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To examine the impact of the extent of education and/or training on sex trafficking among healthcare, social and community service providers and the impact of education and/or training on their capacity to respond to sex trafficked persons.
Cross-sectional survey.
An anonymous, online survey assessing perceptions of, and capacity to respond to, sex trafficking was distributed between February and August 2023 via social media platforms and with professional healthcare, social service and community associations and organisations across Canada to share with their members.
553 healthcare, social and community service providers.
Seven 6-point Likert scale items were used, as part of a larger survey, to measure capacity to respond to sex trafficking. Specifically, respondents were asked to rate their awareness of red flags and capacity to identify, talk to, interview, enhance the safety of, provide appropriate resources or referrals for and collaborate with other professionals to support sex trafficked persons.
Although most respondents (86.8%) reported having received some education and/or training on sex trafficking, the vast majority (94.8%) believed that they would benefit from additional education and/or training. Compared with those with no previous sex trafficking education and/or training, those who received less than 5 hours of education and/or training (b=3.56, p
As the number of hours of education and/or training on sex trafficking increased, so did respondents’ capacity to respond to sex trafficked persons. These results highlight a need for more education and training to help build capacity among healthcare, social and community service providers in identifying sex trafficked persons and providing appropriate care. Appropriately trained service providers can better support sex trafficked persons’ complex needs and potentially mitigate adverse outcomes.
Chronic insomnia is a prevalent but under-recognised sleep disorder in the UK, affecting 6.8%–14.9% of adults. It is associated with significant health and economic burdens, yet remains under-diagnosed and poorly managed in primary care. This study aimed to address key gaps in the understanding, diagnosis and management of chronic insomnia and to develop consensus-based recommendations to optimise care pathways across the National Health Service.
A modified Delphi consensus study.
UK primary care, involving general practitioners, pharmacists and sleep specialists.
A multidisciplinary steering group of seven UK healthcare professionals (HCPs) with expertise in chronic insomnia developed 39 statements. These were tested in a two-round Delphi survey distributed to a panel of 201 HCPs. Consensus was defined as ≥75% agreement on a 4-point Likert scale.
Consensus was reached for 37 of the 39 statements. Key findings included the recognition of chronic insomnia as a distinct chronic condition, the recommendation to include routine sleep-related screening in primary care and the need for increased HCP training in cognitive behavioural therapy for insomnia and pharmacological treatment. Respondents highlighted the necessity for greater awareness and public engagement regarding insomnia and its treatment options. In spite of mitigating biases, responses may have been subject to acquiescence bias.
The study identifies systemic barriers to effective insomnia care and calls for chronic insomnia to be prioritised in UK primary care. The resulting consensus recommendations aim to reduce the burden of untreated insomnia, improve patient outcomes, enhance healthcare delivery and increase economic productivity.
Polypharmacy in older adults is a growing concern, particularly in general practice (GP), where general practitioners (GPs) are the main prescribers managing complex multimorbidity. While often necessary, polypharmacy increases the risk of potentially inappropriate prescribing (PIP), adverse drug events, hospitalisations and reduced quality of life. Although clinical medication reviews using specific tools are frequently employed to address these risks and guide a safe deprescribing process, the specific role and effectiveness of educational interventions—as a component of prescribers’ behavioural change—remain inconsistently evaluated. The objective of this review is to identify, describe and evaluate educational interventions targeting GPs, aimed at improving medication appropriateness and promoting deprescribing in older adults with polypharmacy in GP settings.
This systematic review protocol follows Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Protocols guidelines. Eligible study designs include randomised controlled trials (RCTs), cluster RCTs and quasi-experimental studies. Studies must target GPs, GP trainees or primary care physicians and report outcomes related to medication appropriateness, measured using validated tools (eg, Medication Appropriateness Index, Screening Tool of Older Person’s Prescriptions/Screening Tool to Alert to Right Treatment). Secondary outcomes include hospital admissions, quality of life, prescribing behaviour, medication-related harms and cost-effectiveness. In addition to evaluating effectiveness, we will characterise heterogeneity in educational content and objectives, duration/intensity, theoretical or pedagogical underpinnings, delivery format, implementation fidelity and contextual factors. A comprehensive search will be conducted in MEDLINE, EMBASE, CINAHL and CENTRAL without language or date restrictions. The systematic review will follow PRISMA 2020 guidelines for data synthesis, and if meta-analysis is not feasible, Synthesis Without Meta-analysis reporting guidelines will be used.
Findings will be disseminated through peer-reviewed publications and conference presentations. Results will inform the design of future educational strategies to optimise medication review and deprescribing practices in general practice and primary care, by identifying which approaches most effectively improve patient-centred outcomes and clarifying the role of educational components within complex, multicomponent interventions.
To examine the associations among diabetes-related stress, treatment adherence, perceived social support, and health-related quality of life (HRQoL) in adults with type 1 diabetes mellitus (DM1), and to explore the mediating roles of support and adherence in this relationship.
A cross-sectional observational study using self-report standardised measures and mediation analysis.
