Abstract Background: Leg ulcers represent a global health challenge, especially affecting women and older individuals, leading to significant morbidity and a decrease in the quality of life. Its inter-disciplinary management puts economic strain on health systems. Dermatologists are frequently consulted; however, data on factors associated with healing are scarce. Aims and Objectives: To provide data on factors associated with improvement of leg ulcers. Methods: A retrospective cohort study approved by CES University Human Research Ethics Committee, following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines, was carried out. Medical records of patients with lower limb ulcers referred to the Dermatology Service of a tertiary hospital in Medellín, Colombia, between 2015 and 2022 were reviewed. Entry was defined as the dermatological consultation, with follow-up until specialised discharge. Results: Among 207 patients, 63.8% (n = 132) were women, with an average age of 64 years, and 40% had previously had ulcers. Co-morbidities, such as hypertension, diabetes, anaemia, malnutrition, and internal malignancy, were associated with a lower probability of improvement. Deeper ulcers were statistically significantly associated with a poor response to treatment. Specific topical and systemic treatments were positively correlated with improvement. Conclusions: Several factors highlight the need for timely recognition of lower limb ulcers. A poor response to treatment correlates with pain, ulcer depth, diabetes, and malnutrition, emphasising the need for multi-disciplinary management for effective results.

Healthcare professionals' and students' willingness to provide abortion influences access to care and workforce readiness. We conducted a literature synthesis to identify patterns in willingness across various clinical scenarios. Systematic review and meta-analysis. We searched five databases (PubMed, Scopus, Web of Science, Medline, and CINAHL) and gray literature for studies (January 2014 to February 2025) without language restrictions. Eligible studies reported cross-sectional data on providers' willingness, while we excluded conditionally framed scenarios. Willingness was defined as the intent, readiness, or affirmative response to provide abortion. Summary-level data on theme-specific willingness were extracted and re-coded into binary or proportional format (yes/no or n/N). Estimates were pooled using random-effects models. Meta-regression and publication bias assessments were performed. Study quality was assessed using a novel in-house tool tailored for survey-based research. We included 36 studies (n = 18,779), reporting 137 estimates across 24 themes. Willingness to provide was highest for lethal fetal anomalies (88.7%, 95% CI: 76.1%-95.1%) and maternal physical health risks (88.6%, 95% CI: 55.7%-98.0%) but substantially lower for on-request scenarios (33.1%, 95% CI: 14.9%-58.4%), surgical abortion (32.1%, 95% CI: 11.6%-63.0%), and social reasons (range 20.1%-32.0%). Multilevel modeling captured both converging and diverging response patterns across categories. Meta-regression indicated that students had consistently higher willingness than professionals. Dominant religion was also observed to be more strongly associated than legal status and other country-level indices. Evidence of small-study effects was limited apart from in a few themes. Risk of bias was high in 31% of studies, with our tool showing strong structural overlap with Checklist for Reporting Results of Internet E-Surveys (CHERRIES) and Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) frameworks. Providers often prioritized abortion in life-threatening contexts but hesitated in non-urgent scenarios. Values-based training and systemic reforms are needed for equitable access to and expansion of abortion care. PROSPERO: CRD42025634868.

Alarm fatigue has the potential to have significant consequences for patient safety, and the critical role of intensive care nurses in alarm management is an important component of this process. This study aimed to investigate the alarm management practices of intensive care nurses. This study utilised an observational design. The study was conducted in the intensive care unit of a university hospital in western Türkiye with 21 nurses. To avoid influencing their behaviour, the primary purpose of the observation was not disclosed to the nurses. Two observers used an observation form to record alarms, nurse interventions and intervention times. Environmental noise levels were also measured and recorded during the observation periods. Over 118 h of observation, 460 alarms were recorded. Most alarms (80.4%) were generated by monitors, and 36.3% were due to deviations in the patient's clinical status. It was found that 53.3% of alarms were not responded to, and 73.7% were controlled. Environmental noise levels ranged from 41.90 to 83.10 dB. The control, intervention and response times to alarms by intensive care nurses varied based on the alarm cause and their workload at the time. High environmental noise levels were also observed, which may impact alarm response. The centralised location of the nurses' station, preparation of treatments at the bedside and proximity to patients contribute positively to alarm management. Recommendations to reduce technical alarms include appropriate device calibration; secure technical connections; and appropriate use of ECG electrodes, sensors and medical supplies. Setting appropriate alarm limits by primary nurses and evaluating ICU noise levels for necessary adjustments are crucial. The study was reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklists. No patient or public contribution.

