Conectar
by Zhilan Huang, Tingyi Xie, Mingwen Tang, Zhuni Chen, Dan Jia, Anqi Su, Zhujin Jin, Tuliang Liang, Wei Xie
BackgroundPulmonary fibrosis is a severe chronic lung disease whose prevalence has been rising in recent years, representing one of the major respiratory health challenges globally in the 21st century. The burden of this disease on the elderly population is garnering growing attention, particularly as the global population ages. The Global Burden of Disease (GBD) study has provided valuable insights; however, systematic analyses focused on this condition remain limited. To date, few studies have specifically examined interstitial lung disease and pulmonary sarcoidosis among individuals aged 55 years and older. This study aims to conduct a comprehensive analysis of burden trends from 1990 to 2021 for those aged 55 and above and to project future trends up to 2035.
MethodsOur approach utilizes the estimation of four broad component measures: incidence, prevalence, death and Disability-Adjusted Life Years (DALYs), using data on ILD&PS from the Global Burden of Disease (GBD) 2021 database. Joinpoint regression models were applied to calculate the average annual percentage change (AAPC) in order to analyze temporal trends in disease burden and to identify years with significant trend shifts. Analyses were further stratified by age, sex, region, country, and Sociodemographic Index (SDI). Additionally, a Bayesian age-period-cohort (BAPC) model was used to project future disease burden trends.
ResultsBetween 1990 and 2021, significant increases were observed in incidence, DALYs, and death rates for ILD&PS (AAPC incidence = 1.09, 95% CI: 1.04 to 1.15; AAPC DALYs = 1.10, 95% CI: 0.97 to 1.23; AAPC death = 1.65, 95% CI: 1.47 to 1.83). In 2021, the total number of incident cases reached 284,887 (95% UI 248,300–328,800), with the highest incidence rates observed in Andean Latin America. Across age- and sex-specific analyses, global burden trends were similar, though males consistently exhibited higher rates than females. The oldest age group (95 + years) had the highest incidence and DALYs rates among all age strata. Furthermore, incidence rates increased most markedly in high-SDI regions, showing a strong positive correlation between SDI and incidence. Bayesian age–period–cohort (BAPC) analyses indicated that while prevalence rates are projected to decline slightly, incidence rates are expected to continue rising. Both males and females showed a dip then rise in prevalence trends, but the increase was more pronounced among females. In 2035, the highest number of incident cases is projected to occur in the 65–69 age group, whereas the highest incidence rate is predicted in the 95 + age group.
ConclusionsA concerning upward trend in incidence, DALYs, and deaths related to ILD&PS was observed in the global population aged 55 years and older, particularly among females. To our knowledge, this is the first study to comprehensively analyze the burden of ILD&PS in this age group from 1990 to 2021. Our findings on epidemiological trends and their variations across geography, SDI, age, and sex can inform policy-makers in designing targeted strategies to mitigate the anticipated rise in disease burden.
Procedural pain and distress in children can result in severe short- and long-term consequences, including post-traumatic stress syndrome and needle phobia. While distraction techniques (e.g., toys, music) have been widely used, virtual reality (VR) offers a novel, immersive form of distraction. Despite the rapid development of VR technologies, there is a lack of comprehensive evidence regarding which paediatric patients and procedures benefit most from VR interventions.
We conducted a scoping review following the PRISMA-ScR guidelines. A systematic search across PubMed, Embase, Web of Science, Cochrane Library and Chinese databases (CNKI, Wanfang, VIP, SinoMed) identified studies from January 1, 2000 to November 15, 2025. Inclusion criteria were randomized controlled trials (RCTs) or quasi-experimental designs assessing VR for pain/anxiety management during medical procedures in paediatric patients, with outcomes including pain intensity, distress, feasibility, satisfaction or safety.
Of the 5458 original database citations, 201 were eligible for full-text evaluation. Of these articles, a total of 22 were included in the scoping review. RCTs comprised 81.8% (n = 18). The majority (86.4%) employed immersive VR and 27.3% utilized cost-effective smartphone-based systems. Procedures targeted included venipuncture, needle-related interventions, intravenous access, surgery and burn wound care. Approximately 86.4% of studies reported VR's superiority over standard care in reducing procedural pain and distress.
