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To estimate longitudinal predictive relationships between team resilience and team stress among low-stability clinical nursing teams, identifying core driving factors and bridging mechanisms using cross-lagged panel network analysis. Chronic instability in clinical nursing teams disrupts workflows and triggers systemic team stress, which is further exacerbated by digital health technology burdens and moral distress. Understanding how specific dimensions of team resilience interact with these facets of team stress over time is essential for developing precise organizational interventions. A two-wave longitudinal panel study. Data from the Nurse Team Health Management Research Cohort across two waves (October 2024 and December 2025) included 5164 clinical nurses aggregated into 285 low-stability nurse teams. Team resilience and team stress were assessed using the Analyzing and Developing Adaptability and Performance in Teams to Enhance Resilience Scale and a customized Nursing Job Stressor Inventory. A cross-lagged panel network was estimated to identify influential nodes and network conduits. Digital health technology burden exhibited the highest predictive power, driving team stress and significantly predicting subsequent moral distress. Moral distress emerged as a potentially destructive bridge, which may negatively predict multiple resilience dimensions over time. Conversely, cooperation with other departments appeared to serve as a protective bridge, mitigating subsequent subjective work stress and digital technology burden. Monitoring exhibited a potentially paradoxical effect, positively predicting subsequent subjective work stress. Digital health technology burden drives occupational stress in low-stability nursing teams. Moral distress may erode team resilience, whereas cross-departmental cooperation acts as a potential protective shield. This study shifts the focus of occupational stress management from the individual to the team level. To stabilize nursing teams facing chronic instability and high turnover, healthcare administrators should move beyond generic stress reduction. Targeted interventions must focus on alleviating digital workflow burdens, instituting routine ethical debriefings to resolve moral distress, and formalizing boundary-spanning cooperation protocols.

Preventive dental care is recommended in children with congenital heart disease (CHD) to prevent infective endocarditis (IE). We examined average annual preventive dental care utilization and the association between preventive dental care and IE in children with CHD. We conducted a retrospective cohort study examining children (1-18-year-olds), covered by Georgia Medicaid, with at least one CHD-related ICD code and a healthcare encounter between 2008 and 2019. Preventive dental care encounters were based on Current Dental Terminology (CDT) codes (D1000-D1999). CHD native anatomy was captured based on ICD-9-and-10-CM codes. Log binomial regression estimated adjusted risk ratios (aRRs) and 95% confidence intervals (CIs) for IE risk, controlling for sex, race and ethnicity, birth year cohort, rurality, and Social Deprivation Index. Of 61,024 children with CHD, 65.64% (n = 40,058) had at least one annual preventive dental visit on average, of which 0.30% (n = 181) had IE. For subgroups with valve or shunt lesions, having at least one annual preventive dental care visit showed a significantly lower risk of IE (aRR = 0.32; 95% CI = 0.18, 0.58, and aRR = 0.17; 95% CI = 0.07, 0.38, respectively) compared to no dental visits. No association was found between preventive dental care and IE in those with severe CHD (aRR = 0.81; 95% CI = 0.51, 1.26). Although dental health is important for patients with CHD, and despite universal dental coverage, many children with CHD do not seek annual preventive dental care. Integrating dental health assessments into routine CHD management protocols is imperative not only to promote oral health but also to prevent IE.