Lung ultrasound (LUS) is a non-invasive imaging method that does not use ionizing radiation, making it particularly useful for evaluating children and adolescents. This study aimed to compare LUS findings in children and adolescents with asthma exacerbation to those with controlled asthma. A prospective longitudinal observational study was conducted, following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for reporting observational studies. Among patients with asthma exacerbation, 33 individuals were analyzed, and the study found that 51.5% of children in the exacerbation group had positive ultrasound findings, compared to only 12.1% in the controlled group. The calculated prevalence ratio was 2.27 (95% CI 1.46-3.55), with a p-value of 0.001, indicating a statistically significant difference in ultrasound findings between the two groups. These findings suggest that lung ultrasound may be a useful tool for identifying changes in children with asthma exacerbations. The significantly higher prevalence of positive findings in the exacerbation group (51.5%) compared to the controlled group (12.1%) suggests that LUS has the potential to detect changes associated with asthma exacerbation. Further research, including multicenter studies, is needed to validate these findings. LUS demonstrated a higher prevalence of positive findings during asthma exacerbations, suggesting potential clinical utility as an adjunctive tool in pediatric asthma assessment.

ABSTRACT Background Post-stroke semi-incapacitated patients often experience a strong fear of disease recurrence, which adversely affects their psychological well-being and rehabilitation outcomes. Objectives To develop and evaluate the effectiveness of a psychological intervention program aimed at reducing the fear of recurrence in post-stroke semi-incapacitated patients. Methods This study was conducted in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Post-stroke semi-incapacitated patients were recruited and assigned to either an intervention group or a control group according to the order of hospital admission. The control group received conventional psychological care, while the intervention group underwent a comprehensive psychological intervention program that included psychological support, cognitive-behavioral therapy (CBT), rehabilitation training, and social support. The psychological status of the patients was assessed using the Fear of Disease Progression Scale, Hospital Anxiety and Depression Scale, and the Chinese version of the Perceived Stress Scale before and after the intervention. Results Prior to the intervention, 83.5% of patients reported psychological fear of relapse, 75.5% experienced anxiety, 75.5% had depression, and 70.5% felt stressed. After the intervention, only 41.0% of patients in the intervention group had a psychological fear of relapse, 11.0% had anxiety, 2.0% had depression, and 5.0% perceived stress. The number of patients with psychological conditions was significantly lower in the intervention group compared to the control group (p < 0.001). Conclusions The integrated psychological intervention program, which combined psychological support, CBT, rehabilitation training, and social support, was effective in reducing the fear of recurrence in semi-disabled patients after stroke.

Background/Objectives: Heel pressure ulcers are a relevant complication in critically ill patients and may negatively affect recovery after ICU discharge. This study investigated health-related quality of life (HRQoL) and mobility levels one year after ICU discharge in survivors who developed heel pressure ulcers. Methods: A prospective observational study was conducted in the ICU of an academic tertiary-level hospital in Milan (Italy) from 1 January 2023 to 31 December 2024. Adult survivors were enrolled, and HRQoL was assessed using the EQ-5D-5L questionnaire. Functional status at ICU discharge was evaluated using the Manchester Mobility Score and Barthel Index. This study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Results: Among 3144 ICU admissions, 52 survivors were enrolled. At ICU discharge, functional status was markedly impaired: only 15 patients (28.9%) were able to stand upright according to the Manchester Mobility Score, and none achieved even moderate levels of independence. At one year, 47 patients (90.4%) completed the follow-up, and 15 of them (31.9%) continued to report moderate-to-severe mobility limitations. The mean EQ-5D index value was 0.75 (SD 0.27), representing a significant reduction compared with Italian population norms (p < 0.001). Conclusions: ICU survivors who developed heel pressure ulcers exhibit reduced HRQoL at one year after discharge. These findings emphasize the need for structured post-ICU rehabilitation and targeted follow-up.

