bluuebunny/crossref_metadata_2025 huggingface dataset:
Exploring the Influence of Interorganization Networks on the Dissemination of National Health Behavior Guidelines
Authors: Kauffeldt Kaitlyn D. , Gainforth Heather L. , Latimer-Cheung Amy E. , Faulkner Guy , Tomasone Jennifer R.
Published: January 2025

Background: Interorganization partnerships are important for the development and knowledge mobilization of national health behavior guidelines. However, little is known about how to improve the dissemination of guidelines across professional networks. Social network analysis may offer unique insight into the social structure of interorganization networks and provide guidance for how network features may be harnessed for effective dissemination. The objectives of this study were to apply social network analysis to (1) analyze the connectedness of organizations and/or subgroups within a national health behavior guideline network and (2) identify organization attributes associated with influential network positions. Methods: Organizations involved in the development and dissemination of the Canadian 24-Hour Movement Guidelines for Adults were invited to complete an online survey to examine the connections among health-promoting organizations in Canada. Data were analyzed using UCINET Version 6. Network maps were generated for the interorganization network and its subgroups, and descriptive frequencies were calculated for demographic characteristics. Associations between organization attributes and centrality measures were calculated using Point-Biserial and Spearman rank correlations. Results: Thirty-four organizations completed the survey and reported 228 organizational ties. Density scores for each dissemination network ranged from 1% to 5%, demonstrating the potential for constrained information sharing (ie, dissemination) between organizations. Five attributes were significantly associated with centrality measures, which included location, sector, size, resource allocation, and previous dissemination of sedentary behavior guidelines. Conclusions: Findings demonstrate the utility of social network analysis for understanding knowledge mobilization across networks and offer guidance for how network features may be leveraged to enhance knowledge mobilization outcomes.
Physical Activity and Life Expectancy Free of Cancer: Prospective Evidence From the UK Biobank Study
Authors: Sanchez-Lastra Miguel Adriano , del Pozo Cruz Borja , Ekelund Ulf , Tarp Jakob , Ding Ding
Published: January 2025

Background: Life expectancy free of cancer (LEFC) is a novel measure that considers both morbidity and mortality and could be a useful metric for disease surveillance and risk communication. We aimed to examine the association between physical activity and LEFC in British adults. Methods: This was a prospective cohort study of 292,559 apparently healthy UK Biobank participants (mean [SD] age, 56.0 [8.1] y, 51% women). Participants were categorized based on self-reported physical activity as “no activity” (0 min/wk), “insufficiently active” (10–599 metabolic equivalent-min/wk), “active” (600–1199 metabolic equivalent-min/wk), and “very active” (>1200 metabolic equivalent-min/wk). Hazard ratios from multistate models for transitions between 3 states (cancer-free, cancer diagnosis, and all-cause mortality) were used to calculate differences in predicted remaining LEFC across physical activity levels for men and women at ages 45 and 65 years. Results: During a median follow-up of 11.0 years, we recorded 13,143 cancer cases for men and 10,255 for women, and 6488 deaths for men and 3739 for women. At age 45, “insufficiently active,” “active,” and “very active” had a higher LEFC by 2.35, 2.46, and 2.76 years compared with “no activity,” and by 1.44, 1.62, and 1.84 years at age 65. In women, the “insufficiently active,” “active,” and “very active” had a higher LEFC by 1.09, 1.42, and 1.59 years at age 45, and by 1.25, 1.54, and 1.71 years at age 65. Conclusions: Engaging in physical activity, even below recommended levels, appears to extend cancer-free years of life. Promoting physical activity is an important strategy for cancer prevention.
HIV-1 Vpu and SARS-CoV-2 ORF3a proteins disrupt STING-mediated activation of antiviral NF-κB signaling
Authors: Rui Yajuan , Shen Si , Wang Yanpu , Cheng Leyi , Chen Shiqi , Hu Ying , Cai Yong , Wei Wei , Su Jiaming , Yu Xiao-Fang
Published: January 2025

Activation of the stimulator of interferon genes (STING) pathway by cytosolic DNA leads to the activation of the transcription factors interferon regulatory factor 3 (IRF3) and nuclear factor κB (NF-κB). Although many viruses produce proteins that inhibit IRF3-dependent antiviral responses, some viruses produce proteins that inhibit STING-induced NF-κB activation without blocking IRF3 activation. Here, we found that STING-activated, NF-κB–dependent, and IRF3-independent innate immunity inhibited the replication of the DNA virus herpes simplex virus type 1 (HSV-1), the RNA virus coxsackievirus A16 (CV-A16), and the retrovirus HIV-1. The HIV-1 nonstructural protein Vpu bound to STING and prevented it from interacting with the upstream NF-κB pathway kinase inhibitor of NF-κB subunit β (IKKβ), thus blocking NF-κB signaling. This function of Vpu was conserved among Vpu proteins from diverse HIV-1 and simian immunodeficiency virus strains and was distinct from its action in disrupting other host antiviral pathways. Furthermore, the ORF3a protein from the coronavirus SARS-CoV-2 also promoted viral replication by interacting with STING and blocking STING-induced activity of NF-κB but not of IRF3. These findings demonstrate that diverse viral proteins have convergently evolved to selectively inhibit NF-κB–mediated innate immunity downstream of STING activation, suggesting that targeting this pathway may represent a promising antiviral strategy.
Multicenter validation of a galactomannan chemiluminescence immunoassay for the diagnosis of pulmonary aspergillosis on serum of patients with hematological disease
Authors: Lamberink Hanne , Huygens Sammy , Aerts Robina , Lagrou Katrien , van Dijk Karin , Langerak Diana , Moors Ine , Boelens Jerina , Reynders Marijke , Maertens Johan , Schauwvlieghe Alexander , van Westreenen Mireille , Chong Ga-Lai M. , Verweij Paul E. , Buil Jochem B. , Rijnders Bart J. A.
Published: January 2025

