Burnout is recognized as a disorder in 11th revision of the International Classification of Disease, has a high prevalence amongst healthcare workers and trainees, and has significant sequelae on their health and on patient care. The standard scales to assess burnout like the Maslach burnout inventory-human services survey (MBI-HSS) take time and effort to be completed, and are more appropriate for research rather than clinical settings. There is a short two-item version that has been validated among different healthcare providers and is easier to administer, improving response rates. Our study aimed to validate the two-item MBI-HSS in a national cohort of Saudi health-care trainees, and to compare the prevalence of burnout when using the two-item. MBI-HSS with the prevalence yielded by the full version of the MBI-HSS at various cut off scores (standard, generalized and high cut off scores or definitions). This study was a secondary in-depth analysis of data that was collected during an online survey-based cross-sectional study that targeted all healthcare professions' training programs across Saudi Arabia between February and May 2019. The primary outcome was to validate the two-items MBI-HSS in terms of diagnosing burnout, compared to the full version of MBI-HSS and examine its psychometric properties. The secondary outcomes were: comparing the prevalence of burnout yielded by the full version versus the two-items MBI-HSS. A total of 6,066 of 11,500 Saudi healthcare trainees (57.4%) participated in the survey. There was a significant correlation between the two-item MBI-HSS and the standard, generalized and high burnout definitions on the full MBI -HSS. The 2-item MBI-HSS had a sensitivity of 87.6%, a specificity of 76.35%, a positive predictive value of 82.5%, and a negative predictive value of 82.8% when using the standard definition of burnout. The prevalence of burnout was 48.3% when the 2-item MBI was used. It was 56.1% based on the Standard Burnout definition, 76.2% based on the Generalized Burnout definition and 17.5% based on the High Burnout definitions. This is the first study to validate the two-item MBI in a national sample of Saudi health-care trainees, to our knowledge. Results indicate a high prevalence of burnout amongst Saudi health care trainees, and that the two-item MBI-HSS is a valid easy to use tool to measure burnout in this population. This may inform the use of this short measure among this population for educational, wellbeing and research purposes. They can also inform the evaluation and monitoring of programs addressing wellbeing amongst Saudi trainees, as well as be generalized to other populations.
The article discusses the socio-legal aspects of the development mutual cooperation between Russia and China in the public health. This direction of the current Russian-Chinese political agenda is caused by some factors. One of them is the common nature of public health problems and challenges faced by the healthcare systems. Also the reason is the growth of cross-border mobility of the population of both countries, which necessitates coordination of efforts in the field of regulation, ensuring the quality of services, protecting patients rights and epidemiological control. In this regard, the objective of the study is to analyze the key areas, legal mechanisms and social challenges that influence the development of interaction between Russia and China in the field of public health. Based on the results of the study, the main vectors in the Russian-Chinese cooperation in the field of public health are defined. They include: 1) prevention and control of infectious diseases; 2) digital transformation of healthcare; 3) oncology and nuclear medicine; 4) medical education and science; 5) ethical problems. The main mechanisms of interaction between Russia and China in public healthcare are legal regulatory (bilateral agreements, interdepartmental protocols, harmonization of regulatory requirements) and projects in scientific and educational sphere. Overall, cooperation between Russia and China in healthcare is dynamically developing, multifaceted, and promising. However, there are a number of limitations and problems, including cultural barriers, legal restrictions and ethical challenges. To sum up, the Russian-Chinese cooperation in the field of public health has significant potential, but requires the development of a legal framework and a systematic approach. Одним из актуальных направлений в развитии отношений между Россией и Китаем на современном этапе является сотрудничество обоих государств в сфере общественного здравоохранения. Данный вектор российско-китайской политической повестки обусловлен рядом фактором, а именно: общим характером проблем здоровья населения и вызовами, с которыми сталкиваются системы здравоохранения, ростом трансграничной мобильности населения обеих стран, что вызывает необходимость координации усилий в области регулирования, обеспечения качества услуг, защиты прав пациентов и эпидемиологического контроля, которые обусловливают исследовательский интерес к изучению социально-правовых аспектов в развитии российско-китайского сотрудничества в сфере общественного здоровья. В этой связи цель данного исследования заключается в проведении анализа ключевых направлений, правовых механизмов и социальных вызовов, которые влияют на развитие взаимодействия между Россией и Китаем в сфере общественного здоровья. По результатам проведённого исследования на основе принципа методологической триангуляции были выявлены основные векторы в российско-китайском сотрудничестве в сфере общественного здоровья: 1) профилактика и борьба с инфекционными заболеваниями (в 2025 г. Россия и Китай подписали меморандум о сотрудничестве в области борьбы с инфекционными болезнями); 2) цифровая трансформация здравоохранения (в 2025 г. Минздрав России и Государственный комитет КНР по здравоохранению подписали Меморандум о взаимопонимании в области цифровой трансформации здравоохранения); 3) онкология и ядерная медицина; 4) медицинское образование и наука (образована Российско-Китайская ассоциация медицинских университетов, которая способствует обмену специалистами, разработке совместных образовательных программ и взаимному признанию дипломов о медицинском образовании). Основными механизмами взаимодействия России и Китая в сфере общественного здравоохранения выступают: нормативно-правовые (двусторонние соглашения, межведомственные протоколы, гармонизация регуляторных требований) и научно-образовательные (совместные исследования, обмен кадрами, образовательные программы). В целом, сотрудничество России и Китая в сфере здравоохранения можно охарактеризовать как динамично развивающееся, многогранное и перспективное. Однако есть ряд ограничений и проблем, включая культурные барьеры, правовые ограничения и этические вызовы. Сделан вывод о том, что российско-китайское сотрудничество в сфере общественного здоровья имеет значительный потенциал, но требует разработки правовой базы и системного подхода.
