Conectar
To identify the latent frailty trajectory and explore corresponding predictors among older adults living with frailty who experience hip fracture surgery within 3 months after discharge.
From December 2022 to November 2024, 178 individuals were consecutively enrolled in a longitudinal observational study conducted at a tertiary hospital in Zhejiang Province, China.
The Reported Edmonton Frail Scale measured the frailty level at 5 points, which included baseline (pre-fracture), at discharge, 2 weeks, 1 and 3 months after discharge. Latent class growth models were set up for the frailty trajectory. Multinomial logistic regression was performed to explore the predictors of frailty trajectory classes.
One hundred fifty-three participants completed the full follow-up. Latent class growth models identified 3 frailty trajectories. Class 1: moderate frailty transformed to severe frailty (n = 27; 17.65%); Class 2: mild frailty transformed to moderate frailty (n = 86; 56.20%); Class 3: pre-frailty transformed to mild frailty (n = 40; 26.15%). A higher-level D-Dimer at admission and the five-item version of the Geriatric Depression Scale increased the incidence of Class 2 compared to Class 3. The higher scores of the Abbreviated Mental Test decreased the incidence of Class 2 compared to Class 3. Longer surgical waiting time, a higher-level five-item version of the Geriatric Depression Scale and the Age-Adjusted Charlson Comorbidity Index increased the incidence of Class 1 compared to Class 3. The higher scores of the Abbreviated Mental Test and Mini Nutritional Assessment Short Form decreased the incidence of Class 1 compared to Class 3.
Three frailty trajectory classes were identified among older adults living with frailty who experience hip fracture surgery after discharge within 3 months. D-Dimer at admission, surgical waiting time, depressive symptoms, cognitive status, comorbidity index and nutritional status are associated with these fluctuating frailty trajectories.
Modifiable factors such as improving nutrition and cognitive status and managing depression, comorbidities and preoperative evaluations provide methods for future interventions to prevent or mitigate frailty among this population.
What problem did the study address? Frailty is an inherent dynamic among older adults living with frailty who experience hip fracture surgery after discharge within 3 months. Some factors affect the mitigated frailty process in this population. What were the main findings? Three frailty trajectory classes were identified in this study. And the level of their frailty worsens 3 months after surgery compared to pre-fracture. D-Dimer at admission, surgical waiting time, depressive symptoms, cognitive status, comorbidity index and nutritional status are associated with these fluctuating frailty trajectories. Where and on whom will the research have an impact? The findings of this study provide screening, intervention and discharge plan evidence for healthcare workers in orthopaedics and geriatrics Departments. Helping community healthcare workers and primary caregivers set the theoretical basis for home-based intervention programs.
We have adhered to relevant EQUATOR guidelines using the STROBE reporting method.
No patient or public contribution.
To assess the association between ambient ozone (O3) exposure and semen quality among men with unhealthy behaviours and low income.
A case-control study was conducted from February 2024 to January 2025, in which male participants aged 18–45 years were recruited from Foshan, and following propensity score matching, a total of 820 participants were included in the final analysis.
The evaluated the association between O3 exposure during the 70–90 days, 10–14 days, 0–9 days and 0–90 days prior to semen collection and semen quality using stepwise conditional logistic regression analyses, and restricted cubic splines were incorporated into the models.
O3 exposure during the 70–90 days and 0–90 days preceding semen sample collection was significantly associated with an increased risk of low semen quality, with ORs of 1.020 (95% CI 1.003 to 1.039) and 1.056 (95% CI 1.008 to 1.108), respectively. Additionally, O3 exposure during the 0–90-days period showed a significant positive association with abnormal sperm concentration. A non-linear relationship between O3 exposure and sperm concentration was also observed. Notably, O3 exposure during the 0–9 days before semen collection was inversely associated with the risk of low semen quality. Subgroup analyses across age, lifestyle factors and socioeconomic strata revealed no significant effect modifications.
This study found that O3 exposure during the 70–90 days and 0–90 days before sampling was associated with reduced semen quality in men with unhealthy behaviours and low income.
This study aimed to investigate the network structural characteristics of self-efficacy and professional resilience among emergency nurses, identify core nodes within the network, and elucidate the key interactive mechanisms between these constructs.
