METHODS: This was an interrupted time series study of patients who underwent any of the three emergency bellwether procedures (caesarean section, laparotomy and open fracture fixation) from 1 January 2018 to 31 December 2021 at one of eight institutions in Singapore, Malaysia, Indonesia, India and Vietnam. We compared the weekly volumes, baseline characteristics and outcomes of each procedure across different time periods in each institution defined by different levels of COVID-19 restrictions using selected indicators from a city-level and hospital-level response index.
RESULTS: Weekly volumes of emergency caesarean section decreased significantly in Guwahati Neurological Research Centre (GNRC) (p=1.62×10-5) and Ulin General Hospital (UGH) (p<2.2×10-16) but increased in Adam Malik Hospital (AMH) (p=1.45×10-5). For laparotomies, volume increased in Singapore General Hospital (p=2.38×10-5) but decreased in Military Hospital 175 (p=6.30×10-7). The volume of open fracture fixations decreased in GNRC (p=3.08×10-8), AMH (p=1.68×10-6) and UGH (p=8.15×10-6).
CONCLUSIONS: COVID-19 restrictions on the city and hospital level were associated with a decrease in surgical volumes of the three bellwether procedures in some of the institutions. There was some suggestion of surgical capacity limitations in UGH and Military Hospital 175 during periods of more stringent COVID-19 restrictions.
OBJECTIVE: To estimate the pooled prevalence of OSA among adults in Saudi Arabia.
METHODS: The systematic review and meta-analysis were carried out between May and August 2025 according to PRISMA 2020 guidelines. Observational studies that described the prevalence of OSA among adults (≥16 years) were considered. Pooled prevalence was computed using a random-effect model with Freeman-Tukey transformation. I2 statistics were used to determine the heterogeneity. Subgroup analysis was undertaken according to population, diagnostic tool, size of the sample, and region.
RESULTS: Thirty-three studies with 18,403 participants were included. The overall pooled prevalence of OSA was 26.96% (95% confidence interval [CI]: 20.98%-33.38%), with high heterogeneity (I 2 = 98.9%). This significant heterogeneity is primarily attributed to variations in study populations (general vs. high-risk) and the diverse diagnostic criteria employed across the included studies. The prevalence was 15.95% (95% CI: 11.80%-20.60%) in the general population and 42.60% (95% CI: 29.47%-56.27%) in high-risk groups. The diagnostic method influenced estimates, with polysomnography (34.1%) and STOP-BANG (33.8%) yielding higher prevalence than the Berlin Questionnaire (28.5%). Regional variation was observed, with higher prevalence in Riyadh compared to Mecca.
CONCLUSIONS: About one in four Saudi adults may have OSA, with prevalence markedly higher in high-risk groups. These findings underscore the need for national screening programs and targeted interventions to reduce the burden of undiagnosed OSA.
OBJECTIVES: To compare the clinical efficacy of medicinal plants versus metronidazole in the treatment of bacterial vaginosis using evidence from randomized clinical trials.
METHODS: This narrative review examined randomized clinical trials evaluating herbal interventions for bacterial vaginosis. Web of Science, Scopus, PubMed, and ScienceDirect were searched for studies published up to March 2026. The included studies assessed herbal interventions administered orally or vaginally, alone or with conventional metronidazole therapy. Information on plant species, study design, participants, diagnostic criteria, interventions, results, and conclusions was extracted and synthesized narratively.
RESULTS: Twenty-four published articles were included, covering a range of medicinal plants, including Allium sativum, Myrtus communis, Quercus species, Berberis vulgaris, Zataria multiflora, Calendula officinalis, Cymbopogon olivieri, and others. Herbal therapies showed efficacy comparable to or superior to metronidazole, with fewer side effects and lower recurrence rates. Their effects are attributed to bioactive compounds, including allicin, curcumin, berberine, tannins, flavonoids, and essential oils, which exhibit antimicrobial, anti-inflammatory, and antioxidant properties.
