Nurses in neonatal intensive care units (NICUs) face significant emotional and clinical demands affecting caring behaviours. Psychological empowerment is linked to improved nursing outcomes, yet evidence from conflict-affected settings remains limited.

This study examined the relationship between psychological empowerment and caring behaviours among NICU nurses in the West Bank, Palestine and identified predictors of caring behaviours.

A multicentre descriptive correlational cross-sectional design was used. In total, 178 NICU nurses across 12 hospitals participated (response rate: 178/200, 89.0%). Psychological empowerment was measured using Spreitzer's 12-item scale (1-7); caring behaviours were assessed using the Caring Behaviours Assessment Tool Nursing Version-Short Form (27-135). Descriptive statistics, Pearson correlation and multiple linear regression were applied.

Mean age was 34.4 ± 7.5 years; 65.7% were female. Psychological empowerment was moderate-to-high (mean 4.6 ± 1.3), and caring behaviours were relatively high (mean 96.7 ± 14.5). Psychological empowerment was positively correlated with caring behaviours (r = 0.696, p < 0.001) and was the only significant predictor (B = 7.352), explaining 49.4% of variance.

Psychological empowerment was strongly associated with caring behaviours, suggesting that empowerment-focused leadership and professional development strategies may support caring practice among NICU nurses.

Canada legalized the non-medical use and supply of cannabis in 2018. The public health-relevant outcomes of cannabis legalization documented to date have been mixed, with decreases in cannabis-related crime and illegal distribution markets, while with increases for many - acute and chronic - health problem indicators. One public health-relevant aspect of legalization that has not been adequately assessed to date are its potential effects on alcohol and/or tobacco use and related outcomes in the population. Existing literature suggests that cannabis legalization may impact alcohol and/or tobacco use in different ways and directions, through both 'substitution'- and/or 'complementarity'-type dynamics. While cannabis use prevalence has markedly increased through legalization, recent epidemiological indicators suggest the possibility of (small) changes in rspective other substance use, yet it is empirically unclear whether these developments are causally interrelated. Also considering the substantial adverse public health burden arising from alcohol and tobacco use in the Canadian population, this Commentary makes the case for systemic examination of the potential impacts of cannabis legalization on alcohol and/or tobacco use outcomes by way of rigorous analytical methods as part of assessing the overall public health-related effects of cannabis legalization in Canada as well as other jurisdictions where cannabis has been legalized.

The mechanisms linking childhood adversity and cluster C personality disorders (PDs) remain unclear. Available research points to emotion regulation as a possible mechanism. Emotion regulation difficulties are documented in the case of cluster C, but studies focus on strategy implementation, while regulation goals received less attention. This study aimed to examine the associations between childhood adversity, emotion regulation goals and strategies, and cluster C PDs. Furthermore, we explore the moderating role of childhood maltreatment in the association between emotion regulation and cluster C.

This cross-sectional study employs a sample of 141 adults from the Romanian community (aged 18-55 years; M = 27.31, SD = 9.13). We employed instruments assessing facets of childhood adversity (CTQ, QUIC, MSPSS, CTSPC, RFQ, and the MacArthur Scale of SES), emotion regulation goals (ERGS) and strategies (E-ERQ), cluster C symptoms (SNAP-2) and associated personality dysfunction (LPFS-BF).

Main analyses suggest significant associations between avoidant PD and total QUIC scores (r = 0.206, p ≤ 0.05) and total MSPSS scores (r = -0.206, p ≤ 0.05). Instrumental goals correlated positively with both avoidant PD (r = 0.337, p ≤ 0.001) and dependent PD (r = 0.339, p ≤ 0.001). Reappraisal showed negative correlations with avoidant PD (r = -0.224, p ≤ 0.05) and dependent PD (r = -0.219, p ≤ 0.05). Avoidant PD was also correlated with suppression (r = 0.336, p ≤ 0.001) and selective attention (r = 0.203, p ≤ 0.05). Obsessive-compulsive PD was correlated with situation selection (r = 0.200, p ≤ 0.05). Importantly, childhood maltreatment moderated the association between hedonic goals and obsessive-compulsive PD. Sensitivity analyses were conducted to account for deviations from assumptions in the main analysis.