An accurate diagnosis of invasive aspergillosis (IA) in patients with underlying hematological malignancies relies heavily on galactomannan detection. In this study, we compared the VirCLIA chemiluminescence immunoassay (CLIA) with the frequently used Platelia enzyme-linked immunosorbent assay (ELISA) on serum from hematology patients with suspected IA. Patients were categorized according to EORTC/MSGERC 2020 definitions into proven/probable IA and possible/no IA. The first cohort included 161 patients at four centers, and the VirCLIA manufacturer’s cutoff of 0.200 was evaluated. Next, the optimal cutoff was determined using the Youden’s index. In a second independent cohort of 189 patients from four centers, this optimal cutoff was evaluated again. In the first cohort, sensitivities and specificities for probable/proven IA were 21.1% and 100.0% for ELISA (1.0 cutoff) and 36.6% and 95.6% (0.5 cutoff), compared to 11.3% and 97.8% for CLIA (0.200 cutoff). In the second cohort, the sensitivities of ELISA and CLIA were comparable (ELISA ≥ 1.0: 33.3%, CLIA ≥ 0.200: 38.1%). The area under the ROC curve was lower for CLIA than for ELISA in the first cohort (65.0% vs 78.7%,
P
= 0.005) but comparable in the second cohort (79.5% vs 81.3%,
P
= 0.649). Youden’s index identified 0.100 as the optimal CLIA cutoff with sensitivities of 35.2% and 61.9% in cohorts 1 and 2, respectively, at slightly reduced specificities of 85.6% and 90.5%. While the sensitivity of both assays was low to moderate at best, in patients with a high pre-test probability, we suggest 0.100 as the cutoff for the VirCLIA assay.

IMPORTANCE

This study demonstrates a comparable performance of the novel chemiluminescence immunoassay (CLIA) and the conventionally used enzyme-linked immunosorbent assay for galactomannan serum testing in hematological patients at high risk for invasive aspergillosis. In patients with a high pre-test probability, a lower CLIA cutoff of 0.100 is preferred.
KRT9 is required for GBP5 suppression of human respiratory syncytial virus
Authors: Qu Xinglong , Zhu Ziqi , Zhou Xinpei , Wu Xuehan , Liu Xin , Sun Xiaoyu , Zhang Jiayue , Du Guanyi , Xue Runyu , Zhang Qianhua , Zhang Wenyan , Li Zhaolong
Published: January 2025

Respiratory syncytial virus (RSV) infections continue to plague infants, young children, and older individuals worldwide. Since there is no specific treatment for RSV, characterizing the interactions between RSV and host factors remains crucial for the eventual development of robust therapeutic interventions. In our previous study, guanylate binding protein 5 (GBP5) was shown to promote excessive RSV-small hydrophobic (RSV-SH) protein secretion by microvesicles and inhibited viral replication. In this study, using affinity mass spectrometry, keratin (KRT) 9 was identified to be required for GBP5 to trigger RSV-SH transport. Silencing KRT9 expression reduced the antiviral effects of GBP5 and interferon-γ. A direct interaction was detected between KRT9 and GBP5, but not RSV-SH; a GBP5 binding domain was identified on KRT9. Our results suggest that GBP5, as a bridge, interacts with KRT9 and RSV-SH, after which KRT9 triggers RSV-SH transport. The mechanism underlying the interaction between KRT9 and GBP5 explains the inability of the GBP5-C583A and GBP5-△C mutants in inhibiting RSV replication. Conversely, KRT1, KRT5, and KRT6C, which were identified as potential partners of KRT9, did not affect the GBP5 anti-RSV process. Overall, our study provides evidence for KRT9 involvement in host innate immunity for the first time.

IMPORTANCE

RSV causes severe acute lower respiratory tract infections, which have posed serious health and safety risks to children and older adults worldwide. Although some RSV interventions are available, the longer-lasting monoclonals, which are expensive, are required to be injected before RSV infection, and their protection is observed only up to one RSV infection season; vaccines are currently only available to the elderly but are not suitable for application in infants and young children. As specific drug treatments are absent, a systematic and in-depth mechanism for research is essential. In our study, KRT9 was identified to play an important role in the GBP5 anti-RSV process for the first time. This investigation improved the interaction mechanism between GBP5 and RSV, provided new evidence for the synergistic effect between keratin transport and innate immunity, and opened a new research direction with GBP5 and the keratin transport system as the main subjects.
Concussion and depressive symptoms in high school students: impact of physical activity and substance use
Authors: Wingerson Mathew J , Carry Patrick , Mannix Rebekah , Meier Timothy , Smulligan Katherine L , Wilson Julie C , Howell David R
Published: January 2025

Objective

To investigate the association between concussion history and depressive symptoms after adjusting for physical activity, substance use, and illicit drug use.

