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Community health nurses play a vital role in delivering preventive, promotive, curative, and rehabilitative healthcare services through home visits and outreach programs. The community nursing bag has long served as an essential tool for carrying supplies, equipment, medications, and records required for field-based nursing care. However, conventional community bags face several limitations, including infection-control concerns, excessive weight, poor ergonomic design, environmental impact, and limited integration with digital technologies. These challenges necessitate the modernization of traditional community nursing bags to meet the evolving demands of contemporary healthcare practice. This review explores the concept of eco-smart and technology-integrated community nursing bags as innovative solutions for enhancing field-based nursing care. This review discusses the traditional community bag technique, existing practices, and major challenges associated with conventional bags. It further examines eco-smart innovations such as sustainable fabrics, reusable sterilizable kits, biodegradable packaging, solar-powered charging systems, and water-resistant eco-friendly materials that promote environmental sustainability and improve usability. Technological advancements, including portable diagnostic devices, digital documentation systems, telehealth connectivity, Global Positioning System (GPS) technology, artificial intelligence (AI), and Internet of Things (IoT)-enabled applications, are highlighted for their potential to improve assessment, communication, continuity of care, and patient monitoring. This review also addresses infection-prevention enhancements such as antimicrobial surfaces, UV sterilization units, contamination-control compartments, and integrated hand hygiene systems. The relevance of these innovations to rural healthcare, disaster response, maternal and child health services, and geriatric home care is discussed. Additionally, challenges related to cost, training, digital literacy, and infrastructure limitations are examined. Future directions emphasize policy support, curriculum reform, research, and prototype development. Reimagining the community nursing bag as an eco-smart and technology-enabled system has the potential to improve healthcare accessibility, patient safety, sustainability, and quality of care, thereby strengthening community and public health nursing practice in the digital era.

Dengue is an arboviral disease of major public health relevance in Colombia, where recurrent endemic-epidemic transmission intersects with climatic variability, urbanization, population mobility, co-circulation of viral serotypes and lineages, seasonal healthcare pressure, and substantial direct and indirect costs. Although dengue prevention and response in Colombia include epidemiological surveillance, clinical diagnosis, management of warning signs, vector-control activities, outbreak response, and assessment of preventive interventions, these components may be implemented unevenly across territories and may remain insufficiently integrated with health system planning, operational readiness, and economic risk assessment. This technical report proposes an evidence-informed conceptual preparedness framework for dengue in Colombia. The framework was developed through a structured narrative synthesis of peer-reviewed evidence, preparedness-oriented guidance, and Colombia-specific epidemiological, clinical, operational, and health system considerations. It is intended to complement, rather than replace, existing dengue surveillance, prevention, and response strategies by organizing decision points across five interrelated domains: surveillance-to-action, risk-stratified clinical triage, adaptive vector control, contextual vaccination assessment, and healthcare response capacity. A cross-cutting economic risk-mapping component is included to identify relevant cost domains and potential pathways of preventable burden related to outpatient care, hospitalization, productivity loss, outbreak response, severe disease, and healthcare service saturation, without constituting a formal economic evaluation. The framework emphasizes territorial prioritization, timely translation of risk signals into action, early recognition of patients at risk of progression, alignment between community-based interventions and healthcare capacity, and contextual assessment of emerging tools such as tetravalent dengue vaccines and Wolbachia-based vector strategies. It also recognizes implementation constraints, including data interoperability, laboratory and genomic capacity, workforce availability, territorial inequities, financing, pharmacovigilance, governance, and feasibility of local adoption. Future evaluation should assess operational indicators such as signal-to-alert time, triage performance, severe dengue incidence, hospitalization, healthcare resource utilization, stock availability, equity, and cost-effectiveness. In heterogeneous endemic settings, this conceptual framework may support more coordinated dengue preparedness; however, its operational usefulness, economic value, scalability, and policy relevance require stakeholder validation, territorial adaptation, pilot implementation, and prospective evaluation.