A total of 772 Spanish adults with DM1 completed validated instruments measuring diabetes-related distress, perceived social support, treatment adherence, and HRQoL. Hierarchical multiple regression and serial mediation analysis (PROCESS Model 6, 10,000 bootstraps) were conducted, controlling for age, sex, and time since diagnosis.
Not applicable (primary data collection, not a review).
Diabetes-related stress was the strongest predictor of lower HRQoL. Perceived social support and treatment adherence also contributed significantly. Mediation analyses indicated that the impact of stress on HRQoL was partially mediated by perceived social support and, in sequence, by treatment adherence. The indirect path through social support alone and the sequential path involving both mediators were significant.
Stress and social support are critical in understanding and improving HRQoL in adults with DM1. Treatment adherence appears to be influenced by perceived support, highlighting an indirect mechanism linking stress to quality of life.
Healthcare professionals should integrate psychosocial assessments and interventions into routine diabetes care. Targeting stress reduction and enhancing social support may improve adherence and overall well-being in adults with DM1.
What problem did the study address? The study addressed the need to understand how psychosocial factors—specifically stress, perceived social support, and treatment adherence—contribute to HRQoL in adults with DM1. While prior research often focused on paediatric or clinical populations and rarely explored mediation models, this study sought to fill those gaps with data from a large community sample of adults.
What were the main findings? The main findings indicate that diabetes-related stress is the most significant predictor of reduced HRQoL. This relationship is partially mediated by perceived social support and, sequentially, by treatment adherence. While stress directly affects HRQoL, its negative impact is also channelled through diminished social support and decreased adherence. The indirect effect through treatment adherence alone was not significant.
Where and on whom will the research have an impact? The research has implications for adults living with DM1, particularly those in community settings outside of clinical supervision. It informs healthcare providers, diabetes educators, and policymakers on the importance of addressing emotional distress and strengthening support networks to improve both treatment adherence and overall quality of life.
This study adhered to the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines for cross-sectional studies. All methods and results are reported in alignment with EQUATOR Network recommendations for transparent and rigorous research reporting.
The study was conducted in collaboration with the Spanish Diabetes Federation (FEDE), which supported participant recruitment and dissemination through its affiliated associations. Patient input was incorporated throughout the study. A person with lived experience of type 1 diabetes contributed to the conceptual development of the research questions and the interpretation of findings. Their perspective helped ensure that the study design, choice of measures, and implications were relevant and meaningful to people living with the condition. This involvement supported a patient-centred approach to both the research and the manuscript preparation. Patients' participation as voluntary contributors was essential to the data collection process.
To investigate the relationship between demographic characteristics and extracurricular achievements among UK medical students.
National, cross-sectional survey.
All 44 UK medical schools recognised by the General Medical Council.
8,395 medical students.
Binary indicators of extracurricular engagement, including PubMed-indexed authorship, academic presentations, quality improvement projects, leadership roles and academic prizes. Logistic regression models were used to explore associations with demographic and extracurricular achievement predictors.
Logistic regression analysis showed that students from private schools (OR 1.35, CI 1.20 to 1.53, p
Significant disparities in extracurricular achievement exist among UK medical students, principally associated with gender, private schooling and familial links to medicine. Apparent ethnic differences were largely attenuated after adjustment for other variables, indicating socioeconomic factors as stronger predictors of engagement. Given the role of these achievements in postgraduate selection, targeted interventions by medical schools and professional bodies to widen access to funding, mentorship and structured guidance for all students, regardless of perceived advantage, may support equitable opportunity without undermining merit-based standards.
To explore factors influencing UK medical students’ specialty choices and examine variations in these influences across demographic groups and stages of training.
National, cross-sectional online survey.
All 44 UK medical schools recognised by the General Medical Council.
8,395 medical students.
The primary outcome was the specialty preferences of UK medical students. The secondary outcomes were factors behind these preferences and how these factors vary across demographic groups and different stages of training.
General Practice (15.3%), Paediatrics (10.6%) and Anaesthetics (9.9%) were the most preferred specialties among final-year students. Work-life balance (84.1%), compatibility with family life (78.2%), positive training experiences (85.2%) and future specialty outlook (74.9%) were key factors influencing specialty choice. Only 23.1% of students felt confident about securing a specialty training post, with confidence higher among males (OR 1.36, 95% CI 1.21 to 1.52, p
This study highlights disparities in specialty preferences and influencing factors among UK medical students. A focus on improving career guidance, exposure to various specialties and supporting equitable access to training opportunities is essential for fostering a motivated and sustainable medical workforce.
Older adults may experience a wish to die in the context of deteriorating health, a loss of autonomy, loneliness, or depression. Home care workers may likewise experience burden or symptoms of depression as a result of prolonged contact with this physical and emotional suffering. Training initiatives that can support the well-being of home care workers are therefore important.
To describe the typical profile of older adults who express a wish to die to their home care worker, and to examine whether a psycho-educational intervention for care workers exploring the end-of-life process and self-care strategies had an impact on the older adult's wish to die and on the care worker's perceived burden and depressive symptoms.