Methods

We analysed data from the Adolescent Behaviour and Experiences Survey, a nationally representative survey of adolescents in the USA. Our independent variables were history of concussion in the 12 months preceding survey completion; self-reported weekly physical activity (days per week with >60 min of physical activity, 0–7 scale); substance use over the past 30 days (yes vs no) and illicit drug use throughout lifetime (yes vs no). Our dependent variable was participant-reported sadness/hopelessness over the past 12 months (yes vs no).

Results

Among 7499 adolescents (9th–12th grade, 50.4% female), reporting one or more concussions over the past year was not associated with the odds of depressive symptoms (OR: 1.13, 95% CI: 0.93 to 1.37, p=0.21). Each additional day of physical activity per week was associated with a lower odds of depressive symptoms (OR: 0.91; 95% CI: 0.89 to 0.94; p<0.0001). Illicit drug use (OR ever vs never: 2.48; 95% CI: 1.96 to 3.13; p<0.0001) and substance use (OR yes vs no: 2.77; 95% CI: 2.34 to 3.29; p<0.001) were associated with a higher odds of depressive symptoms.

Conclusions

Adjusting for physical activity, substance use and illicit drug use, concussion was not significantly associated with depressive symptoms. This novel discovery informs clinicians as they counsel adolescents with concussion; future research should examine physical activity and avoidance of substance/illicit drug use as postinjury recommendations in an effort to lower the risk of depressive symptoms.
To what extent do the prevalence of sickness presence and reasons for sickness presence vary between school classes in upper secondary schools? A cross-sectional survey in Trøndelag county, Norway
Authors: Johansen Vegard
Published: January 2025

Objectives

This paper investigated sickness presence (SP) among students in academic upper secondary schools (USS). The research question asked was: To what extent do the prevalence of SP and reasons for SP vary between school classes in USS in Norway?

Design

A cross-sectional survey was done in the final year of USS. Multilevel modelling was used to estimate school class-level effects.

Setting

71 school classes from 13 Norwegian schools participated in the study in April 2018.

Participants

1955 students in academic education programmes were invited to participate in the survey, and 1511 completed it. The response rate was 77%. 58% of the respondents were female students.

Outcome measures

The outcome measures were the number of SP incidents and reasons for practising SP in school. The analysis examined factors that influenced the prevalence of and reasons for SP.

Results

54% of the students reported two or more incidents of SP. The primary reason for reporting SP was attendance pressure, including factors such as not wanting to exceed the absence limit (90%), concerns that high school absences could negatively affect grades (65%) or reduce chances of getting a job (61%). Some students reported positive reasons for SP, such as maintaining social connections (32%). Multilevel modelling indicated that the class-level effect on the prevalence of SP incidents and positive attendance reasons accounted for 5% of the variance. Some of the class-level effect was due to contextual factors (eg, student relations) and less was due to compositional factors (eg, gender distribution).

Conclusions

The study discovered significant variations in SP between school classes, suggesting that students’ attitudes and behaviours towards SP can influence their peers. Moreover, attendance pressure factors for SP were more frequently reported than positive attendance factors.
Breastfeeding empowerment and its relationship with health literacy and spousal support among breastfeeding mothers in Tabriz, Iran: a cross-sectional study
Authors: Targhaq Shaqayeq , Hosseinzadeh Mina , Mirghafourvand Mojgan , Mousavi Zahra
Published: January 2025

Background

Breast milk is crucial for the health and survival of infants, but exclusive breastfeeding often fails due to various reasons such as lack of breastfeeding empowerment.

Objectives

This study aimed to determine the status of breastfeeding empowerment and its relationship with health literacy and perceived spousal support among breastfeeding mothers while recognising that other related factors also contribute to breastfeeding empowerment.

Design

Cross-sectional study.

Setting

Primary health centres of Tabriz city, Iran.

Participants

Included 342 breastfeeding mothers with infants aged 6 months or younger in Tabriz, Iran.

Results

The mean (SD) scores for breastfeeding empowerment, health literacy and partner support were 141.98 (33.92) out of a possible range of 37 to 185, 126.08 (21.27) out of a possible range of 33 to 165 and 64.95 (12.62) out of a possible range of 20 to 100, respectively. Based on the adjusted general linear model, for every unit increase in perceived spousal support, women’s breastfeeding empowerment score increased significantly (B=0.546; 95% CI 0.29 to 0.79; p<0.001). Additionally, working mothers had a significantly higher breastfeeding empowerment score compared with housewives (B=13.91; 95% CI 0.88 to 27.73; p=0.04), and currently, breastfeeding mothers had a significantly higher score compared with mothers who were not currently breastfeeding (B=72.26; 95% CI 60.42 to 84.10; p<0.001).