To evaluate the 2-year efficacy of cylindrical annular refractive elements (CARE) spectacle lenses in slowing myopia progression in European children. Multicenter, double-masked, randomized controlled trial. Children aged 6 to 13 years with documented myopia progression of at least < -0.50 diopters (D) in the preceding 12 months. Participants were assigned to CARE or single-vision lenses (SVL). Cycloplegic spherical equivalent (SE) and axial length (AL) were measured at baseline, 12, and 24 months. Changes in SE and AL over 24 months, and the proportion of rapid progressors (defined as SE change &#x2264; -0.75 D and AL increase &#x2265; +0.30 mm over 24 months). Of the 234 enrolled children, 208 completed the 24-month follow-up. At baseline, mean age was 10.0 &#xb1; 1.9 years and mean SE was -2.20 &#xb1; 0.94 D. All participants met the inclusion criterion of documented myopia progression of at least -0.50 D in the preceding 12 months. At 12 months, CARE lenses slowed both SE and AL progression compared with SVL (both P < 0.001). At 24 months, myopia progression remains lower with CARE than SVL lenses in SE (-0.32 &#xb1; 0.20 D vs. -0.69 &#xb1; 0.18 D; P < 0.001) and AL (0.21 &#xb1; 0.11 mm vs. 0.43 &#xb1; 0.10 mm; P < 0.001). Moreover, the proportion of rapid progressors was lower in the CARE than in the SVL group (30.8% vs. 71.4%; P < 0.001). Younger children in the SVL group progressed faster, while CARE lenses mitigated age-related differences. Cylindrical annular refractive elements lenses effectively slowed myopia progression in European children, with sustained efficacy over 2 years. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Acute myocardial infarction (AMI) mortality has declined over the past decade, but sex- and race/ethnic differences remain. We assessed trends in incident AMI mortality stratified by sex and race/ethnicity across separate time periods following hospitalization, which could help target efforts to reduce disparities in care. We identified 578,274 Medicare fee-for-service beneficiaries hospitalized with incident AMI from 2008 to 2018 (mean age 80.94, 47.17% men, 86.81% White) and assessed annual mortality for the following periods: in-hospital, post-discharge (0-30&#xa0;days post-discharge), intermediate-term (31 to 365&#xa0;days post-discharge), and longer-term (1-3&#xa0;years post-discharge). Patients who died during one period were not counted in subsequent periods. Risk-adjusted mortality ratios stratified by sex and race/ethnicity were calculated using mixed-effects generalized linear models. The 2008 mortality for men (compared to women) and White patients (compared to Black and Hispanic patients) was considered the baseline. Unadjusted mortality declined across all time periods and for all subgroups from 2008 to 2018. In adjusted analyses, in-hospital and post-discharge mortality was similar for women compared to men and for Black and Hispanic patients compared to White patients. However, women compared to men and Black patients compared to White patients had higher mortality for the intermediate-term and longer-term follow-up periods for all years studied (e.g., 2008 longer-term mortality for men 1.00 (95% CI 0.97-1.02) and for women 1.10 (95% CI 1.06-1.14); 2016 longer-term mortality for men 0.77 (95% CI 0.75-0.8) and for women 0.87 (95% CI 0.84-0.9); 2008 longer-term mortality for White patients 1.00 (95% CI 0.98-1.01) and for Black patients 1.22 (95% CI 1.15-1.30); 2016 longer-term mortality for White patients 0.78 (95% CI 0.70-0.80) and for Black patients 1.03 (95% CI 0.96-1.10)). Incident AMI mortality declined from 2008 to 2018 across all subgroups and follow-up periods. However women and Black patients had persistently higher mortality compared to men and White patients from 31&#xa0;days to 3&#xa0;years post-discharge. Opportunities to reduce disparities in AMI care might be particularly effective in longitudinal outpatient care following hospital discharge.

Febrile neutropenia remains one of the most urgent and clinically challenging complications in oncology care, where timely recognition and decision-making can significantly influence outcomes. While traditional risk assessment tools have long supported clinicians in stratifying patients, they are limited in their ability to adapt to the complexity and rapidly changing nature of clinical situations. In this context, artificial intelligence (AI) is increasingly being explored as a way to complement existing approaches and support more responsive and individualized care. This editorial discusses how the role of AI in febrile neutropenia is evolving, moving from static risk scoring systems toward the possibility of real-time clinical decision support. It highlights both the potential of these tools to enhance clinical workflows and the practical challenges that still need to be addressed before widespread adoption. As these technologies continue to develop, careful integration into clinical practice may help improve how clinicians assess risk and manage patients with febrile neutropenia.