Findings highlight the increased use of instrumental goals, suppression, situation selection, selective attention (which could entail disengagement from emotions), and reduced use of reappraisal. Taking the interplay between childhood adversities and emotion regulation difficulties in the case of cluster C into account could expand future literature, which may contribute to the improvement of assessment, prevention, and intervention efforts for cluster C symptoms, especially when exposure to childhood adversities is present.

India is undergoing a significant demographic shift, with the elderly population (60+) projected to reach 20% by 2050. Tribal populations, such as those in Jharkhand, face accumulated disparities, including premature aging, lower life expectancy (63.9 years), and a dual burden of communicable and non-communicable diseases. Despite these challenges, there is a substantial research gap regarding early-onset functional decline-often beginning at age 45 due to physical labour and undernutrition-and the lack of culturally adapted healthcare models for these underserved groups.

This study aims - Phase 1 (Needs Assessment): Assess functional decline, quality of life (QoL), and prevalent health conditions/risk factors among middle-aged and elderly tribal adults in East Singhbhum, Jharkhand and Phase 2 (Model Development): Design and evaluate the feasibility and acceptability of a culturally sensitive, community-based integrated healthcare model to improve functional ability and QoL.

The study employs a two-phase concurrent mixed-methods study design. Setting & Participants: Conducted in 25 villages across five tribal-dominated 5 blocks of East Singhbhum, targeting 520 tribal individuals aged 45 years and above. In Phase 1, Quantitative Component: A cross-sectional needs assessment will use tools like Barthel's Activity of Daily Living (ADL), Lawton's Instrumental Activities of Daily Living (IADL), and WHOQOL-BREF to establish baseline health and functional data. Qualitative Component: In-depth interviews, focus group discussions, and key informant interviews with community members, traditional healers, and health workers will explore contextual barriers and cultural perceptions of aging. Quantitative and qualitative findings will be analysed independently and integrated to identify priority domains for healthcare model development. In Phase 2, these findings will inform the co-development of a culturally sensitive, community-based integrated healthcare model through stakeholder consultation. The model will subsequently be implemented in a selected village to assess its effectiveness, feasibility, and community acceptability before refinement.

The study will establish critical baseline data on tribal aging and develop a validated, scalable healthcare model. Expected results include improved health service utilization, early detection of functional decline, and policy-level impact on geriatric and tribal health strategies in India.

By prioritizing vulnerable populations and integrating indigenous knowledge with formal health systems, this protocol aligns with Sustainable Development Goals (SDGs 3, 10, and 17) to promote social equity and lifelong well-being for India's tribal communities.

Non-communicable diseases (NCDs), including hypertension and diabetes, are leading causes of morbidity and mortality in Ghana, where underserved communities face persistent barriers to screening, early management, and self-care education. Student-run free clinics (SRFCs) may help address these gaps, but their feasibility in sub-Saharan Africa remains underexplored. We used an exploratory sequential mixed-methods design to examine stakeholder perspectives on and support for SRFCs as a model for expanding NCD care in Ghana. Qualitative data were collected through six focus group discussions with 48 health professional students, six key informant interviews with university faculty, academic leaders, and Ghana Health Service officials, and two focus group discussions with 12 community members. Quantitative surveys of 316 health professional students assessed willingness to participate in SRFCs and associated factors. Thematic analysis, descriptive statistics, and logistic regression were used, and qualitative and quantitative findings were integrated narratively. Stakeholders across all groups expressed strong support for student-led initiatives addressing gaps in NCD care. Findings highlighted students' familiarity with NCDs and barriers to care; strong acceptance of SRFCs as relevant, feasible, and potentially impactful; and endorsement from institutional and community stakeholders. Participants emphasized community impact, hands-on training, and interprofessional collaboration as potential benefits, while identifying academic demands, resource constraints, and safety concerns as possible barriers. Overall, 86.7% of surveyed students were willing to participate in SRFCs. Greater familiarity with NCDs predicted willingness to participate (odds ratio = 1.41, p = 0.007), while final-year students demonstrated lower willingness than pre-clinical and non-final-year clinical students (p = 0.0096). SRFCs represent a promising and contextually relevant model for complementing existing NCD services in Ghana. Successful implementation will require structured supervision, adequate resources, and sustainable integration with universities, communities, and the national health system.

