Risk factors for hepatocellular carcinoma: an umbrella review of systematic review and meta-analysis

BACKGROUND

Numerous meta-analyses have identified various risk factors for hepatocellular carcinoma (HCC), prompting a comprehensive study to synthesize evidence quality and strength.

METHODS

This umbrella review of meta-analyses was conducted throughout PubMed, EMBASE, Web of Science, and Cochrane Database of Systematic Reviews. Evidence strength was evaluated according to the evidence categories criteria.

RESULTS

We identified 101 risk factors throughout 175 meta-analyses. 31 risk factors were classified as evidence levels of class I, II, or III. HBV and HCV infections increase HCC risk by 12.5-fold and 11.2-fold, respectively. These risks are moderated by antiviral treatments and virological responses but are exacerbated by higher HBsAg levels, anti-HBc positivity, and co-infection. Smoking, obesity, non-alcoholic fatty liver disease, diabetes, low platelet, elevated liver enzymes and liver fluke infection increase HCC risk, while coffee consumption, a healthy diet, and bariatric surgery lower it. Medications like metformin, glucagon-like peptide-1 receptor agonists (GLP-1 RAs), aspirin, statins, and selective serotonin reuptake inhibitors reduce HCC risk, while acid suppressive agents, particularly proton pump inhibitors, elevate it. Blood type O reduces the risk of HCC, while male gender and older age increase the risk.

CONCLUSIONS

HBV and HCV are major HCC risk factors, with risk mitigation through antiviral treatments. Lifestyle habits such as smoking and alcohol use significantly increase HCC risk, highlighting the importance of cessation. Certain drugs like aspirin, statins, GLP-1 RAs, and metformin may reduce HCC occurrence, but further research is needed to confirm these effects.

Assessment of psychological health effects of nurses during 2022-2023 of the COVID-19 pandemic: a descriptive study in Southern Taiwan

BACKGROUND

Nurses on the frontlines of the pandemic have increased workloads, burnout, and virus exposure, leading to mental health challenges and a lack of resources for patient care. Mental health support for nurses during the COVID-19 outbreak has become a priority. This study evaluated psychological health outcomes of among nurses during the 2022-2023 COVID-19 pandemic in Taiwan, focusing on personal and work-related fatigue as key contributors to emotional distress.

METHODS

A cross-sectional questionnaire was distributed to 200 nurses in a southern Taiwan hospital between 2022 and 2023. Emotional distress and mental health were assessed using the BSRS-5 (Brief Symptom Rating Scale) and CHQ-12 (Chinese Health Questionnaire). Correlation and regression analyses were conducted to identify factors influencing emotional distress and mental health outcomes.

RESULTS

Nurses aged 40-59 (52.85, p = 0.01), those in emergency departments (56.71, p = 0.001), and those caring for COVID-19 patients (50, p = 0.007) reported higher personal exhaustion. Significant differences in work-related fatigue levels were observed based on working environments (52.78, p < 0.001), no beliefs regarding religion (46.53, p = 0.036), care for COVID-19 patients (47, p < 0.001) and previously diagnosed with COVID-19 (46.58, p = 0.005). Key factors influencing emotional distress included marital status, number of children, and workplace (p < 0.05), while mental health variations were noted  in age, marital status, number of children, workplace, and years of experience (p < 0.05). During the COVID-19 pandemic, nurses' emotional distress and mental health were significantly correlated with specific stressors such as age, workplace, care for confirmed COVID-19 patients, and previous COVID-19 diagnoses (p < 0.001).

CONCLUSIONS AND IMPLICATIONS FOR NURSING MANAGEMENT

This study highlights the stressors affecting nurses' mental health during the 2022-2023 COVID-19 pandemic, emphasizing the need for stress-specific mental health support. Understanding these stress-specific factors is important for figuring out what nurses need to improve their mental health, which can lead to better care for patients.

Relationships between workplace violence, psychological symptoms, and adverse events: a nationwide cohort study of Chinese nurses

BACKGROUND

Nurses in China are disproportionately exposed to workplace violence. Rates of psychological symptoms and adverse events among Chinese nurses have increased in recent years. To evaluate whether workplace violence is associated with psychological symptoms and adverse events among nurses.

METHODS

This study is a cross-sectional analysis using baseline data from the Nurses' Mental Health Study (NMHS), conducted across 67 tertiary hospitals in 31 regions of China to assess the mental health of nurses. Workplace violence (WPV) from patients and their relatives was assessed using the Workplace Violence Scale (WVS). Outcomes included depressive symptoms (PHQ-9), anxiety (GAD-7), obsessive-compulsive symptoms (SCL-90-R), burnout, insomnia, and adverse events. To reduce selection bias, propensity score matching was applied, followed by multivariable logistic regression to examine associations between WPV, psychological symptoms, and adverse events.

RESULTS

A total of 105,614 nurses participated, with 93.1 % female and 66.0 % married. WPV was reported by 30.3 % (n = 32,027). Before matching, the prevalence of depression, anxiety, obsessive-compulsive symptoms, burnout, and insomnia was 53.0 %, 36.5 %, 74.2 %, 42.4 %, and 22.1 %, respectively. Adverse events were reported by 32.3 % of nurses. Nurses exposed to WPV were significantly more likely to report psychological symptoms and adverse events than those who were not.

CONCLUSIONS

WPV from patients and their relatives was significantly associated with increased psychological symptoms and adverse events among Chinese nurses. Reducing WPV in healthcare settings may improve both nurse well-being and patient safety.

Workplace stressors and mental health outcomes among personal support workers: A systematic review

BACKGROUND

Although there is a growing focus on the mental well-being of licensed clinicians, there remains a scarcity of comprehensive evidence concerning the mental well-being of personal support workers (broadly defined as direct care workers), a vital segment of the healthcare workforce, particularly for aging populations. This review aims to identify, summarize, and synthesize the literature on work-related stressors associated with mental health problems among personal support workers, while also examining the potential influence of gender or sex differences in this relationship.

METHODS

This systematic review searched the EMBASE, PsycINFO, PubMed/Medline, and Web of Science databases for relevant studies. Studies published between 1 January 2003 and 30 June 2024 were included in the review. A quality assessment of each study was conducted using the Joanna Briggs Institute Checklist for Analytical Cross-Sectional Studies and the Joanna Briggs Institute Critical Appraisal Checklist for Cohort Studies. Meta-analysis was not performed due to the heterogeneity of the studies' characteristics.

RESULTS

Fourteen (14) articles met the inclusion criteria. They assessed burnout, depression, and/or anxiety among personal support workers who were exposed to various work-related stressors including high workload, aggressive client behavior, insufficient resources (e.g., physical and staffing), role ambiguity, conflict, personal growth, job satisfaction, discrimination, lack of co-workers or supervisors support, emotional suppression, extended working hours, complicated grief, and organizational support or respect. Aggressive client behavior, role ambiguity, resource inadequacy, and high workload emerged as the most frequently reported stressors. Burnout was the most frequently observed outcome. These relationships persisted in many multivariable analyses, even after adjusting for potential confounders. Also, females who experienced work-related stressors were more likely than males to report burnout, depression, or anxiety.

LIMITATIONS

The considerable heterogeneity of various work-related stressors and measurements among selected studies prevented a meta-analysis.

CONCLUSIONS

Collectively, this review's results suggest a significant association between major work-related stressors and mental disorders among personal support workers, while also emphasizing notable gender/sex differences in this relationship. These findings not only guide future research into the mental well-being of personal support workers but also underscore the importance for healthcare institutions of implementing organizational interventions to mitigate stressors and cultivate a more supportive work environment.

Associations of Tai Chi With Depression and Anxiety Among Older Adults: Nationwide Study Findings From a Network Perspective

Within the global population, depression and anxiety are common among older adults. Tai Chi is believed to have a positive impact on these disturbances. This study examined the network structures of depression and anxiety among older Tai Chi practitioners vs non-practitioners. Propensity score matching (PSM) was used to construct a non-practitioner group based on Chinese Longitudinal Healthy Longevity Survey (CLHLS) data. 346 Tai Chi practitioners and 1019 non-practitioners were included. The prevalence and severity rates of depression were significantly lower among Tai Chi practitioners compared to non-practitioners though there was no group difference for anxiety. Network analysis showed that, among Tai Chi practitioners, "Felt sadness", "Uncontrollable worrying" and "Trouble relaxing" were the most central symptoms. In contrast, among non-practitioners, the most central symptoms were "Felt sadness", "Uncontrollable worrying", and "Nervousness". Key bridge symptoms linking depressive and anxiety symptoms were "Worry too much", "Bothered by things" and "Uncontrollable worrying" in Tai Chi practitioners and "Nervousness", "Felt nervous/fearful" and "Sleep quality" in non-practitioners. This study underscored how practising Tai Chi is associated with reduced overall prevalence and severity of depression and different interactions of depressive and anxiety symptoms among older adults. Central and bridge symptoms differed between Tai Chi practitioners and non-practitioners.

The role of ferroptosis in Alzheimer's disease: Mechanisms and therapeutic potential (Review)

Alzheimer's disease (AD) is a prevalent neurodegenerative disorder characterized by insidious onset and progressive symptom deterioration. It extends beyond a simple aging process, involving irreversible and progressive neurological degeneration that impairs brain function through multiple etiologies. Iron dysregulation is implicated in the pathophysiology of AD; however, the precise mechanisms remain unclear. Additionally, vitamin E and selenium are key in regulating ferroptosis through their antioxidant properties. The present review examined the mechanistic pathways by which ferroptosis contributes to AD, the regulatory roles of vitamin E, selenium, ferrostatin‑1, N‑acetylcysteine and curcumin, and their potential as therapeutic agents to mitigate neurodegeneration.

The mediating role of childhood maltreatment in the association between being left-behind and adolescent anxiety

BACKGROUNDS

Left-behind and separated from parents are common among Chinese adolescents and many developing countries, which may cause maltreatment and mental disorders, especially anxiety. Nevertheless, the comprehensive study in the prevalence of childhood maltreatment and its role in anxiety among left-behind adolescents is still insufficient.

