Community health volunteers' experiences during the COVID-19 pandemic in Kiambu county, Kenya: A qualitative study

BACKGROUND

For already overburdened health systems in low- and middle-income countries (LMICs), the COVID-19 pandemic presented an almost impossible challenge. In Kenya, efforts to mitigate the impact of the pandemic included the mobilization of community health volunteers (CHVs), a cadre that has been historically understaffed and under-resourced. These volunteers were required to sustain the delivery of routine community-based health services while also taking on additional responsibilities related to COVID-19 mitigation. This study explored the challenges faced by CHVs during the COVID-19 response in Kiambu County; focusing on their experiences with control measures, impacts on community-level healthcare delivery, and perspectives on the government's pandemic response within the community health framework.

METHODS

This study employed a phenomenological exploratory qualitative design. Due to logistical constraints, only two focus group discussions could be conducted with 24 CHVs, representing 48% of eligible participants who met the inclusion criteria: a minimum of five years of experience, active involvement in the pandemic response, and availability for the interview. Data were digitally recorded, transcribed, translated, and coded for thematic analysis.

RESULTS

Specific themes from the experiences of the CHVs during the COVID-19 lockdown were: (1) dedication and commitment to serving the community; (2) overcoming demoralization; and (3) community barriers to health care delivery and access. In regards to the community perspectives of COVID-19, the CHVs relayed widespread misinformation among community members, with experiences of stigma due to COVID-19 misconceptions. They also gave second-person accounts of the economic strife the community went through as a result of mitigation measures. The CHVs were skeptical in the county's preparedness in dealing with both the COVID-19 and future pandemics.

CONCLUSION

Despite facing stigma, misinformation, limited resources, and economic hardships, CHVs demonstrated commitment to their roles. Their efforts not only underscored their resilience but also revealed critical gaps in preparedness and resource allocation within the healthcare system. However, the small number of FGDs and insufficent data saturation should be considered when interpreting the findings. Nonetheless, our study provides a starting point for further research and comparative analysis across other counties in Kenya.

Diagnostic radiographers' lived experiences of trauma imaging

INTRODUCTION

Gauteng in South Africa experiences a high volume of trauma cases that necessitate hospital admissions and medical interventions. As part of the healthcare team, radiographers are responsible for imaging patients with trauma injuries. Treating patients with trauma injuries has a significant impact on the psychological functioning of healthcare workers. Therefore, it was essential to understand diagnostic radiographers' experiences during trauma imaging.

METHODS

A qualitative approach with a phenomenological research design was used. Individual interviews were conducted with qualified diagnostic radiographers experienced in trauma imaging who were purposively sampled from private and public trauma healthcare settings in the Gauteng province. The interview data were thematically analysed.

RESULTS

Three themes and related subthemes were generated: 1) Adverse effects of trauma imaging with the subthemes, professional emotional saturation, desensitisation and vicarious traumatisation; 2) Managing the effects of trauma imaging with the subthemes, preparedness and coping strategies; 3) Developing from trauma imaging experiences with the subthemes post-traumatic growth and professional dedication.

CONCLUSION

Diagnostic radiographers shared that trauma imaging negatively affected them emotionally, compounded by inadequate support and resources. Those with prior exposure to trauma imaging or personal trauma experiences coped better. Despite these challenges, radiographers valued their roles and the chance to improve their skills, expressing a strong passion for their profession and a commitment to their patients' well-being. Diagnostic radiographers would benefit from counselling services and opportunities to debrief.

IMPLICATIONS FOR PRACTICE

This study provides valuable insights into the experiences of diagnostic radiographers working in trauma imaging. These findings can be instrumental for medical imaging departments as they develop targeted strategies to support radiographers imaging trauma patients. Additionally, radiography educators can use the study findings to prepare students for trauma imaging.

The impact of COVID-19 quarantine on college students' mental health

BACKGROUND

The COVID-19 pandemic is a global public health crisis. The quarantine measures for COVID-19 have caused harm to the mental health of college students, and it is of great significance to continue focusing on the impact of COVID-19 on mental health.

METHODS

The data comes from the research group on the impact of COVID-19 on college students' mental health. A total of 2,033 Chinese college students participated in this study, including 1,285 female and 748 male students, with an average age of 19.81 years (SD = 1.22). Using the ordered logistic regression model, the study analyzed the mechanisms of academic stress, employment pressure, and sleep quality to investigate the impact of COVID-19 quarantine on college students' mental health.

RESULTS

Quarantine due to the COVID-19 pandemic has a significant impact on college students' mental health. The impact of quarantine on college students' mental health is economically stratified, with lower family income students experiencing greater effects and higher family income students experiencing lesser effects. Academic stress, employment pressure, and sleep quality are important mechanisms through which quarantine affects college students' mental health.

CONCLUSION

This study provides new insights into the relationship between quarantine and mental health among college students during the COVID-19 pandemic, helping to offer targeted interventions for college students' mental health.

Fear of Death, Emotional Intelligence and Resilience Among Healthcare Staff During COVID-19: A Correlative Study

The suffering, pain and fear of death experienced by patients during the pandemic have evoked a wide range of feelings and emotions in healthcare professionals. Managing these emotions is influenced by factors such as emotional intelligence and resilience. Recognising and addressing these emotions can enhance the quality of care and help prevent mental health issues. This study analyses the relationship among fear of death, emotional intelligence and resilience, as along with the sociodemographic variables of healthcare professionals during the COVID-19 pandemic. A descriptive, comparative and correlational study was conducted. Participants included professionals from the Neurosurgery, Pneumology, Emergency Service and Floating Staff units in a tertiary-level hospital in Spain. Data were collected through an anonymous and voluntary online survey, which included sociodemographic data, Collett-Lester fear of death, emotional intelligence and resilience scale. Participation was anonymous and voluntary. A total of 121 professionals participated, predominantly women (85.12%), with a mean age of 41.89 years (SD ± 9.6). Nurses compromised 64% of the sample. Fear of others' death (37.2%) and the dying process of others (33.1%) increased. Emotional intelligence levels were generally adequate across all work areas, with women scoring higher in attention and clarity. However, significant differences in emotional regulation were observed between groups. Resilience scores were high across all participants (> 78.77). Positive correlations were found among age, fear of the dying process of others (p=0.003) and resilience (p=0.002). An inverse correlation was observed between fear of others' death and resilience (p=0.018) and emotional regulation (p=0.020). Linear regression analysis identified attention to emotions, acceptance and bioethics training as predictors of fear of death.

Body roundness index trajectories in Chinese bariatric surgery patients: a retrospective longitudinal study

OBJECTIVE

To investigate the body roundness index (BRI) trajectory categories 12 months post-bariatric surgery and to explore the association between BRI and metabolic abnormalities.

DESIGN AND METHODS

Subject data were pooled from a tertiary hospital at baseline, 3 and 12 months post-surgery. Anthropometric measurements included the BRI and body mass index (BMI). Metabolic biomarkers comprised triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), glucose (GLU), and uric acid (UA). The BRI level was categorized using growth mixture model, and a multilevel logistic regression model was employed to explore the relationship between BRI and metabolic risk.

RESULTS

A total of 669 patients were included in this study, comprising 286 males (42.8%) and 383 females (57.2%), with an average age of 31.70 ± 9.53 years (range of 18 to 65 years). Patients were classified into three BRI trajectory categories. Compared to the Low-gradual decline group, the High-rapid decline group had an increased risk of abnormal HDL-C (OR = 2.84 [95% CI, 1.73 ~ 4.67]), and had the highest proportion of sleeve gastrectomy plus jejunojejunal bypass (SG + JJB) and single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) (P < 0.001); while the High-gradual decline group had increased risk of abnormal TG (OR = 3.28 [95%CI,1.67-6.42]), HDL-C (OR = 4.30 [95%CI, 2.31 ~ 8.00]), LDL-C (OR = 2.10 [95%CI, 1.12 ~ 3.93]), and UA (OR = 2.33 [95%CI, 1.33 ~ 4.10]). After adjusting for demographics, lifestyle factors, and surgical procedures, the distribution of risk outcomes remained primarily consistent.

CONCLUSIONS

Sleeve gastrectomy (SG) plus procedures could potentially be associated with improvements in abdominal obesity and metabolic status in patients with high BRI. The post-bariatric trajectories based on BRI may offer insights into the metabolic risk levels of Chinese bariatric patients, but further research is needed to confirm these findings.

Trend of psychological symptoms from pregnancy to postpartum: a prospective study during COVID-19 pandemic

Psychological symptoms during pregnancy and the postpartum period require special attention, particularly in the context of the COVID-19 pandemic. This study aims to evaluate the trajectory of psychiatric symptoms from pregnancy to the postpartum period during the COVID-19 pandemic. This prospective study was conducted at Babol University of Medical Sciences from February 2020 to September 2021. A total of 252 pregnant women completed the Symptom Checklist 25 (SCL-25), the Corona Disease Anxiety Scale, and the Post-Traumatic Stress Diagnostic Scale at both prenatal and postpartum time points. Results indicated that the mean total score of psychological symptoms decreased modestly from pregnancy to postpartum (39.61 ± 11.67 vs. 32.78 ± 12.15, p < 0.001). Additionally, symptoms of somatization, depression, anxiety, and phobia significantly declined from pregnancy to postpartum (p < 0.05). However, levels of depression, anxiety, and phobia remained significantly higher among women with a positive history of COVID-19 infection compared to those without, during both pregnancy and postpartum. While the overall mean score of psychological symptoms showed a slight reduction from pregnancy to postpartum, many symptoms persisted, particularly in individuals with a COVID-19 infection history or post-traumatic stress symptoms. The study recommends that healthcare providers, including obstetricians, nurses, and midwives, implement timely screening and treatment for psychological symptoms from pregnancy through postpartum.

