Osteoporosis (OP) is a systemic skeletal disorder that increases fragility and susceptibility to fractures. Despite the availability of teriparatide for the treatment of patients with acute fractures with better efficacy, its long-term daily injection and high cost limit its broader use among a wider patient population, especially for those living in low- and middle-income countries. This study aims to evaluate the efficacy of a novel sequential treatment with teriparatide daily for 6 months followed by denosumab every 6 months for another 18 months, in comparison with denosumab monotherapy every 6 months for 24 months, in reducing the risk of fractures in patients with newly diagnosed osteoporotic fractures. The study will also explore the possible difference between two sequential treatments (shifting to denosumab treatment at 6 or 12 months) in their effect on increasing bone mineral density (BMD).

This study is designed as a multicentre, open-label, randomised controlled trial among 2478 patients with newly diagnosed osteoporotic fractures from 58 hospitals across China. Participants will be randomly assigned in a 10:10:1 ratio to three treatment groups: 24 months of denosumab monotherapy, early sequential treatment (teriparatide for 6 months followed by denosumab for 18 months) and late sequential treatment (teriparatide for 12 months followed by denosumab for 12 months). The primary outcome is the incidence of vertebral fractures over 24 months of treatment. Secondary outcomes include changes in BMD at the lumbar spine, total hip and femoral neck, changes in bone turnover markers (β-carboxy-terminal telopeptide of type 1 collagen and procollagen type 1 N-terminal propeptide), treatment adherence and cost-effectiveness. Follow-up assessments are scheduled at 3, 6, 9, 12, 18 and 24 months post-randomisation for primary and secondary outcomes, and biannually afterwards for the primary outcome.

The study protocol has been registered on ClinicalTrials.gov and has received ethical approval from the Peking Union Medical College Hospital Medical Science Research Ethics Committee (1-22PJ939). The findings will be disseminated through peer-reviewed scientific journals.

NCT05866029.

Globally, work rumination is a common phenomenon related to nurse burnout. However, most existing studies focus on the single negative impacts of rumination, with less exploration of its dual effects and antecedents. Therefore, comprehensively exploring the effect of nurse work rumination and its influencing factors is crucial for enhancing the accuracy of nursing management.

Identify the antecedents and dual effects of nurse work rumination to deepen understanding of this phenomenon and provide references for formulating interventions that enhance nurses’ well-being and improve the quality of nursing work.

Included studies were original research articles focusing on work-related rumination of nurses in clinical settings. Excluded studies were those involving nurses without patient contact, rumination unrelated to work, studies not addressing the effects or influencing factors of rumination and non-Chinese or non-English language publications.

CINAHL, Cochrane, EMBASE, MEDLINE, Pubmed, Scopus, Web of Science, Sinomed, Wanfang, VIP and CNKI were searched to identify articles about nurse work rumination which were published up to January 2025.

A scoping review of the published articles of nurse work rumination was performed with the methodological process guided by the framework proposed by Arksey and O’Malley. A three-step coding procedure was used to synthesise the impacts and antecedents of nurse work rumination, which were subdivided into four categories individually based on the conservation of resources theory, the three-dimension theory of happiness and the distinctive features of the nursing profession.

30 articles from 12 countries were included. The findings indicate that nurse work rumination has 28 kinds of impacts, including positive, negative and double-edged sword effects, in four aspects: nursing quality and safety (n=7), happiness (n=7), health (n=10) and relationship (n=4) from 29 articles. The findings also suggest that from 26 articles, work rumination will be influenced by 31 factors, which are based on conservation of resources theory classified into four categories: resource depletion (n=14), resource protection (n=4), consequences of resource depletion (n=5) and behaviour and cognition (n=8).

This scoping review constructs a conceptual framework of ‘antecedent factors-nurse work rumination-dual impacts’ by systematically synthesising 30 studies. Rooted in the conservation of resources theory, three-dimensional theory of happiness and nursing professional characteristics, the framework clarifies the classification logic and internal connections of 31 influencing factors and 28 bidirectional impacts. The positive effect of work rumination can promote nurses’ personal development by facilitating the problem-solving pondering. Nursing managers can leverage this integrated framework to design targeted intervention strategies, maximising the constructive effects of rumination while mitigating its adverse impacts. Classifying the factors affecting nurse work rumination according to the conservation of resources theory provides an important basis for exploring the influence mechanism of nurse work rumination. Future research should focus more on empirical studies on rumination to reduce nurses’ burnout and improve the quality of nursing work.

