Conectar
Type 1 diabetes (T1D) demands self-management skills, knowledge and confidence to prevent medical complications. Adolescents living with T1D have distinct developmental challenges resulting in a worsening in glycaemic stability, irregular care and an increased risk for complications all while transitioning to adult healthcare. Age-specific online platforms could facilitate transition by fostering self-management education and support. The Support online self-guided training platform has been shown to increase the confidence of adults with T1D in managing their glycaemia. We aim to test the effectiveness of Support-t (ie, adapted for youth), compared with usual care, in improving haemoglobin A1c (HbA1c) and to understand the context of its implementation.
We will conduct a multisite, assessor-blinded, randomised controlled, parallel group, two-arm, superiority trial, evaluating effectiveness and implementation of Support-t versus usual care in 200 adolescents (14–16 years old) living with T1D. The active arm will have an 18-month access to Support-t, and their healthcare team will be trained on the platform’s content. The control arm will receive usual care. The primary outcome is HbA1c at 18 months. Secondary outcomes include self-efficacy for diabetes self-management, transition readiness, diabetes-specific quality of life, diabetes distress, continuous glucose monitoring metrics, number of severe hypoglycaemic events, diabetic ketoacidosis, T1D-related emergency department visits and hospitalisations as well as engagement and satisfaction. A subgroup of participants in the active arm and of healthcare providers will be interviewed assessing barriers, facilitators, engagement and fidelity of the intervention. Primary analysis will be by intention-to-treat. The difference in mean HbA1c at 18 months (with a 95% CI) will be calculated between both arms. A cost-effectiveness analysis is also planned.
December 8, 2024 version of the protocol was approved by the McGill University Health Centre Research Ethics Board (MP-37-2024-9734). Results will be disseminated through peer-reviewed publications and patient-partners’ network.
ClinicalTrials.gov (NCT05910840).
This systematic review aims to: (1) evaluate how behavioural and psychological factors have been incorporated into cardiovascular disease (CVD) risk prediction models; (2) assess their impact on model performance metrics such as area under the curve (AUC) and net reclassification index (NRI); and (3) identify which specific variables are most consistently associated with predictive improvements. This protocol is reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocols (PRISMA-P) 2015, and the systematic review will follow the Cochrane Handbook and report findings based on PRISMA 2020.
A systematic review protocol developed in accordance with the (PRISMA-P) 2015 guidelines.
Systematic searches will be carried out in PubMed, Scopus, Web of Science and Google Scholar, limited to studies published from 2019 to 2024.
Peer-reviewed original studies involving adult populations (≥18 years) at risk of CVD, incorporating at least one behavioural or psychological variable into a CVD risk prediction model. Studies must report model performance metrics such as AUC or NRI. Studies focusing solely on biochemical or demographic factors, paediatric populations, or non-CVD outcomes will be excluded.
Two independent reviewers will screen eligible studies, extract data and assess study quality using the Newcastle-Ottawa Scale and Quality in Prognostic Studies tool. A narrative synthesis will be performed, with meta-analysis conducted if feasible.
Ethical approval is not required for this study. Findings will be disseminated through peer-reviewed publication and conference presentations.
CRD420251014218.
To assess the supply, demand, and utilisation of master's degree nurses in China's top-tier hospitals and identify recruitment and retention challenges.
A convergent parallel mixed-methods design.
From January and September 2022, eight top-tier hospitals in mainland China were selected using convenience sampling. The proportion of master's degree nurses, turnover rates, and recruitment outcomes were investigated and analysed using descriptive statistics. Concurrently, seven nursing administrators from these eight hospitals were interviewed using semi-structured interviews, and transcribed data were thematically analysed through inductive content analysis.
Among the eight hospitals surveyed, the average proportion of master's degree nurses was 3.58% (range: 0.58%–9.43%). The average ratio of planned to actual recruitment was 3.28, with four hospitals showing near parity (approximately 1:1) and three institutions failing to recruit any master's degree nurses. The annual turnover rate of master's degree nurses was 1.18%. Three themes emerged from the qualitative analysis: (1) shortages coexisting with oversupply; (2) nursing leaders' retention efforts versus limited institutional policy support; and (3) prioritisation of research and management over advanced clinical roles.