This systematic review synthesizes empirical research on organizational strategies that support the sustainability and scale-up of community-based interventions designed to promote youth psychological well-being. While research has established the effectiveness of youth mental health interventions in community contexts, less is understood about the processes that ensure their long-term sustainability and scale-up. A search across seven databases yielded 27 eligible empirical studies (2003-2025) including peer-reviewed and grey literature. The Synthesis without Meta-analysis (SWiM) and the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) standards provided a framework for conducting and documenting the review. Evaluations of methodological quality were carried out using Strengthening the Reporting of Observational Studies in Epidemiology (STROBE), Consolidated Standards of Reporting Trials (CONSORT), and the Critical Appraisal Skills Programme (CASP). Two dominant strategies for intervention retention and effectiveness were identified: training and technical assistance (12 studies, 44%) and capacity building with implementation support (12 studies, 44%). The main barriers to sustainability and scale-up were reported as staffing as well as other resource limitations (financial, human, and technical), while facilitators included strong communication and leadership, sufficient funding and partnerships, and access to training and technology. Eleven studies (41%) sustained interventions beyond the initial funding period, with key factors including intervention fidelity, agency incentives, organizational support, therapist retention, and stakeholder engagement. The findings highlight the potential benefits of embedding sustainability and scale-up strategies in the pre-implementation phase, anticipating foreseeable barriers, and considering intervention fidelity, workforce stability, and organizational readiness as important precursors to sustainability and scale-up.

Hip fractures in the elderly, especially among the Chinese population, are among the most serious complications of osteoporosis. As age increases, the incidence of these fractures rises. In this study, we seek to identify a range of lifetime occupational physical-demand factors that may serve as potential indicators of hip-fracture risk in Chinese individuals aged 65 years and older. Our aim is to inform preventive strategies and occupational health policies by enhancing understanding of how long-term physical work demands contribute to fracture risk across the aging population. This study employed a retrospective cohort design and was conducted at the Affiliated Hospital of Yan’an University. We included patients who underwent surgical treatment for intertrochanteric fractures or femoral neck fractures between January 2017 and December 2021. The study followed the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines to enhance transparency and methodological reporting. A total of 434 patients were included in this study, comprising 95 with light, 297 with moderate, and 42 with heavy occupational physical demand. Unadjusted multivariate logistic analysis revealed that moderate occupational physical demand was associated with a decreased risk of hip fracture (OR = 3.57, 95% CI: 2.01–6.33, P <.0001; compared to heavy occupational physical demand). Adjusted multivariate logistic model Ⅰ showed that moderate occupational physical demand (OR = 3.35, 95% CI: 1.75–6.44. P = .0003; compared to heavy occupational physical demand) remained associated with hip fracture. Fully adjusted multivariate logistic model Ⅱ also showed that moderate occupational physical demand (OR = 2.83, 95% CI: 1.51–5.97, P = .0032; compared to heavy occupational physical demand) remained associated with hip fracture. Compared to heavy physical demand, moderate occupational physical demand might be associated with a higher risk of hip fracture among older adults.