Venous leg ulcers (VLUs) result from a multifactorial interplay of etiological factors, posing significant challenges in clinical management. Effective treatment requires a comprehensive assessment to identify the underlying pathophysiological mechanisms, followed by the implementation of an individualized, multidisciplinary approach that integrates the expertise of vascular surgeons, wound care specialists, and other pertinent healthcare professionals. Although both domestic and international vascular surgery societies, as well as other relevant specialties, have issued consensus statements on the diagnosis and treatment of VLUs or clinical guidelines for managing chronic lower extremity venous diseases, there remains a notable gap in systematic guidance specifically focused on wound repair for VLUs. In particular, standardized protocols for surgical wound repair are either lacking or insufficiently detailed in these documents. With the establishment and advancement of wound repair as a specialized field in China, Chinese experts have accumulated substantial clinical experience in the diagnosis and management of VLU-related wound healing. To standardize the surgical repair of VLUs and improve both therapeutic outcomes and patients' quality of life, the Wound Repair Professional Committee of the Chinese Medical Doctor Association convened a panel of multidisciplinary experts for extensive deliberations. Based on a synthesis of current international and domestic evidence and clinical practice, the committee reached consensus on evidence-based recommendations for key issues in VLU wound management, including debridement techniques, indications, timing, and approaches to wound repair for VLUs. This consensus is intended to serve as a practical reference for clinicians involved in the care of patients with VLUs.

Acute kidney injury (AKI) is a common and severe complication of sepsis and is often associated with a poor prognosis. However, there is still a lack of an effective prediction model for early identification of AKI progression in critical septic patients, defined as AKI stage 1 or 2 to stage 3 within 7 days after diagnosis of sepsis-associated AKI (SA-AKI). We extracted the clinical data of patients with SA-AKI from the Medical Information Mart for Intensive Care (MIMIC) datasets, eICU Collaborative Research Database (eICU-CRD) and Salzburg Intensive Care database (SICdb), with the MIMIC-IV (version 3.1) database used for training and internal validation, the MIMIC-III Clinical Database CareVue subset used as temporal validation, and the eICU-CRD and SICdb used as external validation. Lasso regression and recursive feature elimination were used for feature selection. Six machine learning (ML) algorithms, including k-nearest neighbors, logistic regression, na&#xef;ve Bayes, random forest (RF), support vector machine and decision tree, were utilized to establish the prediction model. Model performance was assessed using receiver operating characteristic curves, calibration curves and decision curve analysis. SHapley Additive exPlanations (SHAP) method was used for the interpretation of the models. The MIMIC-IV, MIMIC-III subset, eICU-CRD and SICdb included 9193, 2178, 10&#xa0;332 and 1701 patients with SA-AKI. Twelve variables were selected for model construction, including weight, liver disease, mechanical ventilation, systolic blood pressure, hemoglobin, glucose, blood urea nitrogen, creatinine, chloride, anion gap and urine output. An RF model achieved the best performance in both internal, temporal and external validation (area under the curve is 0.779, 0.758 and 0.713, respectively). A user-friendly platform was built to early predict SA-AKI progression for clinician use. ML could be a useful tool for predicting AKI progression in septic patients. We developed an RF model to predict the risk of SA-AKI progression, which may provide a reference for early identification and prompt intervention of high-risk group.