The aim of the study was to develop a nursing-sensitive quality indicator system for emergency care of patients with severe trauma, providing a scientific measurement tool for evaluating the quality of emergency trauma nursing.

A modified Delphi study.

Experts working in emergency surgery or trauma surgery departments were recruited. First, initial nursing-sensitive quality indicators were derived from an analysis and synthesis of existing evidence and semistructured interviews with 12 clinical experts. Subsequently, two-round expert consultations were conducted with 15 experts from various regions of China to refine and finalise the indicators. Finally, the analytic hierarchy process was used to determine the weights of each indicator.

The valid response rates of questionnaires in the two rounds of expert consultation reached 88.89% and 93.75%, respectively, and the expert authority coefficients were 0.856 and 0.880. The experts ultimately reached a consensus, establishing a nursing-sensitive quality indicator system for emergency care of patients with severe trauma, comprising 3 first-level indicators, 11 second-level indicators and 49 third-level indicators.

This study provides a tool for the assessment of emergency nursing service quality for patients with severe trauma, establishing a scientific and effective nursing-sensitive quality indicator system to evaluate and improve the quality of nursing services provided by emergency nurses to patients with severe trauma.

Dementia contributes to the disease burden worldwide, and people with hypertension or type 2 diabetes are at an elevated risk of developing dementia. It is essential to prevent or delay cognitive decline in people at high risk within the community. Our trials aim to evaluate the effects of adaptive cognitive training on community-dwelling older adults with hypertension or type 2 diabetes but no dementia.

Two multicentre, double-blind, randomised, placebo-controlled trials, named COgNitive Training in community-dwelling older adults at high risk for demENTia and with Hypertension (CONTENT-Hypertension) and COgNitive Training in community-dwelling older adults at high risk for demENTia and with Diabetes (CONTENT-Diabetes), will be conducted to investigate the effects of adaptive cognitive training on participants aged 60 years or above who have been diagnosed with hypertension or type 2 diabetes but no dementia. Each trial will enrol 120 participants. Participants will be recruited from the local community in Shijingshan and Haidian Districts, Beijing, and allocated to either the intervention or control group using a 1:1 ratio. The intervention group will engage in 12 weeks of adaptive cognitive training, while the control group will receive 12 weeks of placebo cognitive training. A 24-week follow-up assessment will be conducted for all participants to evaluate the persistence of the effects. The primary outcome is the 12-week change in Montreal Cognitive Assessment (MoCA) Basic scores from baseline to the end of the intervention (12 weeks). Secondary outcomes include 6-week and 24-week changes in the MoCA from baseline; 6-week, 12-week and 24-week changes in Trail Making Test-A&B (TMT-A, TMT-B), Digit Symbol Substitution Test, the WHO/University of California at Los Angeles Auditory Verbal Learning Test and Boston Naming Test scores of cognitive functions; 6-week and 12-week changes in Geriatric Depression Scale, Generalised Anxiety Disorder-7 (GAD-7), Pittsburgh Sleep Quality Index and 12-week change in blood pressure (CONTENT-Hypertension) or fasting blood glucose and glycated haemoglobin (CONTENT-Diabetes) from baseline.

This study will adhere to the ethical principles outlined in the Declaration of Helsinki and comply with international standards for Good Clinical Practice. All participants will sign the informed consent at baseline. This study has been approved by the Ethics Committee of Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College (approval numbers: 2023-139 and 2024-162). The findings of the trials will be disseminated through publications in peer-reviewed scientific journals and presented at academic conferences.

NCT06512922 and NCT06524388.

The literature examining direct-to-consumer (DTC) commercial virtual care has expanded rapidly over the past decade. Our objective was to synthesise the nature and range of evidence on DTC commercial virtual care.

Scoping review.

MEDLINE ALL, EMBASE Classic+Embase, CINAHL, HealthSTAR, PsycINFO, CENTRAL and grey literature sources.

We included original research studies published in English or French between 1 January 2016 and 30 April 2025 that assessed DTC commercial virtual care in all contexts and in all populations.

Screening titles and abstracts, and full-text manuscripts, and extracting data was done in duplicate. We analysed quantitative data using descriptive statistics and reported findings in tables. We provided a narrative summary of textual data.

