Caregivers of hospitalized infants with critical congenital heart disease (CCHD) experience stress, emotions and contextual challenges with staff and unit culture during their infant's stay in critical care units, especially if the stay is lengthy. These compounding adverse conditions impact a caregiver's ability to learn to care for their infant. The purpose of this constructivist grounded theory study was to construct an explanatory theory, based on the analysis of the caregivers' perspectives, uncovering the process caregivers of hospitalized infants go through to become experts in their infant's care in the critical care setting.

Fifteen mothers and one father participated in semistructured and intensive interviews. Data collection, data analysis and theory formation transpired through an iterative process of constant comparison within and among data cases, theoretical sampling, memos, member-checking and participant feedback.

The result was a co-constructed overarching framework, the Process Model to Caregiver Expertise, progressing through four sequential phases-disorienting, orienting, adapting and knowing-showing how caregiver confidence develops over time and through active participation in caregiving tasks. Findings also indicate that caregivers need prompt peer and mentorship connections and early active participation in caregiving tasks to hasten their transformation into independent, expert caregivers.

Knowing this process may empower caregivers to understand their journey and guide education, support and tool development for healthcare providers. Additional research is needed to explore the paternal caregiver role, healthcare professionals' perceptions of this process and how the model develops as the child ages.

A notable mortality rate is related to cardiovascular disorders despite progress in therapy. Long non-coding RNAs (lncRNAs) play pivotal roles in diverse biological processes, and the abnormal regulation of their downstream signals is linked to a broad range of disorders. A lncRNA, Plasmacytoma Variant Translocation 1 (PVT1), has been found to be associated with the pathogenesis of human diseases. According to recent studies, lncRNA PVT1 participates in a variety of cellular processes, including proliferation, migration, and inflammation, via molecular axes with microRNAs and their downstream targets in neoplastic and non-neoplastic disorders. Given the involvement of these cellular processes in the pathogenesis of cardiovascular disease, we aim to clarify the function of the lncRNA PVT1 in this process. In addition, we aim to determine whether it is a prognostic factor or a potential therapeutic target in cardiovascular disorders.

Cognitive impairment is common among patients with atrial fibrillation (AF), yet its prognostic significance in the context of catheter ablation remains unclear.

We aimed to investigate whether baseline cognitive impairment, assessed by the Montreal Cognitive Assessment (MoCA), was associated with post-ablation AF recurrence.

Based on the China-AF Registry, we identified 2692 patients with nonvalvular AF who underwent index catheter ablation and had baseline MoCA assessments from 2022 to 2024. Patients were stratified into mild cognitive impairment (MCI, MoCA ≤ 26) and normal cognition (MoCA > 26) groups. The primary outcome was AF recurrence beyond the blanking period. The secondary outcome was a composite of all-cause death, ischemic stroke, and major bleeding. To adjust for confounding factors, we applied inverse probability of treatment weighting (IPTW) methodology. Weighted Cox proportional hazards models were used to estimate adjusted hazard ratios (aHRs).

After IPTW adjustment, all baseline covariates were well balanced (all standardized mean differences < 0.03). Over a median follow-up of 218 days (IQR, 192-376), the MCI group had a significantly higher risk of AF recurrence (aHR 1.48; 95% CI, 1.27-1.73; p  <  0.001). The composite secondary endpoint did not demonstrate a statistically significant between-group difference (aHR, 1.05; 95% CI, 0.25-4.52; p = 0.945). The association between baseline MCI and AF recurrence was consistent across all prespecified subgroups (all p for interaction > 0.05).

In this large prospective registry study, an independent association was observed between baseline cognitive impairment and an elevated risk of post-ablation AF recurrence. Cognitive assessment may be useful for risk stratification but requires external validation.

Clinicaltrials.gov Identifier: NCT06987825.

Human Leukocyte Antigen (HLA)-G is selectively expressed by fetal trophoblast cells that encounter maternal natural killer (NK) cells early in pregnancy. In response to HLA-G, the endosomal NK cell receptor KIR2DL4 induces a transcriptional program to support placental development. Structural features of KIR2DL4 that control HLA-G binding and endocytosis are unclear. Random mutagenesis revealed that three cysteines in the first immunoglobulin domain of KIR2DL4 regulate endocytosis and uptake of HLA-G. The atypical Cys10-Cys28 disulfide bond in the KIR2DL4 structure is an allosteric disulfide with potential to switch to a conventional Cys28-Cys74 bond. KIR2DL4 in human cells exists in both disulfide-bonded states, as shown by mass spectrometry analysis. The Cys10-Cys28 bond in a Cys74Ser KIR2DL4 mutant was reduced by protein disulfide isomerase (PDI) in vitro. Inhibition of PDI prevented HLA-G uptake by KIR2DL4 in NK cells. Mutants in the Cys10-Cys28 configuration endocytosed spontaneously but did not bind HLA-G. Conversely, KIR2DL4 with a Cys28-Cys74 bond was detectable at the plasma membrane and internalized soluble HLA-G. A purified Cys10Leu KIR2DL4 mutant bound HLA-G with micromolar affinity in a peptide-dependent manner. Thus, allosteric disulfide-mediated conversion from an inactive to an HLA-G binding form regulates KIR2DL4 trafficking and a functional response that promotes fetal development.

