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Components of Family-Focused Interventions that Have Common Impacts Across Parental Domestic Violence and Abuse, Mental Ill-Health, and Substance Misuse:An Intervention Components Analysis
Get PDFSupport for families experiencing domestic violence and abuse (DVA), mental ill-health (MH) and substance misuse (SU) is often delivered in siloes, despite the frequent co-occurrence of these public health issues. Little evidence-based guidance exists on which interventions best support families experiencing a combination of these problems. Identifying intervention components with common impacts across parental DVA, MH and SU could inform policy and practice. We conducted an Intervention Components Analysis (ICA) to identify intervention components that have common impacts across parental DVA, MH and SU. We searched ten databases for randomised controlled trials of family-focused interventions targeting, and measuring an impact on, one or more of these issues. We developed an initial coding framework using open coding to guide the coding of subsequent studies. Descriptive analyses identified common components across target outcomes (DVA/MH/SU) and robust variance meta-regressions explored the relationship between intervention components and treatment effects. A Lived Experience Advisory Group informed our presentation and interpretation of the results. We identified 164 interventions: 40 focused on a combination of DVA, MH and SU and 124 addressed one issue alone. None of the 20 components identified were unique to any specific outcome and no single component was associated with meaningful improvement in outcomes. Interventions aiming to provide integrated support across outcomes were less successful at improving MH and SU outcomes than those targeting single issues. We found no evidence of commonly effective intervention components. Better alignment between components and underlying processes driving DVA/MH/SU, and alternative intervention designs, are needed
Latent physical activity profiles of people with chronic pain:Associations with pain severity, sleep and accelerometer-measured rest-activity rhythm
No full textQuality of Life in Patients With Variant Syndromes of Autoimmune Liver Diseases—A Cross‐Sectional Multicentre Study
Get PDFBackground & Aims: Primary biliary cholangitis (PBC), primary sclerosing cholangitis (PSC) and autoimmune hepatitis (AIH) go along with reduced health‐related quality of life (HRQOL). Variant syndromes, that is, conditions with features of both PBC/PSC and AIH, are associated with higher clinical complexity and worse prognosis. Studies on HRQOL in patients with variant syndromes are lacking. We aimed to provide large‐scale evidence addressing this gap. Methods: We included adult patients with clinical diagnoses of autoimmune liver diseases across nine countries in a cross‐sectional study. We descriptively compared demographical, clinical and patient‐reported outcomes between the conditions and investigated whether additional AIH contributes to reduced HRQOL compared to the cholestatic liver disease alone. Further, we explored the role of fatigue, cirrhosis and depression severity regarding HRQOL. Results: N = 1275 patients were included (PBC: n = 342, PBC‐AIH: n = 160, PSC: n = 305, PSC‐AIH: n = 121, AIH: n = 347). Patients with variant syndromes showed high rates of cirrhosis and increased depressive or anxiety symptoms. Additional AIH was associated with further reduction in physical and mental HRQOL in people with PSC (physical: ΔR2 = 0.012, p = 0.041; mental: ΔR2 = 0.016, p = 0.020), but not with PBC (physical: ΔR2 = 0.008, p = 0.081; mental: ΔR2 = 0.001, p = 0.609). Physical HRQOL was associated with higher age and fatigue, while mental HRQOL was associated with lower age, fatigue, and depression severity. Conclusions: Patients with variant syndromes of autoimmune liver diseases show high physical and mental burden, with fatigue as the main contributor. Particularly PSC‐AIH goes along with more severely reduced HRQOL compared to the cholestatic liver disease alone, which is attributable to a higher symptom burden
Pedestrian Safety in Developing Countries:A Systematic Literature Review and Gap Analysis
Get PDFPedestrian safety remains a pressing challenge in low- and middle-income countries (LMICs), where global predictive models often misrepresent local realities. This study tests the hypothesis that global predictive models, such as the International Road Assessment Programme (iRAP), overestimate countermeasure effectiveness in LMICs because key contextual factors are omitted. The two-phase research combined a PRISMA-based systematic literature review (SLR) with a quantitative iRAP performance gap analysis of the countermeasures implemented in the candidate studies of the SLR. The review systematically evaluated the effectiveness of pedestrian safety countermeasures, with an emphasis on their application in LMIC contexts. Following PRISMA 2020 guidelines, 14 longitudinal before–after studies were selected from 1911 records and screened with EPPI-Reviewer 4 software. The analysis identified 33 contextual factors shaping countermeasure performance across both high- and low-income settings; of