Quasi-experimental, longitudinal study involving non-randomized experimental and control groups and follow-up at 3–6 months post-intervention.
At the start of the study, all care workers (n = 126) provided sociodemographic information (age, gender) for themselves and the care recipient, and completed the Karnofsky Performance Status scale and the Assessment of the Frequency and Extent of the Desire to Die (AFEDD) interview to provide a baseline measure of the care recipient's functional status and wish to die. They also completed the Beck Depression Inventory (BDI) and Zarit Burden Interview (ZBI) as a measure of their own perceived burden and depressive symptoms. The AFEDD, BDI, and ZBI were completed again by care workers at 3 and 6 months post-intervention.
The typical profile of care recipients was a woman aged 85.5 years who required considerable support and assistance and who had at least occasionally experienced a wish to die, although these thoughts were not always verbalized. Scores on the AFEDD remained relatively stable over the follow-up period in both the control and experimental groups. There was no significant association between the older adult's wish to die and depressive symptoms in the care worker across the study period. However, a positive and significant correlation between a wish to die in the older adult and perceived burden in the care worker was observed at 6 months post-intervention in both the total sample (p = 0.032) and among controls (p = 0.028). By contrast, this significant association was not found for care workers in the experimental group (p = 0.376), suggesting that the psycho-educational intervention may have had a protective effect.
Although further studies are needed to corroborate and extend these findings, the results suggest that psycho-educational interventions aimed at increasing home care workers' understanding of the end-of-life process and which introduce them to self-care strategies may help to reduce their perceived burden when the older person for whom they are caring expresses a wish to die.
Home care workers may find it challenging to care for an older adult who expresses a wish to die. Psycho-educational interventions that enhance care workers' understanding of the end-of-life process and teach them self-care strategies could help to support their well-being and their ability to provide adequate care.
There is evidence that talking about the end of life with patients facing a life-threatening disease is not upsetting, and in fact, it may even be beneficial. However, both patients and health professionals can find it difficult to engage in these conversations. The aim of this clinical trial is to explore whether proactively inviting people with advanced cancer to share their thoughts about death and dying is distressing for them, comparing the impact with usual clinical practice (ie, a reactive approach to these issues).
A stepped-wedge cluster randomised controlled trial involving six palliative care units in Spain will be conducted. Each unit will recruit participants for both the experimental and control groups. Units will be randomised to determine the order in which they will begin implementing the intervention: GO-TaD (Give the Opportunity to Talk about Death thoughts). The trial will involve six sequences and seven periods (steps), with four patients per period (patients in each period will be different). The primary outcome will be emotional distress, assessed with the Detecting Emotional Distress scale. The following secondary variables will also be analysed: hopelessness, using the Beck Hopelessness Scale; quality of the patient–professional relationship, with the Patient–Doctor Relationship Questionnaire (PDRQ-9); and quality of life, with the Palliative Outcome Scale . The trial will follow the CONSORT extension for stepped-wedge cluster randomised designs. The primary analysis will include all eligible patients, applying mixed-effects regression models for binary results and mixed linear models for continuous data. Results will be reported as risk differences and ORs, with 95% confidence intervals. Analyses by sub-groups of interest (eg, age, gender, type of palliative care unit) will also be conducted. All analyses will be performed using R.
Ethical approval has been obtained from the researchers' university and all participating centres. Results will be disseminated through peer-reviewed open access publications, academic conferences and presentations to clinical audiences.
Objetivo: analizar los factores de riesgo cardiovascular del personal sanitario mediante la tabla REGICOR, en función edad, sexo, categoría profesional y turno de trabajo, así como el estrés laboral que experimenta nuestro equipo. Método: estudio descriptivo transversal cuya población fueron profesionales quirúrgicos Área V, Murcia, entre Enero y julio de 2020. Búsqueda bibliográfica y el instrumento un cuestionario con variables sociodemográficas y los factores de riesgo. Se explicó todo el proceso y firmaron Consentimiento Informado. Se calculó el RCV mediante REGICOR. El estrés con test de Hock y Escala General de Satisfacción. Resultados: muestra final n= 55, 18,2% (n =10) hombres y 81,8% (n= 45) mujeres, edades 35 y 64 y X= 49,4 años (DT = 8,7). Según la categoría profesional: 60% enferme-ros/as y 45,5% turno rodado. FRCV recogidos: IMC X=24,6 Kg/m2 presentando sobrepeso 32,1%, colesterol 30,9%, 22,6% hipertensos y 7,3% diabéticos. Edad y el riesgo coronario se relacionan de forma directa y significativa (r=0,550, p<0,001). Estrés< 42 puntos. Escala de satisfacción laboral 61,1 (DT=1,06). Conclusiones: los resultados obtenidos muestran elevadas prevalencias de factores de riesgo modificables especialmente obesidad, dislipemia y tabaquismo. Según la tabla Regicor elevada prevalencia de riesgo alto o muy alto. Sexo y edad fuertemente asociados al riesgo coronario. Mientras que el turno de trabajo y categoría profesional no existe asociación. El estrés no está relacionado en la población del Hospital Virgen del Castillo.
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