To provide a comprehensive national profile of substance use patterns, drug-related harms, treatment and harm reduction responses, and policy developments in Colombia, and to analyze how public health reforms coexist with historically prohibitionist frameworks.

We synthesized data from national household, school, and university surveys, epidemiological surveillance systems, official statistics, policy documents, and peer-reviewed research. Evidence was analyzed to describe trends in substance use, overdose and related harms, treatment access, harm reduction initiatives, and the broader legal and institutional context.

Alcohol, tobacco, and cannabis remain the most widely used substances in Colombia, while emerging synthetic drugs and opioid use have increased pressure on health and social services. Drug-related harms, including overdose and mental health problems, show significant regional and socioeconomic disparities. Although treatment coverage and harm reduction interventions, including community-based programs and supervised consumption services, have expanded in recent years, access remains uneven, particularly in rural and peripheral areas. Colombia's contemporary drug policy reflects a hybrid governance model in which constitutional protections of personal autonomy and recent harm reduction reforms coexist with enforcement-oriented practices shaped by illicit drug markets, armed conflict, and territorial inequality.

Colombia illustrates both the opportunities and the structural constraints of public health-oriented drug policy in middle-income countries deeply embedded in transnational drug economies. Strengthening surveillance systems, expanding territorially adapted services, and integrating health policy with broader social and development strategies will be essential to consolidate more coherent and equitable responses.

In clinics, major depressive episodes (MDE) in adolescents and early adults with mood disorders are a prevalent manifestation with limited treatment efficacy. Previous studies have suggested that early-stage treatment response is an important predictor of patients' final clinical outcome. Finding clinical features related to early-stage treatment response is crucial for optimizing interventions and understanding outcome determinants.

We conducted a study involving 218 inpatients aged 13-25 years with mood disorders currently in MDE. We evaluated patients' multi-dimensional clinical features both at baseline and after 2 weeks of treatment; the main outcome measure was the reduction rate of total the 17-item Hamilton Depression Rating Scale (HAMD-17) scores between baseline and 2 weeks of treatment. Logistic regression analysis was applied to identify baseline predictive clinical factors.

Baseline HAMD total score (OR = 1.10, 95% CI [1.00, 1.20], p = 0.045) and thought disorder factor scores of Brief Psychiatric Rating Scale (BPRS) (OR = 0.79, 95% CI [0.70, 0.91], p < 0.001) were significantly associated with early-stage treatment response.

Our study contributes to predicting early-stage treatment response in adolescents and young adults with MDE based on baseline clinical features. Baseline HAMD total score and thought disorder factor scores of BPRS are potential clinical predictors. Understanding such factors enhances treatment decision-making and efficacy.

Psychological factors, including mood, affect, and pain catastrophizing, critically influence pain perception. We aimed to examine the relationships of these factors with pain trajectories in both acute postsurgical pain (APSP) and chronic non-cancer pain (CNCP) cohorts.

We included 31 patients who underwent total knee arthroplasty (TKA) and 21 patients with CNCP. All included patients completed the pain catastrophizing scale (PCS) questionnaire. In addition, patients reported their status within their natural environment (ten times a day for 6 days) using an experience sampling method-a smartphone app, which contains items regarding pain, positive affect (PA), and negative affect (NA).

Pain scores showed a normal distribution in both cohorts; the APSP cohort reported significantly lower overall pain scores than the CNCP cohort (p = 0.003). In both cohorts, affective state was significantly associated with pain severity (p < 0.001). However, PCS scores were not significantly associated with pain severity. Notably, a higher PA was associated with lower pain severity among patients with high PCS scores, with a stronger association in the APSP cohort.

Our findings indicate that affective state is associated with pain severity in both APSP and CNCP cohorts. The combination of low PA and high PCS may be relevant for identifying individuals with higher pain severity, particularly in the APSP cohort. These results provide a basis for future research on targeted approaches aimed at enhancing PA and reducing catastrophic pain-related thoughts.