Conclusions

The findings of this study underscore the critical role of perceived spousal support in enhancing breastfeeding empowerment among mothers. By encouraging spousal involvement, families can create a supportive environment that values and facilitates breastfeeding. Healthcare providers also can play an essential role in offering guidance and resources to both mothers and their partners. By emphasising the importance of spousal support in breastfeeding, a supportive culture can be fostered that values breastfeeding as a natural aspect of motherhood.
Is first-line treatment with polatuzumab vedotin–rituximab–cyclophosphamide, doxorubicin and prednisone (pola-R-CHP) for previously untreated diffuse large B-cell lymphoma cost-effective in China? A cost-effectiveness analysis using a Markov model
Authors: Dong Liangliang , Zhong Wanfu , Chen Ting , Zhao Qiuling , Liu Wenbin , Qiu Xiuliang , Huang Ruyi , Huang Shengqiang , Xie Ruixiang , Yang Lin
Published: January 2025

Objective

To evaluate the cost-effectiveness of polatuzumab vedotin–rituximab–cyclophosphamide, doxorubicin and prednisone (pola-R-CHP) in CD20-positive patients with previously untreated diffuse large B-cell lymphoma (DLBCL) in China.

Design

A Markov model was constructed to analyse the cost-effectiveness of two strategies in CD20-positive patients with previously untreated DLBCL over a lifetime horizon: (1) pola-R-CHP and (2) rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP). The clinical outcomes were obtained from the POLARIX(NCT03274492), SCHOLAR-1, ZUMA-7(NCT03391466) and TRANSFORM(NCT03575351) trials. Costs were derived from the Chinese official websites and published literature, and utility values were obtained from the published literature. The willingness-to-pay (WTP) threshold was set at triple the 2023 Chinese per capita gross domestic product of US$38 042.49/quality-adjusted life year (QALY). Uncertainty was addressed using sensitivity analyses. The scenario analyses were also conducted.

Setting

Chinese healthcare system perspective.

Participants

A hypothetical cohort of adult patients presenting with CD20-positive, patients with previously untreated DLBCL.

Interventions

Pola-R-CHP versus R-CHOP.

Main outcome measures

The main outcomes of the study were QALYs, incremental cost-effectiveness ratio (ICER) and incremental net-health benefit (INHB).

Results

In China, the ICER and INHB of pola-R-CHP compared with R-CHOP were US$77 036.33/QALY and −1.11 QALYs, respectively. The ICER was above the WTP threshold. Outcomes were most responsive to the price of pola. Probabilistic sensitivity analyses indicated that pola-R-CHP had a low probability of being cost-effective under the current WTP threshold. The scenario analyses demonstrated that when the price of pola fell by more than 32.5% to less than US$33.19/mg, the economic probability of pola-R-CHP was greater than 50% in previously untreated CD20-positive patients with DLBCL in China.

Conclusions

Pola-R-CHP is not cost-effective in the first-line treatment for previously untreated CD20-positive DLBCL in China. A value-based price for the cost of pola is less than US$33.19/mg.
Transfer from long-term care to acute care and risk of new permanent cognitive or physical disability among long-term care residents in Canada: protocol for a retrospective cohort study
Authors: Yin Christina Y , Scott Mary M , Talarico Robert , Hakimjavadi Ramtin , Kierulf Jackie , Webber Colleen , Hawken Steven , Moledina Aliza , Manuel Doug , Hsu Amy , Tanuseputro Peter , Fung Celeste , Kaasalainen Sharon , Molnar Frank , Shamon Sandy , McIsaac Daniel I , Kobewka Daniel
Published: January 2025

Introduction

Long-term care (LTC) residents are frequently transferred to acute care hospitals. Transfer decisions should align with residents’ wishes and goals. Decision to transfer to hospital, when not aligned with the resident’s wishes, can result in transfers that are harmful to residents, leaving residents in a state of disability that could be considered worse than death. We aim to examine whether transfer to an acute care hospital is associated with subsequent new onset of severe permanent physical and cognitive disability in LTC residents.

Method and analysis

We will conduct a retrospective cohort study of all LTC residents ≥65 admitted to LTC homes between 1 April 2013 and 31 March 2018 in Ontario, Canada. We will use health administrative data from the Continuing Care Reporting System (CCRS), National Ambulatory Care Reporting System (NACRS) and Registered Persons Databases (RPDB), which include data on emergency department visits, hospitalisations, demographic information and mortality. All participants will be followed until 31 March 2023. The exposure is any transfer from LTC to an emergency department or acute care hospital. The outcomes are (1) subsequent new permanent physical disability, (2) subsequent new permanent cognitive disability and (3) all-cause mortality. Due to the time-varying nature of the exposure and confounders, we will use an extended cause-specific Cox regression model to explore this relationship. We will fit marginal structural models (MSMs) to account for the known shortcomings of traditional regression modelling, such as collider bias. Lastly, we will use a preference-based instrumental variable approach to address unmeasured confounders.

Ethics and dissemination

Ethics approval was obtained through Bruyère Research Institute Ethics Committee (REB#M16-23-030). Study findings will be submitted for publication in a peer-reviewed journal. Findings will be disseminated in conferences and seminars.