In China, even among top-tier hospitals, the proportion of master's degree nurses remains relatively low. There is an overall shortage of these nurses, juxtaposed with localised oversupply in specific institutions. Promotion to nursing supervisor or administrative roles is the only developmental pathway, while structured career progression pathways for advanced nursing practice remain conspicuously absent.
The study highlights the need to develop targeted policies that support the career advancement of master's degree nurses, particularly by expanding career options in Advanced Practice Nurses (APNs) rather than limiting roles to nursing management or education. This shift would better leverage their clinical expertise and strengthen healthcare systems through specialised practice and innovation.
What problem did the study address?: This study maps the supply–demand dynamics of master's degree nurses in leading hospitals and identifies retention, utilisation, and motivation policies and strategies from the perspective of nursing administrators. What were the main findings?: The proportion of master's degree nurses is low in China's top hospitals. There is both an oversupply and a shortage of master's degree nurses. Neither the government nor hospitals have policies in place to encourage the clinical involvement of master's degree nurses, and their career progression is limited to managerial roles. Where and on whom will the research have an impact?: Nursing administrators and other health policy makers in China and comparable global health systems will be affected. It will also influence nursing associations, nursing educators, and general nurses.
This study adhered to the Mixed Methods Article Reporting Standards.
No contributions from patients or the public were involved in this study.
To systematically identify and appraise existing risk prediction models for EN aspiration in adult inpatients.
A systematic search was conducted across PubMed, Web of Science Core Collection, Embase, Cochrane Library, CINAHL, China National Knowledge Infrastructure (CNKI), Wanfang Database, China Biomedical Literature Database (CBM) and VIP Database from inception to 1 March 2025.
Systematic review of observational studies.
Two researchers independently performed literature screening and data extraction using the Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies (CHARMS). The Prediction Model Risk of Bias Assessment Tool (PROBAST) was employed to evaluate both the risk of bias and the clinical applicability of the included models.
A total of 17 articles, encompassing 29 prediction models, were included. The incidence of aspiration was 9.45%–57.00%. Meta-analysis of high-frequency predictors identified the following significant predictors of aspiration: history of aspiration, depth of endotracheal intubation, impaired consciousness, sedation use, nutritional risk, mechanical ventilation and gastric residual volume (GRV). The area under the curve (AUC) was 0.771–0.992. Internal validation was performed in 12 studies, while both internal and external validation were conducted in 5 studies. All studies demonstrated a high risk of bias, primarily attributed to retrospective design, geographic bias (all from different parts of China), inadequate data analysis, insufficient validation strategies and lack of transparency in the research process.
Current risk prediction models for enteral nutrition-associated aspiration show moderate to high discriminative accuracy but suffer from critical methodological limitations, including retrospective design, geographic bias (all models derived from Chinese cohorts, limiting global generalisability) and inconsistent outcome definitions.
Recognising the high bias of existing models, prospective multicentre data and standardised diagnostics are needed to develop more accurate and clinically applicable predictive models for enteral nutrition malabsorption.
Not applicable.
PROSPERO: CRD420251016435
To describe the perspectives of individuals receiving haemodialysis regarding health literacy in fluid management.
A qualitative descriptive approach using directed content analysis of interviews from an explanatory mixed methods study.
Semi-structured individual interviews were conducted from September 2020 to February 2021 with 28 individuals receiving haemodialysis who had attended a prior quantitative study. A directed qualitative content analysis approach was used to identify categories and subcategories emerging from the data.
Six categories of health literacy were identified: (1) active health management, (2) engagement with healthcare providers, (3) understanding and support from healthcare providers, (4) social support, (5) health information literacy and (6) navigation of the healthcare system.
Based on their real-life experience, individuals receiving haemodialysis have unique health literacy needs regarding fluid management. A comprehensive understanding of these unique needs is crucial in creating person-centered interventions to address inadequate fluid restriction.