Descriptive cross-sectional study.
A multi-center cross-sectional study was conducted from January to February 2025, involving 612 emergency nurses from 20 hospitals in Sichuan, China. Data were collected using a self-administered demographic questionnaire, the General Self-Efficacy Scale, and the Chinese Emergency Nurse Professional Resilience Tool. An adjacent network integrating professional resilience and self-efficacy was developed. Key covariates—including title, position, tenure in the hospital or emergency department, education, and exposure to workplace violence—were included as control variables. Network precision and stability were evaluated using the correlation stability coefficient and confidence intervals for edge weights. To further test the robustness of the network model, sensitivity analyses were performed by adding each significant covariate to the original model. The Network Comparison Test was then used to compare the covariate-adjusted and unadjusted networks, assessing differences in network structure, overall strength, and edge weights.
The analysis identified S9 as the central node in the network. The overall network showed satisfactory stability and precision. The Network Comparison Test showed no significant differences in network structure or global strength between the adjusted and unadjusted models, indicating that the network was stable and robust to covariate adjustment.
This network analysis revealed the interaction mechanisms between self-efficacy and professional resilience among emergency nurses through contemporaneous network modelling and identified S9 as the core node, suggesting that this coping strategy plays a key role in regulating psychological resources. The overall network demonstrated good stability and precision, with no statistically significant differences between the adjusted and unadjusted models according to the Network Comparison Test. These findings indicate that the network structure was robust to covariate adjustment and provide a reference for developing and optimising intervention strategies to enhance professional resilience among emergency nurses.
For Emergency Nurses and the Management of Emergency Nursing Practice: What problem does this study address?
This study addresses the gap in understanding how self-efficacy and occupational resilience interact in emergency nurses under high-stress conditions.
A contemporaneous network analysis revealed a central node linking self-efficacy and resilience, highlighting key pathways in their mutual influence.
The findings offer practical guidance for emergency nursing management, supporting the development of targeted strategies to strengthen nurses' resilience, enhance professional competence, and improve the quality of emergency care.
This study is reported using the STROBE guidelines.
No Patient or Public Involvement: This study did not include patient or public involvement in its design, conduct, or reporting.
To combine the Job Demand-Resource (JD-R) model with machine learning (ML) techniques to identify the key factors affecting job burnout (JB) among Chinese nurses.
A Cross-Sectional Study.
This study utilised a stratified sampling method to recruit 3449 eligible nurses from eight cities in Shandong Province between June and December 2021. After data cleaning, 2998 valid samples were retained. The dataset was randomly split into a training set (75%) and a test set (25%). The Boruta algorithm was used to select relevant variables for model construction. Six-millilitre models were compared using cross-validation, with mean absolute error (MAE), root mean square error (RMSE) and R-squared (R 2) used to select the best model. The Shapley Additive Explanation (SHAP) method was used to identify key predictors of JB.
The average JB score among nurses was (32.88 ± 11.45). Among the 20 variables, 17 were identified by the Boruta algorithm as strongly associated with JB, including 7 job demand-related variables and 10 job resource-related variables. After comparing 6-ml models, the Random Forest was identified as the optimal model (MAE = 6.56, RMSE = 8.86, R 2 = 0.63). SHAP analysis further revealed the importance ranking of these 17 variables and identified four key predictors: psychological distress (SHAP = 4.07), perceived organisational support (SHAP = 2.03), emotional intelligence (SHAP = 1.81) and D-type personality (SHAP = 1.73).
By integrating the JD-R model framework, ML algorithms proved effective in identifying critical predictors of nurses' JB. SHAP analysis identified four primary determinants: psychological distress, perceived organisational support, emotional intelligence and D-type personality. These findings provide novel insights for nursing administrators to optimise intervention strategies.
Not applicable.
This study did not include patient or public involvement in its design, conduct or reporting.