Osteoporotic fractures are underrepresented in administrative data. In the present study, only 1 of 94 admissions for osteoporotic fracture was coded correctly, mostly due to inadequate clinical documentation. Following education of junior doctors, 36% of osteoporotic fractures were coded correctly, with coding of femur fractures particularly amenable to improvement. Osteoporotic fractures are underrepresented in hospital administrative data. This study analysed the accuracy of clinical coding of osteoporotic fractures and prospectively evaluated the effectiveness of an educational intervention for junior medical officers (JMO) to improve documentation and coding accuracy. Coding accuracy was measured in 279 consecutive inpatients deemed to have suffered an osteoporotic fracture based on predetermined criteria. Subsequently, an education programme for JMO was delivered, focusing on osteoporotic fracture criteria and clinical coding requirements. A 10-week post-intervention analysis was conducted to determine improvement in coding accuracy using baseline data as a historical control. At baseline, 1 of 94 (1.1%) admissions meeting the criteria for osteoporotic fracture received the correct ICD-10 M80 primary diagnosis code. Post-intervention, coding accuracy improved markedly, with 14 out of 39 (36%) osteoporotic fracture admissions coded correctly. However, this improvement varied by site, with 77% of femur fractures, but only 10% of radius and 13% of humerus fractures receiving the correct primary clinical code. Coding accuracy decreased with time, from 42% in the first 5 weeks post-education to 27% in the subsequent 5 weeks. Osteoporotic fractures are severely underrepresented in hospital administrative data due to inadequate documentation leading to inaccurate coding. Whilst education programmes can improve coding accuracy, long-term efficacy is limited by multiple factors. Since clinical coding forms an important part of public health resource allocation, automated system-based solutions are required to ensure accurate statistical capture of the true burden of osteoporosis and associated fractures.
Hyperglycaemia is common in intensive care unit (ICU) patients and blood glucose management practices likely vary, but there are limited contemporary data on ICU doctors' and nurses' preferences. We conducted an international online survey of ICU doctors and nurses. The 16-question survey covered respondent characteristics, glucose management practices, perceived challenges with intermittent point of care (iPOC) glucose monitoring and continuous glucose monitoring (CGM), and preferences for a future trial on CGM versus usual care. Data were reported descriptively for all respondents and stratified by profession. We received 1424 responses from 12 countries, of which 63% were from nurses. The overall response rate was 36% and the highest proportion of missing data for any question was 9%. Most respondents (92%) reported that their ICU had a glucose management protocol. The median reported insulin initiation threshold was blood glucose of 10 mmol/L. Long-acting insulin was reported to be used occasionally by 68% of respondents. As needed pro re nata insulin was reported as most often given subcutaneously (43%) or intravenously (25%). Overall, 61% of ICU nurses reported concerns related to iPOC use versus 53% among ICU doctors (concerns among nurses versus doctors included risk of hypoglycaemia in 41% vs. 28%; risk of hyperglycaemia in 28% vs. 16%; patient discomfort in 26% vs. 27%). Overall, 75% of respondents never used CGM and 18% of ICU nurses reported concerns related to CGM use versus 22% of ICU doctors (accuracy and reliability in 14% vs. 18%; calibration and maintenance in 9% versus 16%; patient discomfort in 5% vs. 6%, respectively). Most respondents (89%) supported a randomised trial on CGM versus usual care in ICU and 68% preferred an intervention arm with a specific CGM-treatment protocol. Glucose management preferences varied among ICU staff, particularly in the administration of as needed doses and long-acting insulin. ICU nurses appeared more concerned about iPOC use than ICU doctors. The concerns about use of CGM appeared less common than concerns about iPOC. Most nurses and doctors would support a randomised trial on CGM versus usual care for glucose management in ICU and reported a preference for CGM to be used with a specific treatment protocol. This international survey highlights substantial professional differences and heterogeneity in ICU glucose management practices, particularly regarding as-needed and long-acting insulin use. Nurses expressed greater concern than doctors about intermittentpoint point-of-care glucose monitoring, especially the risks of hypoglycaemia and hyperglycaemia. Although continuous glucose monitoring was rarely used, it was viewed favourably overall, with broad support for a future protocolised randomised CGM trial.
In our earlier report of headache prevalence among children (6-11 years) and adolescents (12-17) in Zambia, we defined undifferentiated headache (UdH) conventionally as mild headache lasting < 1 h. However, we recognised diagnostic uncertainties, which also occurred in our similar studies elsewhere in sub-Saharan Africa (Ethiopia and Benin). Here we use a modified definition of UdH, making new estimates of prevalence accordingly, and estimates based on these of headache-attributed burden. The study was part of the global schools-based programme conducted by the Global Campaign against Headache. In a cross-sectional survey using the standardised protocol of the global programme, the child and adolescent versions of the HARDSHIP questionnaire, translated into the local languages, were completed by pupils in mediated sessions within their classes in nine schools representative of Zambia's urban/rural divide. Headache diagnostic questions were based on ICHD-3 except for UdH, which we redefined as mild or moderate headache lasting < 1 h. Enquiry included multiple aspects of attributed burden. Of 2,759 potential participants, 2,089 (615 children [29.4%], 1,474 adolescents [70.6%]) completed questionnaires (participating proportion 75.7%). The unfeasibly high observed prevalence of migraine reported earlier (51.6%, including probable migraine) was reduced by redefining UdH to 42.9%, still highly questionable. Nonetheless, burden measures clearly distinguished migraine from tension-type headache (TTH) and UdH. Migraine headache was the most intense, most frequent and longest lasting, but proportion of time in ictal state (pTIS) was only 1.3%. However, pTIS was much greater among those with probable medication-overuse headache (7.9%) or other headache on ≥ 15 days/month (9.0%). Headache accounted for an estimated loss of 3.5% of school time in those affected, migraine having twice the impact of TTH or UdH, while H15 + accounted for > 15% of lost school time. Almost one in six parents (15.9%) lost time from their own work. Migraine had greater impact than TTH and UdH on both emotional impact and quality-of-life scores. Headache, prevalent among children and adolescents in Zambia, is associated with burdens that include lost school time, with, potentially, lifelong negative impact. These findings are of importance to national educational and health policies. Our modified definition of UdH was a step towards diagnostic veracity, but did not resolve the diagnostic difficulties among young people. Future studies might consider further modifications, but full review of the ICHD criteria for migraine in these age groups is needed.
