasalis, orbicularis oculi, and orbicularis oris) at the initial visit and after 2 weeks, as well as age, sex, affected side, and diagnosis, were compared between the two groups.
ResultsNo differences were observed in degeneration ratios across all subsites in the initial ENoG, which can be explained by the fact that Wallerian degeneration is not yet complete at this early stage. However, the second ENoG, performed after degeneration had progressed, showed significant differences across all subsites. Binary logistic regression analysis revealed that the degeneration ratio of the orbicularis oris muscle was the best predictor of early recovery (odds ratio, 0.961; p = 0.014). Receiver operating characteristic curve analysis also revealed that the degeneration ratios of all subsites measured in the second ENoG were useful in predicting early recovery, with the highest possibility at the orbicularis oris muscle (area under the curve = 0.789). When the degeneration ratio exceeded 60% in all subsites in the second ENoG, a favorable prognosis was not expected.
ConclusionThis study provides the preferred testing time and measurement sites for ENoG to predict early recovery from facial paralysis. Given the personal and social impact of facial paralysis, predicting early recovery is crucial for reassuring patients, providing better treatment, and encouraging early reintegration into society.
by Andrea Lopez-Soto, Esmeralda Ramírez, Duyen H. Vo, Aigerim Alpysbekova, Seo Woo Lee, Maria Duque, Lawrence Watkins, Cory L. Cobb, Beyhan Ertanir, Alejandra Garcia Isaza, Evelyn Gualdron, Sumeyra Sahbaz, Collette Steed, Neel Devan Youts, Shriya Senapathi, Seth J. Schwartz, Pablo Montero-Zamora
There is a limited understanding of how different subgroups of Latin American immigrant parents experience cultural stressors, as well as its impact on family dynamics, health behaviors, and mental health. The present study aimed to (1) identify latent cultural stress profiles among Latin American immigrant parents in the U.S. and (2) examine differences among these profiles concerning family intimacy, democratic parenting style, family conflict, hazardous alcohol use, and depressive and anxiety symptoms. Participants consisted of a sample of 1,351 parents (61.9% female; M age = 39.83, 62% first-generation; North America [61%], Central America and the Caribbean [21%], and South America [19%]) of children aged 8–16. We used latent profile analysis to identify subgroups of cultural stress, defined by perceived discrimination (PDS) and negative context of reception (NCR). Multinomial logistic regression was conducted to examine key correlates of profile membership. Five latent profiles were identified (1) Low PDS/NCR (22.2%), (2) Low PDS/Elevated NCR (14.8%), (3) Moderate PDS/NCR (18.7%), (4) Elevated PDS/NCR (33.5%), and (5) Highest PDS/NCR (10.8%). Compared with Profile 1 (Low PDS/NCR), parents in Profiles 2–5 generally reported lower family intimacy (RRR = 0.93–0.97). Parents in Profile 5 (Highest PDS/NCR) reported more family conflict (RRR = 1.13), hazardous alcohol use (RRR = 1.20), depressive symptoms (RRR = 1.31), and anxiety symptoms (RRR = 1.29), with markedly elevated depressive (RRR = 22.94) and anxiety symptomatology (RRR = 17.48) compared with Profile 1. Our findings suggest the presence of vulnerable subgroups due to cultural stress among Latin American parents in the United States. A better understanding of cultural stress patterns may improve current and future interventions tailored for Latin American families, addressing health disparities within this population.by Yong Jae Lee, Nam Kyeong Kim, Kidong Kim, Chel Hun Choi, Keun Ho Lee, Jong-Min Lee, Kwang Beom Lee, Dong Hoon Suh, Sunghoon Kim, Min Kyu Kim, Seok Ju Seong, Myong Cheol Lim
ObjectiveTo identify the effect of fascial closure using barbed sutures on the incidence of incisional hernia in patients undergoing elective midline laparotomy for gynecological diseases.
