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.
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.
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.
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.
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.
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.
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.
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.
Anemia remains a significant public health issue, especially in emergency areas and refugee camps. This study was conducted to determine the prevalence of anemia and its associated factors among children aged 6 to 59 months in Qoloji internally displaced people camp site, Somali Region, eastern Ethiopia. A community-based cross-sectional study was conducted among 401 children aged 6 to 59 months. Capillary blood was collected and hemoglobin level was determined using HemoCue Hb 301. Data was analyzed using SPSS version 26. Bivariable and multivariable logistic regression were used to identify determinants of anemia. The overall prevalence of anemia was found to be 51.4% (95% CI: 46.6%, 56.4%). Of the anemic children 29.4% (95% CI: 25.2%, 33.9%), 16.7% (95% CI: 13.2%, 20.7%) and 5.2% (95%CI: 3.2%, 7.5%) had mild, moderate, and severe anemia respectively. Initiation of complementary feeding below 6 months (AOR = 2.6;95% CI:1.5,4.6), household food insecurity (AOR = 5.4;95% CI:2.8,10.2), mothers of child having no formal education (AOR = 2.8; 95% CI: 1.3, 5.7), inadequate dietary diversity (AOR = 7.9; 95%CI:4.4, 13.9) and lack of antenatal care follow up during pregnancy (AOR = 3.5;95% CI:1.8, 6.7) were found associated with of anemia. The prevalence of anemia was high among children. Household food insecurity, dietary diversity, initiation of complementary feeding, maternal educational status and antenatal care during pregnancy were factors found associated with anemia. Therefore, adequate interventions should be designed and implemented considering improvement of household food security, access to maternal education and dissemination of nutrition and health related information.
To investigate the use of contrast-enhanced mammography (CEM) for preoperative prediction of lymphovascular invasion (LVI) status in invasive breast cancer. A total of 243 female patients diagnosed with invasive breast cancer (median age: 49 years; range: 27-77 years) who received preoperative CEM examination in our hospital between September 2018 and February 2024 were retrospectively collected and analyzed. The study population were chronologically divided into training and test datasets in an approximate ratio of 7:3. LVI status was determined using postoperative histopathologic examination. CEM features were analyzed on the low energy and the recombined images. To identify independent predictors for LVI status, univariable and multivariable logistic regression analyses were performed on CEM and clinicopathologic features. Logistic regression and six machine learning methods were used to construct prediction models in the training dataset, and their performance were evaluated with ROC curve in the test dataset. In training and test datasets, the rates of LVI-positive were 39% (67 of 172) and 34% (24 of 71), respectively. High Ki67 index, BI-RADS category 5, breast composition category c/d, axillary adenopathy, mild to marked background parenchymal enhancement level, and lesion with complete enhancement or enhancement extending on CEM images were significantly correlated with LVI-positive (all P < 0.05) and were incorporated to construct prediction models. The AUCs of seven prediction models were in the range of 0.713-0.850 in the test datasets, where the logistic regression model yielded an AUC of 0.835 (95%CI: 0.717-0.924), showing similar or higher AUC than the six machine learning models. CEM could be useful for preoperative noninvasive prediction of LVI status in invasive breast cancer. The prediction model integrating contrast-enhanced mammography features and Ki67 index may serve as a complementary tool to assist clinicians in preoperative prediction of lymphovascular invasion status in patients with invasive breast cancer.