Contraceptive counselling is a key preventive intervention for reducing unintended pregnancies and unsafe abortions. In a setting such as Vietnam, where contraceptive use is prevalent, the quality and consistency of counselling provided by future physicians are critical. Although this is a core competency in medical education, evidence suggests that medical students demonstrate deficits in applied knowledge, skills and confidence regarding counselling. Evidence regarding medical students' intentions to provide contraceptive counselling in Vietnam remains limited and has not been systematically examined. A nationwide cross-sectional study will be conducted from October 2025 to October 2026 at 12 medical universities representing three distinct regions. Self-administered online questionnaires (via KoboToolbox) will be distributed to first-year to sixth-year medical students. This protocol describes a two-phase study. Phase 1 (scale development and validation; n=600, including pilot and psychometric evaluation) aims to develop and validate the Extended Theory of Planned Behaviour (E-TPB) scales (Knowledge, Attitude, Subjective Norms, Perceived Behavioural Control, Intention). This phase uses the Content Validity Index, Classical Test Theory and Item Response Theory Two-Parameter Logistic to generate latent trait scores for Knowledge, followed by exploratory factor analysis, confirmatory factor analysis (CFA) and assessment of convergent and discriminant validity. Phase 2 (main survey; n=1300) describes the current status by academic year, gender and institution. Simultaneously, the E-TPB model will be tested using Covariance-Based Structural Equation Modelling to estimate standardised path coefficients and mediation effects (5000 bootstrap samples). A multigroup SEM will be conducted to test measurement/structural invariance and to compare key groups (gender; preclinical vs clinical). Missing-data handling will prioritise full information maximum likelihood for CFA/SEM, with strict adherence to predefined quality control criteria. The study protocol was formally approved by the Institutional Ethical Review Board for Biomedical Research at Hanoi Medical University on 3 March 2026 (Approval No. 120/GCN-KHCN). Results will be published in international peer-reviewed journals and sent to participating medical universities.
To identify prenatal predictors of tuberous sclerosis complex (TSC) in fetuses with one or more cardiac rhabdomyomas (CR), evaluate an integrated multimodal diagnostic workflow using fetal magnetic resonance imaging (MRI) and trio whole-exome sequencing (trio-WES) and characterize perinatal outcomes. This was a retrospective cohort study of 80 fetuses that were diagnosed prenatally with one or more CR between February 2016 and December 2024 at a single tertiary center and that received a definitive TSC diagnosis either prenatally (via genomic or clinical criteria) or by postnatal pathological verification. All fetuses underwent routine high-resolution echocardiography. Those in which a CR was suspected were then offered the option of further investigation via fetal brain MRI and trio-WES, to identify pathogenic variants in TSC1/TSC2 genes. A definitive prenatal TSC diagnosis was assigned based on genetic testing or the presence of two major clinical features. Clinical, imaging, genetic and perinatal data were retrieved and compared between the TSC-positive and TSC-negative groups. Postnatal or postmortem verification was only required in cases that lacked a definitive prenatal diagnosis. Performance metrics, including sensitivity, specificity and positive (PPV) and negative (NPV) predictive values, were calculated to evaluate the diagnostic utility of tumor multiplicity and fetal brain MRI in prediction of TSC. Forty-eight (60.0%) fetuses were diagnosed with TSC and 32 (40.0%) were TSC-negative. Tumor multiplicity had a sensitivity of 87.5% (95% CI, 74.8-95.3%) but low specificity (50.0%; 95% CI, 31.9-68.1%) for the prediction of TSC. Seventy fetuses underwent brain MRI. Among these, MRI achieved a specificity of 100.0% (95% CI, 89.1-100.0%) and identified central nervous system lesions in 89.4% of those with TSC that underwent the MRI examination, of which 81.0% were occult on ultrasound examination. Trio-WES was performed in 31 cases. Among these, pathogenic variants were identified in 20 cases, with 85.0% of these affecting the TSC2 gene. Trio-WES identified pathogenic variants in five TSC-positive cases that presented with normal fetal brain MRI, demonstrating its essential additive value for fetuses with occult imaging phenotypes, while MRI detected structural lesions in four trio-WES-negative cases. TSC2 variants were associated with more severe phenotypes, including subependymal giant cell astrocytoma, whereas TSC1 variants typically presented with milder manifestations. Sixty-two fetuses underwent termination of pregnancy (TOP); the TOP rate was 87.5% in the TSC-positive group and 62.5% in the TSC-negative group. Eighteen fetuses were liveborn (six TSC-positive and 12 TSC-negative). The TSC-positive infants had significantly lower birth weight compared with the TSC-negative infants (median, 3050 g vs 3500 g; P = 0.025), despite the two groups having a similar gestational age at delivery. All liveborn TSC-positive infants developed postnatal epilepsy. Multiple CR at screening ultrasound examination and a major lesion at fetal brain MRI are key prenatal predictors of TSC, but accurate diagnosis requires not only MRI but also trio-WES, to overcome the developmental limitations imposed by the late appearance of some fetal anomalies associated with TSC and genetic limitations inherent in standard molecular analysis. Given the severe perinatal outcomes associated with TSC observed in this study, including high termination rates and postnatal epilepsy in all liveborn infants, definitive prenatal diagnosis is essential for accurate risk stratification, parental counseling and proactive neurological management. © 2026 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