VR is an effective, non-pharmacological tool for managing procedural pain and distress in paediatric clinical settings, showing promise for integration into routine care. However, existing studies exhibit methodological heterogeneity and focus primarily on short-term outcomes. Future research should prioritize large-scale, rigorously designed RCTs with long-term follow-up, and focus on developing standardized, evidence-based VR protocols for diverse paediatric populations.
No patient or public contribution was required for this scoping review, as it only synthesized existing published literature without primary data collection.
by Weifeng Wang, Xianli Meng, Yan Zhao, Wei Gong, Xiaochen Jiang, Wenjuan Cao, Xueling Qiu, Chenxi Sun, Fan Sun, Yuchen Wang, Lu Tang
BackgroundTo alleviate pain in burn patients during dressing changes, it is necessary to identify an effective analgesic method. Conventional opioid analgesics have many limitations. Nitrous oxide is a fast-acting, safe and reversible inhaled analgesic gas. This systematic review will evaluate the effectiveness and safety of nitrous oxide in the treatment of pain during dressing changes in burn patients.
MethodThe protocol was developed according to the PRISMA-P checklist and registered on PROSPERO (CRD42024550197). A systematic search will be performed in the following databases: PubMed, EMBASE, Web of Science, Cochrane Library to identify clinical trials comparing nitrous oxide inhalation with standard care in pain management during dressing changes in burn wounds. The search of all databases will be conducted on October 15, 2025.Our search scope will include studies published between each database creation and search date.Two researchers will independently screen studies, extract data, and evaluate study quality using the Risk of Bias2 tool. Primary outcomes will include pain, anxiety, side effects, among others.R statistical software (version 4.3.1) and R studio will be used to perform meta-analyses.Effect size will be expressed by 95% confidence interval (Cl) of weighted mean difference (MD) and risk ratio (RR). Subgroup analyses and sensitivity analyses will be performed to explore sources of heterogeneity and assess the robustness of the results.Publication bias will be assessed using funnel plot and Egger test. We will use the Grading of Recommendation, Evaluation, Development and Evaluation (GRADE) to assess the quality of the evidence.
DiscussionOperative pain has always been a difficult problem for burn patients. This study will evaluate the analgesic effect of nitrous oxide on dressing change in burn patients through comprehensive search and rigorous methods, and provide evidence support for clinical decision-making.
To clarify the definition and evolution of Patient and Public Involvement and Engagement (PPIE) and identify its attributes, antecedents, and consequences in health-related research.
This study follows Rodgers' evolutionary concept analysis with a seven-step framework.
Datasets were searched using terms related to PPIE and key categories (i.e., attributes, antecedents, and consequences). Data were sourced from CINAHL, PsycInfo, Scopus, PubMed, and Web of Science covering publications from inception to October 31, 2024. Document titles, abstracts, and keywords were manually screened to identify relevant studies for full-text review.
A total of 1751 documents were screened, resulting in 38 eligible studies included in the final analysis. PPIE has evolved from a narrow focus on patient inclusion and participation, where patients had minimal influence on research and researchers resisted sharing control of research, to a collaborative model emphasising sustained partnerships, shared contributions, equitable power distribution, and active involvement across research stages. This shift has been driven by research innovation, a growing emphasis on healthcare equity and patient-centred care, technological advances, and stakeholder advocacy (e.g., patients, funders, ethics committees). While PPIE enhances research relevance and impact, barriers, such as resource constraints, power imbalances, patient limited research capabilities and increased researcher workload persist. Facilitators, such as training programmes, standardised guidelines, flexible arrangements and transparent communication can enable meaningful partnerships.
The concept of PPIE is evolving toward greater clarity and consistency in research, positioning patients and the public as active, essential contributors rather than passive participants. Barriers and facilitators were identified to inform its utilisation in research.
This study clarifies the conceptual ambiguities of PPIE, informs theory development, and provides actionable insights. Healthcare and nursing researchers can draw on its findings to utilise PPIE to enhance collaborative and inclusive research practices that align with the needs of patients and the public.
This study adheres to the PRISMA (2020) reporting guidelines for systematic reviews.
One of our co-authors is a patient with lived experience of cancer, who contributed valuable comments and suggestions to enhance this paper.
To assess the effect of three educational interventions on self-management behaviours among individuals at risk of diabetes in Burkina Faso, Comoros and Mali, using cluster analysis to identify distinct respondent profiles.