BackgroundThe application of AI in nursing research is increasing, enhancing objectivity and productivity while raising concerns about liability and scientific integrity.AimTo explore predictors and differences in nursing educators’ perceptions of the risks and benefits of using AI in nursing research.MethodsA cross‐sectional study surveyed 311 nursing educators from various universities.Results27% used ChatGPT, and 61.58% were from governmental universities. High perceived risks included liability (M = 3.78, SE = 0.036), unregulated standards (M = 3.76, SE = 0.035), and communication barriers (M = 3.74, SE = 0.036). Perceived benefits included reduced costs (M = 3.88, SE = 0.045) and improved outcomes (M = 3.81, SE = 0.045). Predictors included marital status (B = 7.67, p = 0.001), age (B = −14.65, p = 0.001), level of education (B = 13.80, p = 0.001), academic rank (B = −1.755, p = 0.001), and teaching experience (B = 2.793, p = 0.001). The model was significant (F (df = 7) = 86.82, p = 0.001, R2 = 0.660) and explained 66.00% of the variance in the mean score of the perceived use of AI in nursing research. There are significant differences in nursing educators’ use of AI in nursing research based on their age (F‐test = 27.63, df = 4, p = 0.001), academic rank (F‐test = 60.79, df = 5, p = 0.001), and teaching experience (F‐test = 17.02, df = 4, p = 0.001).ConclusionsEducators recognize both risks and benefits of AI in nursing research. Tailored training and institutional support are essential for responsible adoption. Tackling these issues can pave the way for nursing research to flourish in a rapidly changing digital world. Nursing educators need the tools they need to critically interact with AI in research.Reporting MethodThe authors of this manuscript have adhered to the STrengthening the Reporting of OBservational Studies in Epidemiology (STROBE) checklist, which was used to guide the study.Patient or Public ContributionThere was no patient or public contribution, as the sample included nursing educators from two governmental universities and one private university.

ABSTRACTObjectivesThe aim of this study was to investigate the living space mobility among people with and without dementia and the influence of liberty‐depriving measures on living space mobility.DesignThis empirical quantitative study used a longitudinal design.MethodsResidents in five inpatient long‐term care facilities were examined over a period of 6 months, including individuals with and without dementia. Data were collected at three time points between October 2023 and July 2024. Living space mobility was assessed by nursing staff using the Heidelberg Instrument for Assessing the Quality of Life of People with Dementia (H.I.L.D.E.), and the liberty deprivation measures were assessed by analysing medical records. The data were statistically analysed to obtain frequencies and to examine group differences.ResultsThere was a significant correlation between living space mobility and dementia diagnosis: residents with dementia mainly stayed within their living area, whereas residents without dementia had a greater range of movement, including outside the facility. A significant correlation between liberty deprivation measures and dementia diagnosis could not be established. However, living space mobility was significantly associated with the use of liberty deprivation measures regardless of dementia status.ConclusionThe results highlight the importance of living space mobility for residents with dementia and emphasise the influence of liberty deprivation measures. Further longitudinal studies with larger samples and alternative survey methods are necessary to investigate these relationships in greater depth.Implications for the Profession and/or Patient CareFor professional care, it is important to promote the mobility and well‐being of residents, regularly review freedom of movement and implement strategies for participation and autonomy in order to increase the quality of care.ImpactThe results emphasise the importance of mobility promotion in dementia care and the critical reflection of liberty deprivation measures in long‐term inpatient care. Larger longitudinal studies are recommended to clarify the causal relationships.Reporting MethodThe methods and results of this study were reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.Patient or Public ContributionThe study participants were recruited after being informed about the study and providing their consent.

ABSTRACT Protective factors like peer and teacher social support should be identified to mitigate or prevent the detrimental effects of exposure to psychological maltreatment, which can result in traumatic consequences in adolescents at a critical stage of development. This study aimed to assess whether trust in teachers and friendship qualities mediate the effects of psychological maltreatment on youth internalizing behaviours using a multiple mediation model. The study is an observational, questionnaire‐based, cross‐sectional study. The study was conducted between January and April 2022 with 810 adolescents aged 14–18 years in the paediatric outpatient clinics of a state hospital. To test the research hypothesis, a parallel multiple mediator model was conducted using the PROCESS macro in Mediation Analysis. The study was reported based on Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. The results of multiple mediation analyses revealed a significant direct effect of psychological maltreatment on young internalizing behaviour and a significant indirect effect of psychological maltreatment on youth internalizing behaviour through trust in teachers and friendship qualities. Both trust in teachers and friendship qualities partially mediated the relationship between psychological maltreatment and youth internalizing behaviour. The development of school‐based psychoeducational programmes, counselling services, and group‐based support interventions for nurses and educators in adolescent and family education may be guided by the mediating impact of teacher and peer interactions.