After excluding duplicates, we identified 8055 studies for title and abstract screening; 691 articles for full-text screening; and 103 studies meeting our inclusion criteria. 32 studies (31.1%) reported financial ties to the virtual care industry. 67 (65.0%) studies were conducted in the USA. Studies were largely quantitative (87/103 (84.5%)) or mixed methods (8/103 (7.8%)) studies and used cross-sectional (85/95 (89.5%)) designs. Most quantitative studies were descriptive, reporting on quality of care, health outcomes, platform characteristics and patient views, with only 24 of the 95 quantitative studies (25.3%) including a control or comparison group. 18 of these 24 studies (75.0%) compared the quality of care, costs and/or utilisation to other models of care and reported variable findings. The rest compared patient characteristics. Few studies assessed clinician perspectives or addressed privacy-related ethical concerns.

Despite a large number of studies assessing DTC commercial virtual care, we have little insight into impacts on quality of care, health outcomes, health system utilisation and privacy-related ethical concerns. The financial ties with industry suggest that there may be bias in the body of research literature.

Although female smoking prevalence in China remains low, emerging evidence suggests that social acceptance may be increasing, with tobacco marketing increasingly targeting women. This study explored women’s smoking behaviours, motivations and societal perceptions toward this in urban China.

Between May and October 2019, 28 semistructured focus groups were conducted in Beijing, Changsha and Shenzhen with 288 participants: 12 groups of female smokers, 6 of female former smokers, 6 of female never-smokers and 4 of men. Participants were recruited both online and offline, and smoking status was verified with a carbon monoxide monitor. Discussions were transcribed verbatim and analysed thematically using dual coding.

Four themes emerged. First, while stigma against female smoking persisted, social acceptance is growing, especially among younger generation. Second, three initiation stages were identified: adolescence, early career and post-retirement, often triggered by peer influence, occupational stress and life transitions. Third, many female smokers concealed their behaviour, reflecting tension between shifting descriptive norms and enduring injunctive norms, which may contribute to underreporting in surveillance data. Fourth, misconceptions about smoking harms and quitting were common, with most women who smoke relying on willpower and showing limited interest in cessation support; pregnancy was one of the few strong motivators for quitting.

Findings suggest gradual normalisation of female smoking in urban China, driven by evolving gender roles and targeted marketing. Public health responses should prioritise gender-specific health education, strengthen promotion of cessation services and tighten restrictions on tobacco marketing towards women to prevent future increases in female smoking.

Healthcare workers (HCWs) are at potential risk of Helicobacter pylori (H. pylori) infection due to occupational exposure, yet epidemiological data in this population remain scarce. This study aimed to investigate the prevalence, risk factors, eradication efficacy and antibiotic resistance patterns of H. pylori infection among HCWs.

Retrospective cohort study.

A tertiary hospital in Beijing, China.

725 HCWs who underwent H. pylori testing via urea breath test between January 2020 and December 2023.

Demographic characteristics, lifestyle factors, symptomatic presentations, treatment regimens and antibiotic resistance profiles were extracted from electronic medical records. Univariate analyses using ² tests identified associations between variables, followed by multivariate logistic regression to adjust for confounders and determine independent predictors of H. pylori eradication failure.

The overall H. pylori positivity rate was 22.9% (166/725). Male gender (OR=1.76, 95% CI 1.20 to 2.59) and alcohol consumption (OR=2.40, 95% CI 1.26 to 4.58) were identified as independent risk factors. Notably, H. pylori-positive individuals had a lower incidence of acid reflux symptoms (9.1% vs 17.3%, p=0.011). The eradication rate was 92.0% (95% CI 84.3% to 96.7%), but clarithromycin resistance reached 47.1% (95% CI 36.4% to 58.0%), with 12.8% (95% CI 6.6% to 21.5%) showing dual resistance to clarithromycin and quinolones.

Targeted screening for male HCWs and alcohol users, along with bismuth-containing quadruple therapy, is recommended. High clarithromycin resistance underscores the need for local antibiotic stewardship.

to describe the evolution of anxiety during the COVID-19 pandemic in France and to assess whether it differed according to pre-existing alcohol misuse.

A prospective longitudinal study.

A French online cohort: CONFINS. Data has been collected since the first lockdown in April–May 2020 until January 2022.

1868 participants being at least 18 years of age and who had been confined in France by government measures.

The primary outcome was anxiety, measured through Generalised Anxiety Disorder – seven items (GAD-7). Its association with alcohol misuse (defined using AUDIT-C score) was estimated using segmented linear mixed models. Interactions with gender and perceived loneliness at baseline were evaluated.

