The rapid expansion of short-form educational video platforms has substantially increased public access to health information; however, the characteristics and quality of videos concerning patent ductus arteriosus (PDA) have not been systematically evaluated. This study aimed to evaluate the quality and reliability of short-form videos related to PDA posted on TikTok and Bilibili. The Chinese keyword "patent ductus arteriosus" was used to retrieve relevant videos from TikTok and Bilibili, yielding 140 videos for the final analysis. Uploaders were classified according to publicly available account information. Professional uploaders were defined as accounts identifying the uploader as a healthcare professional and displaying official platform verification and/or an explicit affiliation with a recognized medical institution. Credentials were verified using publicly visible profile elements, including verification badges, profile descriptions, professional titles, and stated institutional affiliations. All included videos were independently evaluated by two reviewers. Because paired reviewer-level ratings were available for the Global Quality Score (GQS), inter-rater reliability for GQS was assessed before consensus adjudication using the intraclass correlation coefficient (ICC) and quadratic weighted Cohen's kappa. Video quality and reliability were assessed using five established instruments: the Global Quality Score (GQS), Video Information and Quality Index (VIQI), Patient Education Materials Assessment Tool (PEMAT), the JAMA benchmark criteria, and modified DISCERN (mDISCERN). Only the first 100 algorithm-ranked videos from each platform were screened, in order to reflect the content most likely to be encountered by typical users, although this approach may preferentially capture videos favored by platform recommendation systems. No independent clinical subject-matter expert (such as a neonatologist or cardiologist) was separately involved in the formal scoring process; instead, the evaluation focused on quality, reliability, transparency, and understandability using established assessment instruments. Clinical accuracy was not independently assessed or adjudicated in this study. A total of 140 short videos related to patent ductus arteriosus (PDA) were included in the analysis, with 57 from Bilibili and 83 from TikTok. TikTok videos demonstrated significantly higher audience engagement than those on Bilibili, with markedly greater numbers of likes, favorites, shares, and comments. Bilibili videos were slightly longer in duration, and there was no significant difference in posting time between the two platforms. Videos on TikTok also achieved significantly higher scores across all five quality assessment tools-mDISCERN, GQS, VIQI, PEMAT, and the JAMA benchmark-and most high-quality videos were uploaded by professional individuals. In the present study, these professional individuals were defined on the basis of publicly visible healthcare-related identity information and platform verification status. When stratified by uploader type, videos created by professionals consistently outperformed those from non-professional individuals and institutions in both quality scores and engagement metrics. Professional videos were predominantly found on TikTok. Correlation analyses indicated weak to moderate positive associations between most quality indicators and likes, favorites, and shares on both platforms, although the correlation coefficients remained low. Notably, the average JAMA benchmark score was approximately half of the maximum possible score on both platforms. Inter-rater reliability for GQS was acceptable, with a single-measure ICC of 0.632, an average-measure ICC of 0.774, and a quadratic weighted Cohen's kappa of 0.630. The overall quality of PDA-related health information on major Chinese short-video platforms appears to be moderate. TikTok and professional uploaders demonstrated clear advantages in reliability, comprehensibility, and communication effectiveness. Platform attributes and uploader background exert significant influence on video quality and dissemination performance. Future efforts should focus on strengthening platform oversight, encouraging greater involvement of qualified healthcare professionals, and standardizing the disclosure of information sources and conflicts of interest. Such measures are essential for improving the accuracy, quality, and trustworthiness of online cardiovascular health information and for better supporting parents of children with PDA and the general public. These findings should be interpreted as reflecting informational quality, structure, transparency, and understandability rather than independently verified clinical accuracy.