Prospective registration was associated with a reduced risk of bias for randomized controlled trials: a meta-research study

OBJECTIVES

To investigate the association between trial registration and the risk of bias (RoB).

STUDY DESIGN AND SETTINGS

Randomized controlled trials (RCTs) from systematic reviews of medication-related harm published between January 1, 2015, and January 1, 2020, were used, assessing first post and start dates on open registries along with RoB. Multivariable logistic regression analyses for both individual safeguards and overall RoB by registration status (ie, nonregistered, retrospectively registered, and prospectively registered) were conducted.

RESULTS

A total of 2030 RCTs were identified from 151 systematic reviews; 65.46% (851/1300) were registered prospectively and 34.54% (449/1300) retrospectively among 64.04% (1300/2030) registered RCTs. Regression analysis indicated that when compared to nonregistered trials, prospective registration was associated with safeguards against bias using randomization sequence generation (odds ratio [OR] = 1.51, 95% CI: 1.09, 2.07), allocation concealment (OR = 1.69, 95% CI: 1.22, 2.36), blinding of outcome assessors (OR = 1.65, 95% CI: 1.14, 2.38), as well as lower overall RoB (OR = 2.04, 95% CI: 1.19, 3.50). When comparing prospectively and retrospectively registered trials, prospective registration was more likely to have lower overall and individual RoB, but this was not statistically significant. Prospective registration was associated with blinding of participants (OR = 1.70, 95% CI: 1.26, 2.30) and health-care providers (OR = 1.68, 95% CI: 1.25, 2.28), but not lower overall RoB as compared to retrospective registration.

CONCLUSION

Prospectively registered trials were more likely than nonregistered trials to implement adequate procedures against bias. Prospectively registered trials may also serve as an indicator of lower overall RoB in RCTs.

Down-regulating HDAC2-LTA4H pathway ameliorates renal ischemia-reperfusion injury

BACKGROUND

The activation of histone deacetylase 2 (HDAC2) is the main pathogenesis of acute kidney injury (AKI), one of the leading causes of end-stage kidney disease. However, the regulatory role of HDAC2 upregulation on inflammation in AKI is still unclear.

RESULTS

In this study, we found that treatment with HDAC2 inhibitor BRD6688 could mitigate the degree of mesangial sclerosis, interstitial infiltration and tubular atrophy, reduce the concentration of blood urea nitrogen (BUN) and serum creatinine (Scr), improve the proliferation, anti-apoptotic, anti-oxidative stress and angiogenesis effects of renal cells. Our results mainly indicated that renal HDAC2 activity was increased by casein kinase 2 (CK2) in renal ischemia reperfusion (I/R) models, and HDAC2 genetic ablation in HREpiC cells suppressed the leukotriene B4 (LTB4) production. Renal leukotriene A4 hydrolase (LTA4H) activity was increased in AKI mice in a HDAC2-dependent manner. LTB4 could induce monocytes to differentiate into M1 macrophages, while BRD6688 could suppress this effect and force the M1 macrophages polarize to M2 macrophages.

CONCLUSION

Inhibition of HDAC2 activities by BRD6688 could suppress the progression of renal I/R injury through the regulation of LTA4H and macrophage polarization.

Characterizing Mental Health in an LMIC Context: Measuring Compassion Satisfaction, Burnout, and Secondary Traumatic Stress Among Health Care Providers in Ecuador During COVID-19 with the ProQOL V5 Questionnaire

OBJECTIVES

This study assessed compassion satisfaction, compassion fatigue, and burnout in health care providers from public health care institutions in Ecuador during the COVID-19 pandemic.

METHODS

A cross-sectional survey was conducted in 2022, involving 111 different public health care institutions in 23 provinces in Ecuador, with 2873 participants recruited via convenience sampling. The survey instrument was the revised Stamm's Professional Quality of Life Scale Version-5 tool, designed to measure self-reported compassion fatigue, work satisfaction, and burnout among providers. Kruskall-Wallis test assessed subscale score differences by gender, professional role, region, and health care facility level. Dunn's test was then applied to determine whether groups differed from each other.

RESULTS

On average, health care providers from all facilities had a high rate of compassion satisfaction (84.9%). However, the majority presented moderate levels of burnout (57.1%), and moderate levels of secondary traumatic stress (59.6%). Higher burnout levels were observed in the Amazon regions compared to Coastal regions.

CONCLUSIONS

Despite high compassion satisfaction, most surveyed health care providers from Ecuador's public health institutions experienced moderate burnout and secondary traumatic stress, with higher burnout levels in the Amazon region. Ecuador, similarly to other LMICs, requires mental health policy and legislation targeted to the mental health workforce and these needs. More research is needed on burnout factors among health care providers in resource-challenged low- and middle-income countries.

Conceptualising wellbeing among health-care workers during the Covid-19 pandemic

Since 2020 health workers everywhere have been challenged by the ongoing ramifications of the Covid-19 pandemic. This virus impacted all aspects of life but health-related workplaces particularly, were transformed virtually overnight. Demands were heightened and customary supports came under pressure presenting a huge crisis for health systems. The goal of this study was to explore how this catastrophic pandemic event impacted the wellbeing of healthcare professionals (HCPs) working through this time. Interviews with 57 HCPs from multiple countries and specialty areas were explored utilising inductive content analysis (ICA). Resulting data were then categorised into themes and deductively analysed utilising a method informed by Capability Theory. These were secondary data as the interviews were part of a larger set collected primarily for the purpose of a documentary being made about this experience. This study found that illbeing experiences were prevalent among HCPs. However, significant sources of wellbeing were also evident, and were instrumental in maintaining HCP resilience. Wellbeing was enhanced when HCPs experienced a small number of key capabilities that enabled a broad range of functionings. The capabilities were for (a) participation in positive relationships, (b) a sense of identity, purpose, meaning and value in relation to one's work and (c) ability to provide an appropriate level of medical treatment, care and other role related support. These capabilities were central to HCP wellbeing irrespective of the individual's location and specialty area, however the ability to realise these capabilities in desired functionings was differentially impacted by each individual's unique circumstances.

Integrin Trafficking, Fibronectin Architecture, and Glomerular Injury upon Adiponectin Receptor 1 Depletion

Key Points

Glomerular expression of adiponectin receptor 1 (AdipoR1) was lower in people with type 2 diabetes and correlates with podocyte loss. AdipoR1 knockout induced glomerular injury and fibrosis in mice, predominantly in males. AdipoR1 knockdown podocytes showed impaired trafficking of active integrin β 1, fibronectin accumulation, impaired adhesion, and increased apoptosis.

Background

Deficiency of adiponectin and its downstream signaling may contribute to the pathogenesis of kidney injury in type 2 diabetes. Adiponectin activates intracellular signaling using adiponectin receptor 1 (AdipoR1) and adiponectin receptor 2, but the role of adiponectin receptor–mediated signaling in glomerular injury in type 2 diabetes remains unknown.

Methods

The expression of AdipoR1 in the kidneys of people with type 2 diabetes and the expression of podocyte proteins or injury markers in the kidneys of AdipoR1 knockout (AdipoR1-KO) mice and immortalized AdipoR1-deficient human podocytes were investigated by immunohistochemistry and immunoblotting. The functional role of AdipoR1 was studied in AdipoR1-deficient podocytes by performing assays for apoptosis, cytokine secretion, mechanical stress, adhesion, and endocytic trafficking.

Results

Glomerular AdipoR1 expression was lower in type 2 diabetes and associated kidney disease, correlating with higher body mass index and podocyte loss. Male AdipoR1-KO mice showed typical signs of early diabetic kidney disease, including albuminuria, glomerular structural abnormalities, and lower expression of central podocyte proteins; females were less affected. Podocyte apoptosis increased in female and male AdipoR1-KO mice, and excessive podocyte loss, potentially due to detachment, was detected in males. AdipoR1 deficiency impaired the yes-associated protein–mediated mechanoresponse and induced accumulation of the extracellular matrix (ECM) protein fibronectin in the glomeruli in vivo and podocytes in vitro . Functionally, AdipoR1 deficiency impaired endocytosis of the ECM receptor active integrin β 1, disturbed focal adhesion turnover, and remodulated podocyte-derived ECM, thereby reducing podocyte adhesion.

Conclusions

AdipoR1 deficiency in mice resulted in the development of kidney injury predominantly in males. Mechanistically, AdipoR1 loss in podocytes impaired endocytosis of active integrin β 1, which plausibly compromised focal adhesion dynamics, disturbed fibronectin matrix turnover, and hindered podocyte adhesion.

Cultivating excellence: Development and validation of a bilingual competency self-assessment tool for infection prevention and control practitioners

BACKGROUND

The study aimed at developing and validating a bilingual competency self-assessment tool for infection prevention and control practitioners based on the core competencies proposed by the World Health Organization.

METHODS

The study was conducted from December 2021 to June 2023. The bilingual tool (Brazilian Portuguese and English versions) was developed according to 4 stages: (1) conceptual framework establishment and item generation; (2) content validity; (3) response process validity; and (4) internal structure validity.