Hospitals play a crucial role in responding to respiratory pandemics, yet the degree of their readiness varies widely across health systems. Identifying and prioritizing the most critical indicators of hospital preparedness can guide policymakers in resource allocation and strategic planning. This study aimed to determine and rank the key indicators influencing hospital readiness for respiratory pandemics in referral hospitals in Kerman Province, Iran.

A mixed-method, multicriteria decision-making (MCDM) approach was applied. Initially, a semi-structured Delphi process involving hospital managers and experts was used to identify essential readiness indicators based on the WHO checklist and local conditions. The finalized indicators were then prioritized using the Analytic Hierarchy Process (AHP) and the Best-Worst Method (BWM).

Eight indicators were recognized as crucial for hospital preparedness. Among them, "Appropriate Management Team and Planning" ranked highest, followed by "Provision of Human Resources" and "Provision of Medicine and Equipment." "Waste Management and Disinfection of the Environment" was identified as the least significant indicator. The consistency ratios for both methods were within acceptable limits, confirming the reliability of expert judgments.

Effective management and proactive planning are the most influential determinants of hospital readiness during respiratory pandemics. Strengthening management structures, optimizing human resources, and ensuring essential supplies are critical steps toward enhancing health care system resilience.

Cardiovascular diseases are the leading global cause of mortality but remain underaddressed in complex emergencies where health responses focus on infectious diseases and acute care. This scoping review mapped public health interventions addressing cardiovascular disease in complex emergencies and identified intervention types, epidemiological findings, and research gaps.

We conducted a scoping review of studies published between 2014 and April 2024, identified through PubMed, the Directory of Open Access Journals, ReliefWeb, and Google Scholar. Eligible studies examined cardiovascular prevention, management, or outcomes in crisis-affected populations.

Thirty-one studies were included, most published in the past 5 years. Evidence primarily focused on hypertension, with interventions targeting primary prevention, including risk factor control, workforce training, and health system constraints, as well as secondary prevention, such as screening, early diagnosis, treatment, and continuity of care. Evidence on coronary artery disease and tertiary prevention, including cardiovascular rehabilitation, was limited. Common barriers included disrupted continuity of care, population displacement, attacks on health services, undertrained staff, medication interruptions, and inadequate funding during complex emergencies. The WHO Noncommunicable Diseases Kit showed mixed effectiveness depending on contextual adaptation and health system capacity.

Addressing cardiovascular disease in complex emergencies requires strengthened primary care platforms and health care access.