BackgroundAccording to the guidelines of the European Centre for Disease Control and Prevention, a specialized vaccination protocol is recommended for individuals with chronic conditions such as asplenia, diabetes, cardiovascular diseases, HIV infection, liver diseases, pulmonary diseases, kidney diseases, and immunodeficiency. The recommended vaccinations for chronically ill patients include the seasonal influenza vaccine, periodic booster doses of tetanus, diphtheria, and pertussis vaccines, the herpes zoster vaccine, and the pneumococcal vaccine. Since December 2020, the COVID-19 vaccine has also been recommended for this group. The aim of the study was to assess the use of recommended vaccinations in patients with chronic diseases, to analyze factors influencing patients’ attitudes towards vaccinations, as well as the severity of fear of getting sick and the correlation of fear with attitudes towards vaccinations.MethodsA cross-sectional study with comparison groups was conducted in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. A convenience sampling method was applied, and the study was carried out among oncology patients, patients with chronic obstructive pulmonary disease (COPD), and healthy individuals in the control group. The study utilized a survey questionnaire, the Positive Health Behavior Scale, and the SL-C Trait Anxiety Scale.ResultsThe study group included patients with cancer, patients with obstructive pulmonary disease, and healthy controls. The most frequently received vaccination was against COVID-19, both in the group of oncology patients (74%), in the group of patients with obstructive pulmonary disease (65%) and in the control group (85%). The percentage of influenza vaccinations was higher in patients with COPD (OR: 1.6, p < 0.05) compared to patients with cancer or the control group. Furthermore, a significant increase in recommended vaccinations was observed in age groups ≥ 65 years (OR: 1.9, p < 0.01) compared to younger age groups in both groups I and II. Fear of severe illness (47%) was the main reason for vaccination. Participants learned about vaccines primarily from the internet (35%). The occurrence of side effects after vaccination did not significantly influence the decision to revaccinate (chi-square = 0.24, p = 0.622).ConclusionsPatients are most willing to be vaccinated against COVID-19, while the percentage of vaccinations with other recommended vaccines in clinical risk groups is below the desired level. Due to the high percentage of people vaccinated against COVID-19 and the mild course of the disease in most cases, it can be concluded that vaccination provided high protection against severe disease and hospitalization among vulnerable groups of the population.Clinical trialNot applicable.

Research in hyperbaric oxygen (HBO) medicine is growing, but the quality of HBO studies is variable. Low study quality may compromise evidence-based decision-making and clinical translation. This cross-sectional study examined the adherence of 50 randomly selected HBO clinical trials (25 randomised controlled trials [RCTs] and 25 observational studies) to relevant core reporting guidelines: consolidated standards of reporting trials (CONSORT), non-pharmacologic treatments (NPT), and strengthening the reporting of observational studies in epidemiology (STROBE). Studies published in peer-reviewed journals between January 2018 and May 2023 and indexed on PubMed were analysed. Reporting quality was classified as 'excellent' (> 85% of guideline items adequately reported), 'good' (50-85%), or 'poor' (< 50%). The sample represented 29% of RCTs and 16% of observational studies for the timeframe assessed. No study was rated as 'excellent' for completeness, 28 (56%) were rated as 'good', and 22 (44%) as 'poor'. In RCTs, only one study (4%) adequately reported protocol adherence and eight studies (32%) reported blinding procedures. The NPT checklist showed that key items, including care provider adherence (0 studies) and participant adherence (one study; 4%), were frequently not reported. For observational studies, basic design elements were adequately reported, but with significant gaps in bias management (nine studies; 36%) and missing data handling (13 studies; 52%). Only six studies (12%) mentioned the use of reporting guidelines. Our results showed that quality of reporting of HBO studies is suboptimal. These findings highlight the need for increased awareness and implementation of reporting guidelines, as well as the potential development of HBO-specific guidelines.