RESULTS

The Brazilian Portuguese version of the tool was organized into 5 areas, 36 items, and a Cronbach's alpha coefficient between 0.89 and 0.97; the English version of the tool was organized into 5 areas, 37 items, and a Cronbach's alpha coefficient between 0.91 and 0.98.

DISCUSSION

The bilingual tool gathers evidence of content validity and internal structure validity.

CONCLUSIONS

The current evidence suggests that these are the first self-assessment tools that have utilized the core competencies proposed by the World Health Organization as a conceptual basis. Such tools can be applied in countries of all income classifications, which makes it possible to design educational initiatives and enhance core competencies.

Evaluating the impact of lavender aromatherapy and music therapy on reducing stress, anxiety, and depression in female nurses during the COVID-19 pandemic

PURPOSE

Nurses often experience high levels of physical and psychological stress due to frequent exposure to emergency and critical situations, which can adversely affect their professional performance. This study aimed to evaluate and compare the short- and long-term impacts of combining aromatherapy with music therapy versus using aromatherapy alone on the physical and psychological well-being of nurses during the COVID-19 pandemic.

METHOD

This study employed a quasi-experimental design without non-intervention control group and recruited 60 nurses from a regional teaching hospital in central Taiwan between February and November 2023. Participants were randomly assigned to two groups: one group received aromatherapy, and the other group received a combination of aromatherapy and music therapy. The aromatherapy intervention involved inhaling gas infused with lavender essential oil. The intervention was conducted once a week during the lunch break for 20 min over a six-week period. Physiological and psychological indicators were compared before and after the intervention. Physiological indicators included systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse rate (PR). Psychological indicators included scores on the Nursing Stress Scale (NSS), Beck Anxiety Inventory (BAI), and Beck Depression Inventory (BDI), which measured stress, anxiety, and depression, respectively.

RESULTS

Overall, after each aromatherapy intervention, the physiological and psychological measures of the nurses in both groups showed significant reductions (p < 0.05) based on paired t-tests. After six measurements, a one-way repeated measures ANOVA was conducted, revealing that most physiological and psychological measures of the nurses in the aromatherapy-only group were significantly reduced (p < 0.05), although no significant differences were found for diastolic blood pressure and pulse rate. In the group receiving aromatherapy combined with music therapy, all physiological and psychological measures showed significant reductions in repeated measures tests (p < 0.05). These results suggest that aromatherapy combined with music therapy not only improved physical and psychological symptoms immediately but also had lasting effects for at least six weeks.

CONCLUSIONS

This study found that aromatherapy effectively reduced the physical and psychological stress of nurses, with even greater benefits when combined with music therapy. This approach not only provided immediate effects but also were associated with lasting benefits for an extended duration.

Large-scale validation of the Kessler-10 Scale's psychometric properties among healthcare professionals in China

OBJECTIVES

The Kessler Psychological Distress Scale (K10) is a 10-item questionnaire designed to measure psychological distress. The present study aimed to validate the factor structure of the K10 and its reliability and validity using a large sample from healthcare professionals in China mainland.

METHODS

K10 data were collected in September 19 to October 20, 2023 via anonymous online survey (total sample, N = 8602). The internal consistency reliability of the K10 was examined. Exploratory factor analysis (N = 4301) and confirmatory factor analysis(N = 4301) were conducted to validate the structural validity.

RESULTS

Exploratory factor analysis revealed two factors, depression (DEP) and anxiety (ANX), which together accounted for 75.91 % of the total variance. Confirmatory factor analysis further supported the two-factor oblique model as the best fit, outperforming the one-factor model. The internal consistency of the K10 was α = 0.952, while the internal consistency coefficients for ANX and DEP were 0.883 and 0.940, respectively.

CONCLUSIONS

K10 is a validated and concise tool that serves a dual purpose of screening psychological distress and assessing depressive and anxiety symptoms among healthcare professionals in China.

Artificial Intelligence-guided Total Opacity Scores and Obstructive Sleep Apnea in Adults with COVID-19 Pneumonia

OBJECTIVE

We previously demonstrated that artificial intelligence (AI)-directed chest computed tomography (CT)-based total opacity scores (TOS) are associated with high-risk obstructive sleep apnea (OSA) based on the Berlin Questionnaire. In the current study, we examined the association between TOS severity and OSA severity based on polysomnography (PSG) recordings among participants with a history of Coronavirus disease-2019 (COVID-19) infection.

MATERIAL AND METHODS

This was a post-hoc analysis of 56 patients who underwent CT imaging after being diagnosed with COVID-19 pneumonia as well as overnight PSG for a validation study with a median of 406 days after the initial COVID-19 onset. The AI software quantified the overall opacity scores, which included consolidation and ground-glass opacity regions on CT scans. TOS was defined as the volume of high-opacity regions divided by the volume of the entire lung, and severe TOS was defined as the score ≥15. OSA was defined as an apnea-hypopnea index (AHI) of at least 15 events/h.

RESULTS

In total, 21 participants had OSA and 35 had no OSA. The median TOS was 10.5 [interquartile range (IQR) 1.6-21.2] in the OSA group and 2.8 (IQR 1.4-9.0) in the non-OSA group (P = 0.047). In a multivariate logistic regression analysis, OSA, AHI, and oxygen desaturation index were associated with severe TOS (P < 0.05 for all, respectively) adjusted for age, sex, body mass index, and hypertension.

CONCLUSION

AI-directed CT-based TOS severity in patients with COVID-19 pneumonia was associated with OSA severity based on PSG recordings. These results support our previous findings suggesting an association between questionnaire-based high-risk OSA and worse outcomes in COVID-19 pneumonia.

Predicting placebo analgesia responses in clinical trials: where to look next? A meta-analysis of individual patient data

ABSTRACT

Estimating the magnitude of placebo responses across pharmacological and nonpharmacological trials is important for understanding their influence on trial outcomes. Yet, the extent to which more intense placebo interventions like sham acupuncture yield larger analgesic responses than placebo pills, and the factors predicting these responses, remain unclear. This meta-analysis investigated the magnitude and predictors of placebo analgesia responses in pharmacological vs acupuncture trials. Analyses included individual patient data from the placebo arm of 11 randomized controlled trials (RCTs): 9 pharmacological RCTs using placebo pills (N = 2021) and 2 acupuncture RCTs using sham acupuncture (N = 747). All trials were conducted in patients with chronic nociceptive pain (osteoarthritis, N = 2068; low back pain, N = 700). The placebo response was calculated as the change in pain intensity (0-100) between baseline and week 12. A random effects model demonstrated that placebo pills and patients with osteoarthritis exhibited smaller placebo responses than sham acupuncture and patients with low back pain (both P < 0.001, marginal effects). A mixed effects model showed that route of administration interacted significantly with baseline pain, premature termination, and the presence of adverse events. Together, predictors explained 20% to 25% of the individual variance in placebo responses, whereas 75% to 80% remained unaccounted for. In summary, sham acupuncture accounted for slightly larger placebo responses than placebo pills. Since basic trial and patient parameters explained only a small portion of this variability, we might need to start considering the patient's perception of the treatment-including cognition and emotions-to better predict placebo analgesia responses.

Performance of AI Approaches for COVID-19 Diagnosis Using Chest CT Scans: The Impact of Architecture and Dataset

AI is emerging as a promising tool for diagnosing COVID-19 based on chest CT scans. The aim of this study was the comparison of AI models for COVID-19 diagnosis. Therefore, we: (1) trained three distinct AI models for classifying COVID-19 and non-COVID-19 pneumonia (nCP) using a large, clinically relevant CT dataset, (2) evaluated the models' performance using an independent test set, and (3) compared the models both algorithmically and experimentally.In this multicenter multi-vendor study, we collected n=1591 chest CT scans of COVID-19 (n=762) and nCP (n=829) patients from China and Germany. In Germany, the data was collected from three RACOON sites. We trained and validated three COVID-19 AI models with different architectures: COVNet based on 2D-CNN, DeCoVnet based on 3D-CNN, and AD3D-MIL based on 3D-CNN with attention module. 991 CT scans were used for training the AI models using 5-fold cross-validation. 600 CT scans from 6 different centers were used for independent testing. The models' performance was evaluated using accuracy (Acc), sensitivity (Se), and specificity (Sp).The average validation accuracy of the COVNet, DeCoVnet, and AD3D-MIL models over the 5 folds was 80.9%, 82.0%, and 84.3%, respectively. On the independent test set with n=600 CT scans, COVNet yielded Acc=76.6%, Se=67.8%, Sp=85.7%; DeCoVnet provided Acc=75.1%, Se=61.2%, Sp=89.7%; and AD3D-MIL achieved Acc=73.9%, Se=57.7%, Sp=90.8%.The classification performance of the evaluated AI models is highly dependent on the training data rather than the architecture itself. Our results demonstrate a high specificity and moderate sensitivity. The AI classification models should not be used unsupervised but could potentially assist radiologists in COVID-19 and nCP identification. · This study compares AI approaches for diagnosing COVID-19 in chest CT scans, which is essential for further optimizing the delivery of healthcare and for pandemic preparedness.. · Our experiments using a multicenter, multi-vendor, diverse dataset show that the training data is the key factor in determining the diagnostic performance.. · The AI models should not be used unsupervised but as a tool to assist radiologists.. · Jaiswal A, Fervers P, Meng F et al. Performance of AI Approaches for COVID-19 Diagnosis Using Chest CT Scans: The Impact of Architecture and Dataset. Rofo 2025; DOI 10.1055/a-2577-3928.