METHODS

A nationally representative middle school sample of 32,620 adolescents participated the pen-paper survey regarding demographics, left-behind status and the source of abuse. The Generalized Anxiety Disorder-7 and Chinese version of the Childhood Trauma Questionnaire were used to assess anxiety symptoms and maltreatment experience. The analyses in prevalence, risk factors and mediating effects were preformed in SPSS 27.

RESULTS

30,174 valid questionnaires were collected, of which 2748 were left-behind adolescents. 46.4 % of left-behind and 35.6 % of non-left-behind adolescents reported anxiety, and left-behind increased risk of anxiety (OR = 1.180, 95%CI: 1.180-1.286, p < 0.001). In left-behind adolescents, female sex, older age, and maltreatment experience were risk factors of anxiety. Additionally, left-behind adolescents were more likely to suffer serious abuse and all abuse subtypes. The maltreatment almost completely mediated the association between left-behind and anxiety (0.857, 95%bootstrap CI = 0.743, 0.976), of which emotional abuse played the largest role (0.648, CI = 0.547, 0.751), followed by physical neglect, emotional neglect, and sexual abuse.

CONCLUSION

This study revealed the prevalence of anxiety and maltreatment in Chinese left-behind adolescents, and suggested that the maltreatment might significantly mediate the anxiety of left-behind adolescents. This may shed a light on other developing countries where the phenomenon of left-behind adolescents exists.

Microbiota-based therapies as novel targets for autism spectrum disorder: A systematic review and meta-analysis

BACKGROUND

Autism Spectrum Disorder (ASD) is a complex neurodevelopmental condition characterized by persistent deficits in social interaction and communication. Emerging evidence suggests that alterations in the gut-brain axis play a key role in the pathophysiology of ASD, and that microbiota-targeted interventions may offer therapeutic benefits. However, no clear consensus has been reached regarding the effectiveness of these strategies in ameliorating behavioral characteristics. This systematic review and meta-analysis (PROSPERO registration ID: CRD42023494067) aimed to evaluate the impact of microbiota-based interventions-including synbiotics, prebiotics, single-strain probiotics, probiotic blends, and fecal microbiota transplantation (FMT)-on behavioral outcomes in individuals with ASD, with particular emphasis on social functioning.

RESULTS

Of the 373 records initially identified, 20 studies met the inclusion criteria, comprising 16 randomized controlled trials and 4 open-label studies. The overall effect size indicated a statistically significant improvement in ASD-related behavioral symptoms following microbiota manipulation (Hedges' g = 0.47; 95 % CI: 0.30-0.64; p < 0.001; I2 = 33.01 %), representing a small but clinically relevant effect. Heterogeneity was classified as moderate. Among the interventions, FMT and probiotic blends yielded the most substantial effects. All major limitations of the current studies were thoroughly addressed and discussed to guide future experimental designs. Additionally, we examined preclinical evidence supporting the involvement of neural, immune, and metabolic pathways in mediating the observed behavioral improvements.

CONCLUSIONS

Our findings support the potential of microbiota-based therapies as a promising and well-tolerated strategy for improving behavioral symptoms in individuals with ASD. FMT and multi-strain probiotic formulations appear particularly effective. Nevertheless, further high-quality randomized controlled trials-especially involving FMT-are urgently needed to validate these results and guide clinical implementation. Thus, these findings provide a critical foundation for future investigations seeking to refine microbiota-based interventions and uncover the underlying mechanisms through which they influence ASD-related behaviors.

Maternal Immune Activation and Autism in Offspring: What Is the Evidence for Causation?

The maternal immune activation hypothesis has gained attention over the past 2 decades as a potential contributor to the etiology of autism. This hypothesis posits that maternal conditions associated with inflammation during pregnancy may increase the risk of autism in offspring. Autism is highly heritable, and causal environmental contributors to autism largely remain elusive. We review studies on maternal conditions during pregnancy, all associated with some degree of systemic inflammation, namely maternal infections, autoimmunity, and high body mass index. We also review studies of inflammatory markers in biological samples collected from mothers during pregnancy or from neonates and their relationship with autism assessed in children later in life. Recent reports indicate familial clustering of autism, autoimmunity, and infections, as well as genetic correlations between autism and aspects of immune function. Given this literature, there is an apparent risk of confounding of the reported associations between inflammatory exposures and autism by familial genetic factors in both clinical and epidemiological cohort studies. We highlight recent studies that have attempted to address potential confounding to assess evidence of causal effects of inflammation during early life in autism.

Prevalence and correlates of generalized anxiety disorder and subthreshold anxiety symptoms in south China: A network perspective

AIMS

To investigate the prevalence of generalized anxiety disorder (GAD) and subthreshold anxiety symptoms (SAS) in Guangdong province of China, and to identify the central anxiety symptoms, while further exploring their associations with sociodemographic characteristics, lifestyle factors, and somatic diseases.

METHODS

This survey was conducted in 21 administrative regions of Guangdong province with multistage-stratified cluster random sampling method. Multivariate logistic regression analyses were performed to estimate the adjusted odds ratios (ORs) and their 95 % confidence intervals (CIs). Network analyses were conducted to explore the centrality of anxiety symptoms.

RESULTS

A total of 16,377 individuals were included in this study. The weight 12-month prevalence rates for GAD and SAS were 3.5 % and 10.0 %, respectively. Multivariable logistic regression analysis identified several factors significantly associated with increased risks of GAD and SAS, including younger age, female, no spouse, current alcohol consumption, never exercising, comorbidities, sleep duration of less than 7 h. Notably, the factors related to GAD and SAS largely overlapped, with urban residency and napping correlating specifically with SAS, and mental health literacy correlating specifically with GAD. Network analysis identified "Trouble relaxing" (GAD4) as the most central symptom of anxiety.

CONCLUSIONS

GAD and SAS were prevalent among residents in south China. More attention and assistance should be prioritized to individuals with younger age, female, no spouse, current alcohol consumption, sleep less than 7 h, and comorbid with somatic diseases. Taking regular exercise and improving mental health literacy may be beneficial in preventing and controlling anxiety.

Exploring perceptions of work motivation through the experiences of healthcare professionals who provided end-of-life care during the COVID-19 pandemic (PRECA-C project): a qualitative study

BACKGROUND

The COVID-19 pandemic posed unprecedented challenges for frontline healthcare professionals (HCPs), leading to high rates of burnout and decreased work motivation. Limited ability to provide adequate end-of-life (EOL) care caused moral distress and ethical dilemmas. However, factors that prevent burnout, reduce intent to leave, and enhance professional fulfillment remain underexplored. This study aimed to explore HCPs' perceptions of work motivation during the pandemic, seeking insights to support their continued dedication.

METHODS

A qualitative descriptive study was conducted through online semi-structured interviews (from August to December 2021) with HCPs who provided EOL care, working at intensive care units, specialized COVID-19 wards, and general wards across Japan. Aiming for a diverse sample in terms of gender, occupation, hospital size, and location, interviewees were recruited via the network of the Department of Health Informatics, School of Public Health, Kyoto University. Inductive thematic analysis was applied to interpret the data semantically.

RESULTS

The study participants were 33 HCPs (15 physicians and 18 nurses) from 13 prefectures. The following four main themes with 13 categories were revealed: Developing proficiency in COVID-19 EOL care through HCP experiences, Unity as a multidisciplinary COVID-19 team, Managerial personnel who understand and support staff in fluctuating work, and Social voices from outside of hospitals. These themes uncovered possibilities beyond the personal traits of HCPs and influenced their motivation by incorporating factors associated with healthcare teams, organizations, and wider societal contexts.

CONCLUSION

In this study, four themes, including the importance of organizational management to prevent isolation, maintaining connections among colleagues, and the need for supportive social voices from outside the hospital, emerged from interviews regarding HCPs' work motivation during the pandemic. These findings highlight the complex interplay of individual, organizational, and societal factors in shaping HCPs' motivation during pandemic waves.

Design and Validation of an Instrument to Evaluate Cognitive-Physiological Repercussions and Coping Strategies in a Pandemic Situation

The coronavirus disease (COVID-19) pandemic has significantly affected mental health worldwide, highlighting the need for reliable tools to assess emotional impact (cognitive-psysiological repercusiones) and coping strategies. To validate the psychometric properties of an evaluation instrument with an ad hoc design, called the Evaluation Inventory of Cognitive-Physiological Repercussions and Coping Strategies in a Pandemic Situation (EICPCP), which has two scales: "Cognitive and Physiological repercussions arising from the pandemic due to COVID-19" (RCFPC19-13) and "Coping strategies during the pandemic due to COVID-19" (EAPC19-15). A total of 1,629 participants (students, teachers, and healthcare professionals) from Spain and Colombia completed the instrument. Exploratory and confirmatory factor analyses were conducted to assess their structure and reliability. Both exploratory and confirmatory factor analyses supported the five proposed dimensions: cognitive and physiological impacts on the RCFPC19-13 scale, and adaptation, support, and organization on the EAPC19-15 scale. In addition, satisfactory internal consistency, reliability indices, and temporal stability were obtained for both scales. The EICPCP is a valid and reliable tool for evaluating the cognitive-physiological impact of the pandemic and coping strategies employed. This instrument provides valuable insights for clinical research and psychological interventions in pandemic-related mental-health studies..

Unveiling the association between chronotype and emotional eating in Spanish adolescents: The EHDLA study

Emotional eating has been associated with a range of negative health outcomes. Research regarding chronotype and emotional eating among adolescents is limited. Thus, this study aimed to verify the association between chronotype and emotional eating in a sample of Spanish adolescents aged 12-17 years. This research used cross-sectional data obtained from the Eating Healthy and Daily Life Activities (EHDLA) study, including 820 students (55.5 % girls) from the three secondary schools in the Valle de Ricote (Region of Murcia, Spain). Chronotype was evaluated using the Morningness/Eveningness Scale in Children (MESC). Emotional eating was assessed using the Emotional Eating Scale Adapted for Use in Children and Adolescents (EES-C). Adolescents with a morning chronotype exhibited lower scores in overall emotional eating and specific domains-such as anxiety, depression, and restlessness-compared to those with an intermediate chronotype. Additionally, those with morning chronotypes showed a lower score in the restlessness domain compared to those with evening chronotypes. These findings suggest that adolescents with morning chronotypes may have enhanced emotional regulation and healthier eating behaviors. This study highlights the importance of considering chronotypes when developing personalized interventions for mental health and nutrition among adolescents.

