Tag: pubmed

Palliat Support Care. 2026 Apr 13;24:e106. doi: 10.1017/S1478951526102211.

ABSTRACT

OBJECTIVE: Providing care for children with life-limiting conditions(LLCs) is an emotionally challenging experience that often exposes caregivers, particularly mothers, to considerable risk of psychological distress. The purpose of this study was to examine the moderating effect of emotional dysregulation on the relationship between severity of anxiety and depressive symptoms and high caregiving intensity, controlling for sociodemographic characteristics among mothers caring for children diagnosed with life-limiting conditions.

METHOD: Using a cross-sectional descriptive design, a convenience sample of 192 mothers caring for children with life-limiting conditions was recruited and filled out an online self-administered questionnaire. Data were collected using online self-administered questionnaires regarding the sociodemographic characteristics of mothers and their children, emotional regulation difficulties (DERS), and the levels of anxiety and depressive symptoms among the mothers (DASS-21).

RESULTS: The analysis showed that 21.4% and 7.8% of mothers had moderate and severe depressive symptoms, and 19.3% and 15.6% had moderate and severe anxiety symptoms, respectively. The analysis also showed that emotional dysregulation is associated with high levels of anxiety (β = 0.74, P < 0.001) and depression (β = 0.74, P < 0.001); however, there was no significant moderating effect.

SIGNIFICANCE OF RESULTS: Anxiety and depression are significant psychological distress among mothers caring for children with life-limiting conditions and can be aggravated by emotional dysregulation and caregiving burden. There is a need to integrate interdisciplinary teamwork and family-centered care to provide holistic care and offer early screening, detection, and emotional regulation-focused management programs for psychological distress at healthcare services that care for children with LLCs.

PMID:41969128 | DOI:10.1017/S1478951526102211

Palliat Support Care. 2026 Apr 13;24:e103. doi: 10.1017/S1478951526102193.

ABSTRACT

OBJECTIVE: Hospices represent the cornerstone of modern palliative services. However, population-level data on hospice utilization and characteristics of patients dying in hospice remain limited to examine national temporal trends in hospice deaths in Italy from 2011 to 2022, with a focus on the underlying causes of death.

METHODS: We performed a nationwide, population-based retrospective study using official mortality data from the Italian National Institute of Statistics. All deaths registered in Italy between 2011 and 2022 were included. Hospice deaths were identified as those occurring in licensed hospice facilities.

RESULTS: Hospice beds increased from 1,681 in 2011 to 3,419 in 2022, while hospice deaths more than doubled from 19,179 (3.2% of all deaths) to 43,972 (6.2%). The mean age of hospice deaths rose from 74.0 to 76.6 years. Among patients dying in hospice, neoplasms remained the leading cause of death but declined from 87.0% in 2011 to 73.8% in 2022, while cardiovascular deaths increased from 6.2% to 9.5%, neurological from 1.2% to 3.4%, and respiratory from 1.0% to 2.5%. The proportion of national neoplasm deaths occurring in hospice reached approximately 20% in 2022. Similarly, the proportion of non-neoplasm hospice deaths tripled (0.6-2.1%).

SIGNIFICANCE OF THE RESULTS: Between 2011 and 2022, hospice deaths in Italy more than doubled, reflecting substantial progress in expanding access to palliative care. The gradual increase in non-neoplasm hospice deaths suggests a shift toward greater inclusivity, although neoplasm remains predominant.

PMID:41969126 | DOI:10.1017/S1478951526102193

Palliat Support Care. 2026 Apr 13;24:e105. doi: 10.1017/S1478951526102120.

ABSTRACT

OBJECTIVES: Medical assistance in dying (MAID) is a rapidly growing and evolving field. The provision of MAID in Canada has substantially outpaced the number of new providers. While challenges of provision have been well described, little is known about the sustainability of providing this care long term. To fill this gap, we aimed to determine if providing MAID is sustainable while identifying factors that impact provider wellbeing.

METHODS: We developed a 20-item Likert scale-based questionnaire that focused on themes of sustainability. We performed descriptive analyses for each question and used Fisher’s exact and Kruskal-Wallis tests to assess differences across provider characteristics. The questionnaire was distributed via a network of MAID navigators and providers in Ontario, Canada.