To quantify changes in incidence, prevalence, mortality, and disability-adjusted life-years (DALYs) from cutaneous melanoma in mainland China, assess demographic drivers, and project age-standardized rates to 2030 using Global Burden of Disease (GBD) 2023 estimates. We extracted annual estimates for 1990-2023 by sex and 5-year age group. Estimated annual percentage changes summarized age-standardized rate trends. Decomposition separated changes in absolute burden into population growth, population aging, and epidemiological change, defined as residual changes in age-specific rates after demographic effects. Bayesian age-period-cohort models projected age-standardized rates to 2030. From 1990 to 2023, incident cases increased from 4,657 to 16,593, and prevalent cases increased from 15,401 to 102,526. The age-standardized incidence rate increased from 0.49 to 0.79 per 100,000, and the age-standardized prevalence rate increased from 1.39 to 5.03 per 100,000, with estimated annual percentage changes of 1.39% and 4.14%, respectively. In contrast, the age-standardized mortality rate declined from 0.33 to 0.27 per 100,000, and the age-standardized DALY rate declined from 9.74 to 7.54 per 100,000. The burden shifted toward older ages, although the largest absolute numbers of cases and DALYs clustered around ages 55-59 years. Aging contributed most to rising incident cases and DALYs, whereas epidemiological change drove prevalence expansion and partly offset DALY growth. By 2030, the combined-sex age-standardized incidence and prevalence rates were projected to reach 0.88 and 5.84 per 100,000, respectively, while mortality was projected to remain nearly stable and the DALY rate to decline slightly. Cutaneous melanoma in mainland China remains uncommon but rising incidence and prevalence, alongside declining age-standardized mortality and DALY rates indicate a changing burden profile. This divergence may increase demand for longitudinal services, but it does not demonstrate improved individual survival or chronicity. Strengthened early detection, age-adapted prevention, standardized diagnosis, and long-term survivorship care are needed. Cutaneous melanoma is an aggressive form of skin cancer that can spread and cause death. It is much less common in China than in populations predominantly of European ancestry and is often regarded as rare there. Using the most recent Global Burden of Disease 2023 data for mainland China, we examined how the disease changed between 1990 and 2023 and projected the burden to 2030. We found two opposite trends. The numbers of people newly diagnosed with, and living with, melanoma rose sharply, while the death rate and the rate of overall health loss declined. Most of the rise in new cases reflected China&#x2019;s ageing population. The database cannot determine whether increasing prevalence reflects earlier diagnosis, registration, treatment, or longer individual survival. The burden increasingly affected older adults, although the largest numbers of patients were in their late 50s. These findings suggest that melanoma may create greater demand for follow-up and longitudinal services in China, but they do not show that melanoma has become a chronic disease. They support earlier detection, diagnosis suited to cutaneous melanoma patterns in Chinese patients, equitable access to treatments, and planning for the long-term care of a growing number of survivors, particularly older adults.

Membranoproliferative glomerulonephritis (MPGN) is an uncommon cause of renal dysfunction and is increasingly being reclassified into immune complex-mediated and complement-mediated forms. Infections, particularly in endemic regions, may act as disease triggers. Pregnancy further complicates renal pathology through physiological and immunological changes. We describe a 22-year-old pregnant woman presenting with generalized edema, proteinuria, and cola-colored urine. Renal biopsy revealed diffuse endocapillary proliferation with mesangial and capillary wall C3 deposition, consistent with immune complex-mediated MPGN, with ultrastructural features suggestive of dense deposit disease (DDD). During hospitalization, she developed fever, papilledema, and neurological deficits. Blood cultures grew Salmonella Typhi, and urine cultures isolated vancomycin-resistant Enterococcus. Targeted antimicrobial therapy improved systemic symptoms, while cyclosporine was initiated for persistent proteinuria. This case report illustrates an atypical presentation of DDD during pregnancy, potentially triggered by typhoid fever and complicated by neurological involvement. It underscores the diagnostic challenges in resource-limited settings and the complex interplay among infection, complement dysregulation, and gestation. This case report illustrates an atypical presentation of MPGN during pregnancy, triggered by typhoid fever and complicated by multidrug-resistant infection and neurological involvement. The patient's renal and neurological symptoms improved with antibiotics and supportive care; however, the pregnancy resulted in intrauterine fetal demise at 28 weeks. Early recognition and multidisciplinary care were pivotal to maternal stabilization and fetal management.