Single-arm before–after longitudinal study with 6-month follow-up.
Community screening initiatives and antenatal clinics in Burkina Faso, Comoros and Mali.
540 adults at risk of diabetes (body mass index ≥25 kg/m² and/or family history of diabetes and/or impaired fasting glucose ≥1.10 g/L; mean age 38.2 years, 69% female) recruited through community screening initiatives and antenatal clinics in Burkina Faso, Comoros and Mali.
Three educational interventions: (1) social media video broadcasting, (2) peer educator outreach and (3) gestational diabetes education at antenatal clinics.
Changes in domain-specific Health Education Impact Questionnaire scores over 6 months assessed using Cohen’s d effect sizes.
Of the 540 initial participants, 528 responded to the follow-up survey 6 months later. Cluster analysis revealed two distinct self-management profiles: cluster 1 showed significant improvement in only two domains, self-monitoring (d=0.35, p=0.006) and skill acquisition (d=0.30, p=0.020), indicating limited but focused gains. In contrast, cluster 2 suggested significant progress in seven out of eight domains, including large gains in positive engagement in life (d=0.74, p
Distinct self-management profiles among diabetes-risk populations revealed critical heterogeneity that demands tailored, context-specific public health strategies to effectively address diverse needs and optimise prevention efforts.
by Adimias Wendimagegn Agegnehu, Butte Gotu Arero
BackgroundMaternal age at first birth (AFB) is a key indicator of reproductive health, influencing maternal and child outcomes, population dynamics, and socio-economic well-being. Early childbearing increases risks of maternal morbidity, poor neonatal outcomes, and intergenerational poverty. Despite progress in Ethiopia, disparities in AFB persist across regions, religions, and residential settings, particularly among women who have already given birth. This study determines the magnitude and direction of effects from religious, regional and residential determinants of maternal AFB in Ethiopia.
MethodsData were drawn from 5,839 women included in the 2019 Ethiopia Mini Demographic and Health Survey (Mini EDHS 2019). A comparative modeling framework was employed; fitting Generalized Linear Models (GLM), Generalized Linear Mixed Models (GLMM), and distributional Gamma regression models to examine the consistency of the coefficients for covariates across different modeling framework. Both classical estimation (Maximum Likelihood Estimation) and Bayesian inference via Markov Chain Monte Carlo (MCMC) were used.
ResultsAmong women in Ethiopia who had experienced a first birth by the time of the survey, the average maternal age at first birth was 18.7 years(95% CI: [18.2, 19.3]), indicating that a substantial proportion of women begin childbearing at the lower limit recommended by the World Health Organization. Regional differences in mean maternal age at first birth were notable: women in Amhara (4%), Oromia (3%), SNNPR (3%), Benishangul-Gumuz (3%), and Gambela (8%) had earlier average maternal age at first births, whereas those in Addis Ababa (11%), Somali (4%), and Dire Dawa (4%) delayed childbirth compared to Togray. Variability in AFB also differed by region, with higher dispersion observed in Afar (37.7%), Benishangul-Gumuz (37.7%), Somali (36%), Gambela (32.3%), SNNPR (27.1%), and Harari (25.9%), while Addis Ababa (22.1%) and Dire Dawa (13.1%) showed lower variability. Women who have already given birth and identify as Orthodox or Protestant tend to experience a higher average age at first birth, with increases of approximately 4% and 3%, respectively, relative to Muslim women. Conversely, women classified under the “other religions” category tend to have their first child approximately 5% earlier than Muslim women. Residence influenced both mean and variability: rural women who had already given birth experienced first births about 5% earlier than urban women and exhibited 7.3% greater dispersion, indicating more heterogeneous reproductive patterns.
ConclusionMaternal age at first birth in Ethiopia remains low (18.7 years), with significant disparities in mean and variabilities across religion, residence, and region. Women from rural areas, Muslim backgrounds, and regions such as Amhara, Oromia, Benishangul-Gumuz, SNNPR, and Gambela are more likely to give birth earlier, while urban women, particularly in Addis Ababa, Dire-Dawa, and Somali, tend to delay childbearing. The persistence of very early childbearing (as young as 10 years) highlights urgent reproductive health challenges. These findings call for context-specific policies: expanding girls’ education, delaying marriage, and strengthening youth-friendly reproductive health services in rural and high-risk regions; engaging religious leaders and institutions as partners in promoting delayed childbearing; and addressing structural inequities through regionally tailored programs that respect cultural and pastoralist lifestyles.
