Resilience refers to maintaining or quickly restoring health after experiencing stress. A recent model proposes that resilience develops with age and results from three factors: flexibility, sociality and meaning. The soundness of this model compared to the theoretical bases of existing scales motivated us to develop a new Human Resilience Scale. A total of 409 participants were included. Confirmatory factor analysis was applied to develop a 3-factor scale. Hierarchical linear regression was used to prospectively examine how resilience interacts with stress experienced between two time points 1 year apart to moderate variation in psychopathology. Incremental validity compared results from a similar regression using an existing scale. Results support that an 18-item, 3-factor model of resilience yields high statistical reliability (McDonald's ω = .91), moderates the relationship between stress and mental health more significantly than a current scale, and discriminates individuals according to their age and clinical status.

Circle of Security-Parenting (COSP) is one of the most popular attachment-based preventive support programs for parents and children. More than 50,000 participants from different (para)professional disciplines have been trained in the formal COSP™ protocol.

In a preregistered meta-analysis and synthesis of all eight randomized trials (N = 1,094 families), we examined COSP's efficacy on caregivers' parenting (sensitive parent-child interactions, reflective functioning, and parenting attitudes), on parent mental health outcomes (stress, depression, and anxiety), and on child attachment security and behavior problems.

We found an overall nonsignificant effect size of Cohen's d = 0.142 (SE = 0.089; p = .154, 95% Confidence Interval -0.068, 0.353, 95% Prediction Interval -0.444, 0.729), in a homogeneous set of studies. The pooled effect sizes of the parenting, parent, and child domains did not differ from each other or from zero. Cluster-robust inference tests showed converging (nonsignificant) results. The majority of the randomized studies (82%) were identified with some concerns about risk of bias.

We conclude that the evidence for COSP efficacy does not keep pace with the uptake of COSP in professional practice and policy.

Despite the increasing adoption of patient experience measurement in Asia, including Japan, limited progress has been made in identifying suitable patient-level adjusters and developing statistical methods for case-mix adjustment. This study aimed to develop and evaluate a case-mix adjustment model for the Japanese version of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) using nationwide benchmark survey data.

We conducted a multicenter cross-sectional study using data from 83 hospitals across Japan that participated in the 2023 national patient experience survey. Self-administered questionnaires were distributed to adult inpatients (aged ≥20 years) discharged between September and November 2023. The Japanese version of HCAHPS, comprising six composite measures and two global ratings, was used to calculate top-box scores (percentage of most positive responses). Candidate case-mix adjusters included age, gender, self-rated general health, self-rated mental health, and admission through the emergency department. The explanatory power (EP) of each adjuster was calculated as the product of predictive power and the between- versus within-hospital variance ratio. The impact of adjustment was evaluated by comparing unadjusted and adjusted scores and by assessing hospital rank changes using Kendall's τ.

Data from 13,602 patients were analyzed. Self-rated mental and general health showed the highest EP, whereas gender and emergency admission contributed minimally. The mean absolute adjustment of top-box scores ranged from 0.77 to 1.96 points. Case-mix adjustment changed hospital rankings in 3.4-10.2% of all possible pairwise comparisons (Kendall's τ = 0.80 to 0.93).

This study provides the first evidence-based case-mix adjustment model for HCAHPS scores in Japan. Applying such an adjustment is crucial to ensure fair benchmarking of PX across hospitals and to support data-driven quality improvement and accountability initiatives within Japan's evolving healthcare quality framework.

Burnout is a pervasive occupational hazard in medicine, beginning early in training and linked to depression, suicide, medical errors, and attrition. While extensively studied in high-income countries, little is known from Latin America. Guatemala faces scarce mental health resources, social inequities, and limited residency regulation. This study aimed to characterize burnout, psychological distress, and moral injury among Guatemalan physicians in postgraduate medical training ("residents").

We conducted a cross-sectional survey of residents in Guatemala (September-October 2024). Surveys included demographics and validated Spanish-language instruments assessing burnout, depression, anxiety, stress, self-compassion, impostor syndrome, and moral injury. Logistic regression identified demographic and occupational risk factors.

Of 1,729 eligible residents, 589 (34.1%) responded; 504 (29.1%) completed surveys. Respondents averaged 30.6 years; 54.5% were female, and 95.6% Guatemalan. Most trained at the University of San Carlos (89.6%), with a minority at Universidad Mariano Galvez and "other." Distress prevalence was high: 83% reported high emotional exhaustion, 90% high depersonalization, and 95% low personal accomplishment. Moderate-to-severe depression affected 32.7%, anxiety 40.7%, stress 49.2%, and impostor syndrome 41.2%. Moral injury was nearly universal (89.3%). Harassment and frequent 24-hr shifts were strongly associated with greater burnout, depression, anxiety, and stress. Female and lesbian, gay, bisexual, transgender, queer+ residents reported higher exhaustion, stress, impostor syndrome, and lower self-compassion. Mid-level trainees had an elevated risk of exhaustion.