Core GRADE 7: principles for moving from evidence to recommendations and decisions

This seventh article in a seven part series presents the Core GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach for moving from evidence to recommendations or policy decisions. Core GRADE users make strong recommendations for an intervention versus a comparator when the desirable consequences clearly outweigh the undesirable consequences, and a conditional (weak) recommendation when the balance is less clear. Primary considerations in deciding on recommendations considering an individual patient perspective include balance of benefits, harms, and burdens; the certainty of evidence; and values and preferences. Secondary considerations, most important from a population perspective, include costs, feasibility, acceptability, and equity. Moving from evidence to recommendations begins with considering evidence regarding patients’ values and preferences and choosing the smallest difference in each outcome that patients perceive as important (the minimal important difference). Core GRADE users construct statements that make clear the values and preferences underlying their recommendations. In general, Core GRADE users make strong recommendations only when certainty of evidence is high or moderate. When evidence certainty is low, recommendations will be conditional under all but special circumstances.

Effects of the Nudge Theory-Based Multifaceted Intervention on Reducing Inappropriate Proton Pump Inhibitors Use for Prophylaxis in Hospitalized Patients: A Non-Randomized Controlled Study

BACKGROUND

Inappropriate use of proton pump inhibitors (PPIs) for prophylaxis among hospitalized patients continues to be a significant issue. Previous interventions have often been ineffective and lack evaluation of their longer-term impacts.

AIM

This study aims to assess the clinical and economic effects of a nudge theory-based multifaceted intervention on reducing inappropriate PPI prophylaxis in hospitalized patients.

METHODS

This non-randomized controlled study was carried out in a teaching hospital's wards from January 2021 to June 2023, with a 12-month pre-intervention period, a 12-month intervention period (including the first and second stages of intervention), and a post-intervention period with 6-month follow-up. The intervention, based on nudge theory, was implemented among 114 doctors across 10 wards, sequentially involved peer comparison, information provision, and face-to-face feedback. The outcomes were assessed by randomly selecting cases of adult patients who received at least one PPI treatment during hospitalization, and the statistical analysis included univariate analysis, and multivariate and subgroup analyses.

RESULTS

The study included 1782 patients, with a median age of 61 years. During and after intervention, the rate of appropriate PPI use significantly increased by 2.83- to 5.47-fold, rising from 23.82% (147/617) to 46.96% (139/296) after the first stage, to 63.13% (202/320) after the second stage, and remained at 53.01% (291/549) later on. The rate of PPI injections decreased from 92.54 to 74.13-84.12%, the median defined daily doses from 16 to 7-12, and PPI-related expenditures from 484.80 to 156.00-262.99 CNY per-patient. The cost associated with inappropriate PPI use dropped from 161.60 to 0-45.58 CNY per-patient. Subgroup analyses supported these findings.

CONCLUSION

A nudge theory-based multifaceted intervention led to increased appropriate PPI use, decreased PPI injections, and cost savings, with benefits lasting at least 6 months post-intervention.

Meaningful differences in patient-reported outcome measurement scores in liver disease

BACKGROUND

Patient-reported outcome measures (PROMs) are being used more often in chronic liver disease (CLD) clinical care and research. Their interpretability can be greatly enhanced by establishing the smallest meaningful score difference (MSD). We report scores of commonly used PROMs and their MSDs in patients at different stages of liver disease.

METHODS

Patient-Reported Outcomes Measurement Information System (PROMIS)-29 Profile, Chronic Liver Disease Questionnaire (CLDQ), and Short Form-36 (SF-36) v1.0 scores were aggregated from 2442 adults with CLD at 4 different stages: inpatients with decompensated cirrhosis (n=1146) and outpatients with cirrhosis (n=677) or CLD (n=128) or recipients of liver transplant (LT, n=490) between June 2014 and April 2023 from 3 academic centers. MSDs were estimated using distribution and anchor-based methods.

RESULTS

The study sample's median age was 60.0 (IQR: 51.0-66.0); 55% were male, 17% Hispanic, 84% White, and 49% college educated. The etiology of CLD was alcohol in 36%, metabolic dysfunction-associated steatohepatitis (MASH) in 31%, and viral hepatitis B/C in 26%. Median PROMIS domain scores were generally lowest in inpatients and highest after transplant. For PROMIS, distribution-based and anchor-based MSDs ranged from 3 to 4 for individual domains and 4 to 6 for summary scores. Distribution-based MSDs were 1 for CLDQ and ranged from 7 to 11 for individual SF-36 domains, except role limitations domains, which ranged from 15 to 18, and component scores, which were 3. When compared across stages of liver disease, PROMIS MSDs were generally similar, although they tended to be 0.5-1.0 points smaller in the decompensated population compared to the stable populations.

CONCLUSIONS

This study provides data-driven recommendations for MSDs, enhancing the interpretability of commonly used PROMs in liver disease and facilitating the integration of PROMs in various clinical and research settings.

Factors associated with core competencies of infection prevention and control practitioners in 511 hospitals: a large cross-sectional survey in Guizhou, south-west China

OBJECTIVE

To examine the determinants that influence the level of core competencies of infection prevention and control practitioners (IPCPs) in different hospitals in Guizhou Province, south-west China.

METHODS

This study conducted a cross-sectional survey of IPCPs from April to June 2022, using a competency self-assessment scale for IPCPs that encompassed four core dimensions, 11 sub-dimensions and 47 measurement items.

RESULTS

The mean ± standard deviation (SD) self-assessed competency score of 1083 IPCPs from 511 hospitals was 4.891 ± 1.204. Among the four core dimensions, the lowest mean ± SD self-assessed score was for professional development ability at 4.494 ± 1.291, and among the 11 sub-dimensions, the lowest score was for comprehensive knowledge at 3.748 ± 1.578. The core competencies of different hospitals showed that traditional Chinese medicine hospitals had the highest score (5.306 ± 1.071). Linear regression analysis showed that the independent factors influencing self-assessed competency were age [B=0.487, 95% confidence interval (CI) 0.189-0.785], years of practical experience of infection prevention and control (IPC) (B=0.216, 95% CI 0.050-0.382), professional title (B=-0.395, 95% CI -0.693 to -0.097), monthly income (B=-0.296, 95% CI -0.484 to -0.107), experience in front-line epidemic response (B=0.236, 95% CI 0.098-0.382), proficiency in office software applications (B=-0.747, 95% CI -0.898 to -0.596), and cultural atmosphere of hospital IPC (B=-0.406, 95% CI -0.799 to -0.013).

CONCLUSIONS

The core competencies of IPCPs in China require enhancement. Differences in the core competencies of IPCPs in different hospitals were identified, providing substantial evidence for further development of competency-based training programmes.

Economic Evaluation of Interventions to Reduce Antimicrobial Resistance: A Systematic Literature Review of Methods

BACKGROUND AND OBJECTIVE

Economic evaluation of antimicrobial resistance (AMR) interventions is complicated by the multisectoral, inter-temporal and international aspects of the problem, further hindered by a lack of available data and theoretical understanding of the emergence and transmission of AMR. Despite the substantial global focus on the problem, there is a lack of comprehensive economic evaluation literature on AMR policies. The goal of this work is to review the available literature on the economic evaluation of AMR interventions focusing on methods used to quantify the effects on AMR and the associated health consequences and costs.

METHODS

The studies included in the review were identified by a previous study by Painter et al. that included all full economic evaluations of AMR policies in the peer-reviewed and grey literature published between 2000 and 2020. The current review extracted additional information to (1) summarise the types and the key features of the AMR intervention economic evaluation literature available; (2) systemise the types of intervention effects on AMR quantified and describe these across the dimensions of AMR burden: time, space, wider pathogen pool and different sectors (One Health framework); and (3) categorise the methods used to derive these outcomes and how were these linked to health consequences and costs.

RESULTS

Thirty-one studies were included within this review, of which 18 evaluated interventions that aimed to reduce infection rates and 11 evaluated interventions that aimed to optimise antimicrobial use. Almost all were conducted with a high-income and/or upper-middle income country perspective and focused on human health. Thirteen of 31 studies were cost-utility analyses. Fifteen of 31 and 7/31 studies estimated the AMR effects through decision tree and/or Markov models and transmission models, respectively. Transmission models and linkage of AMR outcomes to quality-adjusted life-years and costs were more common in evaluations of interventions aimed at reducing infection rates. Most of the included studies restricted the scope of evaluation to a short time horizon and a narrow geographical scope and did not consider the wider impact on other pathogens and other settings, potentially resulting in an incomplete capture of the effects of interventions.

CONCLUSIONS

This review found limited available literature that mainly focused on high-income countries and infection prevention/reduction strategies. Most evaluations used a narrow study scope, which might have prevented the full capture of the costs and outcomes associated with interventions. Finally, despite the known complexities associated with quantifying AMR effects, and the corresponding methodological challenges, the implications of these choices were rarely discussed explicitly.

Does mild COVID-19 in healthcare workers affect functional capacity and work performance in short term?

BackgroundDisproportionately increased workload is one of the main reasons affecting work performance. Healthcare workers who got infected by COVID-19 were further affected mentally and physically which had an impact on their work performance.ObjectiveIn this study, we aimed to show whether work performance is affected even in people with mild Covid 19 disease or whether it is a part of Post-Acute COVID-19 Syndrome (PACS).MethodsThirty healthcare workers in a tertiary hospital had COVID-19 one month ago and gender and age matched 30 healthy workers without a history of COVID-19 (control group) was enrolled between January 2021 and March 2021. Work performance was assessed on a 7-point Likert scale. Participants performed 1-min sit-to-stand test (1MSTS), 5 times sit-to-stand test (5TSTS), and 6-min walk test (6MWT).ResultsAll participants in the COVID-19 group had a mild (non-hospitalized) form of the disease. 23 patients had ongoing symptoms 4-7 weeks after the initial symptoms of COVID-19 (fatigue/malaise (n = 9), myalgia/arthralgia (n = 7), cough (n = 7), loss of smell/taste (n = 5), headache (n = 5), dyspnea (n = 4), and diarrhea (n = 1). The increase in systolic blood pressure after 6MWT was higher in the COVID group (p = 0.018).ConclusionThe functional status and work performance in healthcare workers with COVID-19 infection were negatively affected in the first month even if the disease severity was mild. It is important to prevent both acute and long-term physical and mental complications of the disease and to ensure that these strategies improve the functional status and work performance of healthcare professionals.