Sickle cell disease (SCD) is a chronic and life-limiting hemoglobin and systemic vascular disease. While over 1000 people have undergone hematopoietic cell transplantation (HCT) over the last 40 years, long-term disease-specific and health-related quality of life data are lacking. The American Society of Hematology 2021 Guidelines for SCD emphasized the need for more detailed registry data to inform patients and providers with decision-making and practice recommendations. In January 2021, the Sickle Cell Transplant Advocacy and Research Alliance (STAR) launched Project Sickle Cure (PSC). This multi-center, prospective study of patients who have undergone HCT for SCD includes baseline demographics and SCD-specific post-HCT outcomes, serial neurocognitive testing, health-related quality of life measures, health equity evaluations, a neuroimaging bank, detailed evaluation of neurologic status pre- and post-transplant, and chronic pain evaluation. A biorepository is in the planning stage of development. As of November 2025, 115 participants have enrolled at 18 STAR sites with enrollment ongoing. PSC is a STAR prospective study which will address a major gap in our understanding of outcomes post-HCT specific to SCD. WeDecide, a larger study comparing HCT health-related quality of life outcomes to those who receive non-transplant disease modifying therapy (NT-DMT) is in development, and PSC will provide the HCT comparator data. These data will also be highly relevant as other curative and transformative therapies, such as gene therapy, become more widely used.

The psychological impact of stillbirth on parents is profound, increasing the need for respectful care. Despite the existence of international guidelines, there has been no clinical confirmation of their efficacy in improving parental mental health outcomes. This study is a web-based cross-sectional study and part of the OPALE (Observatory on PerinatAL hEalth) project. Participants were selected if they suffered a pregnancy loss after 20 weeks (including termination of pregnancy for medical reasons) in the last 10 years. The survey includes: the CiaoLapo Stillbirth Support (CLASS) checklist, the Perinatal Grief Scale (PGS), the National Stressful Events Survey PTSD Short Scale (NSESSS), and questions on satisfaction with care. 261 participants completed the survey. In a multivariate analysis, higher CLASS scores were correlated with lower PGS and NSESSS scores, suggesting a direct relationship between guideline adherence and better psychological outcomes. Specifically, satisfying over 40 of the 60 checklist items independently predicted greater care satisfaction (OR 2.0, CI 1.1-3.8), higher experiences of respectful care (OR 3.6, CI 1.9-7.0), lower grief (OR 0.08, CI 0.1-0.2), and reduced PTSD symptoms (OR 0.21, CI 0.1-0.5). This is the first study which identifies a correlation between adherence to stillbirth care guidelines and better psychological outcomes, indicating their importance in enhancing parents' mental health.

To test whether mobile phone surveys conducted remotely might generate data on deaths that are not covered by mortality surveillance systems established in laboratories and health facilities, or in institutions involved in the post-mortem management of corpses (e.g., morgues, cemeteries). We conducted a national survey of mobile phone users in Bangladesh during the COVID-19 pandemic. Respondents were asked to list the deaths that had occurred in their household in recent years. For each death, they were also asked to indicate whether the deceased had been diagnosed with COVID-19 prior to death, whether the death occurred at home or at a health facility, and where the burial took place. Using these data, we represented the overlap between data generated by the mobile phone survey and several potential mortality surveillance systems, which focus on counting deaths in health facilities or communal cemeteries. We described the socio-demographic characteristics of the deaths that were uniquely recorded by the mobile phone survey. From December 2021 to July 2022, 506,659 calls were placed, resulting in 22,731 interviews completed by mobile phone. Respondents reported 1527 deaths that had occurred in their household since 2020. Among those deaths, 99 (6.5%) had received a pre-mortem diagnosis of COVID-19. The proportion of reported deaths that were not covered by other potential mortality surveillance systems, was 32.4% in the large city corporations of Dhaka and Chittagong, 36.3% in other urban areas and 49.6% in rural areas. In urban areas, deaths among men, as well as among youth and the elderly, were more likely to be covered solely by the mobile phone survey. Mobile phone surveys can potentially remedy gaps in the data generated by other recommended mortality surveillance methods.

