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In China, more than 30% of patients have not initiated treatment within 30 days of HIV diagnosis. Delayed initiation has a detrimental influence on disease outcomes and increases HIV transmission. The study aims to evaluate the effectiveness of a nurse-led antiretroviral therapy initiation nudging intervention for people newly diagnosed with HIV in China to find the optimal intervention implementation strategy.
A Hybrid Type II sequential multiple assignment randomized trial will be conducted at four Centers for Disease Control and Prevention in Hunan, China. This study will recruit 447 people newly diagnosed with HIV aged ≥18 years and randomly assign them into two intervention groups and one control group. On top of the regular counselling services and referrals, intervention groups will receive a 4-week, 2-phase intervention based on the dual-system theory and the nudge theory. The control group will follow the currently recommended referral procedures. The primary outcomes are whether treatment is initiated, as well as the length of time it takes. The study outcomes will be measured at the baseline, day 15, day 30, week 12, week 24 and week 48. Generalized estimating equations and survival analysis will be used to compare effectiveness and explore factors associated with antiretroviral therapy initiation. Both qualitative and quantitative information will be collected to assess implementation outcomes.
Existing strategies mostly target institutional-level factors, with little consideration given to patients' decision-making. To close this gap, we aim to develop an effective theory-driven nudging strategy to improve early ART initiation.
This nurse-led study will help to prevent delayed initiation by employing implementation science strategies for people newly diagnosed with HIV. This study contributes to the United Nations' objective of ending the AIDS pandemic by 2030.
Chinese Clinical Trial Registry ChiCTR2300070140. The trial was prospectively registered before the first participant was recruited.
The nudging intervention was finalized through the Nominal Group Technique where we invited five experts in the related field and five people living with HIV to participate.
by Bijuan Chen, Zhouwei Zhan, Sisi Yu, Jiali Huang, Chuying Chen, Jie Wang, Jianji Pan, Shaojun Lin, Yun Xu
BackgroundLaryngeal cancer attributable to occupational asbestos exposure remains a significant public health concern, particularly in industrialized regions. This study analyzes the burden, trends, and contributing factors of laryngeal cancer due to asbestos exposure in China from 1990 to 2021.
MethodsData were obtained from the Global Burden of Disease Study (1990–2021). We analyzed age-standardized death rates, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs). Temporal trends were assessed using joinpoint and decomposition analyses, and an age-period-cohort (APC) model was applied to examine mortality and DALY trends across different cohorts.
ResultsIn 2021, there were 234 deaths and 4,430 DALYs due to laryngeal cancer attributable to occupational asbestos exposure, predominantly affecting males. Mortality rates declined from 1990 to 2008, followed by a rise until 2012, and a subsequent decline. YLDs showed a consistent increase over time. APC analysis revealed higher mortality and DALY rates in older age groups and earlier birth cohorts. Decomposition analysis indicated that epidemiological changes were the largest driver of increased deaths in men, followed by population growth and aging. For DALYs, aging and population growth were key drivers, while epidemiological changes mitigated the burden.
ConclusionsThe burden of laryngeal cancer attributable to asbestos exposure has declined overall, but disability rates continue to rise, particularly among males. Effective strategies targeting prevention, early detection, and management of asbestos exposure are needed to reduce the disease burden in China.
This study aims to explore the trajectories and co-occurrence of perceived control and caregiver self-efficacy among patients with heart failure (HF) and their caregivers within 3 months post-discharge and identify associated risk factors.
A prospective cohort design.
A prospective cohort study was conducted from March to June 2024 in Tianjin, China. Information on perceived control and caregiver self-efficacy was collected 24 h before discharge, 2 weeks, 1 month, and 3 months after discharge. Group-Based Dual Trajectory Modelling (GBDTM) and logistic regression were used for analysis.