Adverse cardiac remodeling leads to the development of heart failure following myocardial infarction (MI), yet the immunometabolic signals governing early infarct repair remain poorly understood. Short-chain fatty acids (SCFAs) are important immunometabolic regulators, but their relevance and mechanistic contribution to post-MI repair remain unclear. Here, we integrated clinical observations with genetic and pharmacological intervention studies to investigate the role of the SCFAs-free fatty acid receptor 2 (FFAR2) axis in post-MI repair. Circulating SCFAs levels were markedly decreased in patients with MI, and associated with more complex coronary lesions and a higher risk of major adverse cardiovascular events. In murine MI, SCFAs supplementation reduced infarct expansion, cardiomyocyte death, and cardiac rupture, and improved left-ventricular function. These benefits were lost in global and myeloid-specific Ffar2-deficient mice, demonstrating an essential role for myeloid FFAR2 in SCFA-mediated cardioprotection. Mechanistically, SCFAs activated FFAR2-G_αi signaling in macrophages to suppress RANKL-RANK-driven osteoclast-like macrophage differentiation. thereby enhancing early fibrotic stabilization, reducing cardiomyocyte apoptosis, and improving infarct healing. Pharmacological blockade of osteoclast-like macrophage activation partially rescued impaired healing and cardiac dysfunction in myeloid-specific Ffar2-deficient mice after MI. These findings identify circulating SCFAs as clinically relevant biomarkers associated with coronary lesion complexity and adverse clinical outcomes after MI, and establish the SCFAs-FFAR2 axis as an immune-metabolic pathway that orchestrates macrophage fate and infarct healing. Targeting SCFAs-FFAR2 signaling may represent a therapeutic strategy to limit adverse post-MI remodeling and prevent heart failure.

Cardiovascular disease (CVD) is a prevalent comorbidity in asthma, yet its impact on clinical outcomes across disease states remains poorly characterised.

We analysed data from two independent prospective cohorts. Cohort I comprised 1058 stable asthma patients (CVD: n = 107; non-CVD: n = 951) followed for 12 months to assess asthma exacerbations. Cohort II comprised 825 patients hospitalised for an acute exacerbation (CVD: n = 233; non-CVD: n = 592). Missing data were handled by multiple imputation, and the CVD and non-CVD groups were balanced using propensity score overlap weighting. Associations were estimated using negative binomial, gamma, and logistic regression. Mediation and dominance analyses were performed as exploratory analyses.

Patients with CVD exhibited greater airflow obstruction and a predominantly non-T2 inflammatory profile characterised by increased neutrophilic inflammation. White blood cells, neutrophils, and monocytes partially mediated the association between CVD and lower FEV₁/FVC ratio, while monocytes additionally mediated the association between CVD and severe exacerbations. In Cohort I, CVD was independently associated with severe exacerbations (adjusted IRR = 1.96, 95% CI (1.12, 3.44)), hospitalisations, and emergency visits. In Cohort II, CVD was associated with longer hospital stay (adjusted IRR = 1.14, 95% CI (1.01, 1.30)) and higher direct costs, with stroke and coronary heart disease as leading contributors to prolonged stay.

CVD is independently associated with worse clinical outcomes across the asthma disease spectrum. These findings support recognition of CVD as an important treatable trait in asthma and highlight the need for integrated cardiopulmonary management.

Erectile dysfunction (ED) significantly affects quality of life, and phosphodiesterase type 5 inhibitors, including tadalafil, are main treatment options. Treatment response varies, and vasculometabolic disturbances may reduce responsiveness.

In this prospective single-centre cohort study, men aged ≥40 years with ED initiating tadalafil 5 mg once daily were followed for 12 weeks. AIP was calculated as log₁₀(triglycerides/HDL-C) after conversion to mmol/L. The primary outcome was a ≥4-point increase in IIEF-EF. Firth penalised logistic regression and ROC analyses were performed.

Among 134 men, the response rate was 73.1%. Nonresponders had higher baseline AIP (0.196 ± 0.271 vs 0.070 ± 0.224, p = 0.008), higher BMI (28.8 ± 4.19 vs 27.4 ± 3.28 kg/m², p = 0.042), and higher prevalence of DM (30.6% vs 12.2%, p = 0.013). Each 0.1-unit AIP increase was independently associated with nonresponse (adjusted OR 1.20, 95% CI 1.01-1.44, p = 0.036), as was DM (adjusted OR 3.39, 95% CI 1.15-10.45, p = 0.027). ROC analysis yielded an AUC of 0.650 (95% CI 0.540-0.760, p = 0.008), with an optimal cutoff of 0.130.

Higher baseline AIP was independently associated with nonresponse to once-daily tadalafil in men with ED, suggesting AIP may offer additional prognostic information, though further validation is needed.