To systematically evaluate the quality of eye disease videos on TikTok, WeChat, and rednote, explore links between engagement and quality, and offer evidence-based guidance for ophthalmic health communication. The top 100 videos retrieved using the keywords "cataract," "glaucoma," and "high myopia" were screened on TikTok, WeChat, and rednote on 3 October 2025. Two reviewers independently assessed video quality using Journal of the American Medical Association (JAMA), the global quality score (GQS), modified DISCERN, and the Patient Education Materials Assessment Tool (PEMAT). Group differences were analyzed using Kruskal-Wallis and χ2/Fisher exact tests, and adjusted associations were examined using Poisson regression with robust standard errors. A total of 827 eligible videos were analyzed. Most videos were uploaded by physicians and focused on disease knowledge. Across TikTok, WeChat, and rednote, video characteristics, engagement, source, content, presentation form, and quality scores differed significantly. In adjusted analyses, compared with TikTok, WeChat videos had lower likes and comments, whereas rednote videos had lower engagement across all four outcomes. High-myopia videos showed higher engagement across all outcomes, while glaucoma videos showed higher collections and shares. Hospital-uploaded videos were associated with lower engagement, whereas news agency videos were associated with higher engagement. Personal experience videos were associated with higher comments and collections. Higher JAMA scores were consistently associated with lower engagement, whereas modified DISCERN and PEMAT actionability showed inverse associations only for selected outcomes. This study represents the first large-scale cross-sectional evaluation of science communication on potentially blinding eye diseases across major Chinese short-video platforms. High engagement does not equate to high quality; in fact, engagement metrics were significantly negatively correlated with reliability, scientific accuracy, and understandability. Clinicians should uphold scientific rigor and use accessible and friendly language to improve public eye health literacy.
Physicians increasingly deliver health information and medical support through online medical teams (OMTs) in telemedicine platforms, where patients interact with multiple physicians within a single consultation episode. Yet limited research has systematically examined how physician collaboration influences team effectiveness in OMTs. This study investigates the impact of physician collaboration on team effectiveness using a panel dataset of 1,181 OMTs from 2017 to 2023 on a leading Chinese telemedicine platform. We employ a difference-in-differences design and large language models to identify the effects of physician collaboration and uncover the underlying mechanisms. Our results show that physician collaboration reduces team effectiveness. To unpack the underlying mechanisms, we further examine two potential effects: the cognitive-load effect and the free-riding effect. The empirical results reveal that the cognitive-load effect significantly decreases team effectiveness, whereas there is no empirical evidence to support the free-riding effect. Additionally, heterogeneity analyses indicate that the negative effect of collaboration is mitigated when more experienced physicians are involved. These results provide theoretical insights into team performance in telemedicine contexts and advance health communication research. The findings also offer practical guidance for platform designers to strengthen communication management in team-based telemedicine platforms.
The rapid adoption of electric bicycles (EB) has led to a significant increase in related injuries, posing a growing public health challenge. In Anhui Province, China, EB-related orthopedic injuries represent a major component of traffic trauma burden. However, systematic data on injury patterns, anatomical distribution, and demographic variations remain limited, hindering optimized clinical management. This study aims to characterize the clinical spectrum of orthopedic injuries associated with EB that necessitate surgical management. This single-center retrospective cohort study analyzed data from the Hospital Information System (HIS) for patients with EB-related orthopedic injuries between January, 2020, and December, 2025. Among 3,412 vehicle-related injuries, 1,735 cases met inclusion criteria. Injury types were classified into six categories (e.g., fractures, dislocations), and anatomical sites were categorized into 16 regions. Statistical analyses included descriptive statistics and chi-square tests to identify factors associated with severe injuries. The study included 1,735 patients (59.20% male; mean age 48.65 ± 15.73 years), with a bimodal age distribution peaking in the 31-44 and 45-59 groups. Fractures predominated (85.01% of cases), followed by combined injuries such as open fractures with soft tissue damage (4.67%). The most frequent anatomical sites were the clavicle, tibiofibula, and hand/foot. Female patients were significantly older than males (95% CI: 3.44, 6.38; p < 0.001), and young males had higher injury rates. EB-related orthopedic injuries predominantly affect middle-aged and elderly populations (1,735 patients; mean age 48.65 ± 15.73 years, bimodal peaks at 34.65 ± 9.41 years and 57.28 ± 6.72 years), with fractures accounting for 85.01% of cases and combined trauma (e.g., open fractures with soft tissue damage) representing 4.67%. The clavicle, tibiofibula, and hand/foot are the most commonly injured sites. These findings provide foundational insights for orthopedic clinical practice pertaining to EB-related injuries, suggesting that age-stratified triage protocols and prioritized evaluation of high-risk anatomical sites (clavicle, lower limbs) warrant further investigation to optimize resource allocation and patient outcomes in clinical settings. However, this study has several limitations, including its single-center retrospective design, absence of severity validation scores, and insufficient data on protective measures/devices/follow-up and so on. Therefore, prospective multicenter studies are warranted to validate and optimize clinical practice.