This retrospective study aimed to evaluate the clinical efficacy of double flap tibial transverse transport (dTTT) in the treatment of Wagner grade 3–4 diabetic foot ulcers (DFUs) and to assess its impact on peripheral nerve function in the affected limb. A total of 25 patients with DFUs who underwent dTTT at our institution were included. Baseline data were collected, and patients were systematically followed at 1, 3, 6 and 12 months postoperatively. Primary outcome measures included wound healing status, postoperative complications, microcirculatory indicators and nerve conduction parameters. All bone transport sites healed successfully, with no major complications observed except for one patient who died from COVID-19. At 12 months postoperatively, significant improvements were noted in foot skin temperature, transcutaneous oxygen partial pressure and the ankle-brachial index (all p < 0.001). Additionally, motor nerve conduction velocities of the posterior tibial and common peroneal nerves increased significantly (p < 0.001), and corresponding compound muscle action potential amplitudes rose to 4.91 ± 0.14 mV and 4.68 ± 0.29 mV, respectively (p < 0.001). These findings suggest that dTTT not only facilitates wound healing by improving local microcirculation but also enhances peripheral nerve function, offering a promising therapeutic approach for improving long-term outcomes and quality of life in patients with advanced DFUs.
The incidence of cancer continues to increase, and cancer patients still suffer from a range of burdens, leading to decreased quality of life. AI has been increasingly studied in the field of cancer care, demonstrating its enormous potential. However, most AI applications in cancer care are still in the developmental stage, and the strength of evidence from randomized controlled trials is not yet sufficient.
To evaluate the effects of AI-enhanced interventions in randomized controlled trials conducted in clinical settings and the impact of AI-enhanced interventions on the health outcomes of adult cancer patients.
Meta-analysis of randomized controlled trials.
Nine databases (MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, CINAHL, PsycINFO, Web of Science, CNKI, VIP, and Sinomed) were systematically searched, and metadata analysis was performed using R software and R Studio. The quality of the included studies was evaluated using the Cochrane Risk of Bias tool (RoB2) and the GRADE approach. The process was independently completed by two authors. The intervention effect was estimated by calculating the standardized mean difference (SMD) and 95% confidence interval (CI) using a random-effects model.
A total of ten articles were included. Meta-analysis results showed that AI-enhanced interventions can significantly improve the quality of life (SMD 0.89, 95% CI 0.06–1.73), symptom burden (SMD −0.81, 95% CI −1.44 to −0.18), anxiety (SMD −0.20, 95% CI −0.32 to −0.07), and self-efficacy (SMD 0.55, 95% CI 0.06 to 1.03) of cancer patients. The type of AI application and the duration of the intervention had an impact on the quality of life of cancer patients: the effect of algorithm recommendations (SMD 1.49, 95% CI 0.04–2.93) was better than that of risk alerts (SMD 0.33, 95% CI 0.03–0.63), and the effect of short-term interventions (< 3 months) (SMD 1.49, 95% CI 0.04–2.93) was better than that of long-term interventions (≥ 3 months) (SMD 0.19, 95% CI −0.04 to 0.43). Sensitivity analysis showed that the results of this study were stable and reliable.
AI-enhanced interventions are effective tools for improving patient outcomes. When integrating AI into clinical practice for cancer patients, priority should be given to the type of technology involved, ensuring its acceptability by enhancing perceived usefulness. AI technology should be adopted to relieve clinical nurses from documentation and low-complexity tasks, thereby addressing concerns about the loss of “humanistic care.” We recommend the formal integration of AI literacy frameworks, such as N.U.R.S.E.S., into nursing education and practice.
Trial Registration: PROSPERO (registration number: CRD420251040938).
Fear of childbirth is common among pregnant women. Mindfulness-based interventions have been used widely in obstetrics. However, the evidence of the effects on fear of childbirth is controversial.
To evaluate the effects of mindfulness-based interventions on fear of childbirth, pain catastrophising, labour pain intensity, use of pain relief medication, mode of delivery and duration of labour among pregnant women planned for normal delivery.
In this systematic review, 10 databases were searched from inception to 7 November 2024. Randomized controlled trials implementing mindfulness-based interventions for fear of childbirth or related outcomes were included. Two reviewers assessed the methodological quality and certainty of evidence independently. Standardized mean difference (SMD), risk ratio (RR), and 95% confidence intervals (CI) were used to evaluate effect sizes.