Trial registration

Open Science Framework (https://doi.org/10.17605/OSF.IO/JCDEY).
Barriers and facilitators to the implementation of the Assessment of Burden of Chronic Conditions tool in Dutch primary care: a context analysis
Authors: Claessens Danny , Boudewijns Esther A , Vervloet Marcia , Keijsers Lotte C E M , Gidding-Slok Annerika H M , van Schayck Onno C P , van Dijk Liset
Published: January 2025

Objectives

The Assessment of Burden of Chronic Conditions (ABCC) tool is developed to facilitate a personalised approach to care through assessment and visualisation of a patient’s experienced burden of disease, and integrating this in the conversation based on shared decision-making and individualised care plans. An indispensable step in the implementation process is an understanding of the context. The aim of this study is to perform a context analysis to identify barriers and facilitators to the implementation of the ABCC tool by healthcare providers (HCPs) in Dutch primary care.

Design

A qualitative context analysis was performed among HCPs prior to using the ABCC tool. The Consolidated Framework for Implementation Research was used to map contextual influences through semistructured interviews. A deductive coding process and content analysis was applied to identify barriers and facilitators for the implementation of the ABCC tool.

Participants

HCPs who participated as interventionists in an effectiveness study were recruited for this study.

Results

17 HCPs (16 practice nurses and 1 general practitioner) participated. Data saturation was reached at the 11th interview. HCPs expected several major barriers to the implementation of the ABCC tool:too many different digital environments, high complexity in access, lack of time, no integration of the ABCC tool in guidelines and care standards, and patients not willing to adopt an active role in their care process. The major facilitators for implementation were a clear perception of the ABCC tool’s benefits, high compatibility with and relative advantage over current practices and being part of a progressive work culture that stimulates innovation.

Conclusions

This study provides insight in the barriers and facilitators to the implementation of an intervention in the patient–HCP conversation. Barriers were present in complexity, available resources, patient needs and resources, and external policies and incentives while facilitators were present in knowledge and beliefs, implementation climate and culture. These barriers and facilitators provide opportunities for the selection and tailoring of implementation strategies for the ABCC tool.
High-intensive physical rehabilitation approach in children and adolescents with acquired brain injury during subacute phase (REHABILITY): a feasibility study protocol
Authors: Gmelig Meyling Christiaan , Verschuren Olaf , Rentinck Ingrid , van der Steen Irene , Engelbert Raoul , Gorter Jan Willem
Published: January 2025

Introduction

While principles of neuroplasticity and motor learning emphasise the potential of high dosage of physical rehabilitation in children and adolescents with acquired brain injury (ABI) during the subacute phase, we lack empirical evidence to demonstrate its impact in terms of meaningful outcomes. Clinical research is needed to investigate adequate dosage of physical rehabilitation and its effects on outcomes with reliable and validated outcome measurements. In this study we will investigate the feasibility of a highly intensive physical rehabilitation intervention and outcomes with reliable and valid outcome measurements.

Methods and analysis

Our study with a prospective case-series design will evaluate (1) The safety and feasibility of a high-intensive physical rehabilitation programme to improve functioning and participation in children and adolescents with ABI, and (2) The feasibility of a core set of clinical outcome measures to assess recovery on relevant International Classification of Functioning, Disability, and Health domains during the subacute phase. We aim to include 10–15 children and adolescents aged 6–20 years with moderate-severe ABI during subacute rehabilitation in a specialised youth department for inpatient rehabilitation in The Netherlands. In the rehabilitation programme, we aim at a highly intensive approach of 3–5 hours physical rehabilitation per day during inpatient rehabilitation. Frequent and systematic assessment (baseline, each consecutive 6 weeks -if applicable- and at discharge) through a core set of outcome measures will provide insights into the degree of recovery of motor and cognitive functioning. We use descriptive and inferential statistics and thematic content analysis for analysis of the data.

Ethics and dissemination

The study has been approved by the Medical Ethics Research Committee of the University Medical Hospital, Utrecht (reference number: 23U-0628). We aim to disseminate our findings in peer-reviewed journals and present at national and international conferences.
Exploring the quality of end-of-life care in the intensive care unit: a qualitative multiple case study approach with family members of Muslim patients
Authors: Nayfeh Ayah , Conn Lesley Gotlib , Dale Craig , Fowler Robert
Published: January 2025

Objective

Muslim patients are an underrepresented community in end-of-life care research, with little evidence around factors that influence the quality and experience of care. The aim of this study was to explore the quality of end-of-life care in the intensive care unit (ICU) from the perspective of next-of-kin family members of Muslim patients.

Design

A qualitative multiple case study design using semistructured interviews with family members of Muslim patients. Healthcare providers’ notes from the patient medical record were also used to contextualise the patient care experience and medical journey. Data were analysed using deductive content analysis.

Setting

A large academic tertiary care hospital in Toronto, Canada.

Participants

Next-of-kin family members of Muslim patients (≥18 years) who were admitted to the ICU and died in hospital between October 2019 and December 2021.

Results

Family members of five Muslim patients of South Asian descent were recruited for this study. Four central themes were identified: (1) trust and confidence in the healthcare team overseen by medical experts; (2) quality communication with medical experts; (3) achieving patient goals of care; and (4) dignity of care through cultural respect and emotional support. Culture, religion and religiosity did not appear to have a major influence on the medical decision-making process. Communication, emotional and psychological well-being for patients, and cultural respect were identified as possible areas for quality improvement.