Commentary on: Lines. L.E., Bell. A., Hunter. S., Matwiejczyk. L., Williams. J., Kakyo. T. A., Baldwin. C. (2024) Interprofessional education within a nurse practitioner led paediatric service: A multi-methods study
Implications for practice and research Using formal and informal interprofessional education (IPE) offers novel approaches to IPE. More high-quality research is required.
Interprofessional education (IPE) is defined as ‘occasions when two or more professions learn with, from and about each other to improve collaboration and the quality of care’ (Barr, p6)
This initiative involved pre-registration nursing and allied-health...
Commentary on: Platz K, Metzger M, Cavanagh C, et al. Initiating and continuing long-term exercise in heart failure: A qualitative analysis from the GEtting iNTo Light Exercise-Heart Failure Study. J Cardiovasc Nurs; 2024 Feb 26. doi: 10.1097/JCN.0000000000001086. Epub ahead of print. PMID: 38411493
Implications for practice and research When clinicians have a better understanding of patient decisions regarding exercise, they are better equipped to redesign traditional cardiac exercise programmes. Themes from this study provide frameworks to design future quantitative and mixed-method studies that will inform clinicians about the patient experience with cardiac exercise programmes.
Management of heart failure (HF) is a challenge, with less than one-third of patients meeting physical activity recommendations.
Oncology nurses are frequently subjected to significant psychological stress due to the demanding nature of cancer care, which negatively impacts their mental and physical health as well as the quality of patient care. Although Mindfulness-Based Stress Reduction has been demonstrated to be effective in alleviating stress, practitioners often encounter barriers such as limited engagement and difficulty maintaining regular practice.
To enhance engagement and adherence, we integrated art elements into the Mindfulness-Based Stress Reduction framework, creating the Mindfulness-Based art therapy program, and evaluated its effectiveness among oncology nurses.
A three-arm randomized controlled trial.
90 oncology nurses participated (Mindfulness-Based Art Therapy group = 30, Mindfulness-Based Stress Reduction group = 30, waitlist controls group = 30) in an 8-week program. Stress, anxiety, depression, fatigue, and mindfulness levels were assessed at baseline, immediately after the fourth week of intervention, and immediately after the intervention concluded. Compliance and satisfaction were evaluated using attendance rates and satisfaction questionnaires. Descriptive statistics were used to analyze general data; intervention effects were compared using one-way ANOVA and generalized estimating equations, and compliance and satisfaction were compared using independent samples t-test.
Both Mindfulness-Based Art Therapy and Mindfulness-Based Stress Reduction significantly improved stress, physiological markers, and mindfulness vs. controls. Mindfulness-Based Stress Reduction better reduced depression (β = −2.980, 95% CI: −5.427, −0.533, p = 0.017), while Mindfulness-Based Art Therapy was superior for fatigue (β = −11.582, 95% CI: −20.615, −2.550, p = 0.012). Mindfulness-Based Art Therapy had higher adherence (93.3% vs. 73.3%, p < 0.05) and satisfaction (3.27 ± 0.45 vs. 2.40 ± 0.52, p = 0.01).
For oncology nurses, Mindfulness-Based Art Therapy is as effective as Mindfulness-Based Stress Reduction for improving stress and mindfulness, while providing greater adherence, satisfaction, and more consistent fatigue reduction.