CONCLUSIONS: Medicinal plants appear to be safe and effective alternatives or adjuncts for bacterial vaginosis; however, the heterogeneity in study designs and short follow-up periods limits definitive conclusions. Further well-designed, multicenter randomized trials with standardized protocols and long-term follow-up, along with studies exploring individual plants and their mechanisms of action, are needed to confirm efficacy, safety, and reproducibility and to support evidence-based use.
DESIGN: We analysed women's data from the Bangladesh Demographic Health Surveys, conducted between 1996 and 2022. Sociodemographic characteristics, changes in BMI distribution and underweight and overweight prevalence were estimated at national and urban-rural levels. Associated factors were identified using multilevel mixed-effect logistic regression, with survey year as a random intercept. Multinomial regressions were used for the individual survey waves.
SETTING: Nationally representative cross-sectional survey.
PARTICIPANTS: 90 510 reproductive-aged women.
RESULTS: There is an epidemiological transition from underweight to overweight by approximately 5 kg/m2 over the period. The prevalence of underweight women declined by 41·34 %, while overweight/obesity increased by 33·62 %. For urban-rural disparities, the prevalence of underweight was consistently higher among rural women, whereas overweight was more common among urban women. Increased age and higher education had higher odds of being overweight/obese and relatively higher socio-economic status had higher odds of being overweight and lower odds of being underweight. Access to television had mostly higher odds of being overweight. Age, education, socio-economic status and watching television showed consistent risks over time, while other factors showed inconsistent risks at different survey times.
CONCLUSIONS: There was an epidemiological transition in BMI, with a declining trend in underweight and a substantial increase in overweight. Targeted interventions are needed to tackle the persistent undernutrition in rural areas and the rapidly escalating epidemic of overweight/obesity, particularly in urban settings.
METHODS: Six development experts and nine relevance experts reviewed the English 56-question instrument. Analyses included 312 baseline participants from 10 countries and 117 paired assessments; 149 participants formed an additional recruitment-wave subset. Language assistance involved oral explanation without a fixed translation script. We evaluated content relevance, keyed knowledge reliability, item-level stability, and exploratory structure using explicit coding and missing-data rules.
RESULTS: S-CVI/Ave was 0.998 across 68 rated rows. The 19-indicator knowledge score averaged 56.1% ± 20.3%; KR-20 was 0.770 and common-factor omega 0.764. Absolute-agreement single-measure ICC was 0.763 (95% bootstrap CI 0.635-0.857); mean retest increase was 2.34 percentage points (p = 0.037). Numeric attitude ICCs ranged 0.345-0.838. Among 303 complete cases for 38 exploratory indicators, full-matrix and common-factor parallel analyses suggested 7 and 11 dimensions. The seven-factor comparison model included two weak two-item factors and ambiguous cross-loadings.
CONCLUSION: The English G-KAP shows strong expert-rated relevance and encouraging preliminary knowledge-score reliability. Oral-assistance variability, unequal recruitment and uncertain dimensionality limit interpretation. Cross-cultural validity, measurement invariance, attitude/practice composite scores and clinical effectiveness are unestablished. Standardized administration, linguistic adaptation and independent confirmatory evaluation are needed before cross-country comparison or subscale development.
METHODS: A cross-sectional study was conducted among 427 registered nurses employed at The Medical City of Medina, Saudi Arabia. Proportionate stratification was used to ensure representation across clinical departments, and all eligible nurses within each stratum were invited to participate. Data were collected using structured self-administered questionnaires and analysed using Partial Least Squares Structural Equation Modelling (PLS-SEM). Direct and indirect associations were evaluated using a bootstrapping procedure with 5,000 resamples.
RESULTS: Work-life balance was positively associated with employee well-being (β = 0.885, p < 0.001), stress reduction (β = 0.888, p < 0.001), and nursing performance (β = 0.219, p < 0.001). Employee well-being (β = 0.320, p < 0.001) and stress reduction (β = 0.417, p < 0.001) were also positively associated with nursing performance. Statistically significant indirect associations were observed between work-life balance and nursing performance through employee well-being (β = 0.283, p < 0.001) and stress reduction (β = 0.371, p < 0.001), consistent with partial statistical mediation.