Suicide remains a leading global cause of preventable mortality, with sleep disturbances, particularly insomnia, nightmares, and circadian disruption, emerging as critical yet underrecognized contributors to suicidal ideation and behavior. This narrative review synthesizes current evidence on the multifaceted links between sleep disorders and suicidality, integrating findings from epidemiological, neurobiological, and interventional studies. Insomnia contributes to suicide risk through pathways of hyperarousal, hopelessness, and impaired emotion regulation, while nightmares are associated with increased risk of suicidal ideation and attempts, potentially exerting an effect distinct from other sleep disorders. Circadian misalignment, including shift work and evening chronotype, further exacerbates vulnerability through neuroendocrine and molecular alterations involving the hypothalamic-pituitary-adrenal axis, serotonergic imbalance, and disrupted clock gene expression. Shared biological mechanisms, such as inflammation, hypothalamic-pituitary-adrenal (HPA) dysregulation, and serotonergic depletion, intersect with cognitive-emotional deficits, compounding risk. Clinically, interventions such as cognitive behavioral therapy for insomnia (CBT-I), imagery rehearsal therapy, and chronotherapeutic approaches have demonstrated efficacy in improving sleep continuity and mitigating suicidality. Routine assessment of sleep quality and circadian patterns should be integrated into suicide risk evaluation across psychiatric and primary care settings. Future research incorporating objective sleep measures, biomarker profiling, and digital monitoring platforms may enable precision risk stratification and early intervention.&#xa0;However, the current evidence base is limited by heterogeneity in study designs, the predominance of observational and cross-sectional studies, and potential confounding from psychiatric comorbidities, warranting cautious interpretation of causal relationships. By addressing sleep as a core modifiable risk factor, clinicians can move toward a holistic, biologically informed, and preventive model of suicide care.

Background Atlantoaxial osteoarthritis (AAOA) is a degenerative disorder of the C1-C2 articulation that causes occipitocervical pain, restricted head rotation, and functional limitation. Treatment ranges from nonoperative care to image-guided intra-articular injection and surgical stabilization in selected patients with persistent symptoms or structural compromise. This study evaluated the clinical and radiographic outcomes of patients with AAOA managed through a defined institutional treatment protocol. Methods This single-center observational cohort study included 232 patients with AAOA treated at a tertiary spine center. The cohort included retrospectively identified patients treated from January 2020 to March 2021 and prospectively followed patients treated from April 2021 to December 2025. All patients underwent initial nonoperative treatment according to an institutional protocol. Patients with persistent symptoms despite conservative care were offered image-guided intra-articular C1-C2 injection, and patients with refractory pain or structural compromise underwent posterior C1-C2 fusion. For analysis, patients were categorized according to definitive treatment into a nonoperative cohort and a surgical cohort. The nonoperative cohort included patients who improved with conservative treatment alone or with injection-based treatment and did not undergo surgery. Clinical outcomes were assessed using the Visual Analog Scale (VAS) and Neck Disability Index (NDI). Radiographic variables included laterality, joint type, osteoarthritis grade, periarticular ossicles, joint destruction, subluxation, instability, and fusion status in operated patients. Results A total of 232 patients were included, with 200 patients in the nonoperative cohort and 32 patients in the surgical cohort. All patients received initial conservative treatment, and 32 patients progressed to C1-C2 fusion. The surgical cohort was significantly younger than the nonoperative cohort, with a mean age of 50.0 &#xb1; 17.5 years compared with 65.7 &#xb1; 9.9 years, respectively. Bilateral involvement and mixed joint disease were the most common radiographic patterns in both cohorts. The surgical cohort showed greater radiographic severity, with higher rates of Grades 3 and 4 disease, joint destruction, subluxation, and instability. In the nonoperative cohort, the mean VAS score improved from 6.23 &#xb1; 1.68 at baseline to 1.61 &#xb1; 1.04 at final follow-up, and the mean NDI improved from 0.32 &#xb1; 0.11 to 0.06 &#xb1; 0.05. In the surgical cohort, the mean VAS score improved from 7.41 &#xb1; 1.19 to 1.97 &#xb1; 1.45, and the mean NDI improved from 0.60 &#xb1; 0.14 to 0.11 &#xb1; 0.10. Radiographic fusion was documented in 30 of 32 operated patients. Conclusions AAOA is a clinically important cause of occipitocervical pain and disability. In this single-center cohort managed through a defined institutional treatment protocol, most patients remained in the nonoperative pathway and demonstrated clinical improvement, while posterior C1-C2 fusion was associated with meaningful improvement in selected patients with refractory symptoms or structural compromise. Further prospective studies using standardized imaging, treatment protocols, and follow-up schedules are needed to refine management pathways for this condition.