Developmental delay affects daily living, social functioning, and mental health. Maternal cardiovascular health (CVH) during pregnancy may indicate an adverse intrauterine environment, but its association with developmental delay is unclear. To examine the association between maternal CVH during pregnancy and developmental delay in offspring at 4 years of age. This cohort study enrolled patients between July 19, 2013, and March 31, 2017, with 5 years of follow-up, at obstetric hospitals and clinics in Miyagi Prefecture, Japan. Participants included eligible mother and offspring pairs enrolled in the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study. Offspring were followed up until age 4 years. Data analyses were conducted from November 12, 2024, to March 24, 2026. Maternal CVH during pregnancy, which was assessed using Life's Essential 8 metrics (diet, physical activity, nicotine exposure, sleep health, body mass index, blood lipids, blood glucose, and blood pressure). Each metric was scored on a scale of 0 (least favorable) to 100 (most favorable), and these scores were used to categorize mothers as having high (80-100), moderate (50-79), or low (0-49) CVH. Developmental delay at age 4 years, which was evaluated by the mother using the validated Japanese version of Ages and Stages Questionnaire, Third Edition. This instrument has 5 domains: communication, gross motor, fine motor, problem solving, and personal-social skills. Domain-specific delay was defined as 2 or more SDs below the mean score, and developmental delay in total was defined as delay in 1 or more of the 5 domains. Among 19 160 eligible mother and offspring pairs, 8238 (43.0%) were analyzed. Offspring were assessed at a mean (SD) age of 4.1 (0.2) years and included 4299 males (52.2%). Among mothers with high, moderate, and low CVH, 154 (8.8%), 763 (12.1%), and 33 (16.8%), respectively, had offspring with developmental delay in total. Compared with high CVH, moderate (risk ratio [RR], 1.30; 95% CI, 1.09-1.54) and low (RR, 1.62; 95% CI, 1.11-2.36) CVH during pregnancy were associated with developmental delay in total. Low CVH was associated with higher prevalence of developmental delay across all 5 domains, with personal-social domain having the largest effect size (RR, 2.23; 95% CI, 1.23-4.07; P for trend = .002) and communication domain having the smallest effect size (RR, 1.40; 95% CI, 0.69-2.85; P for trend = .03). In this cohort study of mother and offspring pairs in Japan, better maternal CVH during pregnancy was associated with a lower risk of offspring developmental delay at age 4 years.
Incremental dialysis, applicable to both hemodialysis (HD) and peritoneal dialysis (PD), is an individualized approach. It consists of offering a dialysis dose adjusted to the patient's residual renal function (RRF) in order to achieve the same clinical outcomes observed with full doses, while improving quality of life and reducing exposure to the risks associated with the dialysis procedure. This Position Statement of the Brazilian Society of Nephrology (SBN) aims to present recommendations on eligibility criteria, prescription, monitoring, and safe implementation, as well as to report the clinical results already described with this approach. Eligibility includes a residual diuresis ≥ 500 mL/24h in HD or ≥ 100 mL/24h in PD and/or a urea clearance (Kru) ≥ 2.0 mL/min/1.73 m2, as well as clinical stability and adequate volume and metabolic control. Monitoring with regular reassessment of RRF is recommended. Indicators for dialysis dose intensification include hypervolemia, uremic symptoms, worsening of nutritional status, hyperkalemia, hyperphosphatemia, refractory metabolic acidosis, and laboratory findings of subdialysis. The implementation of incremental dialysis requires well-defined institutional protocols, systematic education of patients and families, a properly trained multidisciplinary team, and a shared decision-making process. Scientific evidence suggests that incremental dialysis is safe and effective, attenuating the loss of RRF, and can reduce hospitalizations, while maintaining or improving quality of life, without increasing mortality. Additionally, it may contribute to cost reduction and greater sustainability of the healthcare system, and should be considered an integral part of the contemporary therapeutic armamentarium. A diálise incremental, aplicável tanto à hemodiálise (HD) quanto à diálise peritoneal (DP), é uma abordagem individualizada que consiste em oferecer a dose de diálise ajustada à função renal residual (FRR) do paciente, de modo a alcançar os mesmos desfechos clínicos observados com doses plenas, porém, oferecendo melhor qualidade de vida e menor exposição aos riscos associados ao procedimento dialítico. Este Posicionamento da Sociedade Brasileira de Nefrologia (SBN) tem como objetivo apresentar recomendações sobre critérios de elegibilidade, prescrição, monitorização e implementação segura, bem como relatar os resultados clínicos já descritos com essa abordagem. A elegibilidade inclui uma diurese residual ≥ 500 mL/24h na HD ou ≥ 100 mL/24h na DP e/ou um clearance de ureia (Kru) ≥ 2,0 mL/min/1,73 m2, além de estabilidade clínica e controle volêmico e metabólico. Recomenda-se a monitorização com reavaliação regular da FRR. Os indicadores para intensificação da dose dialítica incluem hipervolemia, sintomas urêmicos, piora do estado nutricional, hiperpotassemia, hiperfosfatemia e acidose metabólica refratária, além de quadro laboratorial de subdiálise. A implementação da diálise incremental demanda protocolos institucionais bem definidos, educação sistemática de pacientes e familiares, uma equipe multiprofissional devidamente capacitada e um processo de decisão compartilhada. As evidências científicas sugerem que a diálise incremental é segura e efetiva, atenuando a perda da FRR, podendo reduzir hospitalizações, mantendo ou melhorando a qualidade de vida, sem aumentar a mortalidade. Adicionalmente, pode contribuir para a redução de custos e para a maior sustentabilidade do sistema de saúde, devendo ser considerada parte integrante do arsenal terapêutico contemporâneo.