Integrated network pharmacology and experimental validation to elucidate the mechanism of celastrol in mitigating sepsis-induced acute lung injury in mice

BACKGROUND

Sepsis is an acute, life-threatening condition that precipitates multiple organ failure, including acute lung injury (ALI), characterized by a complex pathophysiological process and elevated mortality rates. Celastrol, a pentacyclic triterpenoid quinone derived from traditional Chinese medicine, exhibits diverse pharmacological properties, including immunomodulatory, anti-inflammatory, anticancer, and antifibrotic effects, and has demonstrated favorable safety profiles in vivo. However, the precise mechanism by which CSL contributes to sepsis-induced ALI remains to be elucidated.

PURPOSE

The study aimed to explore the mechanisms by which celastrol mitigates sepsis-induced ALI using network pharmacology, followed by experimental validation of its regulatory effects on sepsis-induced ALI.

METHODS

Utilizing a network pharmacology analysis, the potential targets and pathways of celastrol were identified. To explore celastrol's therapeutic effects on ALI, a rat model of sepsis was induced via cecal ligation and puncture, followed by assessment through hematoxylin-eosin staining, Real-time quantitative polymerase chain reaction (RT-qPCR), and Western blotting. Further investigation involved evaluating celastrol's influence on LPS-stimulated A549 and Raw264.7 cells, employing RT-qPCR, Western blotting, and immunofluorescence techniques.

RESULTS

Network pharmacological analysis identified 10 core targets and 31 pathways relevant to sepsis-induced ALI, with STAT3, TLR4, HIF-1α, and NF-κB1 emerging as central targets. Animal experiments demonstrated that celastrol treatment significantly reduced lung tissue inflammation, as evidenced by immunohistochemistry, Western blot, and RT-qPCR results, in comparison to the cecal ligation and puncture group. Notably, the levels of IL-1β, TNF-α, HIF-1α, STAT3, and NF-κB1 proteins and mRNA in the celastrol treatment group were significantly reduced compared to those in the cecal ligation and puncture (CLP) group and the LPS-treated group. Additionally, Western blot and immunofluorescence analyses confirmed the activation of the NF-κB pathway in vitro.

CONCLUSION

This study indicates that celastrol significantly suppresses the expression of inflammatory factors in sepsis-induced ALI by inhibiting the NF-κB/HIF-1α pathway in both in vivo and in vitro models, highlighting its therapeutic potential for modulating inflammation. These findings provide valuable evidence for future clinical research and drug development.

Role of Proton Pump Inhibitor as Stress Ulcer Prophylaxis in Sick Children: A Randomized Controlled Trial

OBJECTIVE

To evaluate the efficacy of intravenous pantoprazole as a stress ulcer prophylaxis in sick children to prevent gastrointestinal (GI) bleeding.

METHODS

A randomized controlled trial included children aged one-month to 18 years requiring intensive care. Participants were randomly assigned to receive intravenous pantoprazole or a placebo (normal saline) daily. The primary outcome was the incidence of GI bleeding (clinically significant or overt). Secondary outcomes were the median time of onset of GI bleeding, incidence of ventilator-associated pneumonia (VAP), duration of hospitalization, organ dysfunction scores, and all-cause mortality.

RESULTS

A total of 151 and 150 children were allocated to group A (pantoprazole) and group B (placebo), respectively. No significant difference was observed in the incidence of GI bleeding between the groups (group A: 21/151 vs group B: 19/150 [RR (95% CI) 1.03 (0.18, 5.82), P = 0.985]. Comparable results were observed for clinically significant GI bleeding (1.3% vs 0.6%; RR (95% CI) 0.54 (0.21, 1.28); P = 0.653 and overt GI bleeding [12.6% vs 12%; RR (95% CI) 0.98 (0.39, 2.23); P value = 0.313]. On multivariate analysis, there was a reduced incidence of GI bleeding in children with coagulopathy in pantoprazole group (n = 29) as compared to placebo (n = 25) [RR (95%CI) 0.52 (0.32, 0.87); P = 0.022].

CONCLUSION

Among critically ill children, pantoprazole prophylaxis did not reduce the incidence of gastrointestinal bleeding, although, a notable decrease in gastrointestinal bleeding was observed in children with coagulopathy.

TRIALS REGISTRY

Clinical Trials Registry of India, Ref no: CTRI/2021/08/035785, Date of registration:18th August 2021.

Drug treatments for mild or moderate covid-19: systematic review and network meta-analysis

OBJECTIVE

To compare the effects of treatments for mild or moderate (that is, non-severe) coronavirus disease 2019 (covid-19).

DESIGN

Systematic review and network meta-analysis.

DATA SOURCES

Covid-19 Living Overview of Evidence Repository (covid-19 L-OVE) by the Epistemonikos Foundation, a public, living repository of covid-19 articles, from 1 January 2023 to 19 May 2024. The search also included the WHO covid-19 database (up to 17 February 2023) and six Chinese databases (up to 20 February 2021). The analysis included studies identified between 1 December 2019 and 28 June 2023.

STUDY SELECTION

Randomised clinical trials in which people with suspected, probable, or confirmed mild or moderate covid-19 were allocated to drug treatment or to standard care or placebo. Pairs of reviewers independently screened potentially eligible articles.

METHODS

After duplicate data abstraction, a bayesian network meta-analysis was conducted. Risk of bias was assessed by use of a modification of the Cochrane risk of bias 2.0 tool, and the certainty of the evidence using the grading of recommendations assessment, development, and evaluation (GRADE) approach. For each outcome, following GRADE guidance, drug treatments were classified in groups from the most to the least beneficial or harmful.

RESULTS

Of 259 trials enrolling 166 230 patients, 187 (72%) were included in the analysis. Compared with standard care, two drugs probably reduce hospital admission: nirmatrelvir-ritonavir (25 fewer per 1000 (95% confidence interval 28 fewer to 20 fewer), moderate certainty) and remdesivir (21 fewer per 1000 (28 fewer to 7 fewer), moderate certainty). Molnupiravir and systemic corticosteroids may reduce hospital admission (low certainty). Compared with standard care, azithromycin probably reduces time to symptom resolution (mean difference 4 days fewer (5 fewer to 3 fewer), moderate certainty) and systemic corticosteroids, favipiravir, molnupiravir, and umifenovir probably also reduce duration of symptoms (moderate to high certainty). Compared with standard care, only lopinavir-ritonavir increased adverse effects leading to discontinuation.

CONCLUSION

Nirmatrelvir-ritonavir and remdesivir probably reduce admission to hospital, and systemic corticosteroids and molnupiravir may reduce admission to hospital. Several medications including systemic corticosteroids and molnupiravir probably reduce time to symptom resolution.

SYSTEMATIC REVIEW REGISTRATION

This review was not registered. The protocol is publicly available in the supplementary material.

Non-Suicidal Self-Injury in Depressed Adolescents: A Social-Cognitive Deficit or an Emotional Response?

OBJECTIVE

Non-suicidal self-injury (NSSI) has been identified as a prevalent behavior among adolescents, particularly those with major depressive disorder (MDD). The present study sought to examine differences in neurocognition, social cognition, negative urgency (NU)-the tendency to act impulsively in response to negative emotions-and anxiety among adolescents with MDD and NSSI, MDD without NSSI, and healthy controls.

METHOD

A total of 204 adolescents (aged 11-17 years; 161 girls [78.9%], 43 boys [21.1%]) were divided into three groups: (1) MDD with NSSI, (2) MDD without NSSI, and (3) healthy controls. Participants completed psychiatric assessments, computerized neurocognitive tests, emotion recognition tasks, and self-report measures of NU and anxiety. Data were analyzed using SPSS 22. Descriptive statistics included frequencies for categorical variables and medians for continuous variables. Group comparisons were performed using chi-square-based tests and the Kruskal-Wallis test. Logistic regression identified predictors of NSSI, with significance set at p < .05.

RESULTS

Adolescents with MDD exhibited significant deficits in executive function and episodic memory, as well as elevated NU and anxiety, compared to healthy controls. Furthermore, adolescents with MDD and NSSI reported significantly higher levels of anxiety (particularly panic symptoms) and NU compared to those with MDD alone.

CONCLUSION

These findings suggest that emotional difficulties, particularly impulsivity and panic symptoms, play a crucial role in NSSI among adolescents with MDD rather than cognitive disturbance, highlighting potential targets for prevention and intervention efforts.

Core GRADE 6: presenting the evidence in summary of findings tables

This sixth article in a seven part series presents the Core GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach to summary of findings tables. These tables provide essential information about the effects of interventions on patient important outcomes, including relative and absolute effects, certainty of evidence, and a plain language summary. For binary outcomes calculating absolute effects requires applying relative risk estimates to baseline risks from studies representative of the target population. For groups of patients with very different baseline risks, summary of findings tables include separate rows with different estimates of absolute effects. For continuous outcomes, challenges arise when individual studies use different instruments to measure patient reported outcomes. Facilitating interpretation then requires providing details about units of measurement and minimally important differences.

Comparison of treatment-emergent resistance-associated mutations and discontinuation due to adverse events among integrase strand transfer inhibitor-based single-tablet regimens and cabotegravir + rilpivirine for the treatment of virologically suppressed people with HIV: A systematic literature review and network meta-analysis

OBJECTIVE

This study evaluated rates of treatment-emergent resistance-associated mutations (TE-RAMs) and discontinuation due to adverse events (DC-AEs) across integrase strand transfer inhibitor (INSTI)-based single-tablet regimens and injectable cabotegravir + rilpivirine (CAB + RPV) in virologically suppressed people with HIV.