Guatemalan residents face unprecedented levels of burnout and moral injury, exceeding global rates. Modifiable factors, including harassment and workload, compound structural inequities. Findings underscore the urgent need for residency reform, standardized protections, and culturally responsive mental health infrastructure. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

An estimated 250,000 children each year are transported between hospitals, with many of these transports performed by pediatric critical care transport teams (PCCTs). The makeup and education of these teams varies widely, and many are incorporating simulation into their training. The purpose of this study was to examine postsimulation debrief sessions to better understand how programs experience PCCT education using simulation.

Twelve transport centers and a total of 78 transport teams nationwide participated in the multicenter Improving Pediatric Acute Care Through Simulation (ImPACTS) transport simulation study in which simulation was utilized to measure and compare PCCT performance. Each team went through 3 simulated cases followed by debriefing sessions. Qualitative analysis was conducted on 23 debriefing sessions from 6 centers. A thematic analysis approach using both inductive and deductive techniques was used to identify themes representing elements of practices, thoughts, and beliefs to better understand debriefing approaches used by facilitators and the content of debriefings.

We identified themes in 4 major categories: (1) debriefing process elements (advocacy inquiry, directive feedback, learner self-assessment, shared mental model, and addressing learning objectives); (2) latent safety threats (personnel or staffing, protocol, workspace or environment); (3) response to simulation; and (4) team dynamics. Debriefing process elements reflected how facilitators conducted debriefings, while the remaining categories reflected the content and insights generated during debriefings.

Simulation participants found simulation to be realistic and a helpful tool to identify latent safety threats in their work. Simulation facilitators used consistent strategies to meet learning objectives and support learners in processing their simulation experience. Debriefing also provided insights to system-level vulnerabilities, suggesting a role for simulation not only in education, but also as a quality improvement tool.

Hypofractionated radiotherapy is an established alternative to conventional fractionation for breast cancer, but long-term evidence after mastectomy with regional nodal irradiation is scarce. We aimed to assess the long-term efficacy and adverse event profile of hypofractionated versus conventional fractionated postmastectomy radiotherapy in high-risk breast cancer.

This randomised, non-inferiority, open-label, phase 3 trial was done at a national cancer centre in China. Eligible patients were women aged 18-75 years with high-risk breast cancer who had undergone modified radical mastectomy and axillary dissection with a Karnofsky performance score 60% or higher. Participants were randomly assigned (1:1) to conventional fractionated radiotherapy (50 Gy in 25 fractions over 5 weeks) or hypofractionated radiotherapy (43·5 Gy in 15 fractions over 3 weeks) to the chest wall and supraclavicular region, using a computer-generated sequence with concealed allocation and no masking. The primary endpoint was 5-year cumulative incidence of locoregional recurrence, analysed in the modified intention-to-treat population (including all eligible patients who underwent randomisation, but excluding those who were considered ineligible or withdrew consent after randomisation) and a 5% margin was used to establish non-inferiority. In this prespecified long-term analysis, outcomes at 10 years were analysed without additional confirmatory non-inferiority testing. Safety was analysed in the modified intention-to-treat population. This trial is registered with ClinicalTrials.gov, NCT00793962, and is closed to enrolment.

Between June 12, 2008, and June 16, 2016, 2157 patients were assessed for eligibility. 1337 were excluded and 820 patients were enrolled and randomly assigned (414 to conventional fractionated radiotherapy and 406 to hypofractionated radiotherapy). Five patients were excluded in each group and 810 were included in the analyses (409 to conventional fractionated radiotherapy and 401 to hypofractionated radiotherapy). Median follow-up was 11·5 years (IQR 9·6-13·8). Median patient age was 49 years (range 24-74), and 761 (94%) patients had stage III disease. All patients were female, and data on race and ethnicity were not collected. At 10 years, cumulative locoregional recurrence was 10·3% (95% CI 7·3-13·3) with conventional fractionated radiotherapy and 12·0% (8·8-15·2) with hypofractionated radiotherapy (hazard ratio 1·19, 95% CI 0·79-1·82). The most common grade 3 adverse events at 10 years were ischaemic heart disease (five [1%] of 409 patients in the conventional fractionated radiotherapy group vs five [1%] of 401 patients in the hypofractionated radiotherapy group), lymphoedema (four [1%] vs three [<1%]), shoulder dysfunction (two [<1%] vs one [<1%]), and skin adverse events (none vs one [<1%]). No grade 4-5 events, brachial plexopathy, serious adverse events, or treatment-related deaths occurred.