Interventions to address inadequate fluid restriction should be person-centered, considering each individual's unique health literacy needs. This involves conducting a comprehensive assessment of individuals' health literacy needs, empowering individuals to actively engage in health, engaging the entire support network and facilitating health information literacy in line with individuals' preferences.
This study offers detailed insights into the health literacy needs related to fluid management in individuals undergoing haemodialysis. The findings could inform the development of person-centered fluid management strategies for these individuals.
We adhered to the Consolidated Criteria for Reporting Qualitative Research checklist.
No patient or public contribution.
To systematically analyse international empirical literature and establish a comprehensive understanding of the push and pull factors influencing retention and turnover among mid-career nurses.
An integrative review.
PubMed, Web of Science, Scopus, EMBASE (Ovid), and CINAHL (EBSCO) were searched for studies published between January 2001 and November 2024.
An integrative literature review was conducted following the five-step process outlined by Whittemore and Knafl. Articles were screened by title, abstract, and full text based on predefined inclusion and exclusion criteria. The quality of eligible studies was assessed using the Mixed Methods Appraisal Tool (MMAT). Data were extracted and synthesised narratively, and the findings were presented according to the socio-ecological framework.
A total of 1930 studies were identified, with 14 included for analysis: 10 qualitative, 3 quantitative, and 1 mixed-methods study. Guided by the socio-ecological framework, four themes and 10 subthemes emerged: (1) Intrapersonal (professional knowledge/skills, health issues, work-family balance); (2) Interpersonal (professional collaborative relationships, supervisor support); (3) Organisational (organisational characteristics, work characteristics, career development); and (4) Societal (salary/benefits, Social/governmental recognition).
This review reveals the heterogeneity of research on this topic and confirms previous findings. It identifies certain push-and-pull factors common to nurses across all stages of their careers. However, mid-career nurses face unique challenges, including more complex healthcare demands, declining health status, growing family caregiving responsibilities, unclear organisational roles, underutilisation of professional skills, career stagnation, and limitations on salary growth. These findings highlight the need for tailored retention strategies for mid-career nurses.
A “one-size-fits-all” retention strategy does not meet the needs of all nurses. To improve nurse retention rates, it is essential to address the shifting demands and priorities that arise as nurses reassess and transition through different career stages. For mid-career nurses, acknowledging and valuing their expertise and capabilities, providing sufficient resources, and fostering a supportive work environment that promotes career development may be effective strategies for retaining these experienced professionals.
Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
No Patient or Public Contribution.
Physiological, psychological, and social changes may make older adults more vulnerable to stressors and lead to adverse health outcomes. It remains unclear whether interventions targeting coping strategies in older adults are effective.
This study aimed to systematically review and summarize existing interventions aimed at improving coping strategies in older adults and analyze intervention effectiveness.
A systematic search was conducted using PubMed, EMBASE, Web of Science, Cochrane, CINAHL, PsycINFO, CNKI, SinoMed, VIP, and WanFang databases for randomized controlled trials (RCTs) and quasi-experimental studies. Two researchers independently performed literature screening, quality assessment, and data extraction.
A total of 9 studies were included, comprising 7 RCTs and 2 quasi-experimental studies. Meta-analysis revealed that the interventions significantly enhanced the use of problem-focused coping strategies among older adults (SMD = 0.37, 95% CI: 0.12 ~ 0.63, p = 0.005, I 2 = 39%). However, there was no significant effect on emotion-focused coping strategies (SMD = −0.07, 95% CI [−0.62, 0.48], p = 0.80, I 2 = 76%). Moreover, no significant statistical differences were observed between the intervention group and the control group in terms of positive (SMD = 1.49, 95% CI [−0.23, 3.21], p = 0.09, I 2 = 98%) or negative coping strategies (SMD = −0.76, 95% CI [−1.79, 0.28], p = 0.15, I 2 = 96%).