Group antenatal care (G-ANC), integrating medical care with education, has demonstrated positive effects on maternal and newborn health. Individual studies have shown promising evidence in sub-Saharan Africa, but systematically synthesising the existing research would facilitate implementation and identify gaps for further research. This systematic review aimed, therefore, to review the existing evidence on feasibility, acceptability and effectiveness of G-ANC in resource-limited settings to guide policy and support implementing G-ANC to reduce maternal and perinatal mortality. A systematic and comprehensive literature search was conducted in the PubMed/MEDLINE, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Excerpta Medica Database (Embase) and Google Scholar electronic databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for systematic reviews and meta-analyses of healthcare interventions were followed. Data were extracted using a prespecified protocol and quality was assessed using the Joanna Briggs Institute appraisal tool. Random-effects meta-analyses were used to pool estimates. The review is registered on the International Prospective Register of Systematic Reviews (PROSPERO: CRD42024565501). Of the 576 articles identified, 34 articles with 42 234 participants were included. G-ANC increased the likelihood of attending four or more ANC visits (pooled risk ratio (RR)=1.45; 95% CI 1.22 to 2.82), was associated with the likelihood of attending postnatal care visits (RR=1.23; 95% CI 1.03 to 1.47), increased uptake of postpartum family planning methods (RR=1.85; 95% CI 1.26 to 2.73) and was associated with improved birth weight (RR=1.53; 95% CI 1.09 to 2.14). It was also associated with improved quality of care, health literacy, psychosocial gains, empowerment and facilitating culturally sensitive discussions. There was, however, no significant difference found between groups regarding likelihood of giving birth at health facilities compared with the traditional ANC. Also, no cost-effectiveness studies of G-ANC were identified in sub-Saharan Africa, highlighting a key evidence gap for guiding future implementation and scale-up. Exposure to G-ANC enhances utilisation of maternal healthcare such as ANC attendance, postnatal care, family planning uptake and improves birth weight. It also improves maternal engagement, health literacy and empowerment through a highly participatory learning approach and peer support. Nevertheless, no notable difference was observed between the groups in terms of likelihood of giving birth in health facilities. CRD42024565501.
To analyze the clinical heterogeneity of cutaneous manifestations in systemic lupus erythematosus (SLE) and the features of coexisting dermatologic conditions in these patients. The single-center cross-sectional study included 210 patients with SLE followed at Nasonova Research Institute of Rheumatology. Clinical, laboratory, and instrumental parameters were assessed, including disease activity (SLEDAI-2K [Systemic Lupus Erythematosus Disease Activity Index 2000], SLE-DAS [Systemic Lupus Erythematosus Disease Activity Score]), organ damage (Damage Index of SLICC/ACR [Systemic Lupus International Collaborating Clinics / American College of Rheumatology]), and cutaneous manifestations using the CLASI (Cutaneous Lupus Disease Area and Severity Index), R-CLASI (Revised Cutaneous Lupus Erythematosus Disease Areas and Severity Index), and the mucocutaneous domain of Easy-BILAG (Easy British Isles Lupus Assessment Group). Coexisting dermatologic conditions and skin changes not directly related to SLE activity were additionally analyzed. Cutaneous and mucosal involvement was observed in 85% of patients during the disease course and represented one of the most frequent manifestations at SLE onset. At study inclusion, active mucocutaneous manifestations were present in 50% of patients. Cutaneous involvement was characterized by marked clinical heterogeneity and a high prevalence of overlapping phenotypes, including acute and chronic cutaneous lupus, mucosal lesions, and non-scarring alopecia. Active cutaneous involvement was associated with serositis and hemolytic anemia. Coexisting dermatologic conditions, including treatment-related skin complications, were identified in 70% of patients. Cutaneous and mucosal manifestations in SLE constitute a complex, multicomponent disease phenotype reflecting both systemic inflammatory activity and processes of chronicity and damage accumulation. The high prevalence of overlapping cutaneous phenotypes and coexisting dermatologic conditions underscores the need for comprehensive skin assessment and a multidisciplinary approach to the management of patients with SLE. Цель. Проанализировать клиническое разнообразие кожных проявлений системной красной волчанки (СКВ) и их сочетание с сопутствующей дерматологической патологией. Материалы и методы. В одноцентровое одномоментное исследование включены 210 пациентов с СКВ, наблюдавшихся в ФГБНУ «НИИР им. В.А. Насоновой». Оценивали клинические, лабораторные и инструментальные показатели, активность заболевания (SLEDAI-2K [Systemic Lupus Erythematosus Disease Activity Index 2000] – индекс активности СКВ в модификации 2000 г., SLE-DAS [Systemic Lupus Erythematosus Disease Activity Score] – счет активности СКВ), органное повреждение (индекс повреждения Международной группы сотрудничающих клиник по системной красной волчанке / Американской коллегии ревматологов [Systemic Lupus International Collaborating Clinics / American College of Rheumatology – SLICC/ACR]), кожные проявления с использованием индексов CLASI (Cutaneous Lupus Disease Area and Severity Index – индекс площади и тяжести кожной волчанки), R-CLASI (Revised Cutaneous Lupus Erythematosus Disease Areas and Severity Index – модифицированный индекс площади и тяжести кожной волчанки) и кожно-слизистого домена Easy-BILAG (Easy British Isles Lupus Assessment Group – облегченная группа оценки волчанки на Британских островах). Дополнительно анализировали сопутствующие дерматологические заболевания и кожные изменения, не связанные напрямую с активностью СКВ. Результаты. Поражение кожи и слизистых оболочек выявлено у 85% пациентов за период заболевания, что являлось одним из частых проявлений дебюта СКВ. У 50% пациентов на момент включения обнаружена активная кожно-слизистая симптоматика. Кожные проявления характеризовались выраженной гетерогенностью и высокой частотой сочетанных фенотипов, включая острые и хронические формы кожной волчанки, поражение слизистых оболочек и нерубцовую алопецию. Активное кожное поражение ассоциировалось с серозитом и гемолитической анемией. У 70% пациентов выявлена сопутствующая дерматологическая патология, включая кожные осложнения терапии. Заключение. Кожные и слизистые проявления СКВ формируют сложный, многокомпонентный фенотип заболевания, отражающий как активность системного воспаления, так и процессы хронизации, накопления повреждения. Высокая частота сочетанных форм кожной волчанки и сопутствующей дерматологической патологии подчеркивает необходимость комплексной оценки кожного синдрома и междисциплинарного подхода к ведению таких пациентов.