CONCLUSIONS: Work-life balance was positively associated with nursing performance both directly and indirectly through employee well-being and stress reduction. The findings support the relevance of organizational conditions that address work-life balance, employee well-being, and occupational stress in nursing workforce management. Given the cross-sectional design, the observed associations and statistical mediation should not be interpreted as evidence of causal relationships. Longitudinal and multi-centre research is warranted to further examine these relationships across diverse healthcare settings.
METHODS: A prospective cross-sectional study was carried out involving 111 dengue patients and 42 healthy controls. Among the dengue cases, 85 were identified as primary, while 26 were classified as secondary dengue infections. Serum levels of endothelial markers (Ang-2, CXCL10, MCP1, and TRAIL), liver dysfunction and acute-phase markers (CRP, galectin 3, and serum amyloid protein), systemic inflammatory mediators (MIF, TNF-α, IL-1β), mast cell-derived proteases (chymase, tryptase), and tissue repair markers HGF, IL-10, IL-1Ra) were quantified using ELISA and Luminex multiplex assays. Correlations among serum analytes, severity indicators, and haematological markers were also explored.
RESULTS: Several biomarkers, Ang-2, CXCL10, TRAIL, CRP, MIF, IL-1Ra, TNF-α, and chymase showed differential expression across severity groups, indicating coordinated endothelial and inflammatory activation. Stratification of patients with primary-secondary dengue also followed a similar pattern except IL-1β, which had significant differential expression across the cohorts. Ang-2 showed strong positive correlations with markers of hepatic dysfunction, including ALT, AST, and bilirubin, suggesting a link between endothelial injury and liver involvement.
CONCLUSIONS: Severe dengue is driven by the coordinated activation of endothelial dysfunction, acute-phase responses, mast cell mediators, and counter-regulatory pathways. These processes collectively contribute to vascular leakage and organ injury, reinforcing the value of biomarkers such as Ang-2, CXCL10, CRP, and chymase for severity assessment.
METHODS: This retrospective analysis of prospectively collected KRRD data included patients with RA enrolled between January 2012 and April 2026. Patients were classified as YORA (symptom onset 18-59 years) or LORA (≥60 years). Baseline characteristics, disease activity, treatments, and one-year outcomes were compared. Multivariable logistic regression examined factors associated with moderate-to-high disease activity (DAS28-ESR ≥3.2). Sensitivity analyses additionally adjusted for current age, assessed collinearity, and repeated comorbidity and ESR comparisons after age adjustment and within patients aged 60-79 years.
RESULTS: Among 2,629 patients, 303 (11.5%) had LORA and 2,326 (88.5%) had YORA. LORA patients had shorter disease duration (2.9 ± 4.0 vs. 5.0 ± 7.1 years; p
METHODS: A cross-sectional survey was conducted with 452 undergraduate students from universities in Shandong Province, China. Structural equation modeling (SEM) was employed to test direct and mediating effects, while moderation analyses were used to examine interaction effects.
RESULTS: The results indicated that: (1) resilience had a significant negative effect on perceived stress and a significant positive effect on psychological wellbeing; (2) perceived stress significantly and negatively predicted psychological wellbeing; (3) perceived stress partially mediated the relationship between resilience and psychological wellbeing, indicating that resilience enhanced wellbeing both directly and indirectly by reducing stress; (4) social support significantly moderated the association between resilience and perceived stress, such that the stress-buffering effect of resilience was stronger at higher levels of social support; and (5) physical activity significantly moderated the relationship between perceived stress and psychological wellbeing, with higher levels of physical activity weakening the negative impact of stress on psychological wellbeing.
DISCUSSION: By integrating psychological, social, and behavioral factors within a biopsychosocial framework, this study clarifies the mechanisms underlying psychological wellbeing among university students. The findings highlight the importance of resilience development, stress reduction, social support enhancement, and physical activity promotion in university-based mental health education and intervention programs.