Conclusions

Our findings identified central themes in the quality of end-of-life care for families of seriously ill Muslim patients. These insights can inform clinical processes and interventions to improve the quality of care and reduce psychological and emotional burden at the end of life.
Evaluating the implementation and impact of a volunteer navigation oncology support programme: study protocol for a pragmatic, real-world hybrid type 2 study
Authors: Rocque Gabrielle B , Dent D'Ambra N , Waugh Charlotte , Hill Emily K , Federman Noah , Bostock Rosenzweig Ian , Morris Bonny , Kamal Arif
Published: January 2025

Introduction

Patient navigation is recommended by accrediting bodies such as the Commission on Cancer and is a key element in payment reform demonstration projects, due to the established benefits in reducing barriers to healthcare, improving care coordination and reducing healthcare utilisation. However, oncology practices are often resource constrained and lack the capacity to extend navigation services at the desired intensity for their patient population. The American Cancer Society (ACS) developed the ACS Community Access to Resources, Education, and Support (CARES) programme to expand navigation capacity through the training of students from local universities as volunteers to serve as non-clinical navigators to support cancer patients. Although this approach has great potential for scalability, the best approach to early implementation and impact of volunteer navigation remains unclear.

Methods and analysis

This pragmatic single-arm pre–post study evaluates the implementation and effectiveness of volunteer navigation for patients participating in the 2023–2024 pilot. This study will use data collected during routine care for quantitative implementation and patient outcomes. The Updated Consolidated Framework for Implementation Research will guide evaluation of early programme implementation with three initial pilot sites. This pragmatic evaluation of real-world implementation of volunteer navigation in the oncology setting will support future efforts to scale-up this intervention across US health systems.

Ethics and dissemination

This study was approved by University of Morehouse School of Medicine Social and Behavioral (IRB), which served as the IRB for record for this project (IRB-2025819–2). No consent required for this study protocol. ACS CARES plans to disseminate this model and include additional sites as participants in future years.
Measuring the patient safety climate in community pharmacies: an updated national survey
Authors: Ljungberg Persson Christina , Nordén Hägg Annika , Södergård Björn
Published: January 2025

Background

The patient safety climate in community pharmacies was measured nationally in Sweden in 2008. Since that time the Swedish pharmacy market has undergone a re-regulation which probably has affected the patient safety climate in pharmacies.

Objectives

The aim was to evaluate the patient safety climate among pharmacists working in Swedish community pharmacies and compare it with historical data.

Design

The patient safety climate among pharmacists was analysed in two cross-sectional surveys. Historical data from 2008 and data collected in 2022 were compared. The Safety Attitudes Questionnaire (SAQ), containing items on safety culture arranged in six dimensions, was used in both surveys. It uses a 5-point Likert scale to create a quantitative description of the respondents’ perception of patient safety climate.

Setting

Community pharmacies in Sweden.

Participants

These surveys were census studies because all pharmacists working in community pharmacies in Sweden were invited to participate and no sampling occurred.

Results

The number of respondents was 2738 in 2008 and 1931 in 2022. The patient safety climate in Swedish community pharmacies appears to have worsened between 2008 and 2022 according to the pharmacists. All values of the dimensions included in the SAQ have decreased, except for the dimension of Stress Recognition, where an increase indicated a larger awareness among the pharmacists of how stress impacts their work. The overall negative trend in SAQ values seen between 2008 and 2022 was consistent, irrespective of the respondent’s level of education, their role in the pharmacy or the number of years since their education was completed.

Conclusions

The patient safety climate in community pharmacies in Sweden seems to have deteriorated. With an increasingly strained healthcare system, community pharmacists must be reliable defenders of patient safety, and it is essential to ensure that the climate in their workplace supports the important work being carried out.
Impact of immigration-specific stress on safety attitudes: a national cross-sectional study on overseas qualified nurses in Japan
Authors: Chang Xinyi , Gu Xiuzhu
Published: January 2025

Background

Many countries have addressed the global issue of nursing shortage by recruiting overseas nurses who are also qualified in the host country. Nevertheless, such nurses may encounter various obstacles in their personal and professional lives in the host country, leading to apprehensions about their perceptions of workplace safety in healthcare organisations.

Objective

This study investigated the current state of immigration-specific stress among overseas qualified nurses (OQNs) working in Japan and its impact on safety attitudes.

Settings

Invitation letters with a Quick Response (QR) code for a survey were sent to 119 hospitals across Japan that accepted OQNs as per the Ministry of Health, Labour and Welfare. Additionally, the survey QR code was shared with OQN-specific social media groups.

Participants

The inclusion criteria were being born and having received basic nursing education outside Japan, passing the Japanese national nursing examination, and current employment in the Japanese healthcare organisations. Valid responses were received from 214 OQNs.

Methods

Data were collected via an online survey, including the Demands of Immigration Scale and Safety Attitudes Questionnaire-Short Form (SAQ-SF) to measure stress and safety attitudes evaluation, respectively. Spearman’s correlation analysis and a generalised linear model were used to analyse the relationship between immigration-specific stress and safety attitudes as perceived by OQNs.

Results

The findings showed that various safety attitude dimensions were significantly impacted by stressors such as ‘Not at home’, ‘Occupation’ and ‘Discrimination’. Notably, ‘Occupation’ disadvantages perceived by OQNs significantly affected all the safety attitude dimensions, such as ‘Teamwork climate’ (B=−5.69, [−7.78, –3.60], p<0.001), ‘Job satisfaction’ (B=−9.38, [−12.32, –6.44], p<0.001) and ‘Stress recognition’ (B=5.86, [3.17, 8.54], p<0.001).