A total of 16 studies from 15 trials were included. Based on very low to moderate certainty of evidence, mindfulness-based interventions were effective in decreasing fear of childbirth both immediately post-intervention and within 6-week postpartum (SMD: −0.72; 95% CI −0.89, −0.55; SMD: −0.63; 95% CI −0.91, −0.35, respectively), labour pain intensity (SMD: −1.22; 95% CI −2.07, −0.37), caesarean section rate (RR: 0.58; 95% CI 0.36, 0.93), and total duration of labour (SMD: −1.03; 95% CI −1.34, −0.72), and improving mindfulness level both immediately post-intervention and within six-week postpartum (SMD: 0.48; 95% CI 0.31, 0.66; SMD: 0.50; 95% CI 0.27, 0.73, respectively), but had no significant effect on pain catastrophising (SMD: −0.36; 95% CI −0.72, 0.01) and epidural analgesia use rate (RR: 0.77; 95% CI 0.57, 1.03).
Mindfulness-based interventions have potential effects on reducing fear of childbirth and promoting labour-related outcomes. These interventions might be an effective approach in obstetrics clinical practice to enhance the pregnancy and labour experiences among pregnant women.
PROSPERO registration number: CRD42024610793
To examine the relationship among leadership, clinical teaching competencies, and structural empowerment of nursing clinical instructors in China.
A cross-sectional study.
A total of 152 nurses who come from three Grade A tertiary hospitals located in Beijing, Kunming, and Liaoning Province, China, completed an online questionnaire that included general information, clinical teaching information, the Conditions of Work Effectiveness Questionnaire-II, nurse leadership, and structural empowerment. SPSS 26.0 and AMOS 26.0 were used for normality test, descriptive statistics, correlation analysis, regression analysis, and structural equation model.
The study revealed that nurse leadership (r = 0.402) and structural empowerment (r = 0.568) both positively correlated with clinical teaching competencies. Specifically, the level of nurse leadership exhibited a low but direct positive effect on these competencies (β = 0.22), while the level of structural empowerment demonstrated a moderate direct positive effect (β = 0.56).
Enhancing nurse leadership and structural empowerment positively influence the clinical teaching competencies of nursing instructors.
Constructing a structural equation model to describe the relationship between leadership, structural empowerment, and teaching ability can provide the most intuitive direction for future research, so as to better improve the teaching ability of clinical nursing teachers.
No patient or public contribution.
Nurse-led self-care interventions represent a promising approach for chronic pain management. However, a comprehensive synthesis of their efficacy is lacking.
This systematic review and meta-analysis assessed the impact of the interventions on four key outcomes in chronic pain patients: pain intensity, quality of life, anxiety levels, and depression severity.
The study was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. An electronic search for relevant articles spanning from inception to November 2024 was carried out across multiple databases, including EMBASE, PubMed, CENTRAL, Web of Science (Core Collection), CINAHL, Scopus, and PsycINFO. The Cochrane Risk of Bias Tool was used to assess the quality of the included studies. The meta-analysis was conducted using Stata 18 and Review Manager 5.4, and a GRADE evidence profile was subsequently generated.
The systematic review and meta-analysis involved 30 studies in total. The results of the data analysis indicated that the interventions alleviated pain intensity (SMD = −0.30, 95% CI: −0.41 to −0.20, Z = 5.57, p < 0.001). They also enhanced quality of life (SMD = 0.28, 95% CI: 0.14 to 0.42, Z = 3.83, p < 0.001), while reducing anxiety (SMD = −0.15, 95% CI: −0.29 to −0.01, Z = 2.11, p = 0.03) and depression symptoms (SMD = −0.27, 95% CI: −0.45 to −0.09, Z = 2.88, p = 0.004).
This systematic review demonstrated that nurse-led self-care interventions benefit chronic pain patients. Future research should conduct more rigorous randomized controlled trials to strengthen the evidence base for using such interventions in chronic pain management.
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 study aimed to investigate the interrelationship between organisational climate, workplace loneliness and emotional eating among nurses.
A cross-sectional study Data collection involved several validated instruments: a general information questionnaire to capture demographic and professional details, an organisational climate scale to assess the work environment, a workplace loneliness scale to measure feelings of isolation and an emotional eating scale to evaluate the extent of eating behaviours driven by emotional distress.