METHODS

A systematic literature review was conducted for phase 2-4 randomized controlled trials with ≥48 weeks of follow-up involving virologically suppressed people with HIV aged ≥12 years and published January 2003-March 2024. A random-effects network meta-analysis estimated comparative rates of TE-RAMs and DC-AEs among regimens at 48 weeks. Risk of bias and strength of evidence were assessed using Cochrane RoB and CINeMA, respectively.

RESULTS

Fourteen (7509 participants) and nine (4656 participants) studies were included in the TE-RAMs and DC-AEs analyses, respectively. No significant differences in rates of TE-RAMs were observed; risk ratios (RRs) for TE-RAMs for bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF), dolutegravir/abacavir/lamivudine (DTG/ABC/3TC) and CAB + RPV every 4 weeks (Q4W) versus CAB + RPV every 8 weeks (Q8W) were 0.22 (95% CI, 0.02-2.04), 0.22 (95% CI, 0.00-19.85) and 0.40 (95% CI, 0.14-1.09). Compared with CAB + RPV Q4W and Q8W, DC-AEs were significantly lower with B/F/TAF (RR, 0.15 [95% CI, 0.03-0.75] and RR, 0.16 [95% CI, 0.04-0.67], respectively) and DTG/ABC/3TC (RR, 0.05 [95% CI, 0.01-0.48] and RR, 0.05 [95% CI, 0.01-0.46], respectively).

CONCLUSIONS

In virologically suppressed people with HIV, switching to CAB + RPV Q8W yielded a non-significant increased risk of TE-RAMs compared with INSTI-based 2- and 3-drug regimens and CAB + RPV Q4W. Both CAB + RPV Q4W and Q8W had significantly higher risks of DC-AEs than B/F/TAF and DTG/ABC/3TC. Findings highlight the importance of considering both resistance and tolerability when switching regimens.

Support measures and demand among healthcare workers during the COVID-19 pandemic: a survey in high-workload provinces of China, 2023

OBJECTIVES

To assess the demands for support measures of healthcare workers (HCWs) in China's high-workload provinces during the COVID-19 pandemic and identify specific needs to make evidence-based recommendations.

DESIGN

Prospective cross-sectional study.

SETTING

Conducted in three Chinese provinces characterised by their significant healthcare demands during the pandemic.

PARTICIPANTS

The study comprised 683 HCWs, including doctors, nurses, resident physicians and hospital administrators. The sample was predominantly female (68.1%), with the majority aged between 25 and 34 years. Participants were recruited through convenience and snowball sampling methods, with a focus on individuals working in high-intensity clinical environments.

RESULTS

Hierarchical analysis was performed to assess the layered impact of support measures across different roles and genders. Substantial gender disparity was observed, with female staff reporting significantly reduced access to material support (p<0.001), family counselling (p<0.001) and health management (p<0.05), alongside a generally higher demand for various support types. In contrast, HCWs assigned to COVID-19 units did not exhibit heightened needs for COVID-specific training (p<0.001), material support (p<0.001), stress management (p<0.001), family counselling (p<0.001) or rational shift patterns (p<0.001) compared with those in non-COVID-19-focused roles.

CONCLUSION

The study identifies significant support deficiencies, particularly among female HCWs, and emphasises the necessity for targeted interventions to strengthen healthcare system resilience. Recommendations include prioritising adequate rest, equitable resource allocation and the implementation of gender-oriented policies to ensure workforce sustainability and maintain care quality. Further research should focus on longitudinal support dynamics.

How to approach a patient hospitalized for pneumonia who is not responding to treatment?

Pneumonia is a frequent cause of intensive care unit (ICU) admission and is the most common infection in ICU patients across all geographic regions. It takes 48-72h for most patients to respond to appropriate antibiotic therapy. Non-response is typically defined as the persistence/worsening of clinical signs-such as fever, respiratory distress, impaired oxygenation and/or radiographic abnormalities-with rates ranging 20-30%. Several factors can contribute to non-response. Host factors, including immunosuppression, chronic lung disease, or ongoing aspiration, may impair resolution. Additionally, incorrect antibiotic dosing, atypical or resistant pathogens (such as multidrug-resistant bacteria, Mycobacterium tuberculosis, or fungal infections) may be responsible, requiring alternative antimicrobial strategies. A septic complication related to pneumonia (e.g., empyema) or not (e.g., acalculous cholecystitis) may need to be excluded. Finally, non-infectious conditions (e.g., pulmonary embolism, malignancy, secondary ARDS or vasculitis) that can mimic or potentiate pneumonia must be considered. Although non-responding pneumonia is frequent, its management lacks strong evidence, and its approach is based mostly on the art of medicine and clinical judgement. Clinicians should continuously reassess the medical history and physical exam, review microbiological data, and consider imaging such as chest CT. Bronchoscopy or repeat sputum sampling may aid in identifying alternative pathogens or non-infectious causes. The management of a non-responding pneumonia depends on the findings of a structured reassessment. Herein, we provide guidance on how to identify and manage non-responding pneumonia. Ultimately, addressing pneumonia that does not respond to antibiotics is crucial for preventing complications, optimizing antimicrobial stewardship, and improving patient outcomes.

LincRNA-miR interactions in hepatocellular carcinoma: comprehensive review and in silico analysis: a step toward ncRNA precision

The most prevalent form of primary liver cancer and one of the chief drivers of cancer-related mortality globally is hepatocellular carcinoma (HCC). Imminent evidence has indicated that non-coding RNAs (ncRNAs) play an integral part in the development and propagation of HCC. RNA stabilization, transcription regulation, chromatin and genomic architecture remodeling, enhancer-associated activity, and other varied properties set long intergenic ncRNA (lincRNA) genes apart from messenger RNA (mRNA)-encoding genes. Through a variety of processes, lincRNAs may generally be used to fine-tune the transcription of nearby genes with exceptional tissue specificity, underscoring our quickly developing knowledge of the non-coding genome. Through their binding with divergent cell targets, some HCC-related ncRNAs have been demonstrated to exhibit abnormal expression, contribute to malignant growth, evade apoptosis, and have invasive potential. Therefore, a better comprehension of lincRNA dysregulation might offer novel perspectives on the pathophysiology of HCC as well as innovative instruments for the early detection and management of HCC. In the present review, we provide an overview of the increasing relevance of lincRNAs as a major contributor to the pathophysiology of HCC, emphasizing their influence on signaling pathways implicated in the development, progression, and response to treatment of tumors. In addition, we go over the new approaches that target lincRNAs for HCC treatment as well as the possible therapeutic uses of lincRNAs as prognostic and diagnostic biomarkers for HCC.

Assessment of the prevalence of stress, anxiety and depression in healthcare workers providing services related to communicable diseases in primary-level health units in Maputo city, Mozambique: an observational cross-sectional study protocol

INTRODUCTION

Mental health is essential for well-being and critical to the quality of care delivered by healthcare professionals. Health workers face increased risks of mental health disorders due to long hours, high emotional and physical demands, and exposure to communicable diseases, which exacerbate stress and anxiety levels. Evidence from low-income countries, including Mozambique, is scarce, yet health professionals in these regions frequently deal with the dual burden of communicable diseases and resource constraints. This study addresses a critical evidence gap by focusing on the mental health of healthcare professionals in Mozambique who are frequently exposed to psychological stress while managing communicable diseases. It aims to assess the prevalence of stress, anxiety and depression among healthcare workers providing services related to communicable diseases in primary-level health units (PHUs) in Maputo City, Mozambique. The study also seeks to identify personal and professional factors associated with these mental health disorders.

METHODS AND ANALYSIS

This is an observational cross-sectional study targeting healthcare workers in PHUs who provide services related to communicable diseases in Maputo City. Using convenience sampling, 382 participants will be recruited, stratified by health unit type. This sample size was calculated manually using the formula by Wang and Ji (2020). Data will be collected through a questionnaire, including demographic and professional information and a validated tool (Depression, Anxiety and Stress Scale, DASS-21), using the Research Electronic Data Capture (REDCap) Software for secure data capture. Descriptive and inferential statistical analyses will be performed using IBM SPSS Statistics to estimate prevalence rates and explore associated factors.

ETHICS AND DISSEMINATION

The study was approved by the Interinstitutional Committee on Bioethics in Health of the Faculty of Medicine/Maputo Central Hospital (CIBS FM&HCM/117/2024). Written informed consent will be obtained, and participants experiencing significant discomfort will be referred for mental health support. Findings will be disseminated via academic theses, peer-reviewed publications, national conferences, and reports shared with the Ministry of Health to inform mental health interventions for healthcare workers.

REGISTRATION

This protocol is registered with the Interinstitutional Committee on Bioethics in Health of the Faculty of Medicine/Maputo Central Hospital (CIBS FM&HCM).

The Impact of the COVID-19 Pandemic on Young Adults with Autism Spectrum Disorder: A Systematic Review

BACKGROUND/OBJECTIVES

The COVID-19 pandemic and related public health measures significantly disrupted daily life, with profound consequences for individuals with Autism Spectrum Disorder (ASD). Young adults with ASD faced unique challenges due to disruptions in routines, employment instability, limited access to essential services, and increased social isolation. While some individuals benefited from reduced social pressures and the adoption of remote work, many experienced heightened anxiety, behavioral difficulties, and declines in autonomy. This systematic review examines the impact of the pandemic on young adults with ASD, focusing on key domains such as autonomy, employment, service accessibility, socialization, emotional regulation, and overall well-being.

METHODS

This review followed the PRISMA 2020 guidelines, and its protocol was pre-registered in the PROSPERO database. A search was conducted in four databases-PubMed, Scous, Web of Science, and PsycInfo-as well as in specialized journals in the field.

RESULTS

Eight studies met the inclusion criteria and were included in the final synthesis. The findings highlight significant disruptions in daily life, increased dependence on caregivers, and difficulties in maintaining structured activities. However, technology-assisted interventions, including virtual therapies and remote work opportunities, played a role in mitigating some adverse effects.