BackgroundBioceramic materials have emerged as a significant advancement in endodontics, offering excellent biocompatibility, sealing ability, and bioactivity.Their use has expanded in recent years, particularly for pulp capping, perforation repair, and regenerative procedures.ObjectivesThis study aimed to assess the knowledge of bioceramics among private practice dentists, evaluate the frequency of use of sealing and filling bioceramics, and examine the applied clinical protocols as well as potential shortcomings.Materials and methodsThis cross-sectional study was conducted according to Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines, based on an epidemiological Knowledge, Attitudes, and Practices (KAP) survey. It was carried out among Tunisian private practice dentists. Data were processed and analyzed using Excel 2007 and Statistical Package for the Social Sciences (SPSS) Statistics 21.0. The sample size was calculated using the standard formula for estimating a proportion in a cross-sectional study, and participants were randomly selected. Participation was voluntary, anonymous, and confidential.ResultsA total of 200 dentists participated. Only 54.5% reported using sealing bioceramics, with 35.05% using them in all cases, 19.94% for periapical lesions, and 16.92% for root perforations. Approximately half of the dentists (53.01%) observed faster healing when using these sealers. Regarding filling bioceramics, 67.5% of participants used them, with a preference for MTA. These materials were indicated for various clinical situations, including repair of floor perforations, pulp capping, apexification of immature permanent teeth, and repair of root perforations. However, 45.61% of participants reported treatment failures when using these bioceramics, with failure to adhere to one of the endodontic treatment steps identified as the primary cause.ConclusionThis study concluded that younger dentists tend to use bioceramics more frequently, filling bioceramics are better known than sealing ones, and most participants are familiar with the clinical indications of these materials. It is essential to provide further guidance and recommendations on the clinical application of bioceramics to optimize treatment outcomes.

Self-esteem refers to an individual's overall sense of self-worth, which plays a crucial role in their well-being. One of the most commonly used instruments to measure this concept is the Rosenberg Self-Esteem Scale (RSES), which has been translated and psychometrically validated in numerous cultures and languages to date. Therefore, this study aimed to assess the psychometric properties of the Persian version of the RSES in the Iranian adult population. This cross-sectional validation study was conducted following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines in Shahroud city, northeastern Iran. A total of 533 adults from this city who spoke Persian and were literate were included in the study using convenience sampling. After translating and culturally adapting the RSES in accordance with World Health Organization (WHO) guidelines, face and content validity were assessed using both qualitative and quantitative methods. Additionally, construct validity was evaluated through exploratory and confirmatory factor analysis. Reliability was also determined by calculating Cronbach's alpha coefficient, McDonald's omega coefficient, composite reliability (CR), and intraclass correlation coefficient (ICC). The face and content validity of all items were confirmed through both qualitative and quantitative methods. Based on the results of the exploratory factor analysis using polychoric correlations and robust weighted least squares (WLSMV) estimation, the Persian version of this scale consists of two factors: (1) Positive self-esteem and (2) Negative self-esteem, which account for 59.1% of the total variance of the scale. All goodness-of-fit indices in the confirmatory factor analysis also supported this model (CMIN/df = 2.29, RMSEA = .049, CFI = .981). These two factors showed acceptable internal consistency and stability, as evidenced by Cronbach's alpha coefficients (.828 and .801), McDonald's omega coefficients (.833 and .810), composite reliabilities (.820 and .796), and intraclass correlation coefficients (.838 and .875). The findings of the current study showed favorable psychometric properties of the Persian version of the RSES for measuring self-esteem in the Iranian adult population.

To provide an overview of doctoral programs in nursing offered in Ibero-American countries to inform regional collaboration and academic development. This study was a descriptive, document analysis. A systematic mapping was conducted using data obtained from official university and program websites, national postgraduate databases, and academic documents. The variables analysed included country, institution, year of implementation, number of faculty and students, course duration, delivery modality, costs, scholarship availability, internationalisation activities, and research lines. A total of 94 active nursing doctoral programs were identified. Brazil emerged as the pioneer, launching the first doctoral program in 1982, and remains the regional leader, accounting for 43 programs. Most programs are offered by public institutions (76.6%), delivered primarily in face-to-face format (64.1%), and emphasise research (90.4%). There has been a consistent upward trend in the establishment of programs since 2000, with notable expansion between 2011 and 2025. Despite this progress, regional disparities persist, along with a lack of data standardisation and a limited presence of professional doctorates. While 69.1% of programs reported international activities, few offer joint or dual degrees. The most common thematic axis, "Health Care and Nursing," proved to be broad and non-specific. The study reveals the expanding landscape of nursing doctoral education in Ibero-America, while also exposing persistent challenges regarding access, curricular clarity and regional articulation. Doctoral programs are essential for developing research capacity, academic leadership and evidence-based care. Strengthening these programs could enhance nursing responses to local health needs and promote scientific progress in care delivery. This study provides the first comprehensive mapping of nursing doctoral programs in Ibero-America, highlighting regional disparities and areas for academic collaboration, with potential impact on policy-making, curriculum development, and the strengthening of research capacity in nursing education. STROBE (Strengthening the Reporting of Observational Studies in Epidemiology). No patient or public contribution.