RESULTS: In total, 38 responses were received from well-experienced clinicians in a variety of specialties. A total of 74% of respondents felt their MAID work was sustainable for the long term. Practitioners strongly enjoyed the work and reported little emotional toll and burnout. While some providers felt the compensation and training were sufficient, others felt it could be improved. Nearly all respondents had someone ethically and clinically knowledgeable about MAID they could go to for support.

SIGNIFICANCE OF RESULTS: Our questionnaire has shown clinicians who are well-experienced and connected to supports report very positive experiences providing MAID and view the work as sustainable. While existing literature and media often emphasize the challenges of MAID, the perspectives of providers highlight a positive experience.

PMID:41969123 | DOI:10.1017/S1478951526102120

New Microbiol. 2026 Apr;49(1):44-49.

ABSTRACT

This study characterized the clinical distribution and antimicrobial susceptibility of Burkholderia cepacia complex (BCC) isolates in the Shaoxing region. A total of 303 clinical BCC isolates collected from 15 healthcare facilities during 2023 were analyzed using MALDI-TOF MS for identification and VITEK 2 COMPACT for susceptibility testing, following CLSI 2023 guidelines (Clinical and Laboratory Standards Institute, 2023). B. cenocepacia (75.2%), B. multivorans (13.5%), and B. cepacia (6.9%) were the predominant species, while six isolates remained unidentified at the species level. Isolates were recovered primarily from male patients (58.1%), individuals over 65 years (70.0%), and ICU (intensive care unit) patients (59.7%). Respiratory specimens – including sputum, throat swabs, and bronchoalveolar lavage fluid – accounted for the majority of isolates (79.5%), followed by pleural/ascitic fluids and blood (11.9%), and urine (2.3%). B. cenocepacia was more prevalent in male patients (63.6%), whereas B. multivorans and B. cepacia predominantly affected females, accounting for 63.4% and 61.9% of cases, respectively (p = 0.001). Regarding age distribution, the majority of patients across all three species were over 65 years of age, with no statistically significant difference observed among the groups (p = 0.713). Significant associations were also found between species and both hospital setting (p = 0.020) and specimen type (p<0.001). All three major species exhibited high susceptibility (>90%) to ceftazidime, with no significant differences among them. In contrast, statistically significant differences (P<0.05) were observed in the susceptibility rates of B. cenocepacia compared to the other two species toward minocycline, meropenem, levofloxacin, and trimethoprim-sulfamethoxazole. These results highlight the necessity of AST (Antimicrobial Susceptibility Testing)-guided therapy to optimize treatment and limit resistance development.

PMID:41969112

Ann Med. 2026 Dec;58(1):2656557. doi: 10.1080/07853890.2026.2656557. Epub 2026 Apr 13.

ABSTRACT

BACKGROUND: Children are a particularly vulnerable population for tuberculosis (TB). The present study aims to describe epidemiological characteristics and temporal trends of paediatric TB in Spain.

METHODOLOGY: A retrospective study of paediatric TB in Spain was conducted using data from the National Epidemiological Surveillance Network and the l Basic Minimum Data Set of Hospitalizations from 2012 to 2023. Trends of annual notification rates (NR), hospitalization rates (HR) and annual percentage of change (APC) were calculated.

RESULTS: Between 2012 and 2023 there were 3,472 reported cases and 2,768 hospitalizations. The mean NR and HR of the period were 4.2 and 3.3 per 100,000 inhabitants, respectively. The NR and the HR decreased from 5.0 to 3.5 and from 5.0 to 2.8, with significant APCs of -5.05 and -7.25, respectively. The most affected age group was 1-4 (39.8% of notifications and 43.4% of hospitalizations). Severe presentations (miliary and meningitis) were more common amongst cases less than 1-year-old.

CONCLUSIONS: A decreasing trend in paediatric TB in Spain has been observed since 2012, with a slight rebound since 2021. Younger children aged 1-4 had the highest incidence while children under 1 year had the highest percentage of severe TB. This highlights the importance of prioritizing and strengthening control strategies in this age group.