Of the 1868 included participants, 729 responded to at least one follow-up questionnaire (median follow-up time: 46 weeks). We identified 58% as having pre-existing alcohol misuse. Alcohol misuse was significantly associated with an increased GAD-7 score starting at the second lockdown in women (β=0.30; p=0.014) and in participants having a high perceived loneliness (β=0.59; p=0.011).

Pre-existing alcohol misuse appeared to be a risk factor for anxiety during the COVID-19 pandemic, particularly for women and those with high perceived loneliness. Mental health support should be proposed to these vulnerable groups in the event of a future health crisis.

This study aimed to investigate the burden and characteristics of revision total hip arthroplasty (THA) in China.

A national retrospective study was conducted based on the Hospital Quality Monitoring System (HQMS) in China. Patients who underwent revision total hip arthroplasty (THA) between 2013 and 2018 were included. Revision burden was calculated as the ratio of revision procedures to the total number of THA procedures. Demographic and hospital characteristics, hospitalisation charges, clinical indications and patient migration patterns related to revision THA were analysed.

Tertiary hospitals across China.

A total of 13 029 revision THA cases from HQMS.

Revision burden, indications for revision, hospitalisation charges, hospital level, patient migration and their trend.

During the study period, 13 029 revision THA cases were identified. The revision burden showed an increasing trend from 2013 to 2018 (4.5% to 5.4%; p for trend=0.002). The hospitalisation charges continued to increase between 2013 and 2016 and decreased over the next 2 years. The leading indications for revision THA were prosthesis loosening (44.0%), prosthesis dysfunction (13.7%) and fracture (10.7%). More than 60% of patients were hospitalised in provincial hospitals, but this proportion gradually decreased over time. 14.8% of patients were hospitalised in a hospital outside the province of their residence. Shanghai and Beijing were the most preferred migration destinations, with 63.5% and 52.0% of patients from outside provinces, respectively.

This study provided epidemiological data on revision THA in China based on a national database. During the study period, there was an increasing trend in the revision burden, and hospitalisation costs shifted from an annual increase to a decrease. China exhibits distinct characteristics regarding indications for revision THA. Additionally, significant regional disparities in revision THA were evident, leading to a considerable phenomenon of migration.

To analyse temporal trends of respiratory infectious diseases (RIDs) in Baiyin City from 2014 to 2023, aiming to explore the epidemiological patterns of these diseases (tuberculosis, scarlet fever, pertussis, measles, influenza, mumps, varicella and rubella) and provide evidence for developing effective prevention and control strategies.

A descriptive epidemiological study was conducted to analyse the incidence of tuberculosis, scarlet fever, pertussis, measles, influenza, mumps, varicella and rubella in Baiyin City, China, from 2014 to 2023, using data from the national notifiable disease reporting system.

All reported cases of eight notifiable RIDs in Baiyin City between 2014 and 2023 were included in the analysis. Data were categorised by age and sex.

Joinpoint Regression Software was employed to estimate both the annual percentage change in incidence and the average annual percentage change, facilitating a phased comparison of incidence trends.

Between 2014 and 2023, the annual incidence of major bacterial RIDs (tuberculosis, scarlet fever and pertussis) in Baiyin City fluctuated between 52.69 and 87.94 per 100 000 population, demonstrating an overall declining trend. Specifically, the annual decrease rates for the age groups of 0–14 years, 15–59 years and ≥60 years were 11.62% (95% CI –20.26% to –2.16%), 6.44% (95% CI –10.37% to –2.46%) and 5.15% (95% CI –9.12% to –1.07%), respectively. The annual incidence of major viral RIDs (measles, influenza, mumps, varicella and rubella) fluctuated between 111.70 per 100 000 and 541.12 per 100 000. No significant temporal trend was observed for major viral RIDs in Baiyin City. With the exception of pertussis, measles and rubella, the overall incidence rate was significantly higher in males than in females (p

From 2014 to 2023, the annual incidence of major bacterial RIDs in Baiyin City showed an overall decline, mainly due to a reduction in tuberculosis incidence, whereas the annual incidence of major viral RIDs fluctuated and rose sharply in 2023. The overall incidence of both major bacterial and viral RIDs was consistently higher in males, with major viral RIDs occurring predominantly in children aged 0–14 years and major bacterial RIDs being more common in older adults aged ≥60 years. Further efforts are needed to monitor the epidemiological patterns and develop strategies to reduce the incidence of major viral RIDs, particularly among children aged 0–14 years.