To evaluate the effects of cardiopulmonary bypass (CPB) on peripheral white blood cell counts, neutrophil surface marker expression, and neutrophil function by comparing patients undergoing on-pump CABG (ONCAB) versus off-pump CABG (OPCAB), and to identify CPB-related immunological and inflammatory alterations. Patients undergoing on-pump CABG (ONCAB) or off-pump CABG (OPCAB) were recruited. Blood samples were collected preoperatively and at 24 h postoperatively. The primary outcome was the neutrophil-to-lymphocyte ratio (NLR) measured at 24 h after surgery. Secondary outcomes included monocyte Human leukocyte antigen-DR (HLA-DR) expression, lymphocyte programmed cell death protein-1 (PD-1) expression, and neutrophil surface markers (CD11b, CD18, CXCR2, CD35, CD63, CD66b, CD88, and programmed cell death-ligand 1). Neutrophil apoptosis, reactive oxygen species (ROS) production, and plasma inflammatory mediators (interleukin-6, tumor necrosis factor-alpha, interleukin-10) were also measured. Postoperative clinical outcomes and laboratory parameters were recorded. Data from 36 ONCAB patients and 18 OPCAB patients were analyzed. Postoperative NLR was significantly higher in the ONCAB group than in the OPCAB group (16.6 ± 6.1 vs. 13.1 ± 3.9; p = 0.015). This difference was attributable to lower lymphocyte counts in the ONCAB group (0.7 ± 0.2 vs. 0.8 ± 0.2 × 109/L; p = 0.002), whereas neutrophil counts did not differ significantly between groups. In both groups, monocyte HLA‑DR expression decreased and lymphocyte PD-1 expression increased after surgery. CPB did not result in significant alterations in neutrophil adhesion, chemotaxis, degranulation markers, ROS production, or apoptosis. ONCAB patients had higher postoperative levels of aspartate aminotransferase (AST), cardiac troponin I (cTnI), and procalcitonin (PCT), as well as longer durations of mechanical ventilation and intensive care unit stay. CPB elevates the NLR after CABG primarily, accompanied by reduced level of lymphocyte count, but not neutrophil count or molecular markers of neutrophil functional. These results might reflect a higher risk of short-term complications after on-pump CABG.
Colorectal polyps are the most important precursor lesions of colorectal cancer. Their epidemiological characteristics and risk factors exhibit substantial regional and population-based variations. Qinghai Province, located on the Qinghai-Tibet Plateau in China, is characterized by a unique hypoxic environment and a multi-ethnic population. However, large-scale epidemiological data on colorectal polyps in this region is limited. To characterize the detection rate, temporal trends, demographic distribution, and risk factors for colorectal polyps in Qinghai Province. Retrospective study. A single tertiary medical center in Qinghai Province, China. We enrolled 33059 patients who underwent colonoscopy at Qinghai University Affiliated Hospital (2021-2025). Data on demographics and endoscopic findings were collected. Temporal trends were analyzed using the linear-by-linear association LLA test, and independent risk factors were identified by binary logistic regression. Colorectal polyp detection rate and risk factors. 33059 patients. The overall colorectal polyp detection rate was 31.82% (10519/33059), with a slight upward trend over the study period. Rates were significantly higher in males (39.01%) than females (24.04%) and increased sharply with age. Multivariable analysis identified male sex (OR=2.493, 95 %CI:2.106-2.950, P<.001), age 41-64 years (OR=2.535, 95% CI:2.056-3.125, P<.001), and age ≥65 years (OR=4.379, 95% CI:3.328-5.761, P<.001) as independent risk factors. Tibetan and Hui ethnicities were associated with lower risk compared with Han (OR=0.611, 95% CI:0.448-0.833, P=.002). Colorectal polyp detection is high and rising in Qinghai. Male sex and advanced age are major risk factors. Notably, Tibetan or Hui ethnicity appear as potential protective factors, offering new insights into genetic interactions that may inform region-specific screening strategies. Single-center retrospective design, potential selection bias, lack of lifestyle and metabolic data.
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.