PMID:41969056 | DOI:10.1080/07853890.2026.2656557

Diabet Med. 2026 Apr 12:e70330. doi: 10.1111/dme.70330. Online ahead of print.

ABSTRACT

AIMS: To evaluate whether faster insulin aspart (FIA) improves time in range (TIR) compared with standard insulin aspart (SIA) in children and adolescents with type 1 diabetes achieving glycaemia close to target treated with continuous subcutaneous insulin infusion (CSII) and continuous glucose monitoring (CGM).

METHODS: This prospective, open-label, randomized, 1:1 crossover trial included participants aged 6-17 years with T1D duration of ≥1 year, CSII use ≥3 months, CGM use ≥1 month, and HbA1c 64 mmol/mol (<8%). After a 2-week run-in period, they then crossed over to the alternate insulin for another 4 weeks. All participants used the same CGM system. Assessments were performed at the end of each treatment phase. The primary endpoint was the between-treatment difference in TIR (3.9-10.0 mmol/L, 70-180 mg/dL).

RESULTS: Seventy-seven children were enrolled (mean T1D duration approximately 7 years; 66% male; mean HbA1c 53 mmol/mol, 7%). Mean TIR was 68.5% (SD 12.3%) with SIA and 67.6% (SD 12.1%) with FIA, with no statistically significant difference (mean difference -0.9%; 95% CI -2.60 to 0.86; P = 0.322). Similar patterns were observed for additional glycaemic metrics. Time in tight range was also similar between treatments: 46.3% for SIA versus 45.4% for FIA (P = 0.674).

CONCLUSIONS: In this randomised crossover study of children and adolescents with T1D achieving glycaemia close to target on CSII, switching from SIA to FIA does not improve TIR. The absence of improvement across CGM-derived metrics suggests that FIA does not meaningfully enhance glycaemic outcomes in this clinical setting.

PMID:41968383 | DOI:10.1111/dme.70330

Hum Reprod. 2026 Apr 11:deag058. doi: 10.1093/humrep/deag058. Online ahead of print.

ABSTRACT

STUDY QUESTION: Can natural cycles (NC) be effectively utilized in advanced maternal age (AMA) undergoing oocyte donation, without compromising live birth rates (LBRs) and miscarriage outcomes, when compared to artificial cycles (ACs)?

SUMMARY ANSWER: In donor oocyte embryo transfer cycles, NC demonstrated superior outcomes in reproductive efficacy and obstetrical safety compared to AC, independent of the recipient’s age.

WHAT IS KNOWN ALREADY: Previous studies have posited that NC may result in better outcomes when compared to AC embryo transfer, including a lower risk of miscarriage and hypertensive disorders of pregnancy. Recent studies support that NC-frozen embryo transfer (FET) decreases obstetrical and neonatal complications compared to AC-FET, even if LBR differences remain controversial in some general populations. There is limited research on the use of NCs in women of AMA.

STUDY DESIGN, SIZE, DURATION: This retrospective, multicentre, cohort study included all single blastocyst embryo transfers following oocyte donation performed between January 2010 and December 2023, subdivided according to the type of endometrial preparation performed (NC or AC). The oocyte donation model was chosen to minimize the potential confounding effect related to poor oocyte competence in older women and the influence of ovarian stimulation performed during autologous IVF on endometrial receptivity prior to a fresh embryo transfer.

PARTICIPANTS/MATERIALS, SETTING, METHODS: The main objective of the study was to compare LBR. Secondary outcomes included hCG-positive pregnancy rate, clinical pregnancy rate, miscarriage rate, obstetric, and perinatal outcomes. Confounder-adjustment was performed using a multivariable generalized estimating equations model regression analysis, adjusting for multiple confounders. A sub-analysis compared results when the AC protocol was optimized with progesterone (P4) monitoring and rescue therapy. Additionally, an interaction variable was added to the final multivariable model to assess whether female recipient age may modify the effect of each type of endometrial preparation on LBRs.