The growing use of continuous glucose monitors (CGMs) and mobile health (mHealth) applications has changed how diabetes is managed, allowing real-time tracking of glycemic patterns and remote clinical decision-making. These technologies also generate large volumes of sensitive health data, raising questions about who owns this information, how it is protected, and under what conditions it may be repurposed for research or commercial objectives. This review examines the regulatory frameworks governing CGM and mHealth data in major jurisdictions, with particular attention to the Health Insurance Portability and Accountability Act (HIPAA) in the United States and the General Data Protection Regulation (GDPR) in the European Union. Significant regulatory gaps exist, particularly for consumer-grade devices and direct-to-consumer mHealth applications that fall outside traditional healthcare data-protection frameworks. Data ownership remains legally ambiguous in most jurisdictions, with patients, healthcare providers, device manufacturers, and app developers each holding competing claims. The secondary use of clinical data for research, while it could materially advance diabetes care, raises ethical concerns around informed consent, data de-identification, and the boundaries between clinical care and commercial exploitation. Emerging approaches, including the European Health Data Space, federated learning, and differential privacy, may help balance data utility with individual rights. The review recommends changes to regulation, industry practice, and consent models aimed at reconciling data-driven diabetes research with patient autonomy and privacy.
Underutilised edible plants represent important but insufficiently characterised nutritional resources within plant-based food systems. Stenochlaena palustris is a wild edible fern widely consumed in Southeast Asia; however, its incorporation into formulated food matrices remains poorly documented. The objective of this study was to generate initial physicochemical and nutritional data for dates-based food formulations incorporating S. palustris powder at different inclusion levels, providing validated baseline compositional information on an underutilised edible fern within a contemporary plant-based food system. Dates-based energy bars were formulated with S. palustris powder at 2.5% and 5.0% (w/w), alongside a control formulation without fern inclusion. Proximate composition, sugar profile, mineral content, antioxidant activity, and selected physicochemical properties were determined using validated analytical methods by an accredited laboratory. Incorporation of S. palustris was associated with observed increases in dietary fibre, ash, and protein, with generally higher values of selected minerals, including calcium, magnesium, iron, and zinc, in the fortified formulations compared to the control, while total energy values remained comparable across formulations. Water activity values for all formulations were below 0.48, and total flavonoid content increased with higher fern inclusion, while DPPH antioxidant activity was highest in the control formulation. As each formulation was analysed as a single composite sample, the data are presented as baseline compositional observations.
Intra-hospital transfers (IHT) of hospitalized children are unavoidable practices often performed with emergency patients and postoperative patients. Standardizing IHT processes to minimize adverse events might improve children's outcomes. We developed an evidence-based clinical practice IHT guideline for hospitalized children. The aim of this study was to evaluate the implementation process and the effectiveness of the implementation of this guideline on patient outcomes, healthcare professionals' knowledge and behavior, and hospital organizational context. A type III hybrid effectiveness-implementation design was adopted, using a pre-post intervention trial (January-December 2024). Data of patient demographics, transport-related outcomes, and healthcare providers' knowledge and compliance were collected. We used the RE-AIM framework to assess effectiveness across four dimensions: Reach, Effectiveness, Adoption, and Implementation. Totally, 110 healthcare professionals conducted 213 IHTs of eligible children (109 children in the pre-intervention group and 104 in post-intervention group). The Reach outcomes demonstrated that participation among hospitalized children (n = 312) was suboptimal at 33% (104/312). No differences were observed between the pre- and post-intervention group regarding gender, disease distribution, or pediatric early warning scores. The implementation showed favorable outcomes in the dimensions Effectiveness, Adoption, and Implementation. Healthcare professionals engagement was 95%, with 86% (19/22) of the implementation strategies successfully completed. Healthcare professionals' knowledge in the pre-intervention group (n = 109) improved from median 40 (IQR 28;52) to median 76 (IQR 64;84) in the post-intervention group (n = 104; p < 0.001). Clinically, the new guideline reduced adverse events (12 vs 4; p = 0.047), reduced the median minutes of bedside handover time from 5 (IQR 3;7) to 4 (IQR 3;5; p < 0.001), and improved handover information completeness from median score of 5 (IQR 4;6) to 20 (IQR 12;23, p < 0.001). The total transport time increased from 14 to 19 minutes in the post-intervention group (p < 0.05), while no significant changes were observed in handover interruptions or post-transfer vital sign stability (p > 0.05). The RE-AIM-based evaluation confirmed that the implementation strategies effectively enhanced healthcare professionals' knowledge and compliance while reducing adverse events and optimizing handover efficiency. However, the limited patient participation rate and increased transport duration highlight areas requiring further refinement to maximize the guideline's impact. ClinicalTrials.gov, NCT06512805. Registered 27 June 2024.