Interventions targeting coping strategies can significantly improve the problem-focused coping strategies of older adults. It is crucial to help older adults accurately recognize daily stressors, acquire emotional regulation strategies, and enhance coping skills. More large-scale RCTs are needed to draw more robust conclusions.
by Chenyu Zheng, Ming Fang, Yue Zhang, Xinyu Liu, Zhihuan Huang
Exposure to natural landscapes has been shown to affect both physiological and psychological well-being, with the extent of these effects varying across different landscape types. However, the underlying mechanisms remain poorly understood. The association among stress reduction, environments characteristics and individual differences requires further investigation, particularly considering the complexity of landscape attributes and the variability of personal responses. In this study, 98 university students participated in a survey to evaluate the effects of different landscape types on visual preference and fatigue recovery. Physiological data (blood pressure, heart rate), psychological data (Perceived Restorative Scale), and visual preferences were analyzed before and after participants viewed the images of eight representative landscape space types: mountain, field, waterscape, lawn, desert, forest, artificial nature, plant. The results indicated that landscape type significantly influenced both physiological responses and emotional states, as well as participants’ perceived recovery from stress. Among the eight landscape spaces, water features and forests were reported to be the most restorative. Compared to freshmen, juniors exhibited greater improvements in physical and psychological recovery, alongside more positive evaluations of the environments. Notably, the desert landscape elicited varied responses depending on participants’ grade level and gender, suggesting that restoration effects may be modulated by individual characteristics. This may reflect an evolutionary predisposition to prefer natural features that enhance survival. These findings contribute to environmental psychology and provide valuable insights for educational practice and environmental design.by Yiming Jin, Rong Lu, Mingyuan Wang, Zihao Xu, Zhen Liu, Shuhong Xie, Yu Zhang
ObjectiveIn this study, we aimed to analyze the blood screening detection strategies employed for voluntary blood donation in a specific region of East China and evaluate the efficacy of the blood safety detection system.
Donors and MethodsA total of 539,117 whole blood samples were collected from voluntary blood donors between January 2018 and July 2021, as well as in 2023 and 2024. The samples were screened for hepatitis B surface antigen (HBsAg), hepatitis C virus (HCV) antibodies, human immunodeficiency virus antibodies/antigen (HIV Ab/Ag), and Treponema pallidum (TP) antibodies using enzyme-linked immunosorbent assay (ELISA). Alanine aminotransferase (ALT) levels were measured using a rapid method. Chemiluminescence immunoassay technology was used to detect five hepatitis B virus (HBV) markers. Polymerase chain reaction was employed to detect HBV DNA, HCV RNA, and HIV RNA. The reactivity rates of each marker were analyzed.
ResultsThe overall positivity rate for blood testing among donors in this region was 0.76% (4,078/539,117). The positivity rates for the individual markers were as follows: anti-TP (0.20%)> HBsAg (0.18%)> ALT (0.13%)> anti-HCV (0.085%)> nucleic acid testing (0.080%)> HIV antigen/anti-HIV (0.079%). No significant differences were observed (P > 0.05). Before 2023, the positivity rates for ALT and HBsAg exhibited occasional fluctuations, followed by a significant decline. Conversely, in 2024, a slight upward trend in the HIV positivity rate was noted.
ConclusionThe current multitiered blood screening and detection strategy in this region exhibits complementary advantages, ensuring effective blood safety. However, the observed slight upward trend in the HIV positivity rate among voluntary blood donors highlights the necessity for enhanced pre-donation counseling and risk assessment for key populations.
Injury is a major cause of death in Rwanda, with many deaths occurring before hospital admission. Timely transport of injured patients to appropriate hospitals is crucial, ideally within an hour for severely injured patients. However, delays in reaching treatment facilities are common, with ambulance services using inefficient mobile phone communication. This project aims to evaluate the effectiveness and implementation of an innovative electronic communication platform (912Rwanda).