The amyloid cascade hypothesis provided a compelling rationale for Alzheimer's disease (AD) drug development, but many amyloid-β (Aβ)-targeted agents failed to show benefit. The present review article evaluated emerging Aβ-directed therapies, focusing on mechanisms, clinical efficacy, safety, and regulatory progress. The recent approvals of lecanemab and donanemab offered the first convincing evidence that reducing Aβ burden can modestly slow cognitive decline in early AD. Beyond these first-generation monoclonal antibodies, the pipeline includes next-generation antibodies with enhanced brain penetration (trontinemab), therapies designed also for presymptomatic intervention (remternetug tested for secondary prevention), and novel approaches targeting galectin-3 to disrupt Aβ aggregation and neuroinflammation. Active immunotherapies like UB-311 and small molecules such as ALZ-801, avoiding amyloid-related imaging abnormalities (ARIA), broaden the therapeutic horizon with potentially safer and more accessible options, but with no proven efficacy. Clinical benefits for Aβ-centric therapies are modest, ARIA pose ongoing safety concerns, and high costs coupled with intensive monitoring limit accessibility. Regulators have begun to restrict approval to genetically defined subgroups according to apolipoprotein E genotype, underscoring the need for precision medicine. Therefore, while Aβ-centric therapies are incremental, they represent essential steps toward combination and precision strategies in the treatment of AD. Alzheimer’s disease (AD) is a growing global health problem, with no cure currently available. Most existing treatments only relieve symptoms and do not slow the underlying disease process. One of the earliest and most important biological changes in AD is the buildup of amyloid-β (Aβ), a protein that forms plaques in the brain. For this reason, many new drugs have been designed to remove Aβ or prevent it from accumulating. In recent years, several Aβ–targeting therapies have shown that they can successfully reduce amyloid plaques in the brain. These include monoclonal antibodies given by infusion or injection, vaccines that stimulate the immune system, and oral drugs designed to block the formation of toxic Aβ species. Some of these treatments have reached late-stage clinical trials, and a few have received regulatory approval in certain regions. However, while these drugs clearly reduce amyloid levels, their effects on memory and daily functioning are modest, especially when used after symptoms have already appeared. In addition, treatment can be associated with side effects such as brain swelling or small brain bleeds, requiring frequent medical monitoring, costly for healthcare systems. Most evidence so far comes from carefully controlled randomized clinical trials, and real-world experience remains limited. Current research is therefore shifting toward earlier treatment, including prevention in people at high risk, improved drug delivery methods, and combination approaches that also target other disease processes such as tau pathology, inflammation, and vascular or metabolic changes. New blood-based biomarkers are also making it easier to diagnose AD earlier and to select patients more precisely. Overall, Aβ–centered therapies represent an important scientific advance, but they are unlikely to be sufficient on their own. Future progress in AD treatment will depend on better understanding how amyloid may interact with other brain changes, identifying the right patients at the right time, and developing safer, more affordable, and more comprehensive therapeutic strategies.

Digital twins in medicine are packaged as inevitable, disruptive technologies that will revolutionise healthcare, yet their integration into clinical practice remains slow. In this article, we extend current research on digital twins by shifting attention to the actors behind the technology and their visions. Drawing on multi-sited fieldwork, we identify from where and how the In Silico medicine community envisions the future of medicine and trace embedded ideas and logics. Our analysis reveals a friction between the narrowing of visions of medicine, the human body and clinicians and the technical features of digital twins, which are intended to open futures and possibilities through virtual interventions. We show how digital twins are developed at a distance from the very practices they seek to revolutionise and how the field attempts to navigate this distance through conversion and training. As with other digital health technologies, the burden of adjustment is placed on clinicians. By attending to how distance between modellers and clinical settings plays out in practice, we show how this "future-making from afar" constrains but also enables specific modes of engagement. It offers a starting point for demystifying digital twins in medicine and reflects on the kinds of futures the field promotes.