Associations of perceived social support, resilience and posttraumatic growth among young and middle-aged patients with first-episode psychosis

Background

The prevalence of mental disorders among young and middle-aged populations has demonstrated a significant upward trend, with first-episode psychosis (FEP) frequently associated with psychological distress and functional impairments during initial onset. While persons affected by FEP frequently report psychological distress and reduced quality of life during early illness stages, they may also experience post-traumatic growth (PTG), which fosters positive changes that facilitate their recovery. Yet there is limited attention on PTG in young and middle-aged patients with FEP. Therefore, this study aimed to investigate the level of PTG and identify significant correlates and mediators of PTG among young and middle-aged patients with FEP.

Methods

From January 2021 to December 2023, two hundred eight patients with first-episode psychosis were enrolled from a tertiary hospital in Shandong Province, China, through convenience sampling. The Perceived Social Support Scale (PSSS), Posttraumatic Growth Inventory-Short Form (PTGI-SF), and Connor-Davidson Resilience Scale (CD-RISC10) were administered. Hierarchical linear regression modeling was performed to examine the associations between perceived social support and PTG and the mediating effect of resilience.

Results

The PTG score was 31.22 ± 6.59, and resilience and PSS could positively predict the variance in PTG. Resilience partially mediated the relationship between PSS and PTG, and the value of the mediating effect was 22.8%.

Conclusions

Young and middle-aged patients with FEP have a moderate level of PTG. Resilience partially mediates the relationship between PSS and PTG. Therefore, interventions focusing on promoting PSS and resilience should be developed to encourage PTG in young and middle-aged patients with FEP.

Factors Associated with Intent to Leave and Burnout among Canadian Nurses Amidst the COVID-19 Pandemic: A Quantitative Analysis of the Survey on Health Care Workers' Experiences During the Pandemic

BackgroundThe increased demands and stressors from the COVID-19 pandemic led to widespread burnout and job stress, prompting concerns about retention rates. This study identifies demographic and occupational predictors of Canadian nurses' intent to leave their jobs due to burnout and job stress during the COVID-19 pandemic.MethodsData was utilized from the Survey on Health Care Workers' Experiences During the Pandemic conducted by Statistics Canada. Multivariate logistic regression models were generated to analyze the associations between demographic and occupational factors and nurses' intent to leave.ResultsA total of 12,246 eligible participants responded to the survey (54.9% response); however, the analysis was restricted to 1138 nurses after excluding participants of other healthcare occupations. Younger nurses were significantly more likely to consider leaving their jobs [OR = 9.95, 95% CI: (5.92-16.73)], as well as nurses living in Alberta [OR = 3.16, 95% CI: (1.58-6.32)] and British Columbia [OR = 3.16, 95% CI: (1.66-6.03)]. Moreover, nurses with less work experience [OR = 3.91, 95 CI = (2.53-6.05)], work in acute care [(OR = 3.31, 95 CI = (1.69-6.51)], experienced changes in workload [OR = 2.69, 95% CI: (1.58-4.57)], had increased work hours [OR = 1.92, 95% CI: (1.27-2.92)], and lacked emotional support [OR = 3.43, 95 CI = (2.31-5.09)] had greater odds of intending to leave.ConclusionThe findings underscore the need for strategies to mitigate stress and burnout among nurses, particularly during public health crises. Implementing measures to address these factors could help improve retention rates and ensure a stable nursing workforce during future pandemics.

Delivering rapid, up-to-date, high-quality evidence is feasible during health emergencies: PAHO living systematic review of 305 COVID-19 potential therapeutics

Objective

To develop a living systematic review to deliver continuous, real-time evidence synthesis in the context of a rapidly evolving landscape of studies on potential therapeutic interventions during the COVID-19 pandemic.

Methods

The living systematic review was conducted using the COVID-19 Living Overview of Evidence platform, which aggregates studies from more than 40 sources, including electronic databases and preprint servers. Daily searches identified randomized controlled trials assessing pharmacological interventions for COVID-19. Meta-analytical pooling was applied to derive precise effect estimates, and the GRADE framework was used to assess certainty. The iterative process ensured the continuous integration of new evidence and rapid updates to the review.

Results

The review evaluated 305 interventions across 924 randomized controlled trials and included 48 updates from its launch in April 2020. This dynamic process allowed the team to respond promptly to decision-maker queries and deliver reliable information on intervention effectiveness and safety. The outputs of the review supported the development of therapeutic guidelines and informed decision-makers, playing a pivotal role in shaping clinical practices and public health strategies during the pandemic.

Conclusions

The living systematic review approach demonstrated how dynamic evidence synthesis can meet the demands of a rapidly evolving global health crisis. By providing decision-makers with timely, high-quality evidence, the process underscored the importance of integrating living reviews into preparedness strategies for future public health emergencies or rapidly evolving fields where new evidence emerges quickly.

Perceived stress and performance of daily activities among emergency healthcare workers during the COVID-19 pandemic

BackgroundDuring the COVID-19 pandemic, healthcare workers were exposed to intense stress in the emergency departments and sudden changes in their daily lives.ObjectiveThe study aimed to investigate the impact of the pandemic on performance and participation in the activities of daily living, personal lives, and overall well-being of the healthcare workers in an emergency department.MethodsSeventy-eight people working in an emergency department of a university hospital (100% of those eligible) participated in the study during June-July 2022. A self-report survey, cross-sectional design was used to collect data. Participants completed the Perceived Stress Scale-10 (PSS) and the Canadian Occupational Performance Measure (COPM). Independent sample t-tests, Pearson correlation, and multiple regression analysis were used for statistical analysis.ResultsThere was a significant negative correlation between PSS and COPM Performance (r = -0.524) as well as between PSS and COPM Satisfaction (r = -0.508), indicating that higher levels of stress were associated with lower performance and satisfaction. In addition, work-related factors, including working experience, daily working hours, and time available for rest at work, were significantly associated with PSS, COPM Performance, and Satisfaction (p < 0.05). The strongest multivariate associations (p = 0.001) were found between lacking time to rest at work and PSS (direct) and COPM Performance and Satisfaction (inverse).ConclusionThe stress experienced by emergency healthcare workers during COVID-19 negatively impacted their performance, daily activities, personal lives, and well-being. A potential implication is that policy-makers addressing work-related factors and implementing regulations could improve the well-being of these workers in their professional practices.

Depressive symptoms are highly prevalent and associated with fatigue and pain catastrophizing in the Hypermobility Spectrum Disorders and hypermobile Ehlers Danlos syndrome: a cross-sectional study

Individuals living with Hypermobility Spectrum Disorders and the hypermobile Ehlers-Danlos syndrome (HSD/hEDS) often experience recurrent joint injury, chronic pain, and fatigue. Although generalized anxiety has been recognized as a common comorbidity with HSD/hEDS, minimal research has examined depressive symptoms in this population. The purpose of this investigation was to describe the prevalence, nature, and severity of depressive symptoms in the HSD/hEDS population, and to explore associations with other potential confounding factors. All individuals with HSD/hEDS referred to a specialized connective tissue disorder Physical Medicine & Rehabilitation clinic were asked to self-report demographic data and complete the 9-item Patient Health Questionnaire (PHQ-9), 7-item Generalized Anxiety Disorder Questionnaire (GAD-7), Pain Catastrophizing Symptoms (PCS) questionnaire, and Fatigue Severity Scale (FSS) at their initial clinic visit. Data was prospectively collected between January 2019 and December 2024. Descriptive statistics were performed. A Spearman correlation matrix was used to identify relevant factors associated with depressive symptoms. Relationships emerging as significant (p < 0.001) were further analyzed using independent sample Mann-Whitney U-tests. Fifty-nine individuals (53 female, mean ± SD age: 34.4 ± 11 years) were included, with a mean ± SD PHQ-9 score of 11.2 ± 5.9, indicating moderate depressive symptom severity. 53% of participants (n = 31) met criteria for major depressive disorder (PHQ-9 ≥ 10). Higher pain catastrophizing (ρ = 0.611, p < 0.001) and higher fatigue scores (ρ = 0.593, p < 0.001) were both associated with significantly higher depressive symptoms, but there were no associations with respect to age, working status, and number of alcoholic drinks consumed per week. This research suggests that depression is highly prevalent in patients experiencing HSD/hEDS. There is also a strong association between pain catastrophizing and fatigue in those experiencing depressive symptoms. The interaction between depressive symptoms, pain catastrophizing, and fatigue should be considered in the holistic management of HSD/hEDS.