The study will be conducted through the public ambulance service, Service d’Aide Médicale d’Urgence (SAMU), and receiving health facilities in Kigali city and Musanze district in Rwanda. The 912Rwanda intervention will be rolled out in the two locations at different times. The primary effectiveness outcome is the time from ambulance deployment to patient arrival at the health facility. Secondary effectiveness outcomes include disaggregated times of the primary outcome and clinical outcomes, such as length of stay and requirement for intensive care. These outcomes will be evaluated using an interrupted time series analysis, accounting for non-homogeneous variances, auto-regressive errors and non-linear trends where appropriate. Implementation outcomes will be evaluated using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) Qualitative Evaluation for Systematic Translation (QuEST) framework. Cost-effectiveness will be evaluated using a cost-consequence analysis with consequences as determined by the interrupted time series analysis.
Ethical approval was obtained from the Rwanda National Research Ethics Committee (Ref No: 99/RNEC/2023). Dissemination will occur through open-access peer-reviewed publications, relevant national and international conferences.
Sepsis is a major cause of death both globally and in the United States. Early identification and treatment of sepsis are crucial for improving patient outcomes. International guidelines recommend hospital sepsis screening programmes, which are commonly implemented in the electronic health record (EHR) as an interruptive sepsis screening alert based on systemic inflammatory response syndrome (SIRS) criteria. Despite widespread use, it is unknown whether these sepsis screening and alert tools improve the delivery of high-quality sepsis care.
The Sepsis Electronic Prompting for Timely Intervention and Care (SEPTIC) master protocol will study two distinct populations in separate trials: emergency department (ED) patients (SEPTIC-ED) and inpatients (SEPTIC-IP). The SEPTIC trials are pragmatic, multicentre, blinded, randomised controlled trials, with equal allocation to compare four SIRS-based sepsis screening alert groups: no alerts (control), nurse alerts only, prescribing clinician alerts only, or nurse and prescribing clinician alerts. Randomisation will be at the patient level. SEPTIC will be performed at eight acute-care hospitals in the greater New York City area and enrol patients at least 18 years old. The primary outcome is the percentage of patients with completion of a modified Surviving Sepsis Campaign (SSC) hour-1 bundle within 3 hours of the first SIRS alert. Secondary outcomes include time from first alert to completion of a modified SSC hour-1 bundle, time from first alert to individual bundle component order and completion, intensive care unit (ICU) transfer, hospital discharge disposition, inpatient mortality at 90 days, positive blood cultures (bacteraemia), adverse antibiotic events, sepsis diagnoses and septic shock diagnoses.
Ethics approval was obtained from the Columbia University Institutional Review Board (IRB) serving as a single IRB. Results will be disseminated in peer-reviewed journal(s), scientific meeting(s) and via social media.
ClinicalTrials.gov: NCT06117605 and
‘Hotspotters’ are patients with complex care needs, defined by problems in multiple life domains and high acute care use. These patients often receive mismatched care, resulting in overuse of care and increased healthcare costs. As reliable data on effective interventions for this population are scarce, the goal of this study is to assess the cost-effectiveness of proactive, personalised, integrated care for this group.
The Hotspotters Project is planned as a stepped wedge cluster randomised controlled trial in 20 primary care practices in the Netherlands. All practices and participants will begin with standard care during the control period (2–8 months), followed by an intervention (12 months) consisting of a positive health intake with goal setting, multidisciplinary meetings, a personalised care plan and proactive care management. The study will conclude with a follow-up (2–8 months), resulting in a total study duration of 22 months. We plan to include 200 patients with (a) problems on two or more life domains and (b) at least two acute care encounters in the previous year. Possible Hotspotters are identified using an Adjusted Clinical Groups-based algorithm or via a local primary healthcare team.
Questionnaires and routine care data will be used to gather data on cost-effectiveness, which will then be assessed using multilevel analysis, with levels for the individual, cluster and duration of control period. Secondary outcomes will include psychological outcomes on self-regulation (proactive coping, patient activation, self-efficacy and intention), experience of care (satisfaction, perceived autonomy support and qualitative data from focus groups) and quality of life, qualitative analysis of the Positive Health approach, implementation outcomes and process evaluation including integration of care.