Chinese Clinical Trial Registry, ChiCTR2300078124 (http://www.chictr.org.cn), 30/11/2023
by Xiuxin Liu, Yuhui Han, Ruixue Kuang, Wenjiong Sheng, Yan Zhang, Xinyu Jia, Xiaoxiao Gao, Yanchao Ma
DNA damage-induced by radiotherapy is a critical factor in promoting the death of colorectal cancer cells (CRC). Although high mobility group box 1 (HMGB1) reportedly plays a vital role in tumor radioresistance by modulating DNA damage repair, the precise mechanisms remain unclear. In this study, HMGB1 knockdown markedly enhanced cell apoptosis after radiation. HMGB1 downregulation significantly inhibited DNA damage repair and reactive oxygen species (ROS)-mediated redox homeostasis after irradiation in CRC cells. Mechanistically, HMGB1 interacts with KU70 via its region spanning residues 95–163. This interaction subsequently activates the non-homologous end joining (NHEJ) pathway to facilitate DNA damage repair, ultimately leading to reduced radiation-induced cell apoptosis. KU70 silencing showed the same effect as HMGB1 depletion mediated cell apoptosis and DNA damage response both in vitro and in vivo. Additionally, HMGB1 and KU70 were overexpressed in CRC tissues. Analysis of the GEPIA database indicated that elevated levels of both genes showed a trend toward association with poor patient prognosis, although this did not reach statistical significance. The current study revealed that HMGB1 may promote DNA damage repair through KU70 and its mediated NHEJ pathway to affect apoptosis in CRC cells after irradiation. Thus, targeting the HMGB1/KU70/NHEJ axis may be a potential therapeutic target to promote the response of CRC to radiotherapy and in-depth study of the specific mechanism of this axis in CRC radioresistance will help to the develop more effective treatment strategies.Outcomes for degenerative cervical myelopathy (DCM) patients are limited by delayed and missed diagnoses, driven in part by poor professional awareness. Despite DCM being the most common cause of adult spinal cord injury, it remains under-recognised and undertaught in clinical education. Lessons from other common pathology like stroke and acute myocardial infarction highlight the potential of education to improve early diagnosis. This study will develop a professional education strategy to improve early DCM diagnosis. It will define key audiences and identify an effective delivery method, laying the groundwork for a sustained, targeted intervention.
The study aims to define who needs to know about DCM, what they need to know and how they can learn it. This will be carried out in three phases: phase 1—who and what: to establish the target population and to define core competencies for the educational intervention; phase 2—how: to create and review the educational intervention; phase 3—evaluation: to test whether the framework is an improvement to existing strategies.
Ethical approval is in place from the University of Cambridge (HBREC.2024.24). Results from the study will be disseminated through scientific publication, conference presentation, blog posts and podcasts.
CRD42023461838
In May 2023, the US Food and Drug Administration (FDA) initially approved an AS01E-adjuvanted respiratory syncytial virus (RSV) prefusion F protein-based vaccine (adjuvanted RSVPreF3) for adults aged ≥60 years. The approval was expanded in June 2024 to include adults 50–59 years of age at increased risk for RSV-associated lower respiratory tract disease. In this paper, we describe the protocol of a postmarketing safety study evaluating the association between adjuvanted RSVPreF3 and new-onset Guillain-Barré syndrome (GBS), acute disseminated encephalomyelitis (ADEM) and atrial fibrillation (AF) among adults ≥50 years of age in the USA and provide our rationale for key methodological decisions.
The potential associations between adjuvanted RSVPreF3 and GBS, ADEM and AF will be evaluated using secondary healthcare data and the self-controlled risk interval (SCRI) design. Data from five research partners in the USA spanning August 2023 through June 2030 will be used for the conduct of yearly monitoring queries and, sample size permitting, SCRI analyses. Claims-based definitions for new-onset outcomes (first diagnosis in 365 days) are: ≥1 inpatient diagnosis for GBS and ADEM; ≥1 inpatient or ≥2 ambulatory/emergency diagnoses for AF. The primary risk and control windows are 1–42 and 43–84 days, respectively, for GBS and ADEM; and 1–8 and 9–16 days for AF. SCRI analyses for GBS and ADEM will include chart-confirmed cases. SCRI analyses for AF will adjust for the positive predictive value obtained from validation against charts. Conditional Poisson regression will be used to calculate incidence rate ratios.
This study was approved by the Institutional Review Boards (IRB) of Harvard Pilgrim Health Care Institute; WIRB-Copernicus Group, Inc and its affiliates (collectively, ‘WCG’); WCG IRB, Inc; and Sterling IRB, with Federal Wide Assurance (FWA) numbers FWA00000100, FWA00033319 and FWA00025632, respectively, for all participating research partners. Study results will be shared with the US FDA and publicly disseminated through national or international clinical or scientific conferences and peer-reviewed publications.
This protocol has been registered in the Heads of Medicines Agencies–European Medicines Agency Real World Data Catalogues (EUPAS1000000486).