MAIN RESULTS AND THE ROLE OF CHANCE: In total, 67 048 embryo transfers were analysed, including NC (n = 6922) and AC (n = 60 126). The NC group demonstrated consistent superiority over AC after adjustment for confounders across all transfers. NC was associated with a higher LBR (aOR 1.38, 95% CI 1.29-1.47; P < 0.01) and significantly lower miscarriage rate per hCG-positive pregnancy (aOR 0.68, 95% CI 0.61-0.76; P < 0.01). This superiority persisted even in optimized AC cycles with P4 monitoring and rescue therapy (LBR aOR 1.42, 95% CI 1.31-1.54; P < 0.01). Furthermore, NC was associated with significantly lower obstetrical risks in singleton pregnancies, including hypertensive disorders of pregnancy (aOR 0.72, 95% CI 0.56-0.94; P = 0.01), Caesarean delivery (aOR 0.86, 95% CI 0.77-0.96; P < 0.01), and large for gestational age (aOR 0.77, 95% CI 0.67-0.89; P < 0.01). The interaction between endometrial preparation method and female recipient age was not statistically significant (aOR 1.02, 95% CI 0.99-1.03).

LIMITATIONS, REASONS FOR CAUTION: The retrospective nature of the study and the inherent risk of bias related to unmeasured confounding factors may have impacted the results. Another limitation is the low percentage of NC included in the study (10.32% of all cycles), which could be related to the low uptake to this treatment modality in real-life practice.

WIDER IMPLICATIONS OF THE FINDINGS: NC may offer superior reproductive outcomes and is associated with lower obstetrical risks, with differences unlikely to be modified by female age. Therefore, it seems reasonable to suggest NC for older women, as they could benefit from the decreased risk of miscarriage and hypertension during pregnancy.

STUDY FUNDING/COMPETING INTEREST(S): No specific funding was obtained for this study. A.R.N. has received research grants (to institution) from Theramex; Consulting and Speakers’ fees and travel support from Organon and Merck KgaA; S.S.-R. has received consulting fees from Organon, IBSA, and Besins; Speakers’ fees and travel support from Organon, Ferring Pharmaceuticals, Theramex, IBSA, Gedeon Richter, Abbott, and Besins. He has also received travel support from Organon, Ferring, Theramex, IBSA, Gedeon-Richter, Abbott, and Besins. He holds stocks/shares with IVIRMA Lisboa. He is a member of the ESHRE Executive Committee and was the Senior Deputy of Safety and Quality for ESHRE.

TRIAL REGISTRATION NUMBER: N/A.

PMID:41968377 | DOI:10.1093/humrep/deag058

Eur J Dent Educ. 2026 Apr 12. doi: 10.1111/eje.70158. Online ahead of print.

ABSTRACT

INTRODUCTION: The healthcare sector contributes approximately 5% of global greenhouse gas emissions, and dentistry represents a notable environmental burden due to high energy consumption, material use, and medical waste generation. This study aimed to evaluate dental students’ awareness, attitudes, and perceptions regarding environmental sustainability and to assess the extent to which sustainability is integrated into the dental curriculum.

MATERIALS AND METHODS: This descriptive cross-sectional study was conducted between March and May 2025 at the Faculty of Dentistry of İnönü University, Türkiye. A total of 600 valid questionnaires were obtained from dental students across all academic years. Data were collected using a 28-item questionnaire developed based on current literature and expert evaluation (content validity index = 0.88; Cronbach’s α = 0.87). Descriptive statistics, χ² tests, Mann-Whitney U tests, Kruskal-Wallis tests, and binary logistic regression analyses were performed using SPSS 26.0.

RESULTS: Overall, 82% of students reported being familiar with the concept of sustainability; however, only 28% indicated that sustainability topics were included in their formal education. Students demonstrated generally positive attitudes towards environmentally sustainable dental practises, particularly regarding recycling, energy conservation, and resource management. Significant differences were observed according to gender and year of study in sustainability awareness and perceptions of curriculum integration (p < 0.05).

CONCLUSION: Although dental students display positive attitudes towards environmental sustainability, the findings suggest that sustainability is not systematically integrated into the dental curriculum. Integrating sustainability into dental education through clearly defined learning outcomes and structured curriculum development may contribute to the training of environmentally responsible oral healthcare professionals.

