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Background: In recent years, the pharmaceutical industry in Germany has faced a significant decline in the number of clinical trials conducted. Methods: This study evaluates patient participation in clinical trials for oncology and chronic diseases in Germany, integrating quantitative and qualitative research. Data from the Institute for Applied Health Research Berlin (InGef (Institut für angewandte Gesundheitsforschung, Berlin, Germany)), covering about 88% of the German population, and expert interviews were used. Results: In 2022, 84.6% of 47,305 systemic lupus erythematosus patients (SLE) and 11.9% of 102,300 chronic lymphocytic leukemia patients (CLL) received guideline-based care based on study definitions. Eligibility for clinical trials between 2017 and 2022 was estimated for 8272 SLE and 886 CLL patients, with the actual enrolment of 21 of 2221 SLE patients and 86 of 340 CLL patients reflecting the respective potential. Conclusions: Findings indicate an unexploited potential to enroll patients with chronic diseases compared to the relatively higher enrolment rates observed for oncology diseases, such as CLL. Securing the continuation of clinical trials and utilizing the value of trial participation is of importance for strengthening Germany as an innovation hub and for ensuring that patients have timely access to medical innovations.

Background/objectives: The aim of this study is to assess the knowledge, attitudes, and practices of pregnant women and hospital staff regarding umbilical cord blood (UCB) donation and storage to understand its limitations in clinical practice.

Methods: MEDLINE, Scopus, LILACS, EMBASE, Scielo.br, and PROSPERO were searched from inception to 30 November 2023 with no geographic or language restrictions. The study eligibility criteria included cross-sectional studies that interviewed pregnant women and/or hospital staff about their knowledge, attitudes, and practices regarding private or public storage. A random-effects restricted maximum-likelihood model with Freeman-Tukey Double arcsine transformation meta-analysis was carried out to calculate the pooled estimates. MOOSE guidelines were followed. STATA 14.1 was used for statistical analysis. The Newcastle-Ottawa Scale and ROBINS-I tool were used for quality and risk of bias assessments.

Results: In total, 19 studies providing data for 19,904 pregnant women and 1245 hospital staff members were included. Pooled pregnant women awareness was 61% ((95% CI 0.60 to 0.62), I² = 0%, τ² = 0.00, Q = 11.0 (p = 0.950)), and 61% for hospital staff (95% CI 0.58 to 0.64), I² = 0%, τ² = 0.00, Q = 4.00 (p = 0.310)). In total, 57% ((95% CI 0.56 to 0.58), I² = 0, τ² = 0.00, Q = 4.00 (p = 0.320)) of pregnant women had a positive attitude about UCB, while 34% ((95% CI 0.32 to 0.36), I² = 0%, τ² = 0.00, Q = 4.00 (p = 0.310)) were in favor of donating UCB for research and 65% ((95% CI 0.63 to 0.66), I² = 0%, τ² = 0.00, Q = 4.0 (p = 0.350)) were planning UCB storage. A significant (p < 0.001) preference for public relative to private banking (51% ([95% CI 0.49 to 0.54], I² = 0%, τ² = 0.00, Q = 4.0 (p = 0.310)) vs. 12% ([95% CI 0.10 to 0.13], I² = 0%, τ² = 0.00, Q = 4.0 (p = 0.300))) was noted for pregnant women. The same was retrievable for professionals (84% ([95% CI 0.79 to 0.88], I² = 0%, τ² = 0.00, Q = 2.0 (p = 0.110)) vs. 6% ([95% CI 0.03 to 0.09], I² = 0%, τ² = 0.00, Q = 1.0 (p = 0.070); p < 0.001)).

Conclusions: Despite these efforts, lack of knowledge and positive attitudes about UCB banking remain, emphasizing the need for increasing educational programs on the subject.

Background/objectives: The loss of muscle mass is common in critically ill patients and is associated with poor prognosis, and efforts have been made to mitigate muscle loss through rehabilitation. This study aimed to evaluate changes in muscle mass in critically ill patients following rehabilitation.

Methods: We enrolled 53 patients expected to stay in the ICU for more than 7 days, dividing them into rehabilitation (15 patients) and no rehabilitation groups (38 patients). Muscle mass was measured using ultrasound and bioelectrical impedance analysis (BIA).