Ethical care provision among nurses refers to the provision of care that is in line with ethical principles, which include autonomy, beneficence, non-maleficence, and justice. Ethical care is fundamental to effective and safe care. Violations of ethics can result in negative outcomes for patients and erode trust in healthcare providers. There are gaps between accepted ethical principles and ethical care provision in Ethiopia. Therefore, this study aimed to assess the ethical care provision and its determinants among nurses. An institution-based cross-sectional study was conducted among 411 nurses in public hospitals of the Wolaita Zone, South Ethiopia, from August 1 to 30, 2023. The study comprised two components: a self-administered survey (n = 411) and an embedded overt observational component. Of the total participants, 354 nurses were selected for observation, with 322 successfully completing the component. A simple random sampling method was used to select study participants from selected hospitals. The data were entered into EpiData version 4.6, and analysis was done using SPSS version 25. Bivariate and multivariate logistic regression were used to identify associated factors. Significance was considered at a P-value < 0.05 in the multivariate analysis. The prevalence of self-reported good ethical care provision was 64.5%, while observed practice was 59.9%. Nurses who had good knowledge of the ethical care principles (AOR 5.23; 95% CI 2.27, 12.03), nurses who had good communication skills (AOR 2.32; 95% CI 1.07, 5.00), nurses who were satisfied with their jobs (AOR 9.53; 95% CI 4.54, 20.02), nurses who had training in the nursing code of ethics (AOR 5.68; 95% CI 2.56, 12.59), and nurses who had favorable attitudes (AOR 4.42; 95% CI 2.09, 9.40) were significantly associated with ethical care provision. The ethical care provision in this study was suboptimal. Knowledge, attitude, communication skills, training, and job satisfaction were the predictors of ethical care provision. Therefore, providing in-service training for nurses to improve their skills in the ethical care provision and communication was recommended to maximize the ethical care provision. In addition, nurses should engage in continuous professional development to enhance their knowledge and skills in ethical care. Not applicable.
Given the unprecedented global volume of forced migration, ensuring equitable access to healthcare for refugees has become a pressing global health priority. This comparative case study examined country-level determinants that influence healthcare access and social determinants of health among refugees in Australia, South Korea, and the United States. We conducted a comparative case study to identify country-level factors influencing refugee healthcare access in Australia, South Korea, and the United States. Countries were selected to capture diversity in geographic context, immigration and integration policies, and healthcare system structures. Data sources included a comprehensive review of laws, policies, and peer-reviewed literature, as well as in-depth interviews with refugees, healthcare providers, resettlement agency staff, and legal professionals. We used framework analysis guided by a conceptual model, incorporating both deductive and inductive coding. This study focused on cross-case themes emerging from the synthesis of all data sources. Findings revealed that, while refugees in all three host countries generally view health services as superior to those in their countries of origin, significant disparities persisted in access across various factors. The availability of culturally and linguistically appropriate care, legal frameworks, insurance systems, and social supports varied widely, contributing to health disparities. In the United States, complex healthcare navigation and insurance gaps posed substantial barriers, while in South Korea, legal mandates for interpretation services were lacking, and health insurance coverage was limited for certain refugee groups. Australia's universal health coverage and government-funded language and interpretation services supported more inclusive access, although barriers existed for vulnerable subgroups. This study underscores the significance of national policies, culturally competent care, and long-term integration support in promoting health equity for refugees. It also highlights the need for targeted, context-sensitive strategies to address persistent barriers and calls for better-tailored policies to support the health and well-being of refugees in host countries and beyond.
Modified radical mastectomy (MRM) is frequently associated with moderate to severe postoperative pain, which may negatively affect recovery and quality of life. Regional anesthesia techniques such as the erector spinae plane block (ESPB), thoracic paravertebral block (TPVB), and pectoral nerve block (PECS) have been increasingly used as part of multimodal analgesia strategies for breast surgery. However, their comparative effects on analgesic efficacy and quality of recovery remain unclear. The study included 90 female patients undergoing unilateral elective MRM. Patients were randomly allocated into three groups (n = 30 each) to receive ESPB, TPVB, or PECS block preoperatively with 0.25% bupivacaine. All patients subsequently underwent standardized general anesthesia. Postoperative pain was assessed using the Visual Analog Scale (VAS) at 0, 1, 3, 6, 12, and 24 h. The primary outcome was total morphine consumption at 24 h. Secondary outcomes included time to first morphine request, incidence of rescue fentanyl use, postoperative nausea and vomiting, patient satisfaction, and scores. Demographic characteristics and operative durations were comparable among the groups (p > 0.05). Total 24-hour morphine consumption was significantly higher in the ESPB group (median 10 mg) compared with TPVB (9 mg, p = 0.009) and PECS (9 mg, p = 0.018) groups. Kaplan-Meier analysis revealed that the time to first morphine request was significantly shorter in the ESPB group (p < 0.001), while TPVB provided the longest analgesic duration. No significant differences were found in postoperative pain scores, rescue opioid requirements, or nausea-vomiting incidence (p > 0.05). QoR-15 scores were significantly lower in the ESPB group compared with TPVB and PECS groups (p < 0.001). Both PECS and TPVB provided superior postoperative analgesia and better quality of recovery scores compared to ESPB in patients undergoing modified radical mastectomy. These findings support the use of PECS or TPVB as effective components of multimodal analgesia strategies for breast cancer surgery. ISRCTN Registry, ISRCTN17247698.