Conclusions

The findings underscore the significance of implementing effective strategies such as enhancing the sense of belonging, providing better career advancement prospects and opportunities and addressing workplace discrimination to improve safety attitudes among OQNs. These interventions are crucial for enhancing patient safety in Japan.
Enhancing patient engagement: the influence of an in-consult patient decision aid on shared decision-making for lung tumour radiation – protocol for the randomised trial ‘SDM Lung SBRT’
Authors: Fink Thomas Leth , Hansen Torben Frøstrup , Kristiansen Charlotte , Hansen Torben Schjødt , Thing Rune Slot , Timm Signe , Steffensen Karina Dahl
Published: January 2025

Introduction

Patient engagement is continuously being promoted by patients as well as politicians and healthcare professionals. One way of increasing patient engagement is by using shared decision-making (SDM), which is a joint effort of clinicians and patients making decisions together.

When planning stereotactic body radiation therapy (SBRT) for a lung tumour located close to the thoracic wall, there are conflicting interests between (1) delivering the highest possible dose to obtain local tumour control and (2) reducing the dose to the thoracic wall to decrease the risk of chest wall pain and rib fractures following treatment. The radiation oncologist often makes the choice of dose without any engagement of the patient. We believe that the patients should be engaged in such a decision.

To explore this matter, we have designed a randomised trial, ‘SDM Lung SBRT’, for which we present our study protocol with a special focus on a patient decision aid (PtDA), which is being tested in this trial.

Methods and analysis

This study includes patients with a lung tumour located ≤1 cm from the thoracic wall. Patients are randomised to have the primary consultation with or without use of the PtDA. Treatment options are a radiation dose of either 66 Gray (Gy) in three fractions, 45 Gy in three fractions or no treatment. The primary outcome is patient engagement in decision-making measured by the validated observer-rated OPTION-12 score. Secondary outcomes are patient-reported outcomes, quality of life and side effects following treatment.

Ethics and dissemination

All patients give informed consent to participate. According to Danish legislation, ethical approval is not required for this study as studies using questionnaires, observations or other non-biological studies are not considered interventions according to the Committee Act. Results from this study will be presented at scientific meetings and published in English peer-reviewed journals.

Trial registration number

ClinicalTrials.gov (NCT04940936).
Comfortable knowing little about lymphoedema? A qualitative study of medical interns in Australia
Authors: Kruger Natalie , Plinsinga Melanie , Window Peter , Hayes Sandra , Bunzli Samantha
Published: January 2025

Objectives

Knowledgeable doctors are needed for timely assessment, diagnosis and management of lymphoedema. This qualitative study explored the thoughts and feelings of Australian interns (medical graduates in their first postgraduate year) towards (i) their understanding of the lymphatic system and lymphoedema, (ii) curricula pertaining to lymphoedema within their Australian medical degree and (iii) how they perceive that their understanding and medical training in lymphoedema influence their clinical practice.

Study design and methods

Qualitative semistructured interviews were conducted with interns employed within their first postgraduate year in Australia. Interviews were conducted via Microsoft Teams or telephone, video-recorded, transcribed verbatim and analysed using thematic analysis. Inductive (data-driven) codes identified in the data were organised into themes.

Results

The overarching theme was one of ambivalence. Participants noted that they had knowledge gaps related to lymphoedema (theme 1), but were not concerned by them, as they did not consider lymphoedema a condition they were expected to know about at medical school or in clinical practice (theme 2). Furthermore, they questioned the relevance of lymphoedema to their role (theme 3) and they considered lymphoedema care to be the responsibility of others (theme 4).

Conclusion

These findings suggest a discord between what interns in this study recall being taught about lymphoedema and what current literature suggests newly graduated doctors should know. Future research is needed to explore the extent to which these findings extend to the perceptions of more senior doctors and how these findings impact the unmet needs of people with lymphoedema in Australia.
Effect of a multimodal analgesia strategy on remifentanil daily consumption in mechanically ventilated adult ICU patients: study protocol for a randomised, placebo-controlled, double-blind, parallel-group clinical trial
Authors: Widehem Remy , Nicolet Camille , Delannoy Violaine , Barthelemi Laurie , Soulairol Ian , Lefrant Jean-Yves , Mura Thibault , Roger Claire
Published: January 2025

Introduction

Intensive care unit (ICU) patients under mechanical ventilation experience mild-to-severe pain. International guidelines emphasise the importance and benefits of multimodal analgesia to minimise opioid consumption and its side effects. However, no recommendation about drugs or protocol has been formulated. The aim of the Opioid-Free Analgesia in Intensive Care Unit study is to assess the feasibility of a standardised multimodal analgesia strategy and its benefits following the impact of remifentanil sparing in ICU patients.

Methods and analysis

50 mechanically ventilated adult patients will be recruited in a randomised, placebo-controlled, double-blind, feasibility trial. In the interventional group, patients will receive a standardised multimodal analgesia, initially receiving nefopam and tramadol, implementing with ketamine if patients remain painful, and then implementing with remifentanil with escalating doses in case of insufficient analgesia. In the control group, patients will receive remifentanil, implementing doses gradually to achieve analgesia. The primary outcome will be the daily consumption of remifentanil between the 24th and 48th hour after inclusion. Secondary outcomes will include drug tolerance, mechanical ventilation duration, ICU and hospital length of stay, 28-day and 90-day mortalities and 90-day opioid consumption.