Sexual dysfunction associated with psychological reasons is one of the factors impacting unfulfilled marriages. There are limited data on treatment outcomes in this context. The aim of this study was determining the treatment of unconsummated marriage in psychogenic erectile dysfunction in Iranian Couples. A total of 66 cases were selected from individuals referred to the Family Health Clinic (from 2006 to 2019), who had unconsummated marriages and experienced psychogenic erectile dysfunction, meeting the inclusion criteria for the study. Research tools included couples' demographic information, face-to-face interviews, and the International Index of Erectile Function (IIEF). The treatment was based on couple's therapy. In the initial session, a comprehensive assessment of the couples' condition was conducted, and research instruments were completed. Additionally, during this session, the formation of psychogenic erectile dysfunction and the lack of successful foreplay were discussed. In subsequent sessions, desensitization, instruction on foreplay, and intercourse were addressed. Treatment success was defined as the ability to achieve complete vaginal penetration. Data was analyzed using SPSS 16 software. All 66 couples continued the treatment until they achieved successful vaginal penetration. All International Index of Erectile Function (IIEF) domains improved significantly after couple-based behavioral therapy in men with psychogenic erectile dysfunction in unconsummated marriages (all p < .001; large effect sizes for most domains). No significant associations were found between educational level, place of residence, engagement duration, or marriage duration and post-treatment scores (all p > 0.05). Male age correlated negatively with overall ED (r = -.314, P = .001), erectile function (r = -.361, P = .003), intercourse satisfaction (r = -.365, P = .003), and overall satisfaction (r = -.266, P = .031). Similar negative associations were observed for female age with overall ED (r = -.371, P = .002), erectile function (r = -.354, P = .004), intercourse satisfaction (r = -.344, P = .005), and overall satisfaction (r = -.246, P = .047). Psychogenic erectile dysfunction in unconsummated marriage can be addressed through couple-based therapy.
Screening and referral for type 2 diabetes mellitus (T2DM) during dental care visits has the potential for expanding preventive care. Using the consolidated framework for implementation research (CFIR) and the theoretical domains framework (TDF), we examined the barriers and facilitators at pre-implementation of a community-driven T2DM screening program in an urban dental clinic serving Alaska Native and American Indian (AN/AI) adults. This convergent mixed-methods parallel study was informed by the updated CFIR. Data were collected in 2023 through a 13-item survey of adult AN/AI potential recipients of the T2DM screening innovation/intervention, and individual in-person interviews with dental and primary care providers, staff, and operational leaders who were from the population of potential innovation deliverers. Univariate statistics and differences between strata were analyzed using R software. Interview transcripts were coded onto CFIR and TDF domains using template analysis then thematically analyzed. A convergent analysis identified areas of convergence, divergence, or complementarity. Two hundred and fifty potential innovation recipients provided survey responses. The majority of survey respondents agreed that the dental clinic is a good place to get T2DM screening, thought screening would be helpful, and had no concerns about the setting. Some respondents had concerns about T2DM screening in the dental setting or by dental staff due to T2DM screening not usually occurring in a dental visit. However, most survey respondents thought the dental clinic as a good place to get screened for diabetes and had low levels of concern about T2DM screening in dental settings. Primary care providers did not see the need for T2DM screening in dental settings; however, about half of potential innovation recipients thought the T2DM screening information would be helpful for their doctor and would be a good way to find if they were at risk for or currently had T2DM. Using CFIR and TDF, we identified barriers and facilitators to inform the design of a pilot process, development of pilot materials, and selection of innovation deliverers.