The Ethics Committee of Leiden University Medical Centre granted approval (METC-LDD, P21.123). Results will be shared through peer-reviewed publication and (inter)national conference presentations.
Despite the increasing number of doctorally prepared midwives in Europe, particularly after the Bologna Declaration 1999, little is known about the context and experiences of their doctoral education.
To explore European initially qualified midwives' experiences with doctoral education; and the context of their education through their professional associations.
An exploratory descriptive observational survey.
An ethically approved web-based survey was used to collect data from midwifery associations and midwives in 33 European countries between October and December 2024. Descriptive statistics and inductive thematic analysis were used to analyse the responses.
Twenty-two midwifery associations from 19 European countries and 207 midwives from 23 European countries participated. Over the last two decades, there has been an increase in the number of doctorally prepared midwives. Common reasons to gain doctoral qualifications included an interest in research, career progression, in particular in education, and improving healthcare. Midwives reported growing availability of European-wide opportunities for doctoral programmes, alongside an increase in the number of doctoral midwifery programmes and supervisors with midwifery expertise. Although many barriers were reported, effectively combining study with their personal life and support from family, friends and colleagues was highlighted as crucial factors in completing their doctoral studies.
This is the first study exploring the experiences of European midwives pursuing a doctoral degree. The findings highlight a need for universities to improve the collaboration with midwives' supportive networks as well as for the profession to reduce intraprofessional hostilities to enhance doctoral midwifery students' well-being.
Implications for the profession: Acknowledging challenges faced by these midwives is necessary to improve professional and institutional support in academia and midwifery.
Findings of this study inform strategies to improve doctoral education for midwives and, in this way, strengthen the contributions of midwives to maternal evidenced-based care development and healthcare innovations.
The Consensus-Based Checklist for Reporting of Survey Studies (CROSS) was used to guide reporting.
This study did not include patient or public involvement in its design, conduct or reporting.
To explore the impact of international visiting scholars programmes on the academic and professional development of nursing PhD students and to inform future doctoral curriculum design.
Integrative review.
A systematic search was conducted across six databases (Embase, Medline, CINAHL, ERIC, Scopus and Web of Science) in December 2024, with no restrictions on publication year. After removing duplicates, 1300 records were screened by title, abstract and full text. Studies were included if they focused on nursing PhD students participating in international visiting programmes and addressed academic or professional development. Five studies met the inclusion criteria. Data were synthesised using a thematic analysis approach.
Four themes were identified: (1) advancing academic excellence through enhanced research skills and critical thinking; (2) cultivating cross-cultural learning by fostering cultural sensitivity and adaptability; (3) fostering global networks that promote sustained international collaboration; and (4) shaping doctoral education by encouraging structured and sustainable international experiences. These findings suggest that international visiting scholars programmes contribute meaningfully to the academic, cultural and professional growth of nursing PhD students.
International visiting scholars programmes provide a unique platform for doctoral nursing students to strengthen their academic foundations and expand their global outlook. Integrating such experiences into doctoral curricula can better prepare future nursing leaders for international health challenges.
This review addresses a gap in the literature by focusing on the doctoral-level outcomes of international visiting scholars programmes in nursing. The findings offer guidance for educators and policymakers to design curricula that integrate global engagement, build institutional support for mobility programmes and promote equitable access to international academic opportunities in nursing education.
The review adhered to the EQUATOR and PRISMA guidelines for systematic reviews.
No patient or public contribution.