Ethics and dissemination

The study protocol was accepted by the Nîmes University Hospital’s research committee, the French ethics committee (Institutional Review BoardOUEST IV) and the French National Agency for the Safety of Medicines and Health Products (ANSM).

Trial registration number

ClinicalTrials.gov:NCT05825560
Childhood violence exposure and its contributing factors in Indonesia: a secondary data analysis of the National Survey on Children and Adolescents’ Life Experience
Authors: Amalia Dwi Octa , Sabarinah Sabarinah , Siregar Kemal N , Hadi Ella Nurlaella
Published: January 2025

Objectives

Childhood violence exposure is a public health concern that has long-term impacts on health and well-being. This study aims to identify the factors contributing to childhood violence exposure.

Design

This study conducted a secondary data analysis to examine childhood violence exposure.

Setting

The study uses the National Survey on Children and Adolescents’ Life Experience, a cross-sectional national survey conducted by the Indonesian Ministry of Women’s Empowerment and Child Protection in Indonesia in 2021.

Participants

A total of 4903 children aged 13–17 years participated in the survey.

Outcome measures

The dependent variable was childhood violence exposure. The independent variables included gender, education level, occupation, living arrangement, orphan status, witnessing violence, marital status and residence. Descriptive statistics, χ2test and logistic regression were performed for analysis.

Results

The research findings indicate that nearly half of the children are exposed to violence, with a prevalence rate of 46.2% (95% CI 43.6% to 48.8%), including physical (13.8%), emotional (41.6%) and sexual (6.9%) violence exposure. Factors associated with violence exposure include being a working children (OR 1.85; 95% CI 1.48 to 2.32), not living with biological parents (OR 1.25; 95% CI 1.02 to 1.54) and witnessing violence in the home or neighbourhood (OR 6.78; 95% CI 5.78 to 7.97), all of which increase the risk of childhood violence exposure.

Conclusions

The findings highlight the necessity to focus on vulnerable groups such as working children, those not living with biological parents and children exposed to violence in the home. Policies and practices should prioritise identifying these at-risk children and provide targeted support through community-based early detection and intervention programmes. Strengthening awareness among stakeholders, including parents, educators and community leaders, will be essential to effectively reduce childhood violence exposure. Future research should explore the practical application of early detection strategies to better support these vulnerable groups.
Antenatal pelvic floor muscle exercise intervention led by midwives in England to reduce postnatal urinary incontinence: APPEAL feasibility and pilot randomised controlled cluster trial
Authors: MacArthur Christine , Bick Debra , Salmon Victoria , Jones Ellie , Hay-smith Jean , Bishop Jonathan , Gkini Eleni , Hemming Karla , Webb Sara , Pearson Mark , Coleman Tim , Terry Rohini , Edwards Elizabeth , Frawley Helena , Oborn Eivor , Dean Sarah
Published: January 2025

Objectives

To assess the feasibility of an intervention of midwifery support for antenatal pelvic floor muscle exercises (PFME) to prevent postnatal urinary incontinence (UI).

Design

Feasibility and pilot cluster randomised controlled trial. Clusters were community midwifery teams.

Setting

Community maternity antenatal care.

Participants

One hundred seventy-five women; 186 midwives.

Intervention

Midwifery training and resources for midwives and women to support antenatal PFME. Control clusters continued standard care.

Outcomes

Women reporting: that their midwife explained how to do PFME, PFME adherence and postpartum UI. Midwives reporting: pre-post-training PFME confidence, intervention acceptability. Fidelity of training delivery and implementation.

Results

Ninety-five midwives in intervention clusters; 91 midwives in control clusters. Of 998 women sent questionnaires, 175 responded: 15.8% in intervention, 16.4% in control clusters. Women’s characteristics in both trial arms were similar and characteristics of respondents and non-respondents were similar. Sixty-five percent (95% CI 56.9% to 72.4%) of women in intervention clusters reported their midwife explained how to do PFME vs 38% (95% CI 24.6% to 51.2%) in control clusters. Fifty percent (95% CI 24.1% to 77.1%) of women in intervention clusters vs 38% (95% CI 12.4% to 67.1%) in control clusters reported doing enough PFME to potentially prevent UI. Fourty-four percent (95% CI 32.0% to 56.1%) of women in intervention clusters reported UI vs 54% (95% CI 42.2% to 65.8%) in control clusters.

Intervention training was delivered with fidelity and received positively. Midwives reported improvements in PFME confidence/knowledge (median increase of at least 1 point on a 0–4 scale for each of eight questions). Midwives (26%) most frequently reported insufficient time as an implementation barrier.

Conclusions

This pilot trial produced consistent new findings that training and resourcing midwives to teach and support pregnant women to undertake PFME is acceptable and feasible for women and midwives. It increased the number of women who are informed about PFME, with potential to improve PFME adherence and reduce postpartum UI. Recent changes to the National Health Service perinatal pelvic healthcare means a full trial is not possible.

Trial registration number

ISRCTN10833250.