Recently, patients have been using large language models (LLMs) such as ChatGPT, Gemini, and Claude to address their concerns. However, it remains unclear whether the readability, understandability, actionability, and empathy meet the standard guidelines. In this study, we aim to address these concerns and compare the outcomes of the LLMS to those of professional resources. We conducted a comparative cross-sectional study by following the relevant items of the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for cross-sectional studies and using 14 patient-style questions. These questions were collected from the professional platforms to represent each domain. We derived the 14 domains from validated quality-of-life instruments (EORTC QLQ-H&N35, UW-QOL, and FACT-H&N). Fourteen Responses were obtained from three LLMs (ChatGPT-4o, Gemini 2.5 Pro, and Claude Sonnet 4) and two professional sources (Macmillan Cancer Support and CURE Today). All responses were evaluated using the Patient Education Materials Assessment Tool (PEMAT), DISCERN instrument, and the Empathic Communication Coding System (ECCS). Readability was assessed using the Flesch Reading Ease and Flesch-Kincaid Grade Level metrics. Statistical analysis included one-way ANOVA and Tukey's HSD test for group comparisons. No differences were found in quality (DISCERN), understandability, actionability (PEMAT), and empathy (ECCS) between LLMS and professional resources. However, professional resources outperform the LLMs in readability. In our study, we found that LLMs (ChatGPT, Gemini, Claude) can produce patient information that is comparable to professional resources in terms of quality, understandability, actionability, and empathy. However, readability remains a key limitation, as LLM-generated responses often require simplification to align with recommended health-literacy standards.

IntroductionSecuring patient safety is a global concern. Unsafe care can cause preventable adverse events. Nurses play a key role through two types of patient safety behaviors: compliance (mandatory adherence to safety protocols) and participation (voluntary efforts to improve safety). While value congruence with supervisors promotes positive work behaviors, its influence on patient safety behaviors remains unclear. Moreover, a clear link between psychological safety and patient safety outcomes is yet to be established. To fill this gap, the present study examines whether psychological safety moderates the relationships between value congruence regarding patient safety and patient safety behaviors.ObjectivesTo examine the associations between nurses’ value congruence with their managers regarding patient safety and both patient safety compliance and participation, and to assess the moderating role of psychological safety in these relationships.DesignA cross-sectional, multicenter, self-administered questionnaire survey.Materials and methodsThe survey was conducted from April to May 2025 among registered nurses working in hospitals across Japan with more than 200 beds. Multivariate regression analyses were employed to examine the relationships among patient safety behaviors, value congruence, and psychological safety. This study was conducted in accordance with the STROBE (STrengthening the Reporting of OBservational Studies in Epidemiology) guidelines.ResultsIn total, 509 nurses at six hospitals were included in the study. Value congruence was associated with patient safety compliance (β=0.347, p<0.001) and participation (β=0.341, p<0.001). The interaction effect of value congruence and psychological safety on patient safety compliance and participation yielded β=0.020 (p<0.630) and β=0.081 (p=0.047), respectively.ConclusionsThis study introduced the novel concept of value congruence as a contributor to patient safety. Our findings suggest that sharing values and goals related to patient safety can promote both types of patient safety behaviors, and psychological safety plays a key role in fostering voluntary engagement in patient safety practices.