The research was conducted in March 2024, involving 385 clinical nurses from a large comprehensive hospital in Nanjing, China. The study employed instruments including general information questionnaires, organisational climate scales, workplace loneliness scales and emotional eating scales. The collected data were analysed utilising SPSS 22.0, AMOS 24.0 software and Bootstrap text for mediating effects.
The analysis revealed a significant negative correlation between organisational climate and workplace loneliness, as well as between organisational climate and emotional eating. Additionally, a strong positive correlation was found between workplace loneliness and emotional eating. Conversely, the direct effect of organisational climate on emotional eating was not significant. These findings suggest that workplace loneliness fully mediates the relationship between organisational climate and emotional eating.
Workplace loneliness mediates the relationship between organisational climate and emotional eating among nurses. To address this issue, it is recommended that nursing managers implement effective strategies to enhance the organisational climate and reduce workplace loneliness.
The research aims to alleviate emotional eating and promote the physical and mental well-being of nurses.
No patient or public contribution.
This review aims to explore instructional approaches employed in teaching complex procedural skills among caregivers.
Integrative Review.
Electronic searches were conducted across seven databases: CINAHL, PubMed, OVID, ScienceDirect, Web of Science, ProQuest Central and Google Scholar. Manual searches of references within relevant studies were also performed. Original, peer-reviewed studies published in English between 2014 and 2025 were reviewed.
The Whittemore and Knafl method of integrative review was utilised to comprehensively examine literature encompassing various methodological designs. 17 articles that examined the learning of procedural skills among caregivers were included.
The optimal approach to enhancing caregivers' knowledge, competence and confidence involves a learner-centric training model involving multiple phases. Effective caregiving begins with a thorough preparation of the caregiver, which is key to ensuring the success of the training programme. Next, knowledge can be imparted through diverse learning approaches and paradigms to cater to individual learning styles. Subsequently, the translation of knowledge gained to hands-on practice, deepens understanding and enhances caregivers' practical skills competency. Finally, confidence is built through providing opportunities and platforms for repeated practice, leading to mastery and increased confidence over time.
While specific learning pedagogies were not highlighted in the literature, the instructional approaches summarised in the existing literature closely resembled an existing teaching pedagogy: Peyton's Four-Step Approach. This approach is a stepwise teaching framework that has been widely used in healthcare teaching. The approaches used in the studies align with this approach and future interventions should consider designing their training accordingly to enhance its efficacy.
A well-designed training programme fosters caregiver resilience and preparedness, enabling them to navigate challenges effectively and sustainably. Future research could focus on creating an all-encompassing caregiver training that integrates the various approaches. Its feasibility and effectiveness in improving the caregiver preparation process could then be assessed.
No patient or public contribution.
by Qian Yue Tan, Kinda Ibrahim, Helen C. Roberts, Khaled Amar, Simon D.S. Fraser
BackgroundPeople with Parkinson’s (PwP) and their caregivers have to manage multiple daily healthcare tasks (treatment burden). This can be challenging and may lead to poor health outcomes.
ObjectiveTo assess the extent of treatment burden in Parkinson’s disease(PD), identify key modifiable factors, and develop recommendations to improve treatment burden.
MethodsA mixed-methods study was conducted consisting of: 1) a UK-wide cross-sectional survey for PwP and caregivers using the Multimorbidity Treatment Burden Questionnaire (MTBQ) to measure treatment burden levels and associated factors and 2) focus groups with key stakeholders to discuss survey findings and develop recommendations.
Results160 PwP (mean age = 68 years) and 30 caregivers (mean age = 69 years) completed the surveys. High treatment burden was reported by 21% (N = 34) of PwP and 50% (N = 15) of caregivers using the MTBQ. Amongst PwP, higher treatment burden was significantly associated with advancing PD severity, frailty, a higher number of non-motor symptoms, and more frequent medication timings (>3 times/day). Caregivers reporting higher treatment burden were more likely to care for someone with memory issues, had lower mental well-being scores and higher caregiver burden. Three online focus groups involved 11 participants (3 PwP, 1 caregiver and 7 healthcare professionals) recruited from the South of England. Recommendations to reduce treatment burden that were discussed in the focus groups include improving communication. clear expectation setting, and better signposting from healthcare professionals, increasing education and awareness of PD complexity, flexibility of appointment structures, increasing access to healthcare professionals, and embracing the supportive role of technology.