To prepare hydroxyapatite/chitosan (HA/CTS) nanocomposites at four weight ratios (85/15, 70/30, 50/50, 30/70) and two concentrations (3 and 5 wt.%), incorporate them into conventional glass ionomer cement (GIC), and evaluate their effect on compressive strength, shear bond strength to dentin, and antibacterial activity. HA/CTS nanocomposites were synthesized by co-precipitation and characterized by TEM and FTIR. Nine groups were prepared (n = 10): one unmodified control (Group I) and eight modified groups (Groups II-IX). Compressive strength was tested per ISO 9917-1:2007; shear bond strength to human dentin and antibacterial activity (agar diffusion against Streptococcus mutans, Staphylococcus aureus, and Escherichia coli) were also evaluated. One-way and two-way ANOVA with Tukey's HSD were applied (P ≤ 0.05). TEM confirmed nanoscale particles (7-50 nm) with dispersion improving at higher chitosan content. FTIR verified dual-phase incorporation and Ca2+-NH2 coordination bonding. Compressive strength (F(8,81) = 177.509; P < 0.0001) and shear bond strength (F(8,81) = 202.262; P < 0.0001) differed significantly among groups. A significant ratio × concentration interaction was confirmed for both properties (P < 0.0001). Only the 70/30 nanocomposite at 3 wt.% exceeded the control compressive strength (133.44 vs. 115.02 MPa; P < 0.05). All eight modified groups showed significantly higher shear bond strength than the control (6.04 MPa), with the 85/15 at 5 wt.% achieving the highest value (13.30 MPa). No inhibition zones were detected in any group. The 70/30 HA/CTS nanocomposite at 3 wt.% optimizes compressive strength, while the 85/15 at 5 wt.% optimizes dentin adhesion. Overall, the 70/30 HA/CTS nanocomposite at 3 wt.% demonstrated the most favorable balanced performance profile across both mechanical outcomes. The absence of detectable antibacterial activity under the present agar diffusion testing conditions may be related to chitosan immobilization within the nanocomposite matrix and the diffusion limitations of the assay method. Findings suggest the potential for application-specific optimization of HA/CTS-modified GIC under controlled in vitro conditions, pending further long-term and in vivo validation. HA/CTS nanocomposite modification enhanced the mechanical and adhesive performance of conventional GIC under the present experimental conditions. The observed improvement in compressive and shear bond strength across the modified formulations may support improved marginal integrity in esthetic GIC restorations. Two application-specific optimal formulations were identified based on the functional demands of the restoration site, with the 70/30 HA/CTS nanocomposite at 3 wt.% representing the most favorable overall formulation combining enhanced compressive strength with clinically acceptable dentin adhesion; however, further long-term and in vivo validation remains necessary before definitive clinical translation.
Parental burnout refers to a negative emotional state that parents experience during the process of parenting, which directly affects parents' parenting behaviors, family atmosphere and children's development. However, less studies focusing on the influence mechanism of parental burnout on problem behaviors in preschool children. Therefore, this study mainly explores the relationship between parental burnout and their preschool children's problem behaviors, as well as the mediating role of family functioning and the moderating role of children's effortful control. 537 preschool children and their parents in Shanghai, China participated in this study, parents filled out the Parental Burnout Assessment, Family Functioning Assessment Device, Children's Social Competence and Behavior Evaluation, and Children's Behaviour Questionnaire. The results showed that: (1) Parental burnout was significantly associated with preschool children's problem behaviors; (2) Family functioning played a mediating role between parental burnout and children's problem behaviors; (3) Preschool children's effortful control moderated the second half path of the mediating model, that is, children's high-level effortful control alleviated the adverse effects of parental burnout on children's problem behaviors through family functioning. Results highlighted the importance of parental burnout and children's effortful control on preschool children's problem behaviors.
Antibiotic resistance has emerged largely due to the improper use of antibiotics in clinical practice, although most acute diarrheal diseases resolve without antibiotic treatment and should be reserved for cases of invasive bacterial or dysenteric diarrhea. This study aimed to assess the patterns of antibiotic use for acute diarrheal diseases at Nigist Elleni Mohammed Memorial Teaching Hospital (NEMMTH) in Central Ethiopia. A retrospective cross-sectional study was conducted to assess patients treated for diarrhea between January 1 and June 30, 2023. The appropriateness of antibiotic prescriptions for diarrhea was evaluated according to the Ethiopian Standard Treatment Guidelines. Data were collected using a structured abstraction form, and patient charts were selected through systematic random sampling. The analysis was performed using the Statistical Package for Social Sciences version 25. Among 302 patients evaluated, 53.3% were female and 46.4% were children under five years old. Of the 302 patients, 57.6% had watery diarrhea. A total of 74.5% of patients received at least one antibiotic, of whom 73.5% received a single antibiotic during the treatment of acute diarrheal cases. The most commonly prescribed antibiotics were metronidazole (18.2%), cotrimoxazole (17.5%), and ciprofloxacin (11.6%). The proportion of inappropriate antibiotic prescribing was 77.1%. This study found a high level of inappropriate antibiotic use for acute diarrheal disease at NEMMTH. Metronidazole and cotrimoxazole are the most commonly prescribed antibiotics. Ensuring proper management by adhering to the standard treatment guidelines is crucial.