Background: Liver cirrhosis, a major global health burden, often presents at a decompensated stage. This study aimed to describe the clinical profile, etiology, and complications of liver cirrhosis at a tertiary care center in Western India, with a focus on identifying treatable causes.Methods: This observational cohort study was conducted at the Department of Medicine, Gujarat Medical Education and Research Society (GMERS) Medical College and Hospital, Sola, Ahmedabad, between June 1, 2022, and May 31, 2024. One hundred consecutive patients with cirrhosis were enrolled. The study design included an initial cross-sectional analysis at patient presentation and a subsequent one-year prospective follow-up to monitor complications. Data on demographics, clinical presentation, etiology, laboratory parameters, and complications were collected and analyzed using descriptive statistics. The study has been reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.Results: The mean age was 52.4±14.3 years, with a male predominance (71%; n=71). The most common etiologies were alcohol (66%; n=66), hepatitis B virus (12%; n=12), and non-alcoholic steatohepatitis (11%; n=11). The majority of patients (65%; n=65) had Child-Pugh Class C disease. Common presenting features included abdominal swelling (68%; n=68), jaundice (65%; n=65), and ascites (68%; n=68). Prevalent laboratory abnormalities included anemia (67%; n=67), thrombocytopenia (61%; n=61), hypoalbuminemia (76%; n=76), and an elevated international normalized ratio (INR) (65%; n=65). During follow-up, recurrent ascites (44.6%; n=41 of 92 episodes) was the most common complication leading to readmission. A significant association was found between Child-Pugh Class C and the development of acute kidney injury during follow-up (p<0.01).Conclusion: This study, based on a tertiary care cohort, confirms alcohol as the leading cause of cirrhosis among hospitalized patients but also highlights a significant burden of viral hepatitis. The high proportion of patients presenting with decompensated disease underscores the critical need for enhanced community-level screening and early intervention strategies.

From birth, many young Pacific people in Aotearoa New Zealand experience a disproportionately high burden of psychological distress, metabolic disease, and socioeconomic disparities within education and employment which contribute to significant health inequalities. Further research is needed to understand the drivers influencing these outcomes. This paper provides a comprehensive overview of the quantitative component of the Pacific Island Families Study: Ala mo Tupulaga Pasifika Aotearoa (PIF:ATP; Life Course Trajectories for Young Pasifika in Aotearoa), the latest follow-up of the longitudinal PIF birth cohort study, which uses a mixed-methods approach. The PIF Study is a multidisciplinary longitudinal study that tracks the health and development of 1398 Pacific children born in 2000 at Middlemore Hospital, South Auckland, Aotearoa, New Zealand. Data collection has occurred at 10 time points from infancy through young adulthood, with this PIF:ATP assessment phase occurring at ages 25-26 years, which aims to reach at least 750 cohort members. The assessments will take place at participants' homes or at Auckland University of Technology for those residing in Auckland. Data collection will be conducted across multiple sites, including Auckland, Wellington, Hamilton, and Whangārei in Aotearoa New Zealand, as well as Brisbane, Sydney, and Melbourne in Australia. Physical measurements such as weight, height, waist and hip circumferences, grip strength, body fat mass and muscle mass, blood pressure and pulse, glucose and lipid screening, and skin carotenoid concentration will be undertaken. In addition, self-reported data will be collected on psychological well-being (eg, depression, anxiety, and family functioning), nutritional and metabolic well-being (eg, food intake and physical activity), and economic well-being (eg, educational attainment, employment status, and job occupation and industry). Data collection is scheduled to commence in June 2025 and conclude by December 2026. The first set of results and analysis is expected to be published from December 2027 onward. Reporting of all results will comply with the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) guidelines. This paper presents the protocol for the 25-year follow-up of the first Pacific longitudinal cohort study, which will comprehensively examine psychological, nutritional, metabolic, and economic well-being of Pacific young adults. With 25 years of longitudinal data and extensive expertise in life course research, this protocol outlines the design, methodology, and scope of the quantitative component of the PIF:ATP research program. This phase is uniquely positioned to address key issues identified by Pacific communities and generate evidence to inform meaningful interventions and guide policy development while providing robust, contemporary, high-quality empirical evidence.