A retrospective analysis of combined treatment with escitalopram and Naoan dropping pills treatment for depression

This study evaluated the effectiveness of combining escitalopram with Naoan dropping pills for the treatment of depression, focusing on improvements in depressive symptoms, daily functional abilities, and cerebral hemodynamics. A total of 87 patients diagnosed with depression at The Third People's Hospital of Tianshui over a 2-year period were retrospectively analyzed. They were divided into 2 groups according to whether Naoan dropping pills were used or not. Group A (n = 43) received only escitalopram, while group B (n = 44) received a combination of escitalopram and Naoan dropping pills for a period of 2 months. Efficacy was determined using the Hamilton depression scale (HAMD), with a ≥50% reduction in HAMD score from baseline considered effective. The activities of daily living (ADL) scale was employed to assess daily functional abilities. Cerebral hemodynamics were evaluated using transcranial Doppler ultrasound (TCD). By the end of the 2-month treatment period, Group B demonstrated a significantly higher efficacy rate (90.91%) than Group A (72.09%). In addition, Group B showed more pronounced improvements in ADL scores, indicating enhanced day-to-day functioning. TCD measurements further revealed higher systolic and diastolic blood flow velocities in the major cerebral arteries of Group B, suggesting improved cerebral perfusion. The combination of escitalopram and Naoan dropping pills proved more efficacious in ameliorating depressive symptoms, enhancing daily functional abilities, and improving cerebral hemodynamics than escitalopram alone. These outcomes highlight the potential benefits of integrated treatment strategies for the management of depression, advocating the adoption of personalized and comprehensive treatment modalities.

Digital Psychological Interventions for Adults in the COVID-19 Pandemic: A Systematic Review and Meta-Analysis

This study evaluates the effect of digital psychological interventions on anxiety, depression, and stress symptoms in adults affected by the pandemic. A systematic search across five digital databases, from 1 January 2020 to 6 March 2024, identified 36 studies encompassing 8,662 participants. Compared with all control conditions, random-effects meta-analyses indicated that digital psychological interventions significantly reduced anxiety (g = -0.374; 95% CI, -0.529 to -0.218), depression (g = -0.568; 95% CI, -0.776 to -0.360), and stress (g = -0.452; 95% CI, -0.608 to -0.295). Smaller effect sizes were observed when compared with active controls than with inactive controls. Notable heterogeneity across three outcomes was observed. Publication bias was noted in depression symptoms. Several moderators were identified compared with inactive controls, including participant type for anxiety (psubgroup = 0.005), and region for depression symptoms (psubgroup = 0.000). Larger sample sizes (b = 0.0004; p = 0.028) related to stronger effects on depression symptoms. Publication year positively correlated with effects on stress (b = 0.1573; p = 0.032). This study supports the efficacy of digital psychological interventions in alleviating anxiety, depression, and stress symptoms for adults during the pandemic, offering insights for developing targeted mental health strategies in future public health crises.

Personal protective equipment stewardship across 112 medical facilities: A preliminary survey in Japan

BACKGROUND

The stewardship of personal protective equipment (PPE) is crucial in preventing healthcare-associated infections by safeguarding healthcare workers.

AIM

This study aimed to comprehensively elucidate the selection process and current status of PPE stewardship in Japanese medical facilities and gather evidence that will contribute to the qualitative enhancement of PPE stewardship in the country.

METHODS

A survey on PPE stewardship was conducted at 200 Japanese medical facilities between February and March 2024.

FINDINGS

The response rate was 56.0% (112/200). While 99.1% of the responding facilities had documented protocols for PPE use and provided comprehensive training (including practical skills), only 3.8% extended this training to outsourced staff. Multiple sizes of surgical masks were available in 58.0% of the facilities, and 58.9% were equipped to conduct fit testing for N95 respirators. Moreover, 58.9% of the facilities monitored and evaluated PPE stewardship in conjunction with environmental rounds and hand hygiene assessments.

CONCLUSION

Despite the limited sample size, this study is the first large-scale survey of PPE use in Japan. Our findings provide a basis for future surveys and evidence for establishing optimal PPE-related protocols. They may also contribute to the advancement of healthcare-associated infection control.

Podocytes in health and glomerular disease

Podocytes are highly specialized, terminally differentiated cells in the glomerulus of the kidney and these cells play a central role in blood filtration. In this review, we comprehensively describe the cell biology of podocytes under healthy conditions and in glomerular disorders wherein podocyte injury is a major pathological mechanism. First, the molecular mechanisms that maintain podocyte actin cytoskeleton structure, permanent cell cycle exit, and metabolism under healthy conditions are described. Secondly, the mechanisms of podocyte injury, including genetic alterations and external insults that ultimately disrupt podocyte actin cytoskeleton dynamics or interrupt podocyte quiescence and mitochondrial metabolism are discussed. This understanding forms the basis of described potential therapeutic agents that act by modulating dysregulated podocyte cytoskeleton organization, prevent or reverse cell cycle re-entry, and re-establish normal mitochondrial energy production. Lastly, the application of modern techniques such as single cell RNA sequencing, super resolution microscopy, atomic force microscopy, and glomerular organoids is improving the resolution of mechanistic podocytopathy knowledge. Taken together, our review provides critical insights into the cellular and molecular mechanisms leading to podocyte loss, necessary for the advancement of therapeutic development in glomerular diseases.

Independent effects of the hemoglobin-to-red blood cell distribution width ratio on 180-day mortality in critically ill patients with Gastrointestinal bleeding: analysis from the MIMIC-IV database

BACKGROUND

Gastrointestinal bleeding (GIB) is associated with high mortality rates among critically ill patients. The hemoglobin-to-red blood cell distribution width ratio (HRR) has recently emerged as a potential prognostic marker in various clinical settings. However, the association between HRR and prognosis in critically ill patients with GIB is unclear.

METHODS

We conducted a retrospective cohort study using the MIMIC-IV database (version 2.2). Patients diagnosed with GIB were included based on predefined criteria. The HRR was calculated as the ratio of hemoglobin to red blood cell distribution width. Kaplan-Meier curves and multivariate Cox regression models assessed the association between HRR and 180-day mortality. Restricted cubic spline curves were employed to evaluate the nonlinear relationship between HRR and mortality. Additionally, a segmented regression model was constructed to determine the threshold effect in nonlinearity. Subgroup analyses were performed to assess the consistency of the relationship between HRR and 180-day mortality across different patient populations.

RESULTS

A total of 2,346 patients met the inclusion criteria. Higher HRR was independently associated with reduced 180-day all-cause mortality (adjusted HR, 0.15; 95% CI, 0.07-0.31; P < 0.001). Non-linear associations were observed using restricted cubic splines (P for overall < 0.001, P for non-linearity = 0.002). When HRR was less than 0.81, each unit increase in HRR was associated with a 90% reduction in 180-day mortality among patients with GIB (HR, 0.10; 95% CI, 0.04-0.24; P < 0.001). Subgroup analyses demonstrated that the association between HRR and 180-day mortality was consistent across all subgroups.

CONCLUSION

HRR exhibits a significant nonlinear negative association with 180-day mortality in critically ill patients with GIB. This association was consistent across multiple subgroups, suggesting that HRR may serve as a simple and effective prognostic biomarker in patients with GIB.

The Determinants of Psychological Well-Being Among Kidney Transplant Recipients in Kazakhstan: A Cross-Sectional Study

Background: Kidney transplantation (KTx) significantly improves survival and quality of life in patients with end-stage renal disease. However, post-transplant well-being is influenced by multiple factors, including healthcare accessibility, satisfaction with medical care, and psychological health. This study aimed to assess the well-being of post-KTx patients in Kazakhstan and examine its associations with healthcare access, satisfaction, and anxiety. Methods: A cross-sectional study was conducted among 223 post-KTx patients in Kazakhstan. Participants were recruited through online surveys and telephone interviews. Only patients who had undergone transplantation within Kazakhstan were included. The WHO-5 Well-Being Index was used to measure well-being, and additional surveys assessed healthcare access, satisfaction with post-KTx care, and treatment-related anxiety. Multiple linear regression was performed to identify predictors of well-being. Results: The mean WHO-5 well-being score was 66.1 (SD = 24.6), indicating moderate well-being. Satisfaction with post-transplant information (β = 0.287, p = 0.015) and educational level (β = 0.172, p = 0.019) were significant positive predictors of well-being. In contrast, post-KTx anxiety (β = -0.154, p = 0.024) and difficulties in accessing medical care (β = -0.216, p = 0.014) negatively affected well-being. Patients residing in rural areas reported greater barriers to post-transplant care compared to those in urban settings (χ2 = 31.6, p = 0.002). Conclusions: Post-KTx well-being in Kazakhstan is influenced by educational level, access to healthcare, satisfaction with medical information, and anxiety levels. Targeted interventions to improve access to post-transplant care, enhance patient education, and address psychological distress may help improve outcomes for post-KTx patients.

Development of a Venous Thromboembolism Prophylaxis and Pain Medication Pathway in Thoracic Surgery Enhanced Recovery After Surgery Program

INTRODUCTION

This study aimed to evaluate the beneficial role of clinical pharmacists through a quality improvement project to incorporate a medication pathway into a thoracic surgery Enhanced Recovery After Surgery (ERAS) program.

METHODS

The retrospective cohort study developed a venous thromboembolism (VTE) prophylaxis and pain medication pathway covering the different phases of the perioperative period in the thoracic surgery ERAS program, adhering to Lean management principles, within a multidisciplinary team framework. Outcome indicators related to VTE prophylaxis and pain management, adverse events, per capita drug cost, length of stay, and the total inpatient cost between the first 6 mos (preintervention, January 2023 to June 2023) and the second 6 mos (postintervention, July 2023 to December 2023) were collected and compared.