Black women in the United States experience disproportionately high breast cancer mortality and have high rates of comorbid hypertension; however, the associations of hypertension and antihypertensive medication use with breast cancer survival are unclear. We examined these associations among 2474 Black Women's Health Study participants with invasive breast cancer. Hypertension and antihypertensive medication use were assessed biennially, and breast cancer diagnoses were confirmed through medical records and cancer registries. We used Cox proportional hazards models, adjusted for clinical and lifestyle factors and cancer treatment, to estimate hazard ratios (HR) for breast cancer-specific death. In the full study population, the HR for untreated hypertension compared to no hypertension was 1.17 (95% CI = 0.75-1.82), while the HR for treated hypertension compared to no hypertension was 0.81 (95% CI = 0.60-1.10). For ER+ cases, there was no association between untreated hypertension and breast cancer specific-death (HR = 0.96, 95% CI = 0.50-1.82), but a strong inverse association between treated hypertension and breast cancer-specific death (HR = 0.53, 95% CI = 0.34-0.83). In contrast, for ER- cases, we observed an increased risk of breast cancer specific death among those with untreated hypertension (HR = 2.19, 95% CI = 1.09-4.39), but there was little evidence of an association with treated hypertension (HR = 1.32, 95% CI = 0.80-2.19). Overall, our findings indicate that Black breast cancer patients with hypertension have better survival when their hypertension is treated, possibly due to regular healthcare engagement or the tumor suppressing actions of antihypertensive medications. Randomized trials are needed to establish causality and inform optimal cardiovascular management in oncology.
Adverse social conditions across the life course influence brain aging and dementia, yet their compounded impact on clinical phenotypes remains underexplored, particularly in Latin America, where social inequality and dementia burden are high. We studied 3941 individuals from six Latin American countries, including cognitively unimpaired controls (CU), Alzheimer's disease (AD), and frontotemporal lobar degeneration (FTLD). A life-course questionnaire captured eight domains of social vulnerability, used to derive a social vulnerability index and latent vulnerability profiles. Brain health was characterized across 37 cognitive, functional, mental health, and dementia severity indicators. Higher vulnerability was mostly associated with executive and memory deficits in CU, cognitive and functional impairment in AD, and social cognition and neuropsychiatric symptoms in FTLD. Multidimensional brain health was affected across groups. Compounded social vulnerability is a key determinant of clinical expression in aging and dementia, underscoring the need for life-course-informed and equity-oriented dementia models.
Trigger finger (stenosing tenosynovitis) reflects abnormal tendon-pulley mechanics, primarily at the A1 pulley; however, objective assessment during functional motion remains limited in routine clinical practice. We evaluated electrical contact resistance (ECR) from a wearable tactile sensor during standardized digit motion and examined its association with symptoms. Nine participants with Green grade II-III trigger finger were prospectively enrolled. An origami-inspired pentagon-knot graphene-paper tactile sensor measured ECR over the A1 and A2 pulleys during repeated flexion-extension cycles. A 4-week intervention program (electrical stimulation plus infrared irradiation; three sessions per week) enabled repeated measurements. ECR and patient-reported outcomes were collected at weekly Tuesday assessments, with ECR recorded immediately before and after the session (ECRpre and ECRpost). Outcomes included pain (visual analog scale [VAS]) and triggering severity (ST), frequency (FT), and functional impact (FIT). Within-session change was defined as ΔECRsession = ECRpre - ECRpost. Analyses used linear mixed-effects models, repeated-measures correlation (rmcorr; rrm coefficient) and week-adjusted fixed-effects regression. Sensor placement and recording were feasible, with no adverse events. Across 27 paired weekly sessions (Weeks 1-4), ECR decreased from pre- to post-session at both pulleys (model-estimated mean ΔECRsession: A1 0.0795; A2 0.0990; both P < 0.001). A1 ECRpre declined over Weeks 1-4 (rrm = - 0.672; P = 0.0016). At matched weekly timepoints (N = 6; n = 24), A1 ECRpre correlated with VAS (rrm = 0.781; P < 0.001), FT (rrm = 0.578; P = 0.0095), and ST (rrm = 0.543; P = 0.0164), but not FIT (rrm = 0.165; P = 0.50). Larger A1 ΔECRsession values were associated with greater subsequent week-to-week pain improvement (rrm = 0.625; P = 0.0042). In a fixed-effects model adjusting for week, A1 ECRpre independently predicted VAS (β = 29.19; P = 0.018). Wearable ECR sensing was safe and feasible in this pilot study and demonstrated consistent within-session responsiveness. Clinically, motion-acquired ECR may serve as an objective adjunct for tracking session-level changes and week-to-week status with symptom scales. Retrospectively registered at ChiCTR (ChiCTR2600120811 approved).