ConclusionsTreatment burden is common amongst PwP and caregivers and could be identified in clinical practice using the MTBQ. There is a need for change at individual provider and system levels to recognise and minimise treatment burden to improve health outcomes in PD.
by Zhongqun Guo, Qiangqiang Liu, Feiyue Luo, Shaojun Xie, Tianhua Zhou
The acidic leachate injected during the mining process of ion-type rare earth ores can damage the environmental characteristics of the soil, thereby triggering the activation and release of associated heavy metals. Severe Zn contamination has been found in the environment of ion-type rare earth mining areas, but the activation and release of Zn in the soil during the leaching process have not been fully understood. This study investigated the activation and release patterns and mechanisms of Zn in soil under different leaching agents ((NH4)2SO4, MgSO4, Al2(SO4)3) and varying concentrations of Al2(SO4)3 (1%, 3%, 5%, 7%) using a simulated leaching experimental system. The results show that the activation and release patterns of Zn in the soil vary significantly under the influence of the three leaching agents. During the entire leaching cycle, the peak Zn concentration in the leachate was highest under MgSO4 leaching, while the residual Zn content in the soil under Al2(SO4)3 leaching approached the high-risk environmental threshold. The high-concentration systems (5%, 7%) of Al2(SO4)3 significantly enhanced the activation and release efficiency of Zn in the soil compared to the low-concentration systems (1%, 3%) of Al2(SO4)3. (NH4)2SO4 mainly promotes the activation and release of Zn through ion exchange between NH4+ and Zn2+ and the acidification effect; Al2(SO4)3, on the other hand, dominates the activation and release of Zn by providing a strongly acidic environment and dissolving and damaging the mineral lattice; while MgSO4 not only exchanges ions between Mg2+ and Zn2+, but also alters the soil colloidal structure, facilitating Zn activation and release. The promoting effects of the three leaching agents on the transformation of Zn in soil follow the order of Al2(SO4)3> (NH4)2SO4 > MgSO4, with the environmental risk assessment index (RAC) being highest after Al2(SO4)3 leaching, indicating the greatest potential environmental risk. Compared to the other three concentrations (1%, 5%, 7%) of Al₂(SO4)3, the 3% concentration of Al2(SO4)3 had the most significant promoting effect on the transformation of Zn in soil. This study provides a theoretical basis for optimizing the green mining process of ion-type rare earth ores and preventing heavy metal pollution, and offers scientific support for revealing pollution mechanisms and formulating remediation and risk assessment strategies.To examine the association between socioeconomic status (SES), financial subsidies and awareness-related factors such as age, cancer stage and family history, and the uptake of cancer genetic testing, with a focus on equitable access to care.
Retrospective cohort study.
Tertiary care cancer genetics service in Singapore.
The study population included 2687 individuals of all ages, genders and ethnicities who attended pretest counselling between 2014 and 2020 and were eligible for genetic testing for hereditary cancer syndromes.
The primary outcome was the uptake of genetic testing. The main explanatory variables were SES (proxied by Housing Index), subsidy status, age, cancer stage and family history. Analyses examined whether associations varied across SES and age subgroups.
Receipt of financial subsidies was strongly associated with testing uptake (adjusted OR 9.15, 95% CI 2.68 to 31.20). Uptake exceeded 90% among subsidised individuals across all socioeconomic strata, compared with 56–68% among non-subsidised individuals, with the largest gains in the lowest SES group (43 vs 28 percentage points (pp) in the highest). The level of subsidy was not associated with uptake. Younger patients (18–39 years) had higher uptake than those aged 60+ (66% vs 57%); patients with advanced cancer (stage IV) had the highest uptake (82% vs 57–66% in earlier stages); and family history was associated with increased uptake, strongest for having a child with cancer (+28 pp). Interaction analysis suggested that the additive effects of subsidies were greatest in lower SES groups and in older adults.
Financial subsidies were strongly associated with higher genetic testing uptake. Awareness indicators like age, cancer stage and family history were associated with higher uptake. The association between subsidies and uptake varied by SES and age, suggesting that subsidies may help reduce disparities and improve equitable access to genetic testing services.
FreshRSS 