This study examines the prevalence and impact of bullying and sexual harassment among students in nursing and medical education programmes in Sweden. This cross-sectional survey targeted students from 38 universities. A total of 18,582 individuals responded to the questionnaire, yielding a 25% response rate. The sample included students enrolled in nursing (N = 1,083) and medical (N = 431) programmes. Data were analysed using descriptive statistics and two-sample t-tests. Among female students who experienced bullying, higher levels of stress ( t (1188) = 4.91, p < .001), burnout (t(1188) = 5.83, p < .001), and intention to quit studies ( t (1186) = 4.30, p < .001) were reported. Bullied male students showed elevated stress ( t (317) = 3.15, p = .002), burnout ( t (317) = 3.49, p < .001), and intention to quit ( t (316) = 3.67, p < .001). Female students who experienced sexual harassment reported increased stress ( t (1185) = 4.02, p < .001), burnout ( t (1185) = 4.10, p < .001), and intention to quit ( t (1184) = 2.73, p = .006). In contrast, sexually harassed male students reported higher stress ( t (314) = 2.04, p = .042), but no significant differences in burnout ( t (314) = 0.80, p = .425) or intention to quit ( t (314) = 1.86, p = .064). Students from the nursing- and medical programme reported a higher prevalence of bullying and sexual harassment than other students. Given the high prevalence and detrimental effects of bullying and sexual harassment in nursing and medical education, targeted interventions are needed to prevent and address these behaviours.
Hearing-related quality of life is a crucial outcome for adults with cochlear implants. The Cochlear Implant Quality of Life (CIQOL)-35 Profile is a patient-reported outcome measure originally developed in English. In a previous study, this instrument was cross-culturally adapted into German to address the need for standardized assessment tools in German-speaking regions. To ensure the adapted instrument meets psychometric criteria, validation is required. The German adaptation of the CIQOL-35 Profile was validated through an online survey including questions on demographics, the German CIQOL-35 Profile, and the German Nijmegen Cochlear Implant Questionnaire (NCIQ). The collected data were analyzed for reliability and validity. A total of 204 adults (aged 19-87 years) with bilateral hearing loss completed the online survey. Cronbach's α between 0.84 and 0.91 demonstrates good internal consistency for all subscales of the CIQOL-35 Profile and the global outcome. Moderate to strong correlations (rs = 0.55-0.85) between the CIQOL and NCIQ indicate good convergent validity. Confirmatory factor analysis established construct validity for the German CIQOL instruments. These findings confirm that the adapted German version of the CIQOL instruments is a reliable and valid measure for assessing hearing-related quality of life in adults with cochlear implants and demonstrates higher validity than the NCIQ. The availability of the CIQOL in multiple languages facilitates international comparability of research results and increases clinical application. Implementing quality of life instruments in clinical practice enables a more comprehensive evaluation of patient outcomes and may help identify patient needs that may be addressed in therapy and rehabilitation.
To enhance the competency of clinical medicine students in evaluating the severity of genetic disorders, this study first modularized an assessment of genetic diseases severity based on the World Health Organization's International Classification of Functioning, Disability and Health (ICF) framework. Then, this modular teaching framework was applied in teaching instruction. During the Medical Genetics course, the 2024 clinical medicine cohort at Hunan University of Medicine were clustered into a experimental group (6 classes, 203 students) and a control group (7 classes, 235 students) randomly. The experimental group engaged in the ICF-based module in the case analysis of genetic diseases, while students in the control group followed the traditional teaching methods. Learning outcomes were evaluated by analyzing the student-written genetic disease severity evaluation reports. Results demonstrated that students in the experimental group achieved significantly higher scores on their assessment reports (73.33±7.16) compared to the control group (64.79±5.45), with a statistically significant difference (t=13.87, P<0.001). Furthermore, textual analysis further revealed that reports from the experimental group contained a significantly higher frequency of keywords related to patient psychology, social functioning, and environmental factors, indicating a broader focus on the patients and more comprehensive and in-depth understanding of the patient's situation. These findings suggest that the ICF-based modular teaching framework significantly improves medical students' ability to conduct individualized assessments of genetic diseases and effectively fosters their humanistic care. This study provides an actionable and scalable teaching practice pathway for cultivating clinical genetic counseling professionals. 为提升临床医学生遗传病严重性的评估能力，本文首先基于世卫组织国际功能、残疾和健康分类(International Classification of Functioning, Disability and Health，ICF)框架，对遗传病严重性评估进行模块化整合，形成评估模型。继而在湖南医药学院2024级临床医学班级中随机抽取班级作为实验组(6个班级，203名学生)和对照组(7个班级，235名学生)，实验组学生在遗传病案例讲解中接受基于ICF框架的遗传学教学，对照组学生采用传统教学方式。通过评估学生撰写的遗传病严重性评估报告来检验学习效果。结果表明，实验组学生评估报告得分(73.33±7.16)显著高于对照组(64.79±5.45)，差异具有统计学意义(t=13.87，P<0.001)，并且实验组学生撰写的报告在结构上更具系统性。此外，实验组学生提及患者心理、社会功能及环境因素等关键词的频次显著高于对照组，表明实验组学生对患者的关注面显著拓宽，对患者处境的理解更为全面和深入。上述结果提示，基于ICF框架的模块化教学整合可显著提升临床医学生对遗传病的个体化评估能力，并有效培养其人文关怀精神。本文为临床遗传咨询人才培养提供了可操作、可推广的教学实践路径。.