RESULTS

A total of 1463 individuals were observed. Following the intervention, VTE risk assessment exceeded 95%, and the number of VTE cases notably decreased from 2 to 0. Pain relief was significantly enhanced (χ2 = 4.423, P = 0.035) and the incidence of nausea and vomiting was significantly lower (χ2 = 4.869, P = 0.027) when surgeons stopped using opioid agonist-antagonists. The per capita drug cost reduced from $639.04 to $479.39, the length of stay decreased from 13.68 ds to 12.23 ds, and the per capita total inpatient cost decreased from $6705.62 to $5460.81.

CONCLUSIONS

A medication pathway was significantly associated with improved outcome metrics related to VTE prophylaxis and pain management in thoracic surgery and can be incorporated into ERAS management programs. Further investigations using more current data are needed.

Core GRADE 1: overview of the Core GRADE approach

This first article in a seven part series presents an overview of the essential elements of the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach that has proved extremely useful in systematic reviews, health technology assessment reports, and clinical practice guidelines. GRADE guidance has appeared in many articles dealing with both core issues and more specialised and complex guidance, and it has evolved over time. This series of articles presents GRADE essentials, Core GRADE, focusing on the core judgments necessary to summarise the comparative evidence about alternative care options and to make recommendations that apply to the care of individual patients. This article presents detailed guidance on formulating questions using the PICO (population, intervention, comparison, outcome) structure, and refining the question considering possible differences in relative and absolute effects across patient groups. The article then provides an overview of the remainder of the Core GRADE approach, including decisions about the certainty of the evidence and considerations in moving from evidence to guidance and recommendations.

Histone deacetylases and their inhibitors in kidney diseases

Histone deacetylases (HDACs) have emerged as key regulators in the pathogenesis of various kidney diseases. This review explores recent advancements in HDAC research, focusing on their role in kidney development and their critical involvement in the progression of chronic kidney disease (CKD), acute kidney injury (AKI), autosomal dominant polycystic kidney disease (ADPKD), and diabetic kidney disease (DKD). It also discusses the therapeutic potential of HDAC inhibitors in treating these conditions. Various HDAC inhibitors have shown promise by targeting specific HDAC isoforms and modulating a range of biological pathways. Their protective effects include modulation of apoptosis, autophagy, inflammation, and fibrosis, underscoring their broad therapeutic potential for kidney diseases. However, further research is essential to improve the selectivity of HDAC inhibitors, minimize toxicity, overcome drug resistance, and enhance their pharmacokinetic properties. This review offers insights to guide future research and prevention strategies for kidney disease management.

"I Can't Overcome It": Exploring the Relationship Between Bullying Victimization and NSSI Among College Students Through the Lens of Emotion-Driven Mechanism

With its susceptibility in victimized populations and the potential for suicidality, non-suicidal self-injury (NSSI) is among the most severe health concerns in college students, indicating an urgency to explore its antecedents and interventions. The present study aims to examine the relationship between bullying victimization and NSSI and the mediating roles of internal shame, external shame, depressive symptoms, and PTSD symptoms based on the general strain theory, the vulnerability-stress theory, and the transactional stress theory. By adopting a three-time-point design with 6-month intervals, hypotheses were tested using data from 634 Chinese college students (374 female; Mage = 18.97). Through a structural equation modeling approach, the study found that bullying victimization was positively correlated with NSSI via internal shame and depressive symptoms. However, this study found no evidence for the mediating association of either external shame or PTSD symptoms in the examined relationship. Through a lens of emotion-driven mechanism, this study contributes to understanding the roles of internal shame and depressive symptoms in NSSI intervention strategies among victims of bullying. The results also illuminate the differentiation of the mechanisms of internal and external shame and the discrepancy between depressive symptoms and PTSD symptoms as two types of post-traumatic symptomatology.

Empirical evidence of observer bias in randomized clinical trials: updated and expanded analysis of trials with both blinded and non-blinded outcome assessors

OBJECTIVES

To study the impact of lack of blinding of outcome assessors on estimated treatment effects of randomized clinical trials.

STUDY DESIGN AND SETTING

Meta-epidemiological study. We included randomized trials with binary or measurement scale outcomes that (1) allocated patients to subtrials with and without blinded outcome assessment, or (2) had both blinded and non-blinded assessments of the same outcome. We identified trials from previous meta-epidemiological studies and searched six databases from 2013 to 2024. We calculated a ratio of odds ratios (ROR) for each trial. A ROR < 1 indicated a more favorable effect estimate by the non-blinded assessor. We pooled RORs using random effects meta-analysis and conducted meta-regression, subgroup, and sensitivity analyses.

RESULTS

We included 66 trials (9451 patients) across 18 clinical specialties. The pooled RORs in 43 trials (7055 patients) was 0.71 (0.55-0.92). Thirty of the 43 trials assessed highly subjective outcomes. Meta-regression showed no statistically significant association between ROR and scores for outcome subjectivity (P = .53), vulnerability (P = .91), and involvement (P = .99). Heterogeneity was partly explained by a larger impact in non-drug trials, ROR 0.62 (0.46-0.84), and industry-funded trials, ROR 0.57 (0.37-0.88). Sensitivity analyses, including imputed data for 23 trials (2396 patients randomized), did not modify the observed impact importantly.

CONCLUSION

We provide empirical evidence of considerable bias in effect estimates of randomized trials with non-blinded assessors of subjective binary and measurement scale outcomes. Non-blinded assessors exaggerated effect estimates, expressed as odds ratios, by 29% (8%-45%) on average. This strongly supports blinding outcome assessors of subjective outcomes.

PLAIN LANGUAGE SUMMARY

In a randomized clinical trial, the person evaluating the results (assessor) may be either unaware of the intervention received by participants (blinded assessor) or aware of it (non-blinded assessor). Knowing which treatment a patient received can influence the assessor's evaluation of the effect; for example, if an assessor has high expectations for a new experimental intervention, they may rate a patient's improvement more favorably in the group that received the intervention compared to the group that did not. We call this observer bias. In this study, we compared the results obtained from blinded assessors to those from non-blinded assessors within the same trials to estimate the impact of observer bias in randomized trials. We found that non-blinded assessors exaggerated the experimental intervention effect by approximately 29%, on average, compared to blinded assessors. Our results indicate that when an evaluation of a patient in a randomized trial requires judgment, there is potential for substantial bias if assessors are not blinded. To ensure more reliable results, randomized clinical trials should blind assessors whenever possible.

Cell cycle disorders in podocytes: an emerging and increasingly recognized phenomenon

Proteinuria is observed in various kidney diseases and is frequently associated with a compromised glomerular filtration barrier. Podocytes, as a crucial component of this barrier, play an essential role in preserving the kidney's normal filtration function. Podocytes are terminally differentiated cells that typically do not proliferate. However, certain harmful stimuli can trigger podocytes to re-enter the cell cycle. Due to its unique cytoskeletal structure, podocytes are unable to maintain the structure of the foot process and complete cell division at the same time, eventually form binucleated or multinucleated podocytes. Studies have found that podocytes re-entering the cell cycle are more susceptible to injury, and are prone to detachment from the basement membrane or apoptosis, which are accompanied by the widening of foot processes. This eventually leads to podocyte mitotic catastrophe and the development of proteinuria. Podocyte cell cycle disorders have previously been found mainly in focal segmental glomerulosclerosis and IgA nephropathy. In recent years, this phenomenon has been frequently identified in diabetic kidney disease and lupus nephritis. An expanding body of research has begun to investigate the mechanisms underlying podocyte cell cycle disorders, including cell cycle re-entry, cell cycle arrest, and mitotic catastrophe. This review consolidates the existing literature on podocyte cell cycle disorders in renal diseases and summarizes the molecules that trigger podocyte re-entry into the cell cycle, thereby providing new drug targets for mitigating podocyte damage. This is essential for alleviating podocyte injury, reducing proteinuria, and delaying the progression of kidney diseases.

Should I stay or should I go-Medical assistants´ experiences and coping with patient demand and lack of appreciation during the Covid-19 pandemic

BACKGROUND

This article explores the psychological burden experienced by medical assistants (MAs) in General Practices during the Covid-19 pandemic (Corona virus disease 2019 (SARS-CoV-2)) in Germany. The study aims on demanding patient behavior, increased workload, and the perceived lack of appreciation and discuss their potential impact on the MAs´ well-being and career decisions.

METHODS

A qualitative approach was utilized. MAs were included via a regional practice network as well as professional associations and newsletters. In total, 21 interviews with MAs from various federal states in Germany were conducted between April and September 2021. The semi-structured interview guideline focused on daily work challenges during the pandemic and its consequences. Interviews were recorded, transcribed, and analyzed using qualitative content analysis according to Kuckartz.

RESULTS

The findings highlight core challenges, including demanding communication with patients, lack of appreciation in the media, a high workload, resilience versus career migration, and the needs and wishes of MAs in their everyday work. Abusive language, insults, and theft of materials by patients added significant stress. The interviews reveal how important teamwork and a supportive working environment are for overcoming these challenges.

CONCLUSIONS

The study underlines the urgent need for societal and political awareness regarding the challenges faced by MAs, especially during public health crises. The perceived social egoism in patient behavior, coupled with a lack of recognition and appreciation, contributed to a challenging work atmosphere and potential burnout risk. Recommendations include enhancing support for MAs, recognizing their contributions in the media, and fostering collaborative efforts between practitioners and policymakers to address the unique challenges in general practices.

TRIAL REGISTRATION

German Register of Clinical Studies (DRKS) DRKS00032402; https://drks.de/search/de/trial/DRKS00032402 (Registration Date: 14.08.2023).