CONCLUSIONS

Despite the heterogeneity in methodologies, this review underscores the urgent need for targeted interventions to support young adults with ASD during crises. Future research should focus on long-term consequences and developing inclusive policies that enhance resilience, access to services, and social integration.

Metformin for covid-19: systematic review and meta-analysis of randomised controlled trials

Objective

To summarise the effects of metformin on covid-19 to inform a World Health Organization (WHO) clinical practice guideline.

Design

Systematic review and meta-analysis.

Data sources

As part of a living systematic review and network meta-analysis of drug treatments for covid-19 (covid-19 LNMA), a search was performed of the WHO covid-19 database, six Chinese databases, and the Epistemonikos Foundation's Living Overview of the Evidence covid-19 Repository (covid-19 L-OVE).

Eligibility criteria for selecting studies

Randomised controlled trials that compared metformin with placebo in patients with acute covid-19 infection.

Data synthesis

Frequentist pairwise meta-analyses were performed using the restricted maximum likelihood random effects model. The effects of interventions on selected outcomes were summarised using risk ratios, risk difference, and mean difference when appropriate, along with their corresponding 95% confidence intervals (CIs). To estimate absolute effects, the control arm event rate was used as the baseline risk. The risk of bias of the included studies was assessed using a modification of the Cochrane risk of bias 2.0 tool and the certainty of evidence using the GRADE (grading of recommendations assessment, development and evaluation) approach, with the minimally important difference in effect as the threshold.

Results

Three randomised controlled trials of 1869 patients were included; one study provided long term follow-up on long covid. Metformin might have little or no impact on mortality (risk ratio 0.76, 95% CI 0.30 to 1.90; risk difference 3 fewer per 1000, 95% CI 8 fewer to 11 more; low certainty). The effects of metformin on admission to hospital because of covid-19 remain uncertain (risk ratio 0.74, 95% CI 0.28 to 1.95; risk difference 15 fewer per 1000, 95% CI 42 fewer to 55 more; very low certainty). Metformin results in little or no difference in adverse effects leading to discontinuation (risk difference 0.2 more per 1000, 95% CI 2.7 fewer to 3.1 more; high certainty). Metformin might decrease the development of long covid (risk ratio 0.6, 95% CI 0.4 to 0.9; risk difference 41 fewer per 1000, 95% CI 62 fewer to 10 fewer; low certainty). However, the effect is based on a single trial of 1126 patients, which has a high risk of bias owing to missing data, and nearly half of the participants were unvaccinated.

Conclusions

Current evidence based on randomised trials suggests no significant effect of metformin on acute clinical outcomes in patients with non-severe covid-19. Metformin might reduce the incidence of long covid when used to treat patients with non-severe acute covid-19 infection, but this was suggested by low certainty evidence from a single trial.

Risk perception of emergency medical technicians in biological disasters: a comparison between COVID-19 and Non-COVID-19 cases

BACKGROUND

Emergency medical technicians (EMTs), positioned at the forefront of medical services, are at greater risk of contracting COVID-19 and passing it on to their families and communities than others. Recognizing the risks associated with this disease can play a crucial role in the care and prevention process. Consequently, this study evaluated the level of risk perception (RP) regarding COVID-19 among EMTs and compared it between those who have contracted the disease and those who have not.

METHODS

This was a cross-sectional descriptive-analytical study conducted in 2021. This study employed simple random sampling to select 200 EMTs affiliated with Birjand University of Medical Sciences. The sample included 100 EMTs who had contracted COVID-19 and 100 who had not. Data were collected through a researcher-designed questionnaire, distributed online via WhatsApp and Telegram groups among the participants. The data were analyzed using SPSS version 16, utilizing descriptive statistical methods (frequency, mean, and standard deviation) along with inferential statistical tests such as independent t-tests, chi-square, and two-way analysis of variance (ANOVA).

RESULTS

The infected EMTs exhibited a moderate perception of the risk of COVID-19, while the non-infected EMTs reported a high level of RP. The independent t-test confirmed that the mean total score for COVID-19 RP was significantly lower in the infected EMTs compared to the non-infected group (mean RP score: infected 150.82 ± 32.24 vs. non-infected 161.54 ± 22.50, P = 0.007). Additionally, ANOVA revealed that none of the demographic variables individually had a significant impact on the level of COVID-19 RP (P > 0.05). Furthermore, the interaction effect between the demographic variables and the groups was also insignificant (P > 0.05).

CONCLUSION

EMTs who contracted COVID-19 had a significantly lower RP compared to their non-infected counterparts. This reduced awareness of COVID-19 risks likely contributed to their infection, highlighting the critical role of RP in disease prevention. Targeted educational programs to enhance RP among EMTs could foster stronger adherence to preventive measures, ultimately reducing infection rates during future biological disasters. Therefore, this study not only contributes to expanding existing knowledge in this field but also assists policymakers and health administrators in improving decision-making to strengthen epidemic preparedness.

Core GRADE 5: rating certainty of evidence-assessing indirectness

This fifth article in a seven part series presents the Core GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach to systematic reviews, clinical practice guidelines, and health technology assessments and addresses issues of indirect evidence. Guideline developers and health technology assessment practitioners must carefully specify the population, intervention, comparison, and outcome (PICO)—their target PICO—and consider the extent to which the best available evidence matches their target. When target and study PICOs differ substantially, studies provide indirect evidence and Core GRADE users may rate down the certainty of evidence as a result of this indirectness. Whether examining studies from a search for direct evidence or a deliberate search for indirect evidence, for each substantial difference between target and study PICO Core GRADE users must judge the likelihood that magnitude of effects will differ substantially. The greater the likelihood of substantial differences the more advisable rating down for indirectness.

Longitudinal association between chronotype and depressive symptoms among college students: Mediating roles of perceived stress and self-control

This study aims to explore the longitudinal relationship between chronotype and depressive symptoms and the mediating roles of perceived stress and self-control among college students. A total of 11,010 college students completed two web-based surveys during 17 to 29 October 2023 (Time 1, T1) and 15 to 24 April 2024 (Time 2, T2), respectively. Participants completed the reduced version of morningness-eveningness questionnaire, the 10-item Perceived Stress Scale, the Brief Self-Control Scale, the 2-item Patient Health Questionnaire, and 3 items of the Youth Self-Rating Insomnia Scale. The results indicated that perceived stress (T1) and self-control (T2) serially mediate the relationship between morning chronotype (T1) and depressive symptoms (T2) (β =  -0.010, 95% CI: -0.012 to -0.009), after controlling for baseline sample characteristics, depressive symptoms (T1), and insomnia symptoms (T2). This longitudinal relationship was observed in both male (β =  -0.009, 95% CI: -0.012 to -0.006) and female (β =  -0.011, 95% CI: -0.013 to -0.009) participants. These findings enhance our understanding of the mechanisms by which chronotype affects college students' depressive symptoms, providing valuable insights for developing targeted interventions, such as stress-management workshops, to mitigate depression risk, especially among students with evening chronotypes.

Mindfulness-Based Interventions for Mental Health Outcomes in Frontline Healthcare Workers During the COVID-19 Pandemic: A Randomized Controlled Trial

BACKGROUND

The COVID-19 pandemic significantly impacted the mental health of frontline healthcare workers (HCWs), but solid evidence on psychological interventions for HCWs remains limited.

OBJECTIVE

Whether an adjusted therapist-assisted Mindfulness-based Stress Reduction group intervention (adjusted MBSR) is superior to a minimal self-guided mindfulness-based intervention (self-guided MBI) in improving mental health of HCWs during the COVID-19 pandemic.

DESIGN

Randomized controlled trial.

PARTICIPANTS

201 frontline HCWs (47 physicians, 120 nurses, 34 supporting staff); enrollment between June 2020 and September 2021.

INTERVENTIONS

A 4-week adjusted MBSR with eight biweekly 1.5-h sessions; or a 4-week self-guided MBI with 24 mindfulness/compassion exercises.

MEASURES

Primary outcome was the Patient Health Questionnaire - Somatic, Anxiety and Depressive Symptom Scales (PHQ-SADS) at 6-month follow-up. Secondary outcomes included posttraumatic symptoms, insomnia, alcohol use, repetitive negative thinking, mental well-being, posttraumatic growth, mindfulness, and self-compassion at post-intervention and 3- and 6-month follow-up.

KEY RESULTS

At 6-month follow-up, the adjusted MBSR was not superior to the self-guided MBI (mean difference (SE) PHQ-SADS, 0.23 (1.03), P=0.82). Both interventions showed similar within-group improvement in PHQ-SADS (Cohen's d between baseline and 6-month follow-up: adjusted MBSR -0.78 (95% CI -1.07; -0.48), self-guided MBI -0.72 (95% CI -1.01; -0.43)). Secondary outcomes showed that symptom trajectories differed between groups for PHQ-SADS (intervention*time F(3, 420)=3.99, P=0.008), with greater reduction at post-intervention for adjusted MBSR, and posttraumatic growth (intervention*time F(3, 350)=5.32, P=0.001), with exclusive increase post-intervention in adjusted MBSR. Both interventions showed comparable significant within-group improvements on posttraumatic symptoms, insomnia, repetitive negative thinking, mental well-being, mindfulness, and self-compassion.

CONCLUSIONS

The adjusted MSBR was not superior to the self-guided MBI; both were accompanied by significant reductions of depressive, anxiety, and somatic symptoms after 4 weeks of treatment which was sustained at 6-month follow-up. Further research is needed to investigate the possible role of MBIs to support HCWs involved in future healthcare crises.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04720404; onderzoekmetmensen.nl/en NL73793.091.20.

Evaluation of the effect of the COVID-19 pandemic on depression, anxiety and psychological resilience in patients with primary immunodeficiency

BACKGROUND

Primary immunodeficiencies (PIDs) are a group of diseases that develop as a result of primary or congenital malfunction of the immune system and progress with chronic and/or recurrent bacterial, fungal, protozoal and/or viral infections. In this study, we aimed to examine the effects of the COVID-19 pandemic on depression, anxiety levels and psychological resilience in patients with PID and to compare them with those in controls.