Our study shows that affective states play a key role in pain severity in both acute and chronic pain cohorts. Positive affect is associated with lower pain severity in patients with high PCS scores, with a stronger effect after surgery than in chronic pain. These results suggest that early identification of high catastrophizing and low positive affect may support targeted interventions to enhance recovery and potentially reduce the risk of developing chronic pain.

To explore the barriers and facilitators to maintaining cardiovascular health among Syrian refugees living in the Zaatari camp.

A qualitative study guided by the Social Determinants of Health framework.

Focus group discussions were conducted with 13 Syrian refugees. Twelve themes were identified, which were further organized into barrier and facilitator categories. Data were transcribed, translated and analysed using thematic analysis. Two coders independently applied inductive and deductive coding, with a third reviewer resolving discrepancies.

Barriers included financial constraints, lack of structured daily activities, poor living conditions, long waiting times for medical care, chronic psychological stress, suboptimal access to sports facilities and traditional gender roles with limited employment opportunities. Facilitators included walking, informal sports and home gardening, community advocacy leading to service improvements, positive interactions with refugee healthcare workers, use of the internet and social media for health information, evolving gender roles and strong intra-community support.

Effective interventions should focus on strengthening healthcare infrastructure, improving dietary options and affordability and providing employment opportunities.

Nurses play a crucial role in addressing the barriers to cardiovascular health in refugee settings. Supportive, community-based and culturally tailored approaches can enhance long-term health outcomes.

Problem addressed: Limited evidence exists on refugees' experiences of managing cardiovascular health in refugee camp settings.

Multiple social and structural barriers constrain health management, but community support, self-efforts and refugee healthcare providers act as facilitators. Who and where it impacts: This research informs health professionals and humanitarian actors working with displaced populations in low-resource camp environments. Reporting method: This study adhered to the Standards for Reporting Qualitative Research (SRQR) guidelines.

A refugee nurse assisted in facilitating the male focus group discussion, ensuring that participants were comfortable and that cultural considerations were respected.

Previous studies have tied stress exposure and psychological response, including posttraumatic stress symptoms (PTSS), to changes in gynecological symptoms (pain, urogenital symptoms and menstruation), however the multipartite relationship between these variables has been underexplored.

An online, cross sectional, survey was completed by 527 Israeli women during Israel-Gaza war. The questionnaires included demographics, gynecological symptoms before and after war onset, and validated scales for exposure to war-related stressors, exposure impact and PTSS. Serial mediation models were tested, with cumulative exposure to war related stressors as the predictor and the subjective impact of exposures and PTSS as serial mediators. Reported change in gynecological symptoms (pain, menstrual symptoms and urogenital symptoms) were outcomes.

Indirect effects of cumulative exposure on changes in all gynecological symptoms were significantly mediated through PTSS alone and sequentially through the subjective impact of exposure and PTSS for all outcomes. Independent and direct effects varied between outcomes. PTSS correlated significantly with all the variables in the model.

The results support serial mediation of exposure effects for all three symptom change categories, emphasizing the importance of psychological factors in gynecological symptoms changes among women during times of crisis. Potential underlying mechanisms for future exploration and implications for clinicians are discussed.

Infertility has traditionally been seen as a female problem, causing misconceptions, stigma, and limited attention to male infertility. This study examined undergraduates' knowledge, attitudes, and perceptions of male infertility at Osun State University, Nigeria, and associated factors.

A descriptive cross-sectional mixed-methods design was used. Quantitative data came from 300 undergraduates selected by multistage sampling using a self-administered questionnaire; qualitative data came from focus group discussions. Quantitative analysis used IBM SPSS Statistics 27; qualitative analysis used thematic analysis in NVivo. Findings were integrated through a joint display matrix and narrative synthesis.

The mean knowledge score was 7.12 ± 1.88, and the mean attitude score was 1.96 ± 1.12. Formal education on male infertility was a significant positive predictor of both knowledge (p < 0.001) and attitude (p < 0.001). Faculty affiliation (p = 0.009) and level of study (p = 0.012) were significantly associated with attitude scores. Qualitative findings showed functional understanding but culturally shaped attitudes involving marriage, masculinity, and gender roles, with women disproportionately blamed.

Understanding was moderate but incomplete. Formal education was a strong modifiable predictor. Comprehensive, gender-inclusive reproductive health education should be integrated into university curricula, with open dialogue to reduce stigma.