Healthcare professionals' perceptions of system preparedness during public health emergencies: a path analysis of mental health impacts

Background

The easing of COVID-19 policies in China appears to have been inadequately prepared, leading to a profound shift in the mental wellbeing of healthcare professionals following the lifting of these measures. Our study aims to investigate the pathways underlying negative emotions experienced by healthcare professionals due to perceived inadequate system preparedness, aiming to enhance their mental health protection and facilitate more effective responses during future large-scale public health crises.

Methods

A total of 826 healthcare professionals were enrolled. Depression symptoms, anxiety symptoms, perceived stress, resilience, perceived inadequate system preparedness were measured in our research.

Results

The prevalence of depression and anxiety symptoms among healthcare professionals were 32.1 and 16.2%, respectively, during the concentrated outbreak of COVID-19 in China after easing policy. The chain mediation analysis reveals that perceived inadequate system preparedness significantly directly predicts depression or anxiety symptoms among healthcare professionals, indirectly through the mediating role of stress, as well as via the chain mediation of stress and resilience. However, it does not predict these symptoms through the mediator of resilience alone. Furthermore, contracting COVID-19 directly predicts depression symptoms.

Conclusions

Perceived inadequate system preparedness can have a detrimental impact on negative emotions through various channels. When facing the potential outbreak of a large-scale public health event in the future, it is crucial to implement measures such as providing psychological counseling, increasing risk allowances, and ensuring an adequate supply of personal protective equipment to be better prepared. Additionally, psychosocial interventions should be implemented to enhance the resilience of healthcare professionals and safeguard the mental wellbeing of those infected with COVID-19, etc.

Risk prediction models for non-suicidal self-injurious behavior in patient with depressive disorder: a protocol for systematic review and mata-analyisis

INTRODUCTION

Non-suicidal self-injury (NSSI) frequently occurs in patients with depressive disorder and often presents as burning or severe scratching. NSSI plays a crucial role in increasing the risk of self-injury in individuals with depressive disorder. Despite the progressive development of various risk prediction models to identify NSSI, there are significant differences in their overall predictive performance. This systematic review aims to evaluate the quality and applicability of these models in predicting NSSI among patients with depressive disorders.

METHODS AND ANALYSIS

A systematic review with meta-analysis was conducted targeting patients with depressive disorder. We included studies on risk prediction models for NSSI behavior in this population that were developed and published. The primary outcome was NSSI behavior as reported by the prediction models. Predictive variables were measured at different disease stages in patients with depressive disorder, with no specific limitations on the prediction horizon. The intended use of the risk prediction model is to individualize the prediction of NSSI behavior of in patients with depressive disorder, thus facilitating the implementation of preventive measures to avoid adverse events. Databases, including China National Knowledge Infrastructure (CNKI), Wanfang Database, VIP Database, PubMed, Web of Science, Medline, and Embase, were searched from inception to March 2024 by two independently reviewers. Data extraction followed the guidelines outlined in the Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies (CHARMS). The risk of bias and applicability of the included studies were assessed using PROBAST. Descriptive statistical methods were employed to summarize the characteristics of the NSSI models and meta-analysis for model validation was conducted using Stata software.

CONCLUSION

The study will systematically review the prediction models for NSSI in patients with depressive disorders to enhance clinical practice. This research will also assist clinicians in selecting effective prediction models for NSSI in this patient population.

Limited Moderating Effect of Podcast Listening on Work Stress and Emotional Exhaustion Among Nurses During the COVID-19 Pandemic: Cross-Sectional Study

BACKGROUND

The COVID-19 pandemic placed unprecedented pressure on health care systems worldwide, significantly impacting frontline health care workers, especially nurses. These professionals faced considerable psychological stress from caring for patients with COVID-19 and the fear of spreading the virus to their families. Studies report that more than 60% (132/220) of nurses experience anxiety, depression, and emotional exhaustion, which adversely affect their mental health and the quality of care they provide.

OBJECTIVE

This study aimed to investigate the relationship between work-related stress and emotional exhaustion among nurses and to assess whether listening to podcasts moderates this association.

METHODS

A cross-sectional online survey was conducted between March 1, 2023, and March 31, 2023. A total of 271 clinical nurses, aged 20 years to 65 years, were recruited for the study. Participants were divided into 2 groups: experimental group consisting of regular podcast listeners (n=173) and control group comprising nonlisteners (n=98). Ethical approval for this study was obtained from the local ethics committee (IRB number YGHIRB20230421B). Validated scales were used to measure work stress, emotional dissonance, and emotional exhaustion. Data analysis included descriptive statistics, independent t tests, and structural equation modeling to examine the relationships between variables.

RESULTS

No statistically significant differences were found between the experimental and control groups in terms of overall work stress (mean difference=-0.09, 95% CI -0.31 to 0.13; P=.42) or emotional exhaustion (mean difference=0.07, 95% CI -0.15 to 0.29; P=.53). Emotional dissonance emerged as a significant predictor of emotional exhaustion in both the experimental (β=0.476, P<.001) and control (β=0.321, P=.01) groups. Nurses reporting higher workloads had significantly higher emotional exhaustion levels (experimental group: β=0.302, P<.001; control group: β=0.327, P=.002). Podcast listening demonstrated only a slight, nonsignificant moderating effect.

CONCLUSIONS

Although podcasts alone may not significantly reduce work stress or emotional exhaustion among nurses, there was a potential, albeit limited, moderating effect of podcasts on emotional well-being. They could serve as a supplementary tool for emotional support. However, broader and more comprehensive interventions are required to address the underlying causes of stress and emotional exhaustion in this population. More in-depth exploration and recommendations are possible by analyzing the content and patterns of listening. Further research is needed to examine the long-term benefits of integrating podcasts with other digital tools for holistic stress management in health care settings.

Association between red blood cell transfusion and subsequent cardiovascular events in patients admitted to the cardiovascular intensive care unit: a single-center retrospective study

Anemia can worsen the prognosis of patients with acute cardiovascular (CV) disease; however, the effect of red blood cell (RBC) transfusion on mid-term outcomes in such patients requiring intensive care remains unclear. Therefore, this study investigated the association between RBC transfusions during hospitalization and subsequent CV events (all-cause mortality, non-fatal myocardial infarction or stroke, admission for acute heart failure [AHF], unstable angina, and other CV events) after hospital discharge in patients admitted to the cardiovascular intensive care unit (CICU). We retrospectively enrolled 517 patients with emergent admission to the CICU for suspected acute CV disease between January and December 2018. After excluding 41 patients who died or developed CV events during hospitalization, the remaining 476 patients (44.3% with acute coronary syndrome, 22.1% with heart failure, 6.7% with acute aortic dissection, 16.0% with other cardiac diseases, and 10.9% with non-cardiac diseases) were included in the analysis and divided into transfusion (n = 111) and non-transfusion (n = 365) groups based on RBC transfusion requirements during hospitalization. All patients were followed up for subsequent CV events over a period of 180 days after hospital discharge. Compared with the non-transfusion group, the transfusion group showed a higher incidence of chronic kidney disease (73.9% vs. 48.2%, p < 0.001), Acute Physiology and Chronic Health Evaluation II score (18.0 ± 7.2 vs. 13.9 ± 5.6, p < 0.001), frequency of use of invasive mechanical support devices (52.3% vs. 13.7%, p < 0.001), and surgery rate (35.1% vs. 3.3%, p < 0.001), as well as a lower nadir hemoglobin level (8.9 ± 2.3 g/dL vs. 11.7 ± 1.9 g/dL, p < 0.001). The cumulative incidence of CV events was higher in the transfusion group than in the non-transfusion group (32.9% vs. 9.1%, log-rank p < 0.001), with a similar trend observed even after propensity score matching (29.2% vs. 12.3%, log-rank p = 0.049). RBC transfusion remained independently associated with subsequent CV events after adjusting for age, sex, nadir hemoglobin level, bleeding complications, and CV risk factors (adjusted hazard ratio, 2.46; 95% confidence interval, 1.11-5.46; p = 0.027). These findings suggest that RBC transfusion during hospitalization is independently associated with subsequent CV events in patients admitted to the CICU, indicating the need for cautious evaluation of transfusion practices based on potential long-term adverse effects.

Mitigating Burnout: The Role of Healthcare Organizations

Even before the coronavirus disease (COVID-19) pandemic, burnout in healthcare providers had reached crisis levels, with up to 50% of nurses and 40% of physicians experiencing symptoms of burnout. Because of the immense work-related stress during the pandemic, healthcare providers' burnout dramatically escalated, with percentages reaching as high as 70-90%, and many healthcare providers started to leave their profession. As a result, patients are beginning to experience the deleterious impact of extreme staffing shortages in healthcare facilities. Burnout interventions are defined as either organizational or individually focused. Organizational interventions address problems such as electronic medical records, documentation, or billing systems. Individual interventions provide the necessary skills to address specific job-related stressors. Ideally, the most effective interventions would combine these two categories by teaching healthcare providers to cope with job-related stressors in a safe community that is supported by the healthcare organization. The adoption of combined organizational and individual programs will improve healthcare providers' job satisfaction, decrease burnout and other forms of psychological distress, enhance job retention, and return joy to health care. The resulting decreased turnover rates would also reduce some of the skyrocketing healthcare costs, as turnover is expensive for healthcare organizations. Ultimately, enhancing healthcare providers' well-being would improve the care we deliver to our patients. In this article, I explain why it is a critical time in health care and highlight four general principles that frame the development of specific well-being interventions. Finally, I discuss several interventions that could enhance the well-being of healthcare providers and ultimately transform the culture of health care.