PMID:41968368 | DOI:10.1111/eje.70158

Implement Sci Commun. 2026 Apr 13. doi: 10.1186/s43058-026-00921-2. Online ahead of print.

ABSTRACT

BACKGROUND: Australia’s ≥ 28‑weeks stillbirth rate is 19.5% higher than that of high‑income countries with the lowest rates. The Safer Baby Bundle (SBB) is a national initiative to reduce stillbirth in Australia targeting five components of antenatal care and is the key prevention strategy within National Stillbirth Action and Implementation Plan. This paper reports the experience in one Australian state that delivered the Safer Baby Bundle Improvement Project (SBBIP) to support clinical staff implementing the SBB. In the setting of extreme maternity workforce challenges compounded by the COVID-19 pandemic, the implementation used a modified Breakthrough Series Collaborative (BTS).

METHODS: Over an 18-month period, antenatal services across Queensland used a modified BTS Collaborative approach, removing the need for teams to document Plan-Do-Study-Act cycles, use statistical process control (SPC) charts, document project progress scores and monthly reporting. Engagement during the improvement effort was assessed. A before-and-after multimethod study was used to evaluate the program. Routinely collected perinatal data, clinical audits, project administrative data and surveys of healthcare professionals and women receiving antenatal care were used to measure improvements before and after implementation, and logistic regression interrupted time series (ITS) analyses were used for comparisons of the outcomes.

RESULTS: Despite disruptions from the COVID-19 pandemic, the SBB was implemented across antenatal services, and the modified BTS implementation strategy achieved positive results. Eighty-nine percent of the 45 enrolled teams were actively engaged in the improvement effort across the SBBIP and all (100%) implemented one or more change ideas. Post implementation, improvements were observed in all key process measures and balance measures (planned singleton birth before 39 weeks, late preterm and early-term singleton births), whereas other measures remained unchanged. The stillbirth rate ≥ 28 weeks in singletons remained at 2.1 per 1000 births before and after implementation. ITS analyses of eligible measures supported these patterns.

CONCLUSIONS: In an environment challenged by workforce shortages, high workload demand, and competing priorities (global pandemic), a modified BTS Collaborative approach is a useful model to implement improvement at scale to reduce stillbirth risk factors.

PMID:41968363 | DOI:10.1186/s43058-026-00921-2

Cytometry A. 2026 Apr 12. doi: 10.1002/cyto.a.70024. Online ahead of print.

ABSTRACT

Rapid advancements in mass and flow cytometry technologies have allowed researchers to generate and analyze high-dimensional single cell datasets, often utilizing upwards of 40 protein markers. Such high-parameter cytometry is increasingly used in longitudinal immunological studies, but technical variations across experimental batch runs can confound biological signals. To mitigate the impact on downstream analyses, many studies include reference control samples in every run, and several approaches exist to adjust for batch effects. However, tools that objectively identify problematic batches and markers present within a dataset are limited. We introduce CytoBatchFlagR, a comprehensive and interpretable tool designed to flag batch-related problems at the marker and cell cluster level based on robust statistical evaluations. Batch and marker variations are assessed based on median signal intensities of negative and positive cell populations and positive cell frequencies, along with Earth Mover’s Distance (EMD) of signal intensity distributions. Additionally, CytoBatchFlagR identifies cell type specific batch problems via unsupervised clustering. The tool is suitable for mass and flow cytometry datasets where it objectively detects distinct types of batch issues. We developed and tested CytoBatchFlagR using three cytometry datasets to demonstrate its utility and performance. We also demonstrated CytoBatchFlagR’s effectiveness in assessing datasets that include or lack reference controls. CytoBatchFlagR improves quality control by enabling objective identification of technical variations that may impact downstream analysis in high-parameter cytometry data. The tool uses a series of complementary metrics to identify potential batch-related problems at the marker and cell population level and presents the results through interpretable visualizations. This allows users to make informed decisions about whether to apply batch correction or exclude specific batches or markers from downstream analyses. CytoBatchFlagR is freely available as R scripts, with documentation and a tutorial to help users get started.

PMID:41968341 | DOI:10.1002/cyto.a.70024