The study included 203 dyads of patients with HF and their caregivers (HF dyads). Perceived control identified three trajectories: low curve (15.3%), middle curve (57.1%) and high curve (27.6%). Caregiver self-efficacy demonstrated three trajectories: low curve (17.2%), middle curve (56.7%) and high stable (26.1%). GBDTM revealed nine co-occurrence patterns, with the highest proportion (36.7%) being ‘middle-curve group for perceived control and middle-curve group for caregiver self-efficacy’, and 16.7% being ‘high-curve group for perceived control and high-stable group for caregiver self-efficacy’. Age, gender, household income, NYHA class, symptom burden and psychological resilience were identified as risk factors for perceived control trajectories; marital status, regular exercise and psychological resilience were identified as risk factors for caregiver self-efficacy trajectories.
We identified distinct trajectories, co-occurrence patterns and risk factors of perceived control and caregiver self-efficacy among HF dyads. These findings help clinical nurses to better design and implement interventions, strengthening the comprehensive management and care outcomes for HF dyads.
These findings highlighted the interactive relationship between perceived control and caregiver self-efficacy trajectories, suggesting that interventions should boost both to improve personalised treatment plans and outcomes for HF dyads.
This study adhered to the STROBE checklist.
Patients and their caregivers contributed by participating in the study and completing the questionnaire.
Radiotherapy (RT) can cause a range of negative impacts in addition to the intended treatment impacts. Pulmonary rehabilitation (PR) may improve the physical and psychological conditions of patients with lung cancer receiving RT, but specific evidence is lacking. This review mapped the evidence on PR in patients with lung cancer receiving RT for intervention characteristics and outcome assessments.
PubMed, EMBASE, CINAHL, Proquest, Web of Science, CNKI and WanFang were searched for studies from January 2003 to April 2025.
We included randomised controlled trials and non-randomised comparative intervention studies that included centre-based PR in patients ≥18 years with lung cancer who were receiving RT. PR was defined as any type of exercise, respiratory training, or both and/or at least one additional component (eg, psychological support). Studies were excluded if they were not available in English, were not full-text articles or were non-peer-reviewed.
Two reviewers independently screened titles, abstracts and full texts for inclusion and extracted data. PR components and the typology of outcome assessments used were mapped at the final data synthesis level.
Out of 3120 records, nine studies were investigated in the final data synthesis. In these studies, in addition to exercise or respiratory training, psychological support and disease education were the most common components of PR. Pulmonary function, quality of life, symptom assessment and exercise performance were commonly assessed outcomes in these included studies. Although the effectiveness of PR is difficult to synthesise, the evidence for improvements in exercise performance and symptoms of dyspnoea and anxiety/depression is promising.
Evidence on PR in patients with lung cancer receiving RT is sparse, and there is a heterogeneous understanding of PR. The development of standardised PR protocols and investigation of the capabilities of PR in this growing and under-represented patient population are essential.
Background
Substantial effort has been invested to combat childhood obesity, but overall effects are disappointing, especially in low-income racial minority children. One possible reason is a lack of focus on the important stress–eating connection. Stress can negatively influence eating behaviors, leading to an increased appetite for high-fat and energy-dense foods.
Objective
This study aimed to evaluate the preliminary effects of a healthy eating and stress management program targeting multiple theoretical variables on improving eating behavior (dyads’ fruit/vegetable intake, emotional eating), food insecurity, anthropometric characteristics (dyads’ body mass index, % body fat), cardiovascular health (dyads’ blood pressure), and mental well-being (parental stress).
Methods
A one-group, quasi-experimental pilot study was conducted among 107 low-income parent–preschooler dyads. The 14-week program included a parent component, a parent–preschooler learning component, and a day care-based preschooler component.
Results
The program had positive effects on improving dyads’ fruit/vegetable intake, food insecurity, body mass index, and blood pressure and parents’ nutrition knowledge, self-efficacy, support, food resource management behavior, problem-focused coping, and home eating environment. The overall satisfaction rate was 95.2%, and 88.1% stated that the program assisted their families with having a healthy lifestyle.
Discussion
Results support the preliminary effects of the program on improving health outcomes in rural and urban low-income families. Although warranting further investigation with a more rigorous randomized controlled trial, the healthy eating and stress management program provides a potential solution to the current coexistence of an obesity epidemic and mental health crisis. 
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