by Ming Li, Jingang Ma, Jing Zhao
Since Transformers have demonstrated excellent performance in the segmentation of two-dimensional medical images, recent works have also introduced them into 3D medical segmentation tasks. For example, hierarchical transformers like Swin UNETR have reintroduced several prior knowledge of convolutional networks, further enhancing the model’s volumetric segmentation ability on three-dimensional medical datasets. The effectiveness of these hybrid architecture methods is largely attributed to the large number of parameters and the large receptive fields of non-local self-attention. We believe that large-kernel volumetric depthwise convolutions can obtain large receptive fields with fewer parameters. In this paper, we propose a lightweight three-dimensional convolutional network, LKDA-Net, for efficient and accurate three-dimensional volumetric segmentation. This network adopts a large-kernel depthwise convolution attention mechanism to simulate the self-attention mechanism of Transformers. Firstly, inspired by the Swin Transformer module, we investigate different-sized large-kernel convolution attention mechanisms to obtain larger global receptive fields, and replace the MLP in the Swin Transformer with the Inverted Bottleneck with Depthwise Convolutional Augmentation to reduce channel redundancy and enhance feature expression and segmentation performance. Secondly, we propose a skip connection fusion module to achieve smooth feature fusion, enabling the decoder to effectively utilize the features of the encoder. Finally, through experimental evaluations on three public datasets, namely Synapse, BTCV and ACDC, LKDA-Net outperforms existing models of various architectures in segmentation performance and has fewer parameters. Code: https://github.com/zouyunkai/LKDA-Net.Athletes have been found to experience a similar prevalence of mental health issues to non-athletes. However, they are subjected to a greater array of barriers to help-seeking for mental health, including sport-specific factors. This scoping review synthesised the literature on athletes’ access to, attitudes towards and experiences of help-seeking for mental health from formal (mental health professionals such as psychiatrists) and semiformal sources (those who are not mental health professionals but are a service provider such as a coach).
The Joanna Briggs Institute framework and recommendations were used alongside the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Protocols checklist for scoping reviews. This scoping review was predominantly informed by Arksey and O’Malley’s framework for scoping reviews, supplemented by Levac et al’s additional recommendations. Rickwood and colleagues’ help-seeking frameworks informed the research question, inclusion/exclusion criteria and analysis.
The search terms and synonyms of "athlete" AND "mental health" AND "help-seeking" were searched in PsychINFO, Embase, MEDLINE, APA PsychArticles Full Text, Web of Science Core Collection, Scopus, Sport Discus, CINAHL and Proquest (Education Database, Health & Medical Collection, Nursing & Allied Health database, Psychology Database, Public Health Database, Education Collection, and Medicine & Education). These searches were conducted at three time points between April 2022 and 2024.
The inclusion and exclusion criteria were initially predetermined and specified in the protocol paper published in BMJ Open. Primary research articles, interventions and systematic reviews that referred to semiformal and formal sources of support were included.
The lead reviewer (KRB) screened all titles and abstracts, and full texts, and extracted data from all included studies. A second reviewer was involved in screening and extracting 20%–30% of studies at each stage. Findings were synthesised descriptively (eg, study population, data collection method and location of studies) and by content (eg, access, attitudes and experiences, sources of support, use of theory and the validity of quantitative measures used).
After screening 4954 titles and abstracts and 275 full texts in Covidence, 104 papers were included in the review. This comprised of 87 primary research articles, 13 interventions and 4 systematic reviews. Most of the primary articles and interventions were published in the USA (50%). 49.4% of the primary articles used quantitative methods, 34.5% used qualitative methods and 16.1% used mixed methods. Attitudes towards mental health help-seeking were investigated in 78.8% of the included studies, experiences of help-seeking in 53.8% and access to sources of support in 31.7% of studies. Of the primary articles and interventions, formal sources were investigated in 55% of studies, semiformal sources in 2% and both in 26% of studies.
This scoping review of 104 papers showed the benefit of using help-seeking frameworks to shape and analyse a review. Analysing the results using these frameworks provided a novel contribution to the literature, showing where the athlete help-seeking literature base is currently focused and identified gaps for further research. For example, there is a need for further research on athletes in less developed nations, more qualitative and mixed methods studies, and further research on athletes’ access to mental health support and their interactions with semiformal sources. The results have applied implications in public health and sport by highlighting the different factors that impact athlete help-seeking, and therefore areas where they require support.
In recent years, the critical role of health literacy in diabetes management has become increasingly prominent. The aim of this study was to investigate the impact of social support on health literacy among patients with diabetes, to test the mediating role of self-efficacy and empowerment between social support and health literacy, and the moderating role of eHealth literacy.