The gut microbiota regulates skeletal muscle physiology, with an increasingly recognised role in Duchenne muscular dystrophy (DMD), the most severe X-linked myopathy. Unlike previous studies, we focussed on the genus Bacteroides and its metabolites, assessing their abundance in DMD mice and patients to clarify their potential contribution to the disease. The relative abundance of Bacteroides species was analysed in fecal samples from dystrophic mdx mice and DMD patients, compared with age-matched healthy controls, using PCR-based tecniques. Synthetic and analitical chemistry approaches followed by cell-based assays, in silico and bioinformatic analyses, were employed to identify an unknown mechanism of action of the Bacteroides-derived metabolites. DMD patients and mdx mice exhibited a significant reduction in commensal Bacteroides species, including Bacteroides vulgatus, known producers of SCFAs and commendamide, an endocannabinoid-like molecule with largely uncharacterized biological functions. In skeletal muscles of mdx mice, we observed biochemical features consistent with increased susceptibility to ferroptosis. In murine C2C12 cells and primary human myotubes exposed to the ferroptosis inducer erastin, commendamide conferred significant protective effects, which were further enhanced in the presence of SCFAs. Additionally, we discovered that commendamide acts as an endogenous activator of PPARα and PPARγ, with PPARα preferentially promoting the transcription of the antioxidant genes Gpx4 and Nrf2. These findings provide new insights into the gut-muscle axis in DMD, suggesting that the depletion of Bacteroides vulgatus and its metabolites may contribute to skeletal muscle degeneration. In vitro evidence demonstrates that commendamide, through PPARα signaling; and SCFAs, enhances antioxidant mechanisms. Overall, these results support further investigation of microbiota-derived metabolites as postbiotic candidates for DMD therapy.
Ensuring equitable access to essential medicines is fundamental to universal health coverage, yet disparities in availability, pricing, and affordability persist in many low- and middle-income countries. This study assessed the availability, prices, and affordability of essential cardiovascular and antidiabetic medicines across public and private healthcare sectors in Pakistan using the WHO/Health Action International (WHO/HAI) methodology. A cross-sectional survey of 32 essential medicines was conducted across selected study areas (Rawalpindi, Muzaffargarh, Vehari, Gujranwala, Islamabad, and Azad Jammu & Kashmir). Medicine availability was measured as the percentage of facilities stocking medicines on the survey day. Prices were analyzed using median price ratios (MPRs) against international reference prices, and affordability was calculated as the number of days' wages required by the lowest-paid unskilled government worker to purchase a standard 30-day treatment. Sectoral and regional differences were evaluated using chi-square tests. The availability of the 32 cardiovascular and antidiabetic medications was generally poor, especially in government facilities; originator brands (OBs) and lowest-priced generics (LPGs) were consistently more readily available in private pharmacies (χ²=180.6, p < 0.001). There were notable geographical differences, with rural areas exhibiting very poor access (χ²=202.8, p < 0.001) and Gujranwala exhibiting the greatest availability. While certain OBs, particularly insulin analogs, were noticeably more expensive than LPGs, prices and affordability favored LPGs across all medications. Public and private sectors continued to have insufficient supplies of insulin and emergency medications, falling short of WHO objectives. This study reveals persistent inequities in the availability and affordability of essential medicines across the selected districts in Pakistan. While these findings specifically reflect the studied regions, they provide actionable evidence to strengthen Pakistan's public-sector supply systems, promote generic medicines, and inform national access policies.