Hypofractionated postmastectomy radiotherapy provided durable locoregional control with no increase in severe late adverse events compared with conventional fractionation, supporting its use as a more time-efficient option than conventional fractionated radiotherapy.

Noncommunicable Chronic Diseases-National Science and Technology Major Project, National Natural Science Foundation of China, National High Level Hospital Clinical Research Funding, Cooperation Fund of CHCAMS, and CAMS Innovation Fund for Medical Sciences.

ObjectiveTo evaluate whether upper-airway collapse phenotypes recorded during drug-induced sleep endoscopy were associated with the presence of cardiometabolic comorbidity in adults with polysomnography-confirmed obstructive sleep apnea.MethodsThis single-center retrospective cross-sectional study analyzed 360 drug-induced sleep endoscopy evaluation records from 355 adults. The primary outcome was at least one documented diagnosis of hypertension, diabetes mellitus, coronary artery disease, or cerebrovascular disease. Baseline supine velum-oropharynx-tongue base-epiglottis severity was coded as grade 0, 1, or 2; site-level collapse was defined as grade ≥1. Logistic regression was adjusted for age, sex, body mass index, apnea-hypopnea index, all velum-oropharynx-tongue base-epiglottis sites, and complete concentric velum collapse. Sensitivity analyses examined severity, pattern, repeated identifiers, multiplicity, model fit, and incremental value.ResultsCardiometabolic comorbidity was present in 156/360 records (43.3%). Epiglottic collapse was less frequent with than without comorbidity (17.3% vs. 29.4%). In the primary model, epiglottic collapse showed a nominal inverse association (adjusted odds ratio = 0.55; 95% confidence interval: 0.32-0.95; p = 0.031), but the Holm-adjusted p value across adjusted drug-induced sleep endoscopy predictors was 0.153. In exploratory sensitivity analyses, complete, but not partial, epiglottic collapse showed lower estimated odds (complete vs. none: adjusted odds ratio = 0.42; 95% confidence interval: 0.22-0.80; p = 0.008). The clinical model area under the receiver operating characteristic curve was 0.675 vs. 0.694 after adding drug-induced sleep endoscopy variables; the likelihood-ratio test was not significant (p = 0.203).ConclusionsEpiglottic collapse showed an exploratory inverse cross-sectional association with documented cardiometabolic comorbidity. The association did not remain significant after multiplicity correction and should not be interpreted as protective, temporal, or predictive. Protocolized prospective validation is required.

ObjectiveTo compare clinical characteristics, etiology, imaging findings, treatment, and in-hospital outcomes between patients with pyogenic liver abscess with and without diabetes to support individualized clinical management.MethodsThis retrospective study included 63 patients diagnosed with pyogenic liver abscess between February 2023 and December 2025 at a tertiary hospital in Xi'an, China. The patients were divided into diabetic and non-diabetic groups. Clinical data, laboratory findings, imaging features, pathogen distribution, treatment, and in-hospital outcomes were compared. Multivariate logistic regression was performed to determine risk factors for percutaneous drainage.ResultsIn total, 63 patients were enrolled; there were no significant differences in sex, age, and inflammatory indicators between the two groups. Alanine transaminase and aspartate transaminase levels were significantly higher in the non-diabetic group, whereas albumin levels were significantly lower in the diabetic group (p = 0.04). The detection rate of Klebsiella pneumoniae was significantly higher in the diabetic group (52.2% vs. 15.0%, p = 0.001). The proportion of patients undergoing puncture and drainage was significantly higher (47.8% vs. 22.5%, p = 0.04) and the length of hospital stay was significantly longer (14.0 (9.0, 17) vs. 10 (9.0, 12.75) days, p = 0.01) in the diabetic group. There was no significant difference in the incidence of sepsis between the two groups. Multivariate regression analysis revealed that K. pneumoniae infection was an independent risk factor for the need for percutaneous drainage (odds ratio = 8.73, 95% confidence interval: 2.36-32.34, p = 0.001).ConclusionDiabetic patients with pyogenic liver abscess characteristically exhibit a predominance of K. pneumoniae infection and a longer hospital stay. Non-diabetic patients present prominent transaminitis and higher Escherichia coli infection rates. K. pneumoniae infection, rather than diabetes itself, is an independent factor associated with drainage requirement in this cohort. Tailored therapeutic strategies are recommended for this patient population based on diabetes status.