A cross-sectional study conducted between August 2023 and June 2024.
This study adopted the cluster sampling method and conducted a questionnaire survey among 251 patients with diabetes in a tertiary hospital in Wuhu City, Anhui Province. The questionnaires included the Social Support Rating Scale, the Self-Efficacy for Diabetes scale, the Health Empowerment Scale, the eHealth Literacy Scale and the Diabetes Health Literacy Scale.
Social support was positively associated with health literacy in patients with diabetes. Self-efficacy and empowerment mediated the relationship and formed chained mediation pathways respectively. eHealth literacy has a moderating role between self-efficacy and empowerment.
The results revealed that social support influences health literacy among patients with diabetes through the mediating pathways of self-efficacy and empowerment, and that this process is moderated by eHealth literacy. These findings provide a theoretical basis and practical insights for improving health literacy among patients with diabetes.
Enhancing health literacy among people with diabetes by strengthening social support, self-efficacy and empowerment levels, while focusing on the technology-enabling role of eHealth literacy in this context.
This study adheres to the relevant EQUATOR guidelines based on the STROBE cross-sectional reporting method.
We thank all patients who participated in the study for their understanding and support.
by Hui Ouyang, Xiaolin Dou, Xinying Li, Mingyu Cao, Zhijing Wu, Fada Xia
PurposeThis retrospective cohort study aimed to reevaluate the prognostic impact of sex and determine whether age modifies the effect of sex on cancer-specific survival (CSS) in PTC patients.
MethodsData for PTC patients diagnosed between 2004 and 2015 were retrieved from the SEER database. The primary outcome was CSS. The effect of Sex was evaluated using both relative (hazard ratios, HRs) and absolute measures (survival differences). Additionally, the effect of sex modified by age was assessed using restricted cubic spline curves from the Cox and Poisson models, with further analysis of the interaction between sex and age.
ResultsOf 77,349 patients, 16,152 (20.9%) were male. Men exhibited older age, more aggressive clinicopathological features, and received more radioactive iodine treatment. Multivariate Cox analysis determined male sex as an independent risk factor (adjusted HR: 1.46 (1.24–1.70). The 10-year and 15-year survival differences between men and women were 0.46% (95% CI, 0.25%−0.67%) and 0.77% (95% CI, 0.31%−1.22%), respectively. Moreover, a nonlinear effect for sex across age was observed, with HRs for men plateauing below age 50 and decreasing thereafter. Importantly and conversely, before age 50, the absolute survival difference increased slightly with age, but after 50, it significantly widened. Furthermore, A significant negative multiplicative interaction between sex and age was found.
ConclusionsOur analyses provide robust evidence that male sex is indeed an independent risk factor for CSS in PTC patients. Although younger female patients show a relative survival advantage, this does not translate into a substantial absolute benefit, which widens with advancing age.
This study aimed to systematically review Clinical Practice Guidelines (CPGs) for nutritional management of dementia and use evidence mapping to highlight research trends and identify gaps to inform future research.
A systematic review of guidelines using the PRISMA statement.
Systematically collect literature on dementia management CPGs from PubMed, Embase, Web of Science and guideline databases. Extract basic information, recommendations, methodological quality and reporting quality of the CPGs. Four researchers independently evaluated eligible CPGs using the AGREE II instrument and the RIGHT checklist. All recommendations from the CPGs were summarised and analysed, and evidence mapping bubble charts were created in Excel.
After excluding 5541 records, 10 CPGs were eventually proved eligible, 5 of which were of high quality and 5 of high quality. With 10 CPGs that combined 18 recommendations. The nutrition screening and assessment were summarised on the basis of the dementia recommendations for 4 major items, 7 items on nutritional interventions, 5 items on caring and 2 on education.
This review provides an evidence map and offers new perspectives on CPGs for nutritional management in dementia. However, there are improvements to the included CPGs, but most CPGs have a number of key recommendations that can help guide clinical practice.
The currently available guidelines on dementia nutritional management have room for methodological improvement.
FreshRSS 