Prevalence and associated factors of obsessive compulsive symptoms among under graduate medical and health science students in Dilla university, Ethiopia: a cross-sectional study

BACKGROUND

Obsessive-Compulsive Disorder (OCD) is a debilitating mental health condition characterized by recurrent, intrusive thoughts and repetitive behaviors that significantly disrupt daily life. Medical students may be uniquely susceptible to obsessive compulsive symptoms due to their constant exposure to potential contaminants and infectious diseases during their training. Obsessive Compulsive symptoms among medical students are often overlooked, which can significantly impact their academic performance, well-being, and future career prospects. The prevalence and factors of obsessive compulsive symptom is not widely studied in low and middle income countries and there are limited studies in Ethiopia. Therefore, this study aimed to assess the prevalence and associated factors of obsessive compulsive symptoms among medical students.

METHODS

This was a cross-sectional study conducted among 370 students. The outcome variable was assessed using the Obsessive-Compulsive Inventory-Revised scale (OCI-R). The collected data were entered using kobo collect tool box version 1.3 and analyzed using SPSS version 25. Bivariable and multivariable logistic analysis was conducted to identify factors associated with Obsessive Compulsive symptoms and variables with P-values less than 0.05 were considered to have significant association with 95% confidence interval.

RESULT

The probable prevalence of obsessive-compulsive disorder among medical and health science students was 28% with (95% CI: 26.4-32.7). Being female [AOR = 1.33(95%CI: 1.09, 2.18)], Depressive symptoms [AOR = 2.12(95%CI: 1.95, 4.06)], Maladaptive coping mechanism [AOR = 1.74 (95%CI: 1.23, 2.50)], and Poor sleep quality [(AOR = 1.48(95%CI: 1.08, 2.24)] were significantly associated with obsessive compulsive symptoms.

CONCLUSION

Obsessive Compulsive Symptom has a high probable prevalence among medical and health science students. Being female, experiencing depressive symptoms, employing maladaptive coping mechanisms, and having poor sleep quality were significantly associated with obsessive-compulsive disorder. Therefore, early detection, screening, and appropriate intervention for obsessive-compulsive symptoms in medical students are crucial.

Exploring the magnitude and predictors of the long-term psychological impact of COVID-19 on frontline healthcare workers in Vietnam: a multi-center, cross-sectional study

BACKGROUND

The detrimental impacts of COVID-19 on the mental well-being of frontline healthcare workers (HCWs) have been well studied. However, the long-term trajectory of their mental well-being remains relatively unexplored. We examined the magnitude and predictors of the psychological impact of COVID-19 on frontline HCWs during the transition into the "new normal" phase.

METHODS

A cross-sectional survey was performed on frontline HCWs at two largest designated COVID-19 hospitals in Ho Chi Minh City between May and November 2022. A self-administered questionnaire captured participants' demographic characteristics and psychological distress including depression, anxiety, and insomnia. Multivariable logistic regression models were used to examine factors associated with psychological distress.

RESULTS

Among 462 HCWs, 85.3% self-reported having good, very good, or excellent mental health before their COVID-19 deployment, compared to 40.7% during the deployment and 55.6% at the time of the study. The prevalence of moderate-to-severe depression was 26.8%, anxiety (20.8%), insomnia (23.4%), and overall psychological distress (73.2%). Predictors for depression included pre-existing physical (adjusted odds ratio [aOR] = 2.09, 95%CI 1.03-4.22, P = 0.04) and mental health (aOR = 3.59, 95%CI 1.31-9.84, P = 0.01) conditions and being deployed during the 3rd (aOR = 6.28, 95%CI 1.12-35.08, P = 0.04) and 4th (aOR = 5.01, 95%CI 1.08-23.16, P = 0.04) COVID-19 wave. Those with mental health conditions before the deployment (aOR = 3.95, 95%CI 1.42-11.0, P = 0.008) were more likely to report anxiety symptoms. Predictors for insomnia included physical health conditions before the deployment (aOR = 2.73, 95%CI 1.37-5.44, P = 0.004), working at field hospitals (aOR = 2.44, 95%CI 1.43-4.16, P = 0.001), and currently being deployed to respond to COVID-19 (aOR = 0.35, 95%CI 0.19-0.67, P = 0.001).

CONCLUSIONS

Given the substantial impact of COVID-19 deployment on HCWs' long-term mental well-being, comprehensive mental health support strategies are urgently needed. As HCWs may overlook their mental health issues, a screening program with psychological support services should accompany them early in future pandemics. Further nationwide studies with longer follow-ups are necessary to understand the full extent of psychological distress among frontline HCWs in Vietnam.

Development of a prediction model for antimicrobial stewardship pharmacy consultations to identify high-risk pediatric patients: a retrospective study across two centers

BACKGROUND

Antimicrobial Stewardship Pharmacy Consultation (ASPC) in China has been shown to reduce patients' length of stay (LOS). However, prolonged LOS remains a challenge, resulting in unnecessary psychological and financial burden for patients.

OBJECTIVE

This study aimed to develop a prediction model using ASPC parameters to identify high-risk pediatric patients with infectious diseases. These patients received ASPC interventions but still experienced prolonged LOS, which defined their high-risk status.

METHODS

Predictors for the ASPC model were selected using lasso regression, a nomogram was developed using multivariate logistic regression, and internal validation was performed using tenfold cross-validation. The data set consisted of 474 electronic medical records of pediatric patients with infectious diseases from two hospitals. LOS was dichotomized at the median, and patients with LOS greater than the median were considered to have achieved the outcome.

RESULTS

The proportion of outcome events was set at 50% by design. Five independent predictors were identified in the ASPC model: (1) the suggestions from the crucial consultation (OR: 1.74; 95% CI: 1.10 to 2.74), (2) weight (OR: 0.98; 95% CI: 0.97 to 1.00), (3) whether the patient received first aid (OR: 0.54; 95% CI: 0.3 to 1.00), (4) the aim of the crucial consultation (OR: 0.15; 95% CI: 0.03 to 0.66), and (5) whether the patient was critically ill (OR: 0.22; 95% CI: 0.12 to 0.41). The ASPC model showed good discrimination with a C-statistic of 0.772 (95% CI: 0.748 to 0.797) and good calibration performance with intercept and slope values of 0.00 (95% CI: -0.12 to 0.12) and 0.93 (95% CI: 0.82 to 1.04), respectively, under tenfold cross-validation.

CONCLUSIONS

The antimicrobial stewardship pharmacy consultation model has good discrimination and calibration, and effectively identifies patients at risk for prolonged length of stay.

Association between working conditions during the COVID-19 pandemic and sleep and stress among Colombian healthcare workers

INTRODUCTION

Although COVID-19 is no longer a public health emergency, its mental health effects on healthcare workers persist.

AIM

This study investigated the relationship between working conditions, sleep, and stress among Colombian hospital healthcare personnel during the pandemic.

METHODS

In this cross-sectional study, 79 healthcare workers completed questionnaires on working conditions, stress, and sleep. Sleep duration was measured with Fitbit Armbands. Associations were analyzed using Generalized Linear Models with Gamma and ordinal distributions.

RESULTS

Approximately 79% of participants reported high to very high stress levels (61% "very high," 18% "high"). Sleep complications were minimal, averaging 6.2 hours. Nurses showed significantly higher stress and longer sleep duration than administrative workers. Overtime correlated with less sleep, while workers who had COVID-19 reported lower stress.

CONCLUSION

The study highlights connections between stress, sleep, and working conditions, suggesting targeted health promotion programs could enhance work-life balance.

Biomarkers of Suicidal Ideation in Depression: Insights From VMHC Analysis and Machine Learning

Background

Suicidal ideation (SI) is a major cause of death in patients with major depressive disorder (MDD). Although current clinical tools can assess suicide risk, objective neurobiological markers based on research remain lacking. Clinical evidence suggests that resting-state functional magnetic resonance imaging (rs-fMRI) studies utilizing voxel-mirrored homotopic connectivity (VMHC) analysis can uncover the neural mechanisms underlying mental disorders. This study explores differences in interhemispheric connectivity between MDD patients with and without SI, aiming to identify imaging biomarkers for suicide risk.

Methods

This study included 48 SI patients and 44 non-SI patients. VMHC values were calculated to assess interhemispheric functional connectivity. Brain regions with significant differences between the groups were identified. A support vector machine (SVM) model was applied to evaluate the utility of VMHC values in distinguishing SI patients from non-SI patients with MDD.

Results

Patients with suicidal ideation exhibited significantly increased VMHC values in the superior frontal gyrus, putamen, inferior temporal gyrus, and cerebellum compared to those without suicidal ideation. The SVM model achieved an accuracy of 77.2%, sensitivity of 83.3%, specificity of 70.5%, and an area under the curve (AUC) of 0.81. When combining VMHC values from multiple brain regions, classification accuracy improved to 86.8%.

Conclusion

MDD patients with SI exhibit abnormal interhemispheric connectivity, with VMHC abnormalities in specific brain regions serving as potential biomarkers for suicide risk. The integration of machine learning and neuroimaging highlights the clinical relevance of VMHC as a tool for early detection and targeted intervention in suicide prevention.