Social determinants of health influence maternal and perinatal outcomes, yet tools to operationalize these risks in clinical care remain scarce. We aimed to study social determinants in Brazilian pregnant women and develop a social vulnerability index (SVI) that could correlate with pregnancy and perinatal outcomes. The present study was a secondary analysis of 1565 low-risk nulliparous women enrolled in two Brazilian cohort studies. We selected vulnerability indicators from sociodemographic data and tested the performance and risk association of multiple SVI models with any adverse outcome (preterm birth, gestational diabetes mellitus, pre-eclampsia, small or large for gestational age, low 5-min Apgar score, neonatal intubation, neonatal intensive care unit admission, fetal or neonatal death) using chi-square tests, logistic regression, and receiver operating characteristic analysis. Advanced maternal age, non-white ethnicity, and exclusive publicly funded antenatal care were the most consistent vulnerability predictors of adverse outcomes. The final three-variable SVI demonstrated a significant dose-response gradient, with maternal adverse outcomes increasing from 16.4% (no vulnerabilities) to 43.8% (3 vulnerabilities) and perinatal adverse outcomes rising from 22.1% to 35.6%. The model presented a sensitivity of 64.71%, a specificity of 42.56%, a positive predictive value of 47.46% and a negative predictive value of 60.07% for any adverse outcome. The three-variable SVI offers a simple, reproducible, and context-adapted screening tool for primary care. Either for individual or population screening, it can be easily combined with clinical risk assessment, targeting those who may benefit from equity-oriented maternal health strategies.

The purpose of this state-of-the-art review of reviews was to unify, describe and appraise the relationship between physical activity (PA) and social psychological constructs, using the social dimensions of health behavior (SDHB) framework, which represents a taxonomy of 10 social dimensions applicable to health behaviors. Eligible reviews were published in a peer-reviewed journal in English, included a review in which PA was operationalized as a focal predictor or outcome variable and with data also reported on at least one social construct reported in the results, and published between 2010 and July 2025. Literature searches were completed in August 2025 using seven common databases. The search yielded 54 reviews. We identified limited evidence for reviews of experimental research. Reviews of observational quantitative studies showed associations between PA with injunctive norm, perceived social support, and attachment ties with meta-analysis point estimates in the small, positive effect size range. Reviews of qualitative studies revealed positive associations with PA that covered the entire SDHB framework, yet most were conducted on specific populations so generalizability was not clear. The findings show domains in need of further examination to address gaps in knowledge, opportunities for theoretical integration, and highlight key social dimensions important in PA promotion.

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) may affect cognition, but its association with incident dementia remains inconsistent. We explored the association of SARS-CoV-2 infection and its vaccination with dementia risk in a nationwide sample of middle-aged and older adults. This nested case-control study used electronic healthcare data from Israel's largest health provider. Participants were dementia-free individuals aged &#x2265;&#x2009;50&#x2009;years at baseline (March 2020), followed up until May 2022. Incident dementia cases were matched to dementia-free controls using density sampling by age, sex, and date of entry to the study, with a ratio of 1:10. SARS-CoV-2 was defined by positive polymerase chain reaction (PCR) or institutional antigen tests. Multivariable conditional logistic regression models evaluated the association of SARS-CoV-2, its severity and vaccination, and pneumonia as a comparator, with dementia risk. Among the 1,145,322 eligible participants, 27,280 dementia cases were matched to 272,800 controls. SARS-CoV-2 infection was associated with increased dementia risk (OR&#x2009;=&#x2009;1.18; 95% CI 1.12-1.24; p&#x2009;<&#x2009;0.001). This association was confined to hospitalized individuals with mild (OR&#x2009;=&#x2009;2.39; 95% CI 2.07-2.76) and moderate-to-severe disease (OR&#x2009;=&#x2009;1.93; 95% CI 1.70-2.20), was comparable to pneumonia (OR&#x2009;=&#x2009;1.89; 95% CI 1.80-1.99), and was no longer evident after 6&#x2009;months (OR&#x2009;=&#x2009;1.04; 95% CI 0.96-1.12). COVID-19 vaccination was associated with 7%, 15%, and 31% lower dementia risk after two, three, and four doses, respectively. Unvaccinated individuals with prior COVID-19 had the highest dementia risk. Dementia diagnoses are increased after COVID-19, especially in hospitalized patients. Risk is comparable to other respiratory infections.