METHODS

Seventy patients, aged 18-65 years, who were being followed up with a diagnosis of PID and 69 people as healthy control group, participated in our study. The participants were evaluated cross-sectionally once; sociodemographic data form, Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scale (HAM-A), Resilience Scale for Adults (RSA), and COVID-19 Evaluation form were administered to the participants.

RESULTS

HAM-A and HAM-D scores were significantly higher in PID patients compared to controls (HAM-D: 5.5 vs. 3.0, p < 0.001; HAM-A: 6.0 vs. 4.0, p = 0.008). RSA was significantly lower in the patient group (RSA total: 122.5 vs. 136.0, p < 0.001), and pandemic-related risk perception was higher (PRPS: 33.9 vs. 28.3, p < 0.001). Sleep, appetite, and attention-related disturbances were also more common in the patient group. Multivariate regression analyses revealed that PID diagnosis was an independent predictor of increased depression severity (HAM-D), lower psychological resilience (RSA), and greater pandemic-related risk perception. Female sex was independently associated with higher anxiety severity (HAM-A). A personal psychiatric history and greater number of comorbidities were also significant predictors of psychological vulnerability, particularly in relation to depression and anxiety.

CONCLUSION

Given the observed associations between PID and increased levels of depression, anxiety, and reduced psychological resilience during the pandemic, clinicians may consider heightened vigilance for psychological symptoms in this population during times of public health crisis.

Moral Injury, Mental Disorders, and Suicidal Behavior Among Health Professionals During the COVID-19 Pandemic: A Network Analysis

During extreme conditions such as the COVID-19 pandemic, health professionals were susceptible to mental health issues. A series of network analyses were performed to explore the relationship between moral injury and depressive symptoms, anxiety symptom, PTSD symptom, and suicidal behaviors in 14,993 health professionals. Depressive symptoms were identified as the main pathway through which moral injury led to suicidal behavior, and betrayal was the most significant bridge symptom for moral injury with PTSD, anxiety, and depressive symptoms. The symptom profiles of MI associated with the common mental outcomes included betrayal, self-condemnation, and feeling punished by God. The most central mental symptoms of health professionals were irritability, nervousness, and feeling afraid. It is crucial to implement targeted measures addressing the bridge symptoms of moral injury and the core symptoms of anxiety to prevent and treat mental health consequences among health professionals.

Maternal polycystic ovarian syndrome and offspring psychopathology and neurodevelopment

Polycystic ovarian syndrome (PCOS) is a common female endocrinologic condition that affects both the metabolic and reproductive systems and is the most frequent cause of anovulatory infertility. It is also associated with a range of psychiatric outcomes in individuals, including bulimia nervosa, schizophrenia, bipolar disorder, depression, anxiety, and personality disorders. At the same time, evidence suggests that hyperandrogenism, the characteristic trait of PCOS, may impair fetal neurodevelopment. Epidemiological studies have linked maternal PCOS with a variety of behavioral and psychiatric conditions in offspring including autism spectrum disorder and attention deficit hyperactivity disorder. In this review, we explore evidence for potential underlying biological mechanisms that might explain these observed associations, discuss the complex interplay between genetics and various environmental factors across generations, and highlight avenues for future research.

Maternal high fat and high sugar diet impacts on key DNA methylation enzymes in offspring brain in a sex-specific manner

Maternal obesity associates with an increased risk of offspring neurodevelopmental disorders. Although the underlying mechanism(s) remain unclear, evidence suggests a role for altered DNA methylation. We utilized a murine model of diet-induced obesity to investigate the impact of maternal obesity on the offspring brain transcriptome and DNA methylation. C57Bl/6 dams were fed high-fat high-sugar (HFD, n = 7) or control (CON, n = 7) diets. Maternal obesity/hyperglycemia associated with offspring growth restriction, with brain-sparing specifically in females. Postnatal hypoglycemia was seen in HFD males, but not females. The 3' RNA-sequencing revealed perturbations in metabolic and cell differentiation pathways in neonatal male and female offspring frontal cortex and cerebellum. Compared with controls, HFD males, but not females, had lower cortical and cerebellar DNMT gene and protein expression, and reduced cerebellar TET enzyme mRNA. Whilst female offspring had lower cerebellar 5-methylcytosine (5mC) and 5-hydroxymethylcytosine (5hmC) than males, there were no effects of HFD on 5mC/5hmC in cortex or cerebellum in either sex. Our data suggest that maternal obesity has sex-specific effects on fetal neurodevelopment, including enzymes involved in DNA methylation/demethylation. These mechanisms may play a role in the increased risk of neurodevelopmental disorders following obese/diabetic pregnancies, including increased male susceptibility to these disorders.

Reproducible feature selection in heterogeneous multicenter datasets via sign-consistency criteria

The identification of risk features associated with disease plays a crucial role in biomedical fields. These features are often used to provide evidence for clinical decision-making. However, in the presence of between-center heterogeneity, covariate effects across data centers may exhibit inconsistent directions, making feature selection challenging. In this work, we propose a novel framework to select reproducible risk features whose underlying effects are consistent across different centers. We quantify the feature reproducibility based on the sign-consistency criterion, which provides an acceptable level of heterogeneity in effect sizes and ensures the reasonable similarity of reproducible signals. Compared with the existing feature selection methods, our proposed method effectively protects data privacy and does not rely on the assumption of data homogeneity. Extensive simulations demonstrated that the proposed method has greater power than existing methods do. We apply the proposed approach to analyze data from the China Health and Retirement Study Longitudinal Study (CHARLS) and identify nine important risk factors that show reproducible associations with depression.

The second victim phenomenon´s impact in male and female healthcare workers: a scoping review

BACKGROUND

The second-victim phenomenon occurs when a healthcare provider experiences trauma after being profoundly affected by a negative medical event. As a work-related phenomenon, it may be influenced by sex and gender-related factors, particularly since women constitute 70% of the health and social sector workforce. This study aims to describe the impact of the second-victim phenomenon on male and female healthcare professionals, identifying differences in their experiences. It also identifies differences in the reactions and behavior of supervisors, colleagues, patients, and their relatives to errors made by male and female healthcare workers.

METHODS

A scoping review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension guidelines. Comprehensive searches were performed in the electronic databases BDENF, ProQuest, PsycInfo, PubMed, Scopus, and Web of Science, without filters or time limits. Original articles in Portuguese, English, Spanish, or German that mentioned any aspects concerning differences between male and female healthcare workers in relation to the second-victim phenomenon were selected.

RESULTS

Twenty-seven articles were included, most of which were cross-sectional studies from the USA, China, Germany, and Spain, conducted among physicians and nurses. The findings highlighted that women experienced more intense anxiety responses in the aftermath of severe adverse events than men. Male healthcare workers were more resistant to seeking support compared to their female counterparts. Gender-based discrimination against women was identified in both education and practice, further exacerbating the second victim syndrome experienced by female healthcare professionals.

CONCLUSION

Understanding male/female differences is essential for comprehending the second-victim phenomenon and designing effective measures to mitigate its impact. Women may be more psychologically affected by adverse events than men. They are judged more negatively than men after making an error and are more likely to seek help.

The Prevalence of Insomnia Disorder in the General Population: A Meta-Analysis

Insomnia disorder is a significant public health issue, but the prevalence estimates vary widely. We performed a meta-analysis aiming to pool prevalence rates in studies (1) carried out in the general population (2) using a true random sample (3) and using a diagnostic interview, DSM based self-report questions, or a questionnaire with a cut-off established against the DSM criteria. A literature search (in PubMed, Embase, APA PsycInfo) was performed up to April 2024. Two independent reviewers assessed title and abstracts (n = 6732), full-text manuscripts (n = 621) and extracted the data of the 47 included studies. Prevalence rates were pooled using a three-level hierarchical random-effects model, stratified by diagnosis type and adjusted for gender distribution and mean sample age. The pooled prevalence of all studies using an interview to establish the DSM criteria was 12.4% (95% CI: 9.0-16.8%), and of self-report questions assessing the DSM diagnosis 16.3% (95% CI: 11.3%-23.0%). There were 27 studies using different insomnia questionnaires with different cut-offs (prevalence range 7.5%-32.3%). The prevalences differed significantly across regions and high quality studies yielded a lower prevalence rates than lower quality studies. This meta-analysis confirms that insomnia is a common disorder with a prevalence of 12.4 as the most accurate estimate. It also shows the need for standardised ways of assessing insomnia. We think the golden standard is using standardised structured clinical interviews. However, if this is not feasible, we recommend using well validated questionnaires such as the Sleep Condition Indicator or the Insomnia Severity Index. Trial Registration: PROSPERO CRD42023402745.

Knowledge, attitudes and practices regarding sexual health among Chinese medical students: a multicenter cross-sectional study

BACKGROUND

Sexual health is crucial for overall well-being, yet sexual health education among medical students in China remains limited. This multicenter cross-sectional study assesses the knowledge, attitudes, and practices (KAP) regarding sexual health among Chinese medical students to inform educational policies.

METHODS

An electronic survey was conducted across three leading medical institutions in Beijing, targeting postgraduate medical students. The survey assessed demographics, sexual health knowledge, attitudes, and behaviors. Data were analyzed using descriptive statistics and logistic regression to identify factors associated with sexual behavior.

RESULTS

Among 765 participants, 79% identified as heterosexual, and 28.2% reported engaging in sexual activity. While the overall sexual health knowledge was relatively high, students with sexual experience had significantly higher contraceptive knowledge. Misconceptions were common, with 25.8% believing that sex during the safe period doesn't lead to pregnancy, and 14.9% considering withdrawal before ejaculation effective for contraception. Positive attitudes toward sexual health were noted, though traditional views on committed relationships persisted. Logistic regression identified factors associated with sexual activity: higher monthly expenses, rural residency, and non-heterosexual orientation. Undergraduate and female students were less likely to engage in sexual activity.

CONCLUSIONS

This study highlights significant gaps in sexual health knowledge, particularly about contraception and HPV vaccination. The findings stress the need for comprehensive sexual health education to address knowledge gaps and cultural attitudes, preparing future healthcare professionals for effective, non-judgmental patient care.