MethodsIn this multicenter, non-blind randomized controlled trial conducted from February to December 2021, patients with a BMI 2 and aged >18 years, scheduled for midline laparotomy, were randomly assigned to receive either barbed (experimental) or non-barbed sutures (control) for fascial closure. The primary outcome was the cumulative incidence rate of incisional hernia up to 1-year post-surgery. Secondary outcomes included incisional hernia up to 2-years post-surgery, wound complications, and postoperative pain assessed by Brief Pain Inventory-Korean scores, and Numeric Rating Scale.
ResultsOut of 174 patients (experimental, 86; control, 88), 36 were excluded due to dropout or loss to follow-up, leaving 138 patients (experimental, 67; control, 71) included in the analysis. The groups were balanced in terms of cancer surgeries, mean wound length, and mean surgery time. The cumulative incidence rates of incisional hernia up to 1-year (0.0% vs. 1.4%; p > 0.999) and 2-years (0.0% vs. 3.4%, p = 0.496) post-surgery did not differ significantly between the experimental and control groups. Additionally, no significant differences were observed in the incidence of wound dehiscence 4 weeks post-surgery, cumulative incidences of wound dehiscence and wound infection up to 4 weeks post-surgery, or postoperative pain scores between the groups.
ConclusionsFascial closure using barbed sutures resulted in no cases of incisional hernia up to 2-years post-surgery, but did not demonstrate a significant reduction in incisional hernia rates compared with the non-barbed suture.
Trial registrationClinicalTrials.gov NCT04643197
The aim of this study is to identify the factors associated with nurses' perceptions and behaviours related to climate change and health (PBCH) according to their PBCH levels.
A cross-sectional study was used.
This study included a sample of 499 Korean nurses and adhered to the STROBE checklist. Data were collected from March 23 to May 10, 2023. Quantile regression analysis was performed, and PBCH levels were measured using the Korean version of the Climate Health and Nursing Tool.
Across all quantile groups, the experience of extreme weather events and awareness of climate change-coping facilitators were associated with PBCH. Differences were observed in factors associated with PBCH levels. Significant associations with PBCH were observed within the 75th percentile group, for having a religion, household income, and workplace climate friendliness. In the 25th percentile group, having a child, the number of sources for climate change–health-related information, and experience in setting climate change–health goals and strategies significantly influenced PBCH.
We propose a differentiated strategy by elucidating the factors associated with high and low quantiles of PBCH levels.
By verifying specific factors associated with PBCH levels, nurses can enhance their preparedness to respond to the health risks posed by climate change in their clients.
Identifying common factors associated with all quantiles of nurses is important for establishing universal PBCH characteristics. Recognising the distinctions between high and low PBCH levels can aid in developing tailored nursing strategies to enhance PBCH among nurses.
This study adhered to the STROBE guidelines.
No Patient or Public Contribution.
by Yoo Kyung Choi, Seok Hyun Son, Hong Seok Jang, In-Ho Kim, Sea-Won Lee, Soo-Yoon Sung
BackgroundRadiotherapy for locally advanced esophageal cancer can induce lymphopenia, potentially worsening outcomes. This study examines the association between clinical outcomes and the effective dose to the immune cells (EDIC), a measure of lymphocyte radiation exposure.
MethodsWe retrospectively analyzed 107 patients with locally advanced esophageal squamous cell carcinoma treated with definitive concurrent chemoradiotherapy (CCRT). The EDIC was calculated based on the mean lung dose, mean heart dose, and integral total body dose using established models. Patients were stratified into high (n = 42) and low (n = 65) effective dose to the immune cells (EDIC) groups using a cut-off value of 4.28 Gy. Survival outcomes, including overall survival (OS), progression-free survival (PFS), locoregional failure-free survival (LRFS), and distant metastasis-free survival (DMFS), were assessed.
ResultsThe 5-year OS and PFS rates were significantly lower in the high EDIC group than in the low EDIC group (51.9% vs. 66.6%, p = 0.043; 20.8% vs. 31.8%, p = 0.002, respectively). Multivariate analysis identified high EDIC as an independent predictor of poorer OS (hazard ratio (HR): 2.06, 95% confidence interval (CI): 1.1–3.86, p = 0.024) and PFS (HR: 1.7, 95% CI: 1.04–2.78, p = 0.034). Similarly, the 5-year LRFS and DMFS rates were significantly lower in the high EDIC group than in the low EDIC group (24.1% vs. 34.9%, p = 0.003; 29.0% vs. 44.0%, p = 0.018, respectively).