Sensory symptoms have been increasingly recognized as core characteristics of tic disorders (TD). This study aimed to systematically investigate the core features of sensory processing abnormalities in Chinese children with tic disorders, analyze their association with tic severity, and explore potential subtypes based on sensory profiles. This cross-sectional study recruited 151 children diagnosed with TD (encompassing Tourette syndrome, chronic motor tic disorders, and provisional tic disorders) along with 100 age-matched healthy controls (HC). Sensory processing characteristics were assessed using the Short Sensory Profile, and tic severity was evaluated with the Yale Global Tic Severity Scale. Principal component analysis (PCA) and latent profile analysis (LPA) were employed to explore sensory subtypes. Correlation analyses and regression models were used to examine sensory-symptom relationships. Children with TD showed significantly lower total SSP scores than HCs (P < 0.001), with deficits primarily in "under-responsive/sensation seeking", "auditory filtering" and "low energy/weakness". PCA extracted two core dimensions: "sensory dysfunction" and "sensory hypersensitivity". A significant positive graded relationship was found between the degree of sensory abnormality and tic severity (P for trend = 0.025). The "under-responsive/ sensation seeking" dimension was an independent predictor of tic severity (β = -0.164, P = 0.044). LPA identified two subtypes: a "relatively typical sensory processing" subtype (88.7%) and a "sensory over-responsivity" subtype (11.3%). However, no significant difference in tic severity was found between these subtypes. Sensory processing abnormalities, particularly generalized sensory modulation dysfunction, are prevalent across TD subtypes and are closely associated with tic severity. Sensory under-responsivity represents a core risk dimension, while the unique "sensory over-responsivity" subtype may be relatively independent of tic severity. This study provides important evidence for sensory-based subtyping of TD and for developing individualized interventions targeting sensory symptoms.
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.
Insulin resistance (IR) is a multifactorial metabolic condition influenced by lifestyle, body composition, and behavioral factors. Regular physical activity is known to improve insulin sensitivity, yet its associations with anthropometric and socio-demographic variables remain incompletely understood, particularly among young women. A total of 443 women aged 18-35 years participated in this cross-sectional study, including 301 with medically confirmed IR and 142 metabolically healthy controls. Anthropometric indices, Body Mass Index (BMI), Waist-Hip Ratio (WHR), Abdominal Volume Index (AVI), and Body Adiposity Index (BAI), were self-measured using standardized procedures. Physical activity was assessed via the Global Physical Activity Questionnaire (GPAQ), with total energy expenditure expressed as Metabolic Equivalent of Task (MET). Group comparisons were performed using Mann-Whitney U tests and Generalized Linear Models (GENLIN) with robust covariance estimation. Women with IR exhibited significantly higher BMI, WHR, AVI, and BAI values (all p < 0.001) and lower total physical activity (2,615 vs. 3,679 MET; p = 0.01) compared with controls. Sedentary behavior was more prevalent among IR participants (449 vs. 363 MET; p < 0.001). The observed differences were independent of anthropometric covariates. Socio-demographic factors showed nonlinear associations: lower and higher income levels, as well as rural residence, were linked to reduced activity in the IR group. Sleep duration showed no significant effect. Physical activity, independent of body composition, is a key determinant of metabolic health in women. The results highlight the need for targeted behavioral interventions promoting movement as a core therapeutic and preventive strategy in insulin resistance management.