Results: Baseline characteristics and comorbidities showed no statistical differences between the two groups. Initial measurements of muscles showed no significant differences between the groups in rectus femoris thickness, total anterior thigh muscle thickness, cross-sectional area, echogenicity, or in-body skeletal muscle mass at baseline and 7 days. However, at 14 days, significant differences emerged. The rehabilitation group had greater rectus femoris thickness (1.42 cm vs. 0.81 cm, p = 0.007) and total anterior thigh muscle thickness (3.79 cm vs. 2.32 cm, p = 0.007) compared to the no rehabilitation group. Additionally, the rehabilitation group experienced a significantly smaller reduction in rectus femoris cross-sectional area (-4.6% vs. -22.8%, p = 0.021). Although survival rates were higher in the rehabilitation group (73.3% vs. 52.6%), this difference was not statistically significant (p = 0.096).

Conclusions: Our findings suggest that rehabilitation in critically ill patients is associated with a slower rate of muscle loss, particularly in the cross-sectional area of the rectus femoris muscle, which may be beneficial for patient recovery.

Background/objectives: Childbirth is a profoundly personal experience that often does not align with expectations. The World Health Organization has established guidelines for best practises; in this sense, it is crucial to understand the childbirth experiences of Portuguese women in comparison with these guidelines.

Methods: A quantitative, descriptive, correlational, and cross-sectional study was conducted to achieve this. In total, 615 women completed a sociodemographic questionnaire and the Labour and Childbirth Experience questionnaire, which comprised 39 statements based on the WHO's recommendations. Additionally, the study utilized the Life Satisfaction Scale and gathered insights into participants' overall perception of care during this phase.

Results: The results were categorized as follows: (1) practises influencing the labour experience; (2) practises influencing the experience of vaginal birth; (3) practises affecting the experience of caesarean birth; and (4) emotional experience during labour and birth.

Conclusions: Notably, the study found that practises discouraged by the WHO are still prevalent, potentially enabling obstetric violence. However, a robust and statistically significant correlation was observed between the childbirth experience and the overall perception of care.

Background/objectives: This cross-national study focuses on adolescents who provide care and support to family members or significant others. Current evidence regarding their mental health and solutions to strengthen it is limited and mostly available in a few countries. The aim of this study is to evaluate the results of a primary prevention intervention for improving the mental health and well-being of adolescent young carers (AYCs) aged 15-17 years in six European countries. The intervention was based on a psychoeducational program and tools adapted from the Discoverer, Noticer, Advisor, and Values (DNA-V) model.

Methods: We designed a randomized controlled trial with 217 AYCs participating in the study, either in the intervention or control group. Quantitative and qualitative data were collected via questionnaires at baseline, post-intervention, and a 3-month follow up.

Results: The results were mixed, as positive improvements in primary (i.e., psychological well-being and skills) and secondary (school/training/work functioning) outcomes were shown by the experimental group but, in most cases, they were not statistically significant. The qualitative data supported positive claims about the intervention and its appropriateness for AYCs.

Conclusions: The study implementation during the peak of the COVID-19 pandemic forced the consortium to adapt the design and may have influenced the results. More long-term studies are needed to assess similar mental health programs with this hard-to-reach target group.

Background: There are increasing mental health concerns in the construction industry workforce, with stress being a primary concern. This qualitative study investigates stress experiences and the management of stress in office-based and on-site workers in the UK building construction sector. This study can provide key insights for construction, but also potentially other industries which struggle with high stress levels among their employees.

Methods: A total of 40 semi-structured interviews (20 on-site/20 office-based) were conducted at large-scale building construction projects in the southeast UK. Framework method analysis was used to derive an understanding of stress in the workplace and coping strategies.

Results: The study identified two major themes: the negative influence of work stress on personal and professional wellbeing, and the management of stress through proactive and reactive coping strategies. Results indicated that on-site workers frequently cited high workloads, tight deadlines, and safety concerns, whereas office-based workers tended to highlight job complexity and organisational pressures. Both population sub-groups reported stress affecting their work performance, with site-workers having the added concern of physical health and safety. Coping strategies among workers tended to rely on support networks, outside-the-workplace hobbies, and boundary-setting, among others.

Conclusions: Stress remains a significant problem in the workplace and affects wellbeing; however, there are ways to mitigate the stress. Our findings could provide a foundation for intervention development.

Background: Breast cancer is the most common cancer among women worldwide and remains the leading cause of death among Italian women. Despite increased breast cancer awareness and improved diagnostic techniques, mortality rates remain high globally. In Italy, despite the availability of screening programs by the National Health System (NHS) for all Italian women aged 50-69 every two years, the participation rate remains relatively low. The low uptake of screening may be attributed to a lack of general cancer knowledge among women, including awareness of risk factors, symptoms, and prevention measures. This study investigates the knowledge and misinformation in a population of Italian women regarding breast cancer risk factors, symptoms, and prevention.