Accurately measuring vaccination coverage is crucial for programmatic and policy decision making, however accurate measurement of coverage can be challenging. We aimed to understand the extent of, and reasons for, inaccurate vaccination card records in a rural, low-income setting in Jigawa state, Nigeria. We conducted an explanatory sequential mixed-methods study in Kiyawa Local Government Area, Jigawa State, from September 2022 to July 2023, using data from the INSPIRING Jigawa trial (ISRCTN39213655). Quantitative data was gathered from surveyed women aged 16-49 in sampled compounds, who presented their child's vaccine card. Vaccine documentation was defined as inaccurate when the vaccine card is discordant with caregiver report. Adjusted logistic regression identified factors associated with inaccuracies. We conducted in-depth interviews with healthcare workers and focus groups with community members, analyzing transcripts using conventional content analysis, and triangulated findings with quantitative results. Records for 4258 children under five-years, from 3232 women, were examined. Of these children, 441 (10.4%) had vaccine cards that were deemed inaccurate by their caregivers. Inaccuracies were primarily attributed to cards being filled despite the child not receiving the vaccine, misplacement or loss of vaccine cards, vaccine stock-out when cards had already been filled, and vaccine card stock-out when the vaccine had been administered. Our adjusted logistic regression results show the following variables were associated with reporting inaccurate vaccine cards (under or over-reporting): any education compared to none (adjusted odds ratio (aOR): 1.33, 95%CI: 1.03, 1.75), having co-wives compared to no co-wife (aOR: 0.78, 95%CI: 0.62, 0.98), and child's age: 12-24 months compared to < 12 months (aOR: 2.70, 95%CI: 1.94, 3.75) and 25 months and above compared to < 12 months (aOR: 2.30, 95%CI: 1.69, 3.12). Our qualitative findings highlighted maternal lack of knowledge of vaccination schedule and forgetfulness about the vaccination schedule as common reasons for vaccine card inaccuracy. We identified health system failures and caregiver barriers leading to inaccurate reports in vaccine cards. It is essential to sensitize caregivers and healthcare providers on the importance of accurately documenting vaccines and validating immunization recording systems. Not applicable.
To review extant literature for the use of digital technology to deliver cognitive training perioperatively to prevent or mitigate postoperative delirium (POD). Increasing rates of surgical care place pressures on healthcare systems. POD is a prevalent complication in older adults, worsening patient outcomes and up to 40% may be preventable. Since preoperative cognitive dysfunction is a primary risk factor, understanding the impact of technology-assisted cognitive enhancement on POD may improve patient experience and alleviate costs. Five databases were searched, and articles were reviewed by two investigators. Clinical trials that used digital technology perioperatively to prevent POD in older adults and written in English or French were included in the study. Relevant information was extracted. Out of the 630 articles identified, six (n = 6) were included. Surgical type, targeted cognitive domains and intervention dosing varied, exclusion criteria were restrictive and effectiveness was both positive and null. Relatively few relevant studies were identified indicating the literature is in its infancy. While two of the studies showed positive outcome trends, further research is needed to address adherence, modifiability of cognitive training programs, intervention dosage and less restrictive sampling.
Specialized pediatric oncology is typically concentrated in a few high-volume centers, creating tensions between the need for centralization and equitable spatial access. For regional health planning, robust methods are required to delineate hospital catchment areas and understand how structural site characteristics and accessibility shape patient-to-hospital travel flows. This study uses pediatric oncology in Bavaria, Germany, as a case to develop and test an extended, empirically calibrated Huff model for modeling hospital catchment areas. We analyzed 3,320 incident cases of pediatric oncology recorded in the German Childhood Cancer Registry between 2014 and 2023, which were treated at the seven specialized hospitals in Bavaria. An extended Huff model was specified that integrates structural indicators of hospital capacity and quality (bed capacity, staffing, cancer center accreditation), a spatial clustering variable that captures proximity-related interactions among nearby hospital sites, and a logistic distance-decay function based on travel times. Model parameters were estimated using maximum likelihood, and competing specifications were compared primarily using mean absolute percentage error (MAPE). A scenario analysis was conducted to assess how a reduction of nurse staffing ratios at two Munich hospitals would affect patient-to-hospital travel flows and catchment areas. Our final baseline model, comprising four structural indicators, a clustering variable, and a logistic travel-time function, achieved a MAPE of 5.85% and an R² of 0.89. Capacity and quality indicators displayed positive effects on hospital choice, whereas the clustering parameter was negative, indicating proximity-related interaction effects among nearby hospitals. In the case scenario, a 20% reduction in the nursing staff ratio at the Munich sites led to declining modeled patient shares at both hospitals (- 2.0 and - 2.5% points, respectively) and corresponding gains primarily at Augsburg (+ 3.5% points) and Regensburg (+ 1.3% points), particularly in overlapping and transitional catchment zones. Our extended Huff model, which combines multidimensional structural indicators, spatial clustering, and realistic travel-time effects, can accurately represent hospital catchment areas and patient-to-hospital travel flows in specialized pediatric oncology. The approach provides a transparent, empirically grounded framework for assessing accessibility, identifying spatial interdependencies between hospital sites, and conducting scenario-based simulations to inform regional health planning and workforce policy in specialized care settings.