This study aimed to investigate the knowledge, attitude and practices (KAP) of patients undergoing gastrointestinal endoscopy regarding out-of-operating-room anaesthesia and sedation.

A cross-sectional study.

The study took place at the Second Affiliated Hospital of Hainan Medical University in Haikou from January to June 2024.

A total of 638 participants were included, with 339 (53.13%) being male. Among them, 232 (36.36%) had previously received out-of-operating-room anaesthesia during gastrointestinal endoscopy.

Participants completed a questionnaire designed to evaluate their KAP related to anaesthesia and sedation.

The primary outcomes measured were knowledge scores (possible range: 0–10), attitude scores (possible range: 8–40) and practice scores (possible range: 6–30), which were derived from responses to the KAP questionnaire. Secondary outcomes included factors associated with proactive practices.

Mean scores for KAP were 4 (1, 7), 31 (30, 35) and 24 (20, 27), respectively. Multivariate logistic regression analysis indicated that knowledge score (OR=1.210, p

Patients displayed inadequate knowledge but positive attitudes and proactive practices regarding out-of-operating-room anaesthesia and sedation. Educational interventions by healthcare providers are recommended to improve patient knowledge, enhancing attitudes and practices.

Chronic insomnia is a pressing public health issue that significantly affects patients’ quality of life. In China, Prolong Life With Nine Turn-Method (PLWNT) Qigong exercise has long been used to improve sleep quality, yet evidence that supports its efficacy for chronic insomnia treatment remains lacking. The aim of this study is to evaluate the effectiveness and safety of the PLWNT qigong exercise for treating chronic insomnia and its relationship with hyperarousal.

This multi-centre randomised controlled trial will recruit 348 eligible patients from three hospitals in Shanghai. Participants will be randomly assigned to either the treatment group (PLWNT qigong exercise) or the control group (cognitive behavioural therapy). The treatment will occur once a week for 12 weeks, followed by an 8-week follow-up phase. The primary outcome is the change in the total Pittsburgh Sleep Quality Index (PSQI) score from baseline to week 12. The secondary outcomes are the scores on the Hyperarousal Scale (HAS), Insomnia Severity Index (ISI), Multidimensional Fatigue Inventory 20 (MFI-20), Hospital Anxiety and Depression (HADS), Medical Outcome Trust 36–Item Short Form Health Survey (SF–36) and Gastrointestinal Symptom Rating Scale (GSRS), gut microbiota, actigraphy, sleep diary, cortisol, adrenocorticotrophic hormone, corticotropin-releasing hormone, polysomnography and functional MRI. All adverse events during the trial will be promptly recorded and assessed. The PSQI, HAS, ISI, MFI-20, HADS, SF–36 and GSRS will be evaluated at baseline, 6 weeks post-treatment and 12 weeks post-treatment, as well as at the 4- week and 8- week follow-ups. Other outcomes will only be evaluated at baseline and 12 weeks post-treatment.

The trial has been approved by the Ethics Committee of the Shanghai Municipal Hospital of Traditional Chinese Medicine (2024SHL-KY-92–01). Written informed consent was obtained from all participants before their involvement in the trial. Results of this study will be published in peer-reviewed journals or at conferences.

ITMCTR2024000534.

This article outlines the research protocol for a multicentre, randomised, controlled study designed to evaluate the therapeutic effect of a modified olfactory training (MOT) based on bi-directional nasal drug delivery system for patients with postinfectious olfactory dysfunction (PIOD), and to compare its efficacy with conventional olfactory training (COT).

This is a multicentre study in which patients will be recruited from several participating hospitals. Patients will be divided into three groups: COT group using COT device, MOT group using MOT device, Control group without any intervention other than follow-up. The olfactory training (OT) intervention will last for 12 months. The primary outcome will be the improvement in olfactory ability from baseline measurement to the end of intervention or control period, evaluated through the total Threshold, Discrimination, Identification (TDI) score of the Sniffin’ Stick test. Secondary outcomes will be changes in olfactory bulb volume and shape, olfactory-related brain area volume, olfactory and trigeminal nerve-related potentials, and subjective assessments.

This study protocol has been registered with ClinicalTrials.gov. The Peking University Third Hospital Medical Science Research Ethics Committee reviewed and approved this study protocol. The results will be published in BMJ Open.

NCT06829706.