ConclusionA higher EDIC is an independent predictor of poor survival in patients with esophageal squamous cell carcinoma undergoing CCRT. Reducing radiation exposure to the immune system through optimized radiation planning and lymphocyte-sparing techniques may improve patient outcomes.
To explore the association between the degree of coronary artery calcium (CAC) and the progression of calcific aortic valve disease (CAVD).
A single-centre retrospective cohort study using a hospital-based database.
A total of 2898 patients who underwent coronary CT angiography and serial echocardiograms at ≥6 months apart were included. Initial echocardiography was performed within 6 months from the time of CCTA.
CAC was divided into four groups: 0, 1–99, 100–399 and ≥400 (Agatston units, AU). The progression of CAVD was defined in two ways: progression 1 as at least one grade of progression, progression 2 as at least moderate aortic stenosis (AS) at follow-up.
At the initial CAVD grade, patients with at least mild AS tended to increase with increasing CAC (p
CAC was significantly associated with the progression of CAVD. Particularly, CAC≥400 was linked to progression toward significant AS.
Allergic rhinitis (AR) is a common chronic inflammatory condition that significantly impairs quality of life (QoL) through symptoms such as nasal congestion, rhinorrhoea, sneezing and itching. Conventional treatments often show limitations, prompting interest in complementary therapies like herbal medicine (HM). HM is widely used in East Asian countries and has demonstrated potential in modulating immune responses and reducing AR symptoms. In Korea, a government pilot project expanded in 2024 to include AR under limited insurance coverage for HM, highlighting the need for robust clinical evidence on its safety and effectiveness.
This study is a multicentre, prospective registry conducted in 21 Korean Medicine (KM) clinics across Republic of Korea. The registry systematically collects real-world data on HM treatments for AR, focusing on patient demographics, treatment patterns and clinical outcomes. Participants meeting predefined criteria will receive HM or other KM therapies as part of routine care. Data will be collected bi-weekly for the first 4 weeks, with additional follow-ups at 6 and 12 months. Primary outcomes include changes in Total Nasal Symptom Score, QoL scores and safety evaluations, analysed using descriptive and inferential statistical methods.
This study was approved by the Institutional Review Board of Kyung Hee University on 11 December 2024 (Approval No. KHSIRB-24–631). The study findings will be published in peer-reviewed journals and presented at academic conferences.
KCT0010172.
Human papillomavirus (HPV) is the most common cause of cervical cancer in women. However, among adolescent boys, initial exposure to HPV is associated with a higher risk of developing oropharyngeal and oral cancers compared with girls. Notably, the incidence of oropharyngeal cancer has been rising sharply in high-income countries, yet HPV vaccination coverage among adolescent boys remains suboptimal. Therefore, understanding the perceptions of adolescent boys and their parents regarding HPV vaccination in high-income countries is crucial for the development of effective public health strategies.
This scoping review aims to explore the perceptions of adolescent boys and their parents regarding HPV vaccination and investigate the facilitating factors and barriers influencing HPV vaccination.
The method framework of Arksey and O’Malley, the Joanna Briggs Institute, as well as the recommendations of Levac will be used to conduct the scoping review. This scoping review will be reported in accordance with the PRISMA extension for scoping reviews checklist. A systematic literature search will be performed on Ovid-MEDLINE, CINAHL, Cochrane CENTRAL, Ovid-Embase, PsycINFO and Web of Science. Two reviewers will independently perform the study selection and data extraction. Identified studies will be extracted using a customised extraction template on Covidence and analysed descriptively using narrative synthesis. The review commenced in April 2024 and will be completed in July 2025.
Formal ethical approval is not required, as primary data will not be collected for this study. The findings will be disseminated through publication in a peer-reviewed journal.
This protocol has been registered with the Open Science Framework (https://doi.org/10.17605/OSF.IO/M5NH2).
FreshRSS 