Methods: From March 2021 to January 2022, we conducted a survey targeting the female population in Italy, with a total of 2375 participants willingly participating in the study. To investigate factors linked to variations in attitudes toward breast cancer, the participants were categorized into two groups: the general population (Group A, n = 2235) and women who have had or currently have breast cancer (Group B, n = 140). Statistically significant differences were identified between these two groups.

Results: The findings revealed considerable confusion regarding both the symptoms and causes associated with cancer, as well as prevention measures. This confusion was particularly prominent among women in the general population and those with lower levels of education.

Conclusions: Given these insights, it remains crucial to promote accurate health information concerning risk factors, symptoms, and prevention strategies related to this devastating disease, emphasizing the ongoing importance of disseminating correct health information.

Background: Antimicrobial stewardship (AMS) involves a coordinated set of actions aimed at promoting the appropriate use of antibiotics within healthcare settings. This systematic review of qualitative studies assessed nurses' knowledge and perceptions of the barriers and facilitators that impact their involvement in AMS programs.

Methods: This meta-synthesis followed the Joanna Briggs Institute methodology for systematic reviews of qualitative evidence. Relevant studies published between 2018 and 2023 were identified through searches on PubMed, CINAHL, EMBASE, PsycINFO, and Google Scholar. The studies were critically appraised using the CASP checklist, with 19 articles meeting the inclusion criteria from five continents.

Results: Six recurring themes emerged from the analysis of nurses' experiences and opinions regarding their roles in AMS programs. These themes included the organization of AMS programs, availability of resources, training and education, communication, and the evolving role of nurses in AMS.

Conclusions: Nurses at every level of the profession might play a crucial role in antimicrobial stewardship. Although active involvement of nurses in antibiotic stewardship requires further exploration and research, this topic is being examined internationally. The literature on this subject primarily analyzes the phenomenon from a quantitative perspective rather than a qualitative one, and it is contextualized more within hospital settings rather than community settings.

Background/objectives: The way in which topics like suicide, mental health concerns and alcohol and other drug use are communicated matters. It has the potential to have either a positive or negative impact on people and communities, particularly those with a lived experience of these concerns. This article draws on the findings of a qualitative study designed to explore the experiences and perceptions of stakeholders on the imagery and language used to depict suicide, mental health concerns or alcohol and other drug use.

Methods: The focus group method was used as a form of participatory action research to gain an in-depth understanding of the experiences and views of those who use or are impacted by language and imagery about suicide, mental ill-health and AOD use, including those with lived experiences of these topics.

Results: A series of 10 focus groups were created in February and March 2022 with media and other professional communicators; people identifying as having a lived experience of suicide, mental ill-health or alcohol and other drug use; mental health and suicide prevention sector professionals; and people from priority populations (n = 49). From these focus groups, principles were developed as well as exemplars of helpful and less helpful depictions. Rather than prescriptive or static rules, the participants indicated that safe representations require an ongoing engagement with the principle of "do no harm".

Conclusions: A positive conclusion arose-that words and images have the potential to promote help-seeking, challenge stigma or stereotypes and create change.

Background: Although patients undergoing peritoneal dialysis (PD) typically have complex treatment needs, the effect of medication regimen complexity on patient outcomes has not been thoroughly evaluated. This study aims to quantify medication regimen complexity and evaluate patient-centred outcomes including medication adherence and its determinants in patients undergoing PD.

Methods: This study combined a retrospective audit of baseline data with a prospective evaluation of patient-related outcomes among patients undergoing PD at a large metropolitan dialysis centre in Australia. Medication regimen complexity was assessed using the 65-item Medication Regimen Complexity Index (MRCI), while patient outcomes were evaluated with validated self-reported questionnaires, including the 4-item Morisky-Green-Levine Scale (MGLS), EQ-5D-5L and EQ VAS.

Results: A total of 131 patients participated [median age 67 (IQR 57-74) years]. Patients on PD were found to have complex medication regimens with an average MRCI score of 28.6 ± 11.4. Over half of the participants were deemed to be adherent to their prescribed medications as measured by the MGLS (n = 79; 60.3%). Male participants were more likely to be non-adherent to medications compared to female participants (OR 2.465; 95% CI 1.055-5.759). Participants with higher serum phosphate levels were 2.5 times more likely to report non-adherence to their medications (OR 2.523; 95% CI 1.247-5.104), while a higher health-related quality of life (HRQoL) was associated with medication adherence (OR 0.151, 95% CI 0.031-0.732).

Conclusions: Patients on PD are prescribed complex medication regimens in addition to PD treatments that they perform at home. Patients on PD who were adherent to their medications had significantly better outcomes in terms of HRQoL and serum phosphate levels compared to non-adherent patients.