Core GRADE 4: rating certainty of evidence-risk of bias, publication bias, and reasons for rating up certainty

This fourth article in a seven part series presents the Core GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach to addressing risk of bias, publication bias, and rating up certainty. In Core GRADE, randomised controlled trials begin as high certainty evidence and non-randomised studies of interventions (NRSI) as low certainty. To assess certainty of evidence for risk of bias, Core GRADE users first classify individual studies as low or high risk of bias. Decisions regarding rating down for risk of bias will depend on the weights of high and low risk of bias studies and similarities or differences between the results of high and low risk of bias studies. For publication bias, a body of evidence comprising small studies funded by industry should raise suspicion. Core GRADE users appraising results from well conducted NSRI can consider rating up certainty of evidence when risk ratios from pooled estimates suggest large or very large effects.

Changing Trends in the Mental Health Status of Healthcare Workers at COVID-19 Wards Three Years After the COVID-19 Pandemic Outbreak in Saudi Arabia

Background

The current study aimed to investigate the severity of anxiety and depression symptoms among the healthcare workers of COVID-19 wards three years after the pandemic outbreak in Saudi Arabia.

Methods

An online cross-sectional survey was conducted during the fourth quarter of 2022 and early 2023 at the COVID-19 wards of public primary healthcare hospitals of the AlQassim region of Saudi Arabia. The sample included 323 healthcare workers including physicians, nurses, laboratory, and imaging personnel. The Generalized Anxiety Disorder (GAD-7) and Patient Health Questionnaire (PHQ-9) questionnaires were used to collect data using the self-administered approach. The degree of severity of anxiety and depressive symptoms were the main outcome variables. Descriptive and inferential statistics were derived using Statistical Package for Social Science (SPSS) software version 28.0.

Results

Three years following the outbreak of the pandemic, a transition toward a high prevalence of mild symptoms of anxiety and depression was noted. The present study reported 85.1%, 8.4%, and 6.5% mild, moderate, or moderately severe depression and 90.7%, 6.8%, and 2.5% anxiety, respectively. Depression was more common in men (t=3.009; p=0.003). Phlebotomists, x-ray and imaging personnel, and paramedics showed a strong association with symptoms of depression (t=8.36; p< 0.001) and anxiety (t= 10.325; p<0.001). Sleep deprivation, fatigue, loss of interest, and changes in eating behavior were depressive symptoms with a high degree of severity. Anxiety symptoms that showed a high degree of severity were having trouble relaxing and getting annoyed quickly. An overall depressive and anxiety score of 16.5 and 12.8 was obtained.

Conclusion

The long-term impact of the pandemic on healthcare workers in COVID-19 wards includes the persistence of depression and anxiety symptoms. These findings highlight the need for implementing mental health wellness programs and coping strategies that reduce work stress and improve the quality of life.

Psychological Care in Spanish Nurses at the Frontline of the COVID-19 Pandemic: A Prospective Study on Symptoms, Burnout and Psychological Variables

(1) Background: Previous studies have highlighted the emotional symptoms experienced throughout the COVID-19 pandemic by nurses and their consequences. It would be of interest to analyze the extent to which healthcare workers (HCWs), in the context of the psychological health crisis, have sought (and received) psychological care. Likewise, it would be highly relevant to analyze the profile of these professionals, both in terms of the sociodemographic and occupational characteristics as well as the emotional symptoms they presented, and the percentage of nurses who requested psychological help during the COVID-19 pandemic, their sociodemographic and occupational characteristics as well as their levels of associated symptoms. Additionally, one could study the associated psychological personality variables, including both risk factors and protective variables, as this is of special interest for the design of appropriate interventions. (2) Methods: An observational, descriptive, prospective longitudinal study with three data collection periods was carried out. At the first time point, anxiety, insomnia, self-efficacy, resilience and social support were assessed. Anxiety, insomnia, fear of COVID-19, cognitive fusion and burnout syndrome were assessed at the second time point. Finally, at the third time point, we assessed anxiety, insomnia and burnout syndrome. During the second and third time points, the nurses' requests for psychological help were assessed. (3) Results: Overall, 33.1% of the final sample requested psychological support, and 20.5% of them had sought psychological support by the first time point, of which 7.3% continued to in the final time measure. The request for psychological help was significantly related to higher means for anxiety (p = 0.003), insomnia (p = 0.001) and burnout (p < 0.05), as well as high levels of cognitive fusion (p = 0.001) and low levels of resilience (p = 0.009). Requests for psychological help were not significantly related to social support (p = 0.222) or fear of COVID-19 (p = 0.625). (4) Conclusions: The data suggest the need to promote measures for the implementation of psychological help among nurses aimed not only at reducing the consequences of the psycho-emotional affectation derived from a stressful work situation but also strengthening health-promoting traits such as self-efficacy or resilience.

Susceptibility from the immunological perspective of COVID-19-associated pulmonary aspergillosis: A literature review

The incidence rate of COVID-19-associated pulmonary aspergillosis (CAPA) is rising. However, the pathogenesis of CAPA remains unclear. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection disrupts pathways related to type I interferon and Toll-like receptors, key components in innate immunity, thereby elevating the incidence of CAPA. Additionally, SARS-CoV-2 infection results in T and B cell functional deficiencies or exhaustion within adaptive immunity, weakening the defense against invasive Aspergillus. Furthermore, SARS-CoV-2 infection enhances the replication of cytomegalovirus and alters the gut microbiota, factors that may aid in diagnosing CAPA. Immunosuppressive therapy in COVID-19 patients is also believed to heighten the risk of invasive aspergillosis. Therefore, this review, examines the immune response to SARS-CoV-2 infection combined with invasive aspergillosis, and explores the pathogenesis and susceptibility factors of CAPA. We propose that variations in an individual's immune response significantly determine susceptibility to CAPA. The aim of this paper is to deepen clinical understanding of CAPA's pathogenesis, thereby aiding in mitigating susceptibility risk and advancing novel treatment approaches.

EASL Clinical Practice Guidelines on the management of hepatitis B virus infection

The updated EASL Clinical Practice Guidelines on the management of hepatitis B virus (HBV) infection provide comprehensive, evidence-based recommendations for its management. Spanning ten thematic sections, the guidelines address diagnostics, treatment goals, treatment indications, therapeutic options, hepatocellular carcinoma surveillance, management of special populations, HBV reactivation prophylaxis, post-transplant care, HBV prevention strategies, and finally address open questions and future research directions. Chronic HBV remains a global health challenge, with over 250 million individuals affected and significant mortality due to cirrhosis and hepatocellular carcinoma. These guidelines emphasise the importance of early diagnosis, risk stratification based on viral and host factors, and tailored antiviral therapy. Attention is given to simplified algorithms, vaccination, and screening to support global HBV elimination targets. The guidelines also discuss emerging biomarkers and evolving definitions of functional and partial cure. Developed through literature review, expert consensus, and a Delphi process, the guidelines aim to equip healthcare providers across disciplines with practical tools to optimise HBV care and outcomes worldwide.

Dehydrozingerone ameliorates renal structure compromised in diabetic nephropathy

Kidney structural integrity is critical for bodily excretory mechanism. Diabetes has been considered as one of the major risk factors for chronic kidney disease, but the underlying mechanism remains elusive. The present study investigates the transcriptomic and proteomic profiling of long-term impact of high-fat diet (HFD) on renal tissue in mice and role of dehydrozingerone (DH) in reinstating the normal kidney function. Animals were divided into four groups- healthy (NCD+Veh), diabetic (HFD-STZ+Veh), healthy+DH (NCD+DH) and treatment (HFD-STZ+DH). 65th days of HFD-fed C57BL/6J mice developed diabetes and kidney dysfunction evident by albuminuria, proteinuria, and glucotoxicity with accumulation of glucose, triglyceride, cholesterol, albumin, and total protein in blood serum. The HFD-fed kidney showed renal injuries, including prominent defects in the glomerular filtration system by downregulation of proteins involved in transport, metabolic process, energy production, anti-oxidation, etc. Downregulation of lipid metabolism is the most impacted metabolic process under diabetic condition. Downregulation of transport proteins mainly impact the functioning of podocytes, cell adhesion and cytoskeletal rearrangement. HFD feeding also increased oxidative stress and induced mitochondrial dysfunction, and thereby activating the pro-apoptotic pathway which is evident by activation of BAX led mitochondrial apoptosis and mitochondrial dysfunction under diseased condition. Progression of DNA damage under diabetic condition triggered the epigenetic alteration and subsequent downstream changes which is evident by activation of HDAC1 under diseased condition. Both transcriptomic and proteomic studies revealed the potential of DH in attenuating the diabetic condition by positively regulating transport system, mitochondrial function, lipid metabolism, DNA damage and epigenetic alteration, and oxidative stress, which ameliorate the kidney function.

The Possible Role of Postnatal Biphasic Dysregulation of IGF-1 Tone in the Etiology of Idiopathic Autism Spectrum Disorder

Autism spectrum disorder (ASD) is a pervasive condition of neurodevelopmental origin with an increasing burden on society. Idiopathic ASD is notorious for its heterogeneous behavioral manifestations, and despite substantial efforts, its etiopathology is still unclear. An increasing amount of data points to the causative role of critical developmental alterations in the first year of life, although the contribution of fetal, environmental, and genetic factors cannot be clearly distinguished. This review attempts to propose a narrative starting from neuropathological findings in ASD, involving insulin-like growth factor 1 (IGF-1) as a key modulator and demonstrates how the most consistent gestational risk factors of ASD-maternal insulin resistance and fetal growth insufficiency-converge at the perinatal dysregulation of offspring anabolism in the critical period of early development. A unifying hypothesis is derived, stating that the co-occurrence of these gestational conditions leads to postnatal biphasic dysregulation of IGF-1 tone in the offspring, leading first to insulin-dependent accelerated development, then to subsequent arrest of growth and brain maturation in ASD as an etiologic process. This hypothesis is tested for its explanation of various widely reported risk factors and observations of idiopathic ASD, including early postnatal growth abnormalities, the pervasive spectrum of symptoms, familial predisposition, and male susceptibility. Finally, further directions of research are outlined.