these, 23 were specific to LMICs, and 13 are not accounted for in the iRAP model. The findings show that iRAP systematically overestimates countermeasure effectiveness in LMICs due to weak enforcement, poor maintenance, and informal road use. Transverse rumble strips were the only intervention consistently effective across diverse LMIC settings. A novel performance gap analysis of five LMIC case studies revealed an average discrepancy of 30.9% (SD = 29.7%) between predicted and observed outcomes. A risk of bias assessment showed that most LMIC studies were of moderate to serious risk, reflecting systemic data limitations and a frequent reliance on proxy outcomes. These findings highlight the urgent need for recalibrated, context-sensitive frameworks that incorporate enforcement, maintenance, and socio-economic variables. Policy implications include prioritising affordable and scalable countermeasures, pairing infrastructure with enforcement and education, and strengthening crash data systems to support more realistic, evidence-based road safety planning
Examining Traffic Safety Perceptions and Attitudes Among Motorcyclists and Car Drivers in Hanoi, Vietnam
Get PDFRoad transport across Asia is undergoing rapid motorisation and exemplifies growing road safety challenges, with rising accident rates closely linked to driver behaviour. Recent reports indicate that Vietnamese drivers often perceive risk as manageable and enforcement as inconsistent, contributing to habitual violations such as speeding, signal ignoring, and risky manoeuvres, particularly when traffic is light. Evidence shows that riders, especially young adults, feel confident controlling their vehicles and frequently disregard safety warnings. This study investigates traffic safety awareness among motorcyclists and car drivers in Hanoi, based on a questionnaire survey of 393 respondents. Principal Component Analysis (PCA) was used to group 11 attitudinal statements into key components influencing road safety perceptions, identifying five: non-compliance with traffic regulations (Component 1), aggressive driving behaviour (Component 2), traffic signal issues (Component 3), road quality and infrastructure (Component 4), and preventive measures (Component 5). Multiple Correspondence Analysis (MCA) and two-step cluster analysis (TCA) were then applied to determine user clusters by socio-demographic characteristics, producing three groups: young adults in employment riding motorcycles (Cluster 1), young adults in education riding motorcycles (Cluster 2), and mature adults in employment driving cars (Cluster 3). Finally, Multinomial Logistic Regression (MLR) was applied to assess variations in road safety perceptions across the different groups (clusters). Mature adults driving cars (Cluster 3) identified the first four components as significant, with Components 1 and 2 showing negative associations and Components 3 and 4 positive associations
The Influences of RARγ on the Behavior of Normal and Cancer Stem Cells
Get PDFRetinoic acid receptor (RARγ) mRNA is expressed spatially and temporally during mouse embryogenesis and largely within stem and progenitor cells, indicating a role in organ formation. RARγ agonism promoted the maintenance of hematopoietic stem cells, and blocked stem cell development as shown for hematopoiesis, zebrafish development, and chondrogenesis. Transgene expression enhanced the generation of induced pluripotent stem cells, indicating a role in ground-state pluripotency. RARγ is oncogenic in acute myeloid leukemia, cholangiocarcinoma, and colorectal, head and neck, hepatocellular, ovarian, pancreatic, prostate, and renal cancers. RARγ agonism or overexpression enhanced the proliferation of cancer cells. Conversely, antagonism or inhibition of all-trans retinoic acid synthesis led to the death of cancer cells including cancer stem cells. The pathways regulated by RARγ, via canonical activation and repression of gene expression, include Wnt/β-catenin and Notch signaling. RARγ also acts as a co-factor to Smad3 and reduced or enhanced TGFβ-driven and Smad3-mediated events when liganded and non-liganded, respectively. Collectively the findings support the view that RARγ plays a crucial role in controlling stem and progenitor cell behavior
The Influence of Nursing Leadership Styles on Medication Safety:A Mixed-Methods Systematic Review
Get PDFAim: To synthesise evidence on the impact of nursing leadership styles on medication errors.Background: Leadership plays a critical role in medication safety by shaping staff behaviour, promoting adherence to clinical guidelines and fostering a safety-oriented culture. However, the effects of specific leadership styles on medication safety have not yet been comprehensively synthesised.Methods: The Joanna Briggs Institute convergent segregated approach for mixed-method systematic reviews was employed and reported in accordance with PRISMA guidelines. Searches were conducted in MEDLINE, CINAHL, Scopus, PubMed, Web of Science, EMBASE, PsycINFO and Google Scholar, encompassing literature published from January 2014 to April 2025.Results: The review includes 15 papers: 11 cross-sectional, 2 quality improvement, 1 quasi-experimental and 1 mixed-methods study. Transformational (n = 11) and ethical leadership styles were associated with enhanced medication safety, as evidenced by increased error reporting and greater adherence to medication protocols. Situational leadership was linked to gradual improvements in self-reporting behaviours. In contrast, passive-avoidant and toxic leadership styles correlated with higher rates of medication errors and decreased willingness to report errors. The effects of transactional leadership (n = 5) were mixed and appeared to be influenced by contextual factors.Discussion: Synthesising both consistent and divergent findings clarified the complex dynamics through which leadership can mitigate or exacerbate medication errors, and offered guidance for the development of innovative and integrated leadership approaches.Conclusion: Transformational, ethical and situational leadership styles contribute to improved medication safety, whereas passive-avoidant and toxic leadership styles lead to increased medication errors.Implications for Nursing and Nursing Policy: This review highlights the relevance of leadership approaches associated with safety-oriented behaviours. Understanding the effects of different leadership styles will inform and support decision-making, enabling nurse leaders to implement more effective strategies to reduce medication-related risks. Investment in leadership development, particularly programmes based on transformational and ethical principles, has the potential to strengthen safe medication practices.PROSPERO RegistrationThis systematic review's protocol was registered in PROSPERO (registration number CRD42023380426).</div
Safety and feasibility of liver maximum capacity assessment in patients undergoing transarterial chemoembolisation for hepatocellular carcinoma
Get PDFTransarterial chemo-embolisation (TACE) is an established treatment for patients with hepatocellular carcinoma (HCC). As the majority have pre-existing liver disease, only patients with adequate liver function undergo TACE. Liver maximum capacity (LiMAx), using C13-Methacetin, is a novel method to assess liver function prior to major oncologic resections. We evaluated the safety and feasibility of using LiMAx to assess the changes in liver function with TACE and whether it could predict post-intervention complications. The prospective study was conducted between November 2021 and March 2023 on patients undergoing TACE for HCC at the University Hospitals Birmingham NHS Foundation Trust, UK. Patients underwent LiMAx assessment on three occasions: 1–2 weeks before, 4–6 weeks after, and 12–14 weeks following TACE. This was compared with well-established biochemical analyses. Thirty non-consecutive patients were included, with a median LiMAx value of 278 μg/kg/h (range 44–688) on visit 1, 30% had a LiMAx value < 140 μg/kg/h. There was no significant difference in the pre- and post-TACE LiMAX values (median difference − 6%). One patient presented with symptoms consistent with post-intervention liver decompensation with a pre-TACE LiMAx value of 95 μg/kg/h. LiMAx correlated with established biochemical scoring systems of liver functions such as Child-Pugh (r=-0.4055, p = 0.0262) and UKELD (r=-0.4166, p = 0.0220). LiMAx assessment is a safe, feasible and non-invasive measurement of liver function. Despite low LiMAx values in some patients, there was no incidence of post-procedural liver decompensation. Future research should aim at identifying patients with Child-Pugh B disease with adequate liver function, based on LiMAx assessments, who may benefit from TACE
Endemic penetrance of SARS-CoV-2 has impacted marginally on immunity to spike protein of human coronaviruses
Get PDFSARS-CoV-2 has emerged as the 5th endemic coronavirus and immunological cross protection between coronaviruses will influence their infectivity and clinical impact. We determined adaptive immunity against the spike protein of each human coronavirus during the course of the COVID-19 pandemic. A characteristic pattern of HCoV immunodominance, dominated by OC43 and 229E, was apparent prior to SARS-CoV-2 and was largely unaffected by SARS-CoV-2 infection, which itself elicited moderate antibody titre. Vaccination or hybrid immunity elicited supraphysiological levels of coronavirus-specific antibodies, only a proportion of which was cross-reactive with SARS-CoV-2 spike indicating substantial backboosting of HCoV-specific responses. SARS-CoV-2 vaccination focused antibody responses against the S1 domain of SARS-CoV-2 spike whilst T cell responses recognised peptides equivalently across S1 and S2. Coronavirus-specific T cells exhibited strong production of IFN-γ, IL-2 and CXCL8. In summary, the entry of SARS-CoV-2 into its ecological niche has impacted marginally on relative immunity against other human coronaviruses although vaccination provides a modest antibody increment which is unlikely to be maintained. Further, although SARS-CoV-2 vaccination elicits spike-specific adaptive immune responses that are focused against the S1 domain, thereby favouring neutralising antibodies, the natural history of HCoV immunity indicates that adaptive responses may transition towards S2 recognition across the life course
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