Tuberculosis is one of the major infectious diseases that result in a significant morbidity and mortality, especially in the resource-limited communities with a lack of health literacy that hinders the early detection and the compliance with the treatment. Health education through technology is an up-and-coming method of bettering community empowerment in the TB control programs. In this paper, the researcher compared the robustness of a holistic technology-based health education framework using interventions of mobile applications, interactive voice response systems, and digital kiosks in communities to empower the communities with TB. The study was a cluster-randomized controlled trial in 24 communities (12 intervention and 12 control) and used on 1847 adults above 12 months. The main outcomes were TB knowledge levels, health-seeking behavior levels, community-engagement levels, and TB case detection rates. Community empowerment was conceptualized as a multidimensional construct encompassing knowledge acquisition, proactive health-seeking behavior, collective engagement, and stigma reduction. Findings showed that communities that were equipped with technology scored higher in terms of TB knowledge (76.8 ± 12.4 vs. 52.3 ± 14.7, p < 0.001) and index of health-seeking behavior (3.82 ± 0.67 vs. 2.41 ± 0.84, p < 0.001) than control communities. The score of community engagement in intervention communities scored 156 percent higher than in controls, which scored 23 percent higher. It is interesting to note that the rate of TB cases detection in the intervention communities was 34.2 percent as opposed to 8.7 percent in the control community (p = 0.002). The platform that had been enabled by the technology proved to be very effective when it came to empowering communities to undertake the TB control process and provided a model that could be expanded to enable the introduction of digital health education into the public health programs aimed at protecting against the spread of infectious diseases in the endemic areas.
Parents of children with achondroplasia face sustained caregiving demands that may affect multiple dimensions of well-being. Despite growing recognition of these challenges, no validated, condition-specific instrument exists to assess the quality of life (QoL) of parents of children with achondroplasia. This study aimed to develop, and pilot test the Quality of Life of Parents of Children with Achondroplasia (QOLA) questionnaire. QOLA was developed using a multi-phase mixed-methods design in accordance with established standards for developing self-reported outcome measures for caregivers and parents. Phase 1 comprised semi-structured qualitative interviews with 17 parents of children with achondroplasia to identify relevant QoL domains and language. Interview data were analysed using qualitative content analysis and informed systematic item generation (Phase 2). Conceptual structure was examined through researcher-led card sorting (Phase 3) and two rounds of international card sorting following translation (Phase 4). The resulting 63-item questionnaire across eight domains was pilot-tested in a cross-sectional, multi-country study with embedded cognitive debriefing in Germany, Italy, and Portugal (total N = 50). The final pilot version of QOLA comprised 63 items across eight domains covering healthcare experiences, challenges and support, physical health, mental health, social life and relationships, coping, family and daily life, and worries and future concerns. Item-level missing data were minimal, and no pronounced floor or ceiling effects were observed. Internal consistency was acceptable to good for domains (α = 0.624-0.821) and good for the total scale (α = 0.798). Inter-domain correlations were generally moderate to strong. Cognitive debriefing was highly acceptable and relevant across countries, with some suggestions for further refinement. QOLA shows strong preliminary evidence of acceptability and internal consistency and addresses a key measurement gap in achondroplasia research. Further large-scale psychometric validation is warranted.
To report patterns of asthma control, medications and healthcare utilisation in Australian adults with asthma in 2021, and assess changes since a similar survey in 2012. Cross-sectional web-based survey (February-March 2021; n = 5427), compared with a similar 2012 survey (n = 2686). Adults (≥ 18 years) with asthma, recruited from large web-based panels, with enrolment stratified by age group, gender and state/territory. Asthma control test (ACT), healthcare utilisation and medications. Median age was 46 years; 59% of participants reported female gender. Compared with 2012, fewer participants had well-controlled symptoms (ACT ≥ 20: 2021, 48.0%; 2012, 54.4%; p < 0.001), and more had very poorly controlled symptoms (ACT 5-15: 2021, 26.8%; 2012, 22.9%; p < 0.001). Urgent asthma healthcare had increased (2021, 37.9%; 2012, 28.6%; odds ratio 1.53 [95% confidence interval, 1.37-1.69]; p < 0.001). Inhaled corticosteroid (ICS) use in the previous year was similar (2021, 60.9%; 2012, 60.8%) but adherence was lower (p < 0.001). Fewer participants had good symptom control while taking little/no ICS (2021, 33.4%; 2012, 40.1%), and more had uncontrolled symptoms with little/no ICS (2021, 38.1%; 2012, 25.6%; p < 0.001); among the latter group, urgent healthcare utilisation had increased (2021, 63.5%; 2012, 41.2%; p < 0.001). In 2021, 28.7% reported using oral corticosteroids for asthma in the previous year; only 42.0% of ICS users recalled their inhaler technique having been checked in the past 12 months. Overuse of short-acting beta2-agonists was common: 56.3% adults obtained ≥ 3 inhalers in the previous year, and 10.5% obtained ≥ 12 inhalers. For symptom relief in the previous 4 weeks, only 13.3% adults reported using an anti-inflammatory reliever (ICS-formoterol). Our comparison of these two large nationally stratified sample surveys demonstrates significant worsening of key asthma indicators between 2012 and 2021, including worse symptom control and urgent healthcare use, but also indicates opportunities for improvement. The findings highlight an urgent need for system-wide implementation of the 2025 Australian asthma guidelines to reduce preventable morbidity. ACTRN12620000977976p. The known: The first national survey of asthma control in Australian adults in 2012 found uncontrolled asthma symptoms in 46% of participants; 29% had required urgent medical care in the previous year, and only 34% were taking regular inhaled corticosteroids (ICS). The new: A repeat cross‐sectional survey in 2021 found worse asthma control (uncontrolled symptoms 52%; urgent healthcare 37%). ICS adherence had decreased (29%). Overuse of short‐acting beta2‐agonists was common (56%), and only 13% of participants were using a best‐practice combination ICS–formoterol anti‐inflammatory reliever. The implications: This comparison demonstrates an increasingly high burden of preventable morbidity from asthma in Australia. There are substantial opportunities for improvement with system‐wide implementation of recent major changes in Australian asthma guidelines published in 2025.