This prospective community-based cohort study (Acute Respiratory Infection Epidemiological Characteristics Assessment Study (ARI-ECAS)) aims to systematically monitor acute respiratory infection (ARI) incidence, characterise multiple pathogen coinfection patterns and explore microbial landscape dynamics in Shanghai’s general population. By integrating syndromic surveillance, molecular diagnostics and metagenomic sequencing, the study seeks to enhance understanding of ARI epidemiology, seasonal variation and host–pathogen interactions to inform predictive modelling and optimise public health interventions in high-density urban environments.
The study enrolled 15 199 permanent residents from all 16 districts of Shanghai, with baseline oropharyngeal swab samples across five representative districts (Xuhui, Jing’an, Jiading, Songjiang and Fengxian). Inclusion criteria required residency ≥6 months and consent for weekly follow-ups. Exclusion criteria addressed mobility limitations (planned relocation >6 months) and recent ARI history. Participants provided demographic, behavioural and clinical data via the Shanghai Health Cloud platform, with baseline and symptomatic-phase biological samples collected for analysis.
During the initial 8-month surveillance period (May 2024–January 2025), the ARI-ECAS cohort demonstrated critical insights into the epidemiology of acute respiratory infections in Shanghai’s urban communities. Among 15 199 participants, 10.96% reported symptomatic episodes, of whom 21.43% experienced recurrent infections. Pathogen detection using targeted next-generation sequencing (tNGS) identified microbial aetiologies in 53.52% of symptomatic cases, revealing a high prevalence of coinfections: 27.96% involved dual pathogens, while 33.01% showed polymicrobial interactions (≥3 pathogens). Notably, 85.09% of symptomatic episodes were self-managed, underscoring a low healthcare-seeking rate (14.91%) consistent with patterns observed in urban China during postpandemic transitions.
The current phase of data collection will conclude in June 2025; however, syndromic surveillance and tNGS protocols will be sustained to capture multiyear seasonal transmission patterns. To enhance comparative rigour, future protocols will aim to collect samples from participants during asymptomatic periods in the subsequent year to serve as seasonal baseline controls. Building on this foundation, the study will integrate contact behaviour and mobility surveys to quantify parameters critical for understanding pathogen transmission dynamics (eg, household contacts and public transportation usage). Furthermore, pathogen detection and metagenomic data will be combined with transcriptomic and metabolomic profiling in selected cases to model multipathogen interaction networks and delineate host immune response pathways, thereby advancing mechanistic insights into polymicrobial cocirculation.
Cancer in adolescents and young adults (AYAs; ages 15–39 years) is a rising global epidemic. Yet, AYAs remain an understudied population, and little is known about what research topics should be prioritised according to those with lived experience. The AYA Cancer Priority Setting Partnership (PSP) was established to identify the top 10 research priorities for AYA cancer in Canada according to patients, caregivers, and clinicians.
This project followed the James Lind Alliance (JLA) Priority Setting Partnership (PSP) methodology that included two national cross-sectional surveys and a final priority setting workshop following an adapted nominal group technique.
A national sample was recruited to participate from across Canada.
Participants were patients, caregivers, and clinicians with lived personal and/or professional experience of AYA cancer in Canada.
In the first survey, open-ended responses were collected from participants about questions they would like answered by research. Responses were collated into overarching summary questions and a literature search was undertaken to verify if questions were true uncertainties and not fully answered by existing evidence. Unanswered questions were ranked by participants in a second survey. The top-ranked questions were prioritised through consensus at the final priority setting workshop. The final outcome was the top 10 priorities for AYA cancer research in Canada.
In the initial survey, 1916 potential research questions were submitted by 275 patients, caregivers, and clinicians. Following data processing, summary question formation, and the evidence check, 58 questions were put forward for interim prioritisation in a second survey (n=285 patients, caregivers, and clinicians). The top 20 questions from the interim prioritisation were ranked at the final priority setting workshop attended by a diverse group of 23 patients, caregivers and clinicians from across Canada. The resulting top 10 priorities reflect topics across the cancer continuum including: diagnostic delays, screening and early detection, novel therapies, psychosocial impacts, end-of-life concerns, and survivorship issues.
This patient-directed research agenda will guide researchers, funding agencies, and policymakers to ensure that future research is aligned with what matters most to the AYA cancer community.
FreshRSS 