The purpose of this study was to explore why and how medical students use non-traditional learning resources relative to the formal curriculum, to inform curriculum development efforts, and support self‑directed learning. A qualitative study grounded in a pragmatic research approach was conducted using semi structured interviews with medical students at the University of Ottawa. Participant recruitment occurred via email/social media, and a pre survey was used to ensure sampling of both low- and high-level resource users. Transcripts were analyzed using reflexive thematic analysis in NVivo. Analysis was both deductive, guided by self-regulated learning (motivation, goal setting, feedback, self-monitoring), and inductive to capture unanticipated themes. Twenty-nine students participated (18 pre-clerkship; 11 clerkship). Four themes were developed: two addressing motivations  for using non‑traditional resources-the traditional curriculum is repetitive and inflexible and non‑traditional resources are high‑yield and flexible; one addressing goal setting-studying for today's exam or tomorrow's patient; and one addressing how students engage with resources, captured through three archetypes-the Traditionalist, the Supplementer, and the Reformer. This study demonstrates how medical students navigate learning by turning to non-traditional resources, shaped by their motivations, goal orientations, and distinct engagement patterns. These insights highlight opportunities to streamline and modernize curricula, integrate vetted high yield resources, and strengthen students' self-regulated learning skills. Leveraging the three learner archetypes can further guide curriculum planning by recognizing diverse learning approaches, engaging Supplementers as indicators of curricular gaps, supporting Traditionalists with structured pathways, and viewing Reformers' non-attendance as an expression of SRL rather than disengagement.
Despite continuously evolving medical advances, CVD risk in Rheumatoid Arthritis (RA) remains paradoxically high to date. Carotid intima-media thickness (cIMT) is a widely used surrogate marker for atherosclerosis. However, issues related to operator-dependent assessment, availability and cost of carotid ultrasound are barriers to its wide implementation as an aid to cardiovascular risk assessment in RA. We aimed to develop a computational artificial intelligence (AI) model for cIMT prediction in RA. The recently proposed DERGA algorithm (Data Ensemble Refinement Greedy Algorithm) was employed in a database of datasets from 101 patients with RA, utilizing information on a wide range of clinical and laboratory variables, classical cardiovascular risk factors, disease-related parameters, and vascular assessments obtained with nailfold videocapillaroscopy (NVC). A total of 13,917,800 models were designed and trained. Among the four evaluated regression metaheuristic algorithms, the best predictive performance was achieved by the DERGA-Extra Trees model. The optimal model utilized only 8 of the 52 available input variables, while maintaining excellent predictive accuracy. Eventually, the 8 most important parameters predicting cIMT, listed from the most influential to the least influential, were white blood count, age, high density lipoprotein cholesterol, capillary density, systolic blood pressure, microhemorrhages, inhibitors of the renin-angiotensin-aldosterone, and methotrexate. A very strong positive linear correlation was observed between predicted and actual (measured) cIMT values (R = 0.9843), supporting the high predictive capability of the proposed computational intelligence model. Pending external validation in larger cohorts, the findings of the present study should be considered preliminary. Nevertheless, they provide further evidencesupporting the potential utility of AI applications for the assessment of subclinical vascular involvement in RA. While the role of NVC as an indicator of cardiovascular health is beginning to unfold, these findings underscore its promise as an adjunctive modality to facilitate more effective CVD risk stratification in RA.
Approximately 40% of women stop endocrine therapy for hormone-receptor-positive breast cancer within the first 5 years of prescribed treatment because of side effects. Musculoskeletal complaints are among the most frequently reported side effects. The Cancer Of the BReast Asanas (COBRA) study examines the effect of an 18-week yoga programme on endocrine therapy-associated musculoskeletal complaints in women with breast cancer. In total, 140 women will be randomised in a 1:1 ratio to the intervention or waitlist control group. The intervention programme consists of two times a week 1-hour supervised Hatha or (easy) Vinyasa yoga classes at a yoga or sports centre for 18 weeks and once per week a half-hour at home using videos. The waitlist control group is asked to maintain their habitual lifestyle during the first 18 weeks and will participate in a similar yoga programme to the intervention group for the following 18 weeks. The control group yoga programme is offered live-remote. The primary outcome (musculoskeletal complaints) is assessed with the Brief Pain Inventory questionnaire at baseline and 18 weeks (primary comparison) and additionally at 36 weeks. Secondary outcomes include lower and upper extremity joint complaints, menopausal symptoms, fatigue, sleep, quality of life, anxiety and depression, cognitive complaints and habitual physical activity (all patient-reported), vital signs and anthropometrics, physical fitness, blood biomarkers, medication use, safety data and patient and teacher experiences. At baseline and 18 weeks, cognitive complaints are also assessed with an online neuropsychological test battery. The COBRA study was approved by the Medical Ethical Committee of the University Medical Center Utrecht. The study started on 8 October 2024, and 65 participants have been included (20 January 2026). Results will be